PDF
ePub
Citation
Print
Abstract
Objectives
Cognitive behavioral therapy of schizophrenia has been developed as a psychological therapy for drug resistant patients with schizophrenia. However, there are some controversial issues regarding the size and mode of the therapeutic effect. The aim of this study is to compare the effect of cognitive behavioral therapy with supportive therapy after treatment.
Methods
Patients with drug resistant schizophrenia were randomly allocated, and stratified according to two mental health institutes to two different therapy groups. We used four assessment scales to evaluate residual symptoms of patients in detail. Patients were assessed twice by a blind rater, at baseline and after treatment.
Results
No significant differences in the change of PANSS (Positive and Negative Syndrome Scale) scores were observed between the cognitive behavioral therapy and supportive therapy groups at one month after treatment. There was no significant difference in change of K-PSYRATS (Korean-Psychotic Symptom Rating Scale)-Delusion score, however, a trend toward significance in K-PSYRATS - Hallucination was observed between the two groups. In the aspect of insight, a significant difference in the change of SDMD-K (The Scale to assessment Unawareness of Mental Disorder-Korean version) score was observed between the two groups after treatment.
Conclusion
Despite remarkable development of pharmacotherapy for schizophrenia, many patients still suffer from residual symptoms. Findings of this study showed that cognitive behavioral therapy can improve the insight of patients and reduce the severity of residual positive symptoms, especially hallucination. Cognitive behavioral therapy should be practiced effectively in the psychiatric clinic and community mental health system.
Figures and Tables
Table 2
Main prescribed antipsychotics and minimum dosage in CBT and ST group at baseline
Used minimum dosage of antipsychotics : Risperidone ≥5 mg, paliperidone ≥6 mg, aripiprazole ≥20 mg, quetiapine ≥400 mg, amisulpride ≥800 mg, sulpiride ≥200 mg, olanzapine ≥20 mg, clozapine ≥300 mg, ziprasidone ≥80 mg. ( ) : Number of patients with augmentation or combination of other antipsychotics. CBT : Cognitive behavioral therapy, ST : Supportive therapy, SD : Standard deviation
References
1. McGlashan TH, Nayfack B. Psychotherapeutic models and the treatment of schizophrenia: the records of three successive psychotherapists with one patient at Chestnut Lodge for 18 years. Psychiatry. 1988. 51:340–362.
2. Gunderson JG, Frank AF, Katz HM, Vannicelli ML, Frosch JP, Knapp PH. Effects of psychotherapy in schizophrenia: II. Comparative outcome of two forms of treatment. Schizophr Bull. 1984. 10:564–598.
3. Tarrier N, Yusupoff L, Kinney C, McCarthy E, Gledhill A, Haddock G, et al. Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia. BMJ. 1998. 317:303–307.
4. Sensky T, Turkington D, Kingdon D, Scott JL, Scott J, Siddle R, et al. A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Arch Gen Psychiatry. 2000. 57:165–172.
5. Lewis S, Tarrier N, Haddock G, Bentall R, Kinderman P, Kingdon D, et al. Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: acute-phase outcomes. Br J Psychiatry Suppl. 2002. 43:S91–S97.
6. National Institute for Clinical Excellence. Clinical Guideline 1: Schizophrenia - Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care. 2010. London: National Institute for Clinical Excellence;257–274.
7. Lynch D, Laws KR, McKenna PJ. Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials. Psychol Med. 2010. 40:9–24.
8. Kim KR, Lee SY, Kang JI, Kim BR, Choi SH, Park JY, et al. Clinical efficacy of individual cognitive therapy in reducing psychiatric symptoms in people at ultra-high risk for psychosis. Early Interv Psychiatry. 2011. 5:174–178.
9. Chung YC, Kim JH, Eun HB, Hwang IK. Effect of cognitive-behavioral therapy on the delusion in schizophrenic patients. J Korean Neuropsychiatr Assoc. 2001. 40:63–71.
10. Haddock G, McCarron J, Tarrier N, Faragher EB. Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychol Med. 1999. 29:879–889.
11. Amador XF, Strauss DH, Yale SA, Flaum MM, Endicott J, Gorman JM. Assessment of insight in psychosis. Am J Psychiatry. 1993. 150:873–879.
12. Song JY, Kim KT, Lee SK, Kim YH, Noh JH, Kim JW, et al. Reliability and validity of the Korean version of the Scale to Assessment Unawareness of Mental Disorder (SUMD-K). J Korean Neuropsychiatr Assoc. 2006. 45:307–315.
13. BJ Sadock, VA Sadock. Synopsis of Psychiatry. 2007. 10th ed. Philadelphia: Lippincott Williams & Wilkins;1091–1098.
14. Wiersma D, Nienhuis FJ, Slooff CJ, Giel R. Natural course of schizophrenic disorders: a 15-year followup of a Dutch incidence cohort. Schizophr Bull. 1998. 24:75–85.
15. Samarasekera N, Kingdon D, Siddle R, O'Carroll M, Scott JL, Sensky T, et al. Befriending patients with medication-resistant schizophrenia: can psychotic symptoms predict treatment response? Psychol Psychother. 2007. 80(Pt 1):97–106.
16. Mortimer AM. Symptom rating scales and outcome in schizophrenia. Br J Psychiatry Suppl. 2007. 50:S7–S14.
XML Download