Jens Peter Hansen

Cognitive adaptation training combined with assertive community treatment: - A randomised longitudinal trial

BACKGROUND Cognitive adaptation training (CAT) targets the adaptive behaviour of patients with schizophrenia and has shown promising results regarding the social aspects of psychosocial treatment. As yet, no reports have appeared on the use of CAT in combination with assertive community treatment (ACT). Our purpose was to evaluate the effect of CAT in comparison with ACT, focusing on social functions (primary outcome), symptoms, relapse, re-hospitalisation, and quality of life of outpatients with schizophrenia. METHODS The trial was a parallel, randomised, multicentre trial conducted in three centres treating patients with a first episode of schizophrenia disorder. A total of 62 outpatients diagnosed as having schizophrenia were randomly assigned to CAT+ACT or ACT alone. The CAT was conducted in the patients home and included instruction in prompting for specific actions. The treatment lasted for 6months, and the patients were assessed at baseline and at 6- and 9-month follow-ups. RESULTS The results of mixed-effects regression models indicated no significant differences between intervention group and control group at 6 and 9months in any outcome [Global Assessment of Functioning at 6months (p=0.32) and the Health of the Nation Outcome Scales social subscale at 6months (p=0.30)]. CONCLUSION The results from this trial differ from previous CAT trials because use of CAT showed no significant effects. However, the low number of participants may have been responsible for these results. Thus, additional studies are needed to determine whether the use of some elements of CAT can help to make ACT more economically effective.

Treatment of adult patients with schizophrenia and complex mental health needs: A national clinical guideline

Abstract Background and aim: The Danish Health and Medicines Authority assembled a group of experts to develop a national clinical guideline for patients with schizophrenia and complex mental health needs. Within this context, ten explicit review questions were formulated, covering several identified key issues. Methods: Systematic literature searches were performed stepwise for each review question to identify relevant guidelines, systematic reviews/meta-analyses, and randomized controlled trials. The quality of the body of evidence for each review question was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Clinical recommendations were developed on the basis of the evidence, assessment of the risk-benefit ratio, and perceived patient preferences. Results: Based on the identified evidence, a guideline development group (GDG) recommended that the following interventions should be offered routinely: antipsychotic maintenance therapy, family intervention and assertive community treatment. The following interventions should be considered: long-acting injectable antipsychotics, neurocognitive training, social cognitive training, cognitive behavioural therapy for persistent positive and/or negative symptoms, and the combination of cognitive behavioural therapy and motivational interviewing for cannabis and/or central stimulant abuse. SSRI or SNRI add-on treatment for persistent negative symptoms should be used only cautiously. Where no evidence was available, the GDG agreed on a good practice recommendation. Conclusions: The implementation of this guideline in daily clinical practice can facilitate good treatment outcomes within the population of patients with schizophrenia and complex mental health needs. The guideline does not cover all available interventions and should be used in conjunction with other relevant guidelines.

The Feasibility of Cognitive Adaptation Training for Outpatients with Schizophrenia in Integrated Treatment

Cognitive adaptation training (CAT) has been tested as a psychosocial treatment, showing promising results. To date there are no reported tests of CAT treatment outside the United States. Thus, we decided to adjust CAT treatment and apply it to an Integrated Treatment setting in Denmark. In this article we describe and discuss the feasibility of using CAT treatment in a randomized clinical trial in Denmark. The treatment period was shorter and the patients were instructed in prompting for specific actions by using newer tools such as schedules in their mobile phones. Social functioning, symptoms and quality of life were assessed using instruments validated in a Danish context. It was judged that, after some adjustments to fit the Danish assertive community treatment, CAT treatment was feasible in a Danish setting.

EPA-1033 – Cognitive adaptation training for outpatients with schizophrenia in integrated treatment

Can Cognitive Adaptation Training (CAT) improve daily living due to impaired cognition and social cognition? Compared to a background population, most patients with schizophrenia have impaired cognition as well as impaired social cognition, giving problems in managing daily living and social contacts. Antipsychotic treatment can decrease cognitive impairment, even though it cannot eliminate the problem and cognitive remediation has only been shown to have a moderate effect on cognitive impairments. CAT is a treatment that circumvents cognitive impairments by rearranging the environment to support, prompt and sequence appropriate behaviours. CAT has shown promising results, including improved social functioning. As yet, no reports have appeared on the positive effect of CAT in combination with Assertive Community Treatment (ACT). The ACT treatment includes several supportive elements. Patients in ACT teams meet a specifically mental health worker in their own home, who has the opportunity to support and advise the patients. The low caseload allows for regular visits and the 14-hour crisis support gives a sense of security. Furthermore, the ACT mental health worker can assist patients in achieving sufficient material aid and services A trial comparing CAT+ACT versus ACT alone in regard to social functioning did not document differences. However the treatment as usual in this trial was more intensive than that in previous studies in regard to time spent with patients, in instructions in correct medication management, and adjusting the medication. Thus it is uncertain if some elements from CAT can make ACT more economically effective.