Ronald Siddle

A randomized controlled trial of cognitive-behavior therapy for persistent symptoms in schizophrenia: A five-year follow-up

Meta-analyses of randomized controlled trials support the efficacy of cognitive behavioral therapy (CBT) in the treatment of symptoms of schizophrenia refractory to antipsychotic medication. This article addresses the issue of medium term durability. A five-year follow-up was undertaken of a sample of 90 subjects who participated in a randomized controlled trial of CBT and befriending (BF). Patients received routine care throughout the trial and the follow-up period. Intention to treat multivariate analysis was performed by an independent statistician following multiple imputation of missing data. Fifty-nine out of ninety patients were followed up at 5 years (CBT=31, BF=28). In comparison to BF and usual treatment, CBT showed evidence of a significantly greater and more durable effect on overall symptom severity (NNT=10.36, CI -10.21, 10.51) and level of negative symptoms (NNT=5.22, CI -5.06 -5.37). No difference was found between CBT and BF on either overall symptoms of schizophrenia or depression. The initial cost of an adjunctive course of CBT for individuals with medication refractory schizophrenia may be justified in light of symptomatic benefits that persist over the medium term.

Religious delusions in patients admitted to hospital with schizophrenia

Background Religious delusions are clinically important because they may be associated with selfharm and poorer outcomes from treatment. They have not been extensively researched. This study sought to investigate the prevalence of religious delusions in a sample of patients admitted to hospital with schizophrenia, to describe these delusions and to compare the characteristics of the patients with religious delusions with schizophrenia patients with all other types of delusion. Method A cross-sectional investigation was carried out. The prevalence of religious delusions was assessed and comparisons were made between religiously deluded patients and a control group on demographic, symptom, functioning and religious variables. One hundred and ninety-three subjects were examined of whom 24% had religious delusions. Results Patients with religious delusions had higher symptom scores (as measured by the PANSS), they were functioning less well (as measured by the GAF) and they were prescribed more medication than those patients with schizophrenia who had other types of delusion. Conclusion It is concluded that religious delusions are commonly found in schizophrenia and that by comparison with other patients who have schizophrenia, those patients with religious delusions appear to be more severely ill. This warrants further investigation.

Befriending patients with medication-resistant schizophrenia: can psychotic symptoms predict treatment response?

OBJECTIVES Supportive interventions are used in schizophrenia, but little research has been conducted into whether any baseline variable predicts treatment response. The aim of this study was to establish if baseline delusions or hallucinations are associated with changes in overall symptoms in patients who received a befriending intervention. DESIGN The sample consisted of 44 patients with schizophrenia. These patients comprised the befriending arm of a multicentre randomized controlled trial which compared the efficacy of using CBT against befriending as an adjunct to routine care for patients with medication-resistant schizophrenia. METHODS Scores for auditory hallucinations and delusions relating to persecution or control were entered into two regression models. The dependent variables were change in overall symptoms (1) between baseline and end of the intervention, and (2) between baseline and 9 months post-intervention. RESULTS Baseline delusions predicted a good response and auditory hallucinations predicted a poor response at 9 months. CONCLUSIONS Baseline psychotic symptoms strongly predicted outcome in this sample. The finding that hallucinations predicted a poor outcome is consistent with previous research. These results may help to determine which patients would benefit from supportive interventions.

The validation of a religiosity measure for individuals with schizophrenia

Measures of religiosity validated for psychotic patients do not exist. This study sought to examine the psychometric properties of a modified version of the Religious Life Inventory (RLI) in this population. It was anticipated that religiosity would be affected by psychotic symptoms. The religiosity of patients with schizophrenia was assessed while symptoms were more evident and again after treatment, to evaluate changes in religiosity. Four factors were found which characterized the religiosity of people with schizophrenia. These factors were found to have good construct validity. Patients responses indicated a reduced need for religion when re-assessed once symptom scores were reduced.

Religious beliefs and religious delusions: Response to treatment in schizophrenia

It has been suggested that patients with strong religious beliefs or religious delusions have poor outcome from psychiatric treatment. The aim of the investigation was to establish if the patients’ shorter-term response to psychiatric treatment was affected by these factors. A quasi-experimental design was used, in which patients with schizophrenia were assessed soon after admission to hospital. They were categorised as (1) religious or not religious, (2) experiencing religious delusions or not, using reliable criteria. Patients were given their routine treatment and their symptoms were then re-assessed after four weeks. There was no difference in response to treatment between the religious and non-religious patients. There was no difference between patients who had religious delusions and those who had other types of delusions. Though this study does not settle the debate, it suggests that strong religious beliefs or religious delusions do not adversely affect the patients response to treatment in the shorter term.

Improving Understanding and Coping in People with Schizophrenia by Changing Attitudes

Abstract In order to have a chance of coping and developing a reasonable quality of life, the individual suffering from the symptoms of schizophrenia will very often need to change lifelong attitudes towards psychiatric illness and medication. Deeply held personal attitudes towards achievement, approval, and control will often need to be developed to facilitate optimal understanding of the emergence of psychosis, its maintenance, and to optimize symptom control. This paper describes viable approaches to changing attitudes in schizophrenia within a CCOR1 framework, which should facilitate optimal adherence and coping.

First episode psychosis: Two cases to illustrate the role of cognitive behaviour therapy in making sense of unusual experiences

This paper describes two cases involving the use of cognitive behavioural therapy (CBT) to treat the positive symptoms of schizophrenia. In both cases the individuals were experiencing acute psychotic symptoms during their first admission to hospital. Each case illustrates how CBT was used to tackle a particular issue pertinent to the delivery of treatment at this early stage in the development of an individuals experiences of psychotic symptoms. Case one describes therapy with a young person of 17 where developmental issues are pertinent; case two describes the use of therapy to engage a person whose symptoms have ostensibly remitted. In both cases the promotion of understanding of the origin of their experiences was vital to the conduct of therapy. The implications of these issues to conducting therapy with this client group and the methods used to overcome them are discussed with reference to the future developments of cognitive behavioural therapy for use with this client group.

Cognitive Therapy in the Treatment of Drug‐Resistant Delusional Disorder

Four unselected patients with drug-resistant delusional disorder were individually treated with eight sessions of cognitive therapy plus a booster session every month up to 1 year. All patients improved on a global measure of delusional severity (the GSDS), and showed a marked reduction in belief conviction. Related psychopathology as measured on the Comprehensive Psychopathological Rating Scale (CPRS) also markedly improved and all the gains were maintained at 1-year follow-up. Improved compliance with medication was achieved with half of the patients, and contributed to the improvement gained.

Identifying and Overcoming Negative Symptoms

The symptoms of schizophrenia are commonly described in two broad categories; positive symptoms and negative symptoms. Positive symptoms are considered excesses, that is, go beyond what is considered to be ‘normal’ behaviour or experience. Negative symptoms, are generally considered to be deficits in normal functioning and include the core negative symptoms such as flattening of affect and poverty of speech (Barnes and Liddle, 1990).

Cognitive Behaviour Therapy in a Case of Organic Hallucinosis

This single case study investigates a woman with organic hallucinosis, who was assessed using the Comprehensive Psychopathological Rating Scale (CPRS). She then received cognitive behaviour therapy (CBT) for 11 months. The CBT approach involved engaging the patient and specific symptom targeting. An individual formulation was developed, leading to schema focused intervention and relapse prevention. The subjects total CPRS scores and schizophrenia subscale scores were reduced dramatically.