in Therapy of Psychotic Disorders
(Oleksandr Avramchuk, Hrystia Shalak)
Ukrainian Catholic University, Lviv, Ukraine
Introduction. According to the National Institute of Mental Health in 2015, in the United States, about 100,000 people survived the first psychotic episode, and three in 100 people have at least one psychotic episode in their lives (National Institute of Mental Health, 2015).
According to World Health Organization, schizophrenia in the world affects about 21 million people. The onset of the disorder occurs in adolescents and early adulthood (15-29 years) (World Health Organization, 2012). People suffering from psychotic disorders, 2.5 times more often than others, died at a young age due to somatic causes – cardiovascular, metabolic and infectious disorders.
In 2015, according to official statistics of the Ministry of Health of Ukraine, the incidence of psychotic disorders (schizophrenia, schizotypal and delusion disorder) was 15.82 per 100,000 population. The prevalence of schizophrenia was 292.6 per 100,000 population, of which the working age was 355.4 per 100,000 of the population (Ministry of health of Ukraine, 2016).
Considering these statistics, it can be argued that psychotic disorders occupy an important place in the structure of the general morbidity of the population, affect quality and life expectancy, reduce working capacity and often cause disability. Psychotic symptoms cause significant distress in patients and lead to violations in important spheres of life, social functioning, may be the cause of suicidal or socially dangerous behavior, affective disorders. Therefore, the issue of effective treatment and prevention of these disorders, as well as social rehabilitation of patients, is relevant. Recent systematic reviews on cognitive-behavioral therapy (CBT) as a method of early intervention in psychotic disorders were implemented in 2010 (Early intervention services, cognitive-behavioral therapy and family intervention in early psychosis: a systematic review) and 2012 (Cognitive Behavioral Therapy in Prodromal Psychosis) years (Bird, Premkumar, 2010, Addington, 2012). Among the Ukrainian publications, these interventions don’t enough highlights in comparison with medical therapy.
Purpose. The aim of the present research is to investigate the features of the use of cognitive-behavioral therapy techniques and their effectiveness in the treatment of psychosis in the early stages. This study complements already existing systemic literature reviews and meta-analyses on the topic of cognitive-behavioral therapy of psychotic disorders those devoted to CBT of the first psychotic episode. This review contains an analysis of new articles on this topic. In addition, it examines the effectiveness of the use of CBT not only in the prodromal stage of psychosis and during its manifestation, as well as in the remission period as a method for preventing recurrence.
Methods and organization of research. For review, we used the following the inclusion criteria:
- The research should be having been published no more than 10 years;
- The research should be having been related to the use of cognitive-behavioral therapy in the treatment of patients with psychotic disorders in the early stages. These include prodromal phase (high risk of developing psychosis), first psychotic episode, recovery, and remission after the first psychotic episode;
- The articles should be having been published in authoritative scientific research resources: PubMed, Medline, Web-of-Science, BIOSIS, Cochrane library and Research gate databases.
Results and Discussion. Most studies confirmed the effectiveness of CBT psychotic symptoms. For the most common is the inclusion in the therapy of psychoeducation, normalization of experiences and developing preventing relapse plan. The necessity of these components is confirmed by the theory and points to the importance of open presentation of information to the patient, interpretative work on the symptoms, their prevalence, possible causes and triggers in each case. Their effectiveness has been proved by the technique of teaching useful coping strategies about positive and negative symptoms, which is confirmed by the theoretical basis and proves the usefulness of the skills of adaptation and management of the symptoms of the disorder. Some studies also suggest that typical CBT protocols for comorbidities, such as depression, anxiety disorders, and low self-esteem, may be used for patients with psychotic disorders. The training of social skills and assertiveness helps in restoring social functioning. The effectiveness of the application has been demonstrated in both individual and group formats.
Limitations and strengths of the study. It should be noted that the one limitation of the present review is the paucity of randomized controlled trials included in a review. Some trials include CBT early interventions and addition antipsychotic courses in both trial group, that could impact the effects of early intervention. In addition, a small number of early intervention trials provided long-term data, limiting the comparison and review.
Practical/Social value. Based on this study, recommendations for the use of cognitive-behavioral therapy for the first psychotic episode as a method of choosing early psychotherapeutic intervention can be formulated. Given that the work contains a theoretical overview of the basic principles of cognitive-behavioral therapy of psychosis, the results of the study can be used in practice. The present review can be useful to psychiatrists, psychologists, social workers and anyone who works with people at high risk for a psychotic disorder, with people which were experienced the first psychotic episode or are in the recovery stage after it and need help in preventing relapse.
Conclusions. According to the data, CBT-techniques is an effective and scientifically based method in the integrated therapy of patients in the early stages of the course of psychotic illness. CBT early interventions reduce positive and negative symptoms severity, improve access to engagement with treatment, which also reduces hospital admission and relapse rates. Consequently, based on the results of the research, it is possible to recommend programs, techniques, and manuals based on CBT for use in the integrated therapy of psychotic disorders in the early stages.
Keywords: Psychiatry, psychology, mental health, mental illness.
1. Bird, V. & Premkumar, P. (2010) Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review. Br.J.Psychiatry, 197(5), 350-356. http://doi.org/10.1192/bjp.bp.109.074526
2. Addington, J. (2012) Cognitive Behavioral Therapy in Prodromal Psychosis. Current pharmaceutical design, 18(4), 558-565. http://doi.org/10.2174/138161212799316082
3. Ministry of health of Ukraine (2016) Notice on the publication of a draft order of the Ministry of Health of Ukraine “On approval and implementation of medical technology documents on the standardization of medical care for schizophrenia”. Retrieved from: http://old.moz.gov.ua/ua/print/dn_20160702_0.html.
4. National Institute of Mental Health (2015) Fact Sheet: First Episode Psychosis. Retrieved from: https://www.nimh.nih.gov/health/topics/schizophrenia/raise/fact-sheet-first-episode-psychosis.shtml
5. World Health Organization (2012) Psychoeducation, family interventions and cognitive-behavioural therapy. Retrieved from: http://www.who.int/mental_health/mhgap/evidence/psychosis/q10/en/.