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Query: UMLS:C0036341 (schizophrenia)
 60,220 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This article reviews the state of knowledge about strategies used by people with a diagnosis of schizophrenia to cope with hallucinated voices, and considers the role of coping in psychological treatments for persisting symptoms. The use of self-initiated ('natural') coping strategies appears almost universal amongst voice-hearers. These strategies are similar across cultures, and include diverse behaviours, only a minority of which is specific to hallucinations. Most strategies are reported by at least some users to be effective, but more sophisticated outcome studies are lacking. Some evidence for the efficacy of certain behavioural techniques of coping, for the manipulation of auditory input, and for strategies involving subvocalisation, is available from experimental studies. Therapeutic enhancement of natural coping strategies for persisting symptoms has demonstrated some efficacy, but its benefit for voices is unknown. Despite this, it has become an established part of some CBT interventions for psychosis. Further advances in knowledge and practice may come from utilisation of coping models in research, longitudinal and ideographic methods of study and a movement away from descriptive coping lists to investigations of coping styles, mechanisms of action, and the process of coping.
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PMID:Coping with hallucinated voices in schizophrenia: a review of self-initiated strategies and therapeutic interventions. 1722 38

Despite the favourable effects of antipsychotics on positive symptoms of schizophrenia, many patients continue to suffer from distressing symptoms. Additional benefits of cognitive behaviour therapy for psychosis (CBTp) have been reported for approximately 50% of such patients. Given the role of left hemisphere-based language processes in responsiveness to CBT for depression, and language pathway abnormalities in psychosis, this study examined whether pre-therapy brain activity during a verbal monitoring task predicts CBTp responsiveness in schizophrenia. Fifty-two outpatients, stable on antipsychotics with at least one persistent distressing positive symptom and wishing to receive CBTp adjunctive to their treatment-as-usual, and 20 healthy participants underwent fMRI during monitoring of self- and externally-generated (normal and distorted) speech. Subsequently, 26 patients received CBTp for 6-8 months adjunctive to their treatment-as-usual (CBTp + TAU, 20 completers), and 26 continued with their treatment-as-usual (TAU-alone, 18 completers). Symptoms were assessed (blindly) at entry and follow-up. The CBTp + TAU and TAU-alone groups had comparable demographic characteristics, performance and baseline symptoms. Only the CBTp + TAU group showed improved symptoms at follow-up. CBTp responsiveness was associated with (i) greater left inferior frontal gyrus (IFG) activity during accurate monitoring, especially of own voice, (ii) less inferior parietal deactivation with own, relative to others', voice, and (iii) less medial prefrontal deactivation and greater thalamic and precuneus activation during monitoring of distorted, relative to undistorted, voices. CBTp + TAU patients, on average, displayed left IFG and thalamic hypo-activation (<healthy participants). The findings implicate language processing (IFG), attention (thalamus), insight and self-awareness (medial prefrontal and parietal cortices) in CBTp responsiveness in schizophrenia.
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PMID:Beyond dopamine: functional MRI predictors of responsiveness to cognitive behaviour therapy for psychosis. 2017 88

Psychotic symptoms appear frequently in schizophrenia and other related disorders, and until relatively recently were not generally considered to be amenable to psychological interventions. Recent studies have changed these conceptualizations. Theoretical models, based on a stress vulnerability perspective, show how misinterpretations of anomalous experiences are factors in both the development and maintenance of psychosis. This review describes CBT treatment for persons with psychosis which focuses on education about symptoms and the cognitive model as well as a collaborative exploration of thoughts and schemas surrounding delusions and hallucinations. Treatment outcome studies show that CBT is an effective and acceptable treatment for psychosis.
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PMID:Cognitive behavioral treatment for persons with psychosis: a new direction in psychological intervention. 2063 78

Grandiose delusions (GDs) are found across a wide range of psychiatric conditions, including in around two-thirds of patients diagnosed with bipolar disorder, half of patients diagnosed with schizophrenia, as well as in a substantial proportion of patients with substance abuse disorders. In addition, over 10% of the healthy general population experience grandiose thoughts that do not meet full delusional criteria. Yet in contrast to other psychotic phenomena, such as auditory hallucinations and persecutory delusions, GDs have received little attention from researchers. This paper offers a comprehensive examination of the existing cognitive and affective literature on GDs, including consideration of the evidence in support of 'delusion-as-defence' and emotion-consistent' models. We then propose a tentative model of GDs informed by a synthesis of the available evidence designed to be a stimulus to future research in this area. As GDs are considered to be relatively resistant to traditional cognitive behavioural techniques, we then discuss the implications of our model for how CBT may be modified to address these beliefs. Directions for future research are also highlighted.
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PMID:Grandiose delusions: a review and theoretical integration of cognitive and affective perspectives. 2148 26

Psychotherapy is one of the major methods of treatment in the mental health field. A review of the literature suggests that some forms of psychotherapy are evidence-based. Findings from hundreds of meta-analytic studies indicate that psychotherapy can often achieve outcomes that are clinically meaningful and may also contribute to cost savings. This review contains findings pertaining to the main psychotherapy approaches: the psychodynamic, the cognitive-behavioral (CBT) and the dialectical-behavioral (DBT). The findings suggest that there is ample evidence on the effectiveness of CBT in the treatment of various mental disorders. There is also an accumulating body of evidence suggesting that short-term psychodynamic psychotherapy is effective in the treatment of mental disorders except for psychosis and schizophrenia. On the other hand, there are only preliminary findings supporting the effectiveness of DBT and questions remain concerning the cost-effectiveness of this labor-intensive treatment technique. Similarly, there are only preliminary results that long-term psychodynamic psychotherapy is effective in the treatment of complex mental disorders. Recent technological advances in the measurement of psychotherapy outcome were reviewed. These include methods of tracking changes throughout the course of treatment and computer-assisted programs designed to generate on-going feedback to the therapist. These techniques are designed to improve outcome by focusing the psychotherapy on clearly defined objectives and by the use of measures aimed at reducing negative reactions to treatment and lowering the risk of premature termination of treatment by clients. The authors conclude by proposing guidelines for evidence-based care policy for the public sector based outpatient psychotherapy in Israel.
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PMID:[Psychotherapy--outcome studies and guidelines for evidence-based care policy in Israel]. 2157 64

The current study aimed to test the clinical effectiveness of a cognitive-behavioural program (CBT) specifically adapted for pathological gamblers with chronic schizophrenia, carried out in a naturalistic setting of community Mental Health Centres. Forty-four pathological gamblers with chronic schizophrenia were assigned either to a standard drug therapy for schizophrenia (control group) or to cognitive-behavioural therapy for pathological gambling plus a standard drug therapy for schizophrenia (experimental group). Psychological treatment comprised a 20-session program including psychoeducation, stimulus control, gradual exposure and relapse prevention. Therapeutic success was defined as abstinence or the occurrence of only 1 or 2 episodes of gambling during the follow-up period. While the patients treated in the experimental group showed a rate of success of 73.9%, only 19% of the participants belonging to the control group gave up gambling at the 3-month follow-up. The CBT group also did better than the control group in the number of gambling episodes and in the amount of money spent on gambling. However, the improvement of the experimental group was weaker at the 6- and 12-month follow-up. These findings support the beneficial effects of CBT as adjunctive therapy for patients with dual diagnoses (schizophrenia and pathological gambling).
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PMID:Cognitive-behavioural treatment of pathological gambling in individuals with chronic schizophrenia: a pilot study. 2192 May 1

Across two continents, Cognitive-Behavioral Therapy for Psychosis (CBT-P) has been endorsed as an adjunctive treatment for individuals who experience persistent positive symptoms of schizophrenia. The moderate effect sizes reported in early studies and reviews were followed by better controlled studies indicating more limited effect sizes. This article provides a review of the literature that addresses the effectiveness of CBT-P, including particular areas of emphasis and practice elements associated with this approach. In addition, because the majority of research on CBT-P has been performed in the United Kingdom, implications for implementation and sustainability of this practice in the United States are presented.
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PMID:Cognitive behavioral therapy for psychosis in clinical practice. 2264 28

This special theme issue of Schizophrenia Bulletin presents a series of related articles focusing on auditory hallucinations, prepared by members of the International Consortium on Hallucination Research [InCoHR] working groups. The InCoHR is a large collaborative framework that serves as a platform for researchers to meet and collaborate on multidisciplinary projects relating to auditory hallucinations [AH] and discuss methodological issues facing transdiagnostic research. Laroi et al. observe the similarities in characteristic features of AHs in different clinical and nonclinical groups, but they also note that differences exist, reflecting the contribution of disease-related process. Waters et al. use findings of shared cognitive impairments across different diagnostic groups with AHs to propose a novel theoretical cognitive framework. Allen et al. describe that the neurobiological substrates of AHs include neural systems involved in language processing, as well as sensory and nonsensory brain regions and that studies are increasingly using fine-grain analysis of patients' characteristics in analyzing neuroimaging data. Ford et al. discuss different neurophysiological approaches and describes hallucination-related alterations in activity in temporal and frontal regions of the brain and particularly in auditory cortical areas. Finally, Sommer et al. review different treatment options for AHs in schizophrenia and other disorders, including pharmacological treatment, cognitive-behavioral therapy [CBT] and acceptance and commitment therapy [ACT], transcranial magnetic stimulation [TMS], and electroconvulsive therapy [ECT]. These related publications describe the current substance and direction of research on AHs across different diagnostic groups.
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PMID:Multidisciplinary approaches to understanding auditory hallucinations in schizophrenia and nonschizophrenia populations: the International Consortium on Hallucination Research. 2283 51

OBJECTIVES: Varenicline was approved by the FDA in 2006. In 2009, based largely on case reports, the FDA issued a warning of possible adverse neuropsychiatric effects including depression and suicidal thoughts and behavior for varenicline and bupropion. Prospective trials of varenicline have not reported increased incidence of psychiatric adverse events other than sleep disturbance, but smokers with major mental illness have been excluded from large prospective trials of varenicline to date. We sought to evaluate the effect of a standard open-label 12-week varenicline trial on prospectively assessed safety and smoking outcomes in stable, treated adults with schizophrenia spectrum disorder and nicotine dependence. METHODS: One-hundred-and-twelve stable outpatients who smoked >10 cigarettes/day participated in a 12-week, open-label, smoking cessation trial of varenicline and weekly group cognitive behavioral therapy. Participants took varenicline for 4 weeks before attempting cessation. Trained raters collected safety and smoking outcome data weekly. RESULTS: Participants demonstrated improved psychotic symptoms, depressive symptoms and nicotine withdrawal symptoms from baseline to week 12 or early termination. At the end of 12 weeks open label treatment, the 14- and 28-day continuous abstinence rates were 47.3 and 34%, respectively. Expired CO declined significantly during treatment in those who did not achieve abstinence. CONCLUSIONS: This prospective study suggests that varenicline may be well-tolerated and effective for smoking cessation in combination with group CBT in stable outpatients with schizophrenia, a group with high rates of smoking and smoking-attributable morbidity and mortality.
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PMID:Varenicline for Smoking Cessation in Schizophrenia: Safety and Effectiveness in a 12-Week, Open-Label Trial. 2288 9

CBT for Psychosis (CBTp) is an empirically-supported intervention for schizophrenia, but few people have access to it in the U.S. "Coping with Voices" is an interactive, computerized self-directed web-based CBTp program developed to increase access to CBTp with the objective of reducing the severity, distress, and functional impairment caused by auditory hallucinations. This open pilot study tested the feasibility and effects of this new intervention. Twenty-one individuals with schizophrenia spectrum disorders and auditory hallucinations were enrolled in the individual-based 10-session Coping with Voices program at one of 4 community mental health centers. High levels of participant satisfaction with the program were found, with most reporting that the program was engaging and helped them manage their symptoms. Seventeen participants (81%) completed more than 50% of the scheduled program sessions (i.e., 6 or more sessions), and were defined as "exposed" to the program. Exposed participants showed statistically significant reductions from baseline to post-treatment in several measures of auditory hallucinations, including overall severity and the perception of voices as an "outside entity" and intensity of "negative commentary," as well as reductions in other psychotic symptoms, and overall psychopathology. This study supports the feasibility of the web-based Coping with Voices program and its potential clinical benefits, and suggests that more rigorous research is warranted to evaluate its effects.
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PMID:Web-based cognitive-behavioral therapy for auditory hallucinations in persons with psychosis: a pilot study. 2341 Jul 9


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