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Cognitive therapy for people with a schizophrenia spectrum diagnosis not taking antipsychotic medication: an exploratory trial

Published online by Cambridge University Press:  14 September 2011

A. P. Morrison ,
P. Hutton ,
M. Wardle ,
H. Spencer ,
S. Barratt ,
A. Brabban ,
P. Callcott ,
T. Christodoulides ,
R. Dudley  and
P. French
...Show all authors
A. P. Morrison*
Affiliation:
School of Psychological Sciences, University of Manchester, UK Greater Manchester West NHS Mental Health Foundation Trust, Manchester, UK
P. Hutton
Affiliation:
Greater Manchester West NHS Mental Health Foundation Trust, Manchester, UK
M. Wardle
Affiliation:
Greater Manchester West NHS Mental Health Foundation Trust, Manchester, UK
H. Spencer
Affiliation:
Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, Newcastle-upon-Tyne, UK Newcastle University, Newcastle-upon-Tyne, UK
S. Barratt
Affiliation:
Greater Manchester West NHS Mental Health Foundation Trust, Manchester, UK
A. Brabban
Affiliation:
Tees, Esk and Wear Valley NHS Mental Health Foundation Trust, UK University of Durham, UK
P. Callcott
Affiliation:
Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, Newcastle-upon-Tyne, UK
T. Christodoulides
Affiliation:
Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, Newcastle-upon-Tyne, UK
R. Dudley
Affiliation:
Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, Newcastle-upon-Tyne, UK Newcastle University, Newcastle-upon-Tyne, UK
P. French
Affiliation:
Greater Manchester West NHS Mental Health Foundation Trust, Manchester, UK
V. Lumley
Affiliation:
Tees, Esk and Wear Valley NHS Mental Health Foundation Trust, UK
S. J. Tai
Affiliation:
School of Psychological Sciences, University of Manchester, UK
D. Turkington
Affiliation:
Northumberland, Tyne and Wear NHS Mental Health Foundation Trust, Newcastle-upon-Tyne, UK Newcastle University, Newcastle-upon-Tyne, UK
*
*Address for correspondence: Professor A. P. Morrison, School of Psychological Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK. (Email: anthony.p.morrison@manchester.ac.uk)
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Abstract

Background

Although antipsychotic medication is the first line of treatment for schizophrenia, many service users choose to refuse or discontinue their pharmacological treatment. Cognitive therapy (CT) has been shown to be effective when delivered in combination with antipsychotic medication, but has yet to be formally evaluated in its absence. This study evaluates CT for people with psychotic disorders who have not been taking antipsychotic medication for at least 6 months.

Method

Twenty participants with schizophrenia spectrum disorders received CT in an open trial. Our primary outcome was psychiatric symptoms measured using the Positive and Negative Syndromes Scale (PANSS), which was administered at baseline, 9 months (end of treatment) and 15 months (follow-up). Secondary outcomes were dimensions of hallucinations and delusions, self-rated recovery and social functioning.

Results

T tests and Wilcoxon's signed ranks tests revealed significant beneficial effects on all primary and secondary outcomes at end of treatment and follow-up, with the exception of self-rated recovery at end of treatment. Cohen's d effect sizes were moderate to large [for PANSS total, d=0.85, 95% confidence interval (CI) 0.32–1.35 at end of treatment; d=1.26, 95% CI 0.66–1.84 at follow-up]. A response rate analysis found that 35% and 50% of participants achieved at least a 50% reduction in PANSS total scores by end of therapy and follow-up respectively. No patients deteriorated significantly.

Conclusions

This study provides preliminary evidence that CT is an acceptable and effective treatment for people with psychosis who choose not to take antipsychotic medication. An adequately powered randomized controlled trial is warranted.

Keywords

Antipsychotic medicationcognitive therapypsychosisschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 5 , May 2012 , pp. 1049 - 1056
Copyright
Copyright © Cambridge University Press 2011

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