a research update and clinical workshop Tony Morrison Division of Clinical Psychology University of Manchester amp Psychosis Research Unit GMWMHT Objectives Outline UHR and Psychosis Cognitive approach to understanding psychosis ID: 225860
Download Presentation The PPT/PDF document "Cognitive Therapy cognitive therapy for ..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1Slide2
Cognitive Therapy cognitive therapy for prevention and treatment of psychosis:
a research update and clinical workshop
Tony MorrisonDivision of Clinical Psychology, University of Manchester& Psychosis Research Unit, GMWMHT Slide3
Objectives
Outline UHR and Psychosis
Cognitive approach to understanding psychosis
Application of CT to people with distressing psychotic experiences (UHR, FEP and beyond)
Formulation
Normalisation
Strategies for common difficulties
Case illustrations, exercises, videos
Evidence baseSlide4
Psychosis ‘prodrome’
A period of months to years prior to the onset of Psychosis
(assessed retrospectively) Progressive symptoms/signsMoodThinkingBehaviourCognitive functionsReduction in ability to function Slide5
Onset of psychosis
Prodrome
First psychotic symptom
Build up
Emergence of psychosisSlide6
Why is early detection important?
If psychosis is detected early, many problems can be prevented and functioning can be restored.
The earlier the problems are treated, the greater the chance of a successful recovery.
Onset is often in a critical stage of a young person’s life. Adolescents and young adults are just starting to develop their own identity, form lasting relationships, and make plans for the future.
People are help seeking and distressed.Slide7
Ultra High Risk Criteria
Original PACE criteria
(Yung et al. 1996)
Age between 14 and 30 years
AND
Family history of DSM-IV psychotic disorder and reduction on GAF scale of ≥ 30
AND/OR
Attenuated symptoms, occurring several times during the week for at least one week
AND/OR
Brief, limited or intermittent psychotic symptoms (BLIPS) for less than one week and resolving spontaneously
Modified criteria now assessed using CAARMSSlide8
Identification Study at PACE
Yung et al 1998 British Journal of Psychiatry
Months of assessment
Number
not
psychotic
40% made
transition at six
months, 50% at
one year
Slide9
Intervention Study at PACE:
The prevention of psychosis
McGorry et al 2002 Archives of General Psychiatry
Months
% making transition
to psychosisSlide10
PRIME Study: Olanzapine versus placebo
McGlashan et al. 2006 American Journal of Psychiatry
*Slide11
Early Detection: Problems
Ethics of interventions in pre-psychotic phase
Solution:
employ interventions with minimal risks / side effects
employ interventions that will be useful to those who will never become psychotic
informed choice
Balancing the costs and benefits of treatment must be weighted in some way according to the ratio of people actually helped to those unnecessarily treatedSlide12
Psychosis is not necessarily dreadful
Prediction not very accurate (e.g. 60% false positives)
Side effects of medication (and can be fatal)atypicals commonly produce weight gain and sexual dysfunction; diabetes; cardiovascular problemsEffects of medication on developing brain unknownSlide13
Caveats
Distressing psychosis
Indisputable that antipsychotics help some people a great dealNot anti-antipsychotics, but anti over-reliance (or exclusive reliance) on antipsychotics and lack of patient choiceSlide14Slide15Slide16Slide17Slide18
Antipsychotics Oversold?
“Risperidone may well help people with schizophrenia, but the data in this review are unconvincing. People with schizophrenia or their advocates may want to lobby regulatory authorities to insist on better studies being available before wide release of a compound with the subsequent beguiling advertising. People given risperidone may wish to negotiate on length of prescription, ask about adverse effects, and help generate better evidence than currently exists.”
(Rattehalli et al., 2010, p.18).Slide19Slide20Slide21
Aripiprazole 10mg/day or 30mg/day Versus Placebo: PANSS Change in acute psychosisSlide22Slide23Slide24Slide25
kg
Months
12
24
0
48
36
Chronic RCT
Chronic RCT
10
5
20
15
12 kg
4 kg
3 kg
Alvarez
-Jimenez et al; CNS Drugs, 2008
Antipsychotic-Induced Weight Gain in Chronic and First-Episode Psychotic Disorders:
A Systematic Critical Reappraisal
Alvarez
-Jimenez et al; CNS Drugs, 2008
22 (7): 547-562
FEPSlide26Slide27Slide28
The British Journal of Psychiatry 2010
196, 116–121. doi: 10.1192/bjp.bp.109.067512
Twenty-five year mortality of a community
cohort with schizophrenia
Steve Brown, Miranda Kim, Clemence Mitchell and Hazel Inskip
Conclusions
People with schizophrenia have a mortality risk that is two to three times that of the general population. Most of the extra deaths are from natural causes.
The apparent increase in cardiovascular mortality relative to the general population should be of concern to anyone with an interest in mental health.
The most clinically useful intervention is probably to try to help people with schizophrenia
stop smoking
, to
promote exercise
and to
facilitate effective health screening
.