Psychological interventions for acute psychiatric inpatients with schizophrenia-spectrum disorders: A systematic review and meta-analysis.

BACKGROUND: Acute inpatient psychiatric wards are important yet challenging environments in which to implement psychological interventions for people with schizophrenia-spectrum disorders. No meta-analysis to date has evaluated whether psychological interventions are effective in this context. METHODS: We systematically searched Embase, Medline and PsycInfo databases for randomised controlled trials (RCTs) of psychological interventions implemented in acute inpatient psychiatric settings with individuals with schizophrenia-spectrum disorders. We conducted random effects meta-analyses of between-groups outcomes at post-intervention and relapse/re-hospitalisation rates by follow-up. RESULTS: Twenty-nine trials were suitable for meta-analysis. Psychological interventions improved post-intervention positive symptoms, social functioning and treatment compliance and reduced the risk of relapse/ re-hospitalisation, relative to control conditions. Analyses of specific intervention effects found positive effects of psychoeducation on several key outcomes (power > 80%) and preliminary evidence for positive effects of acceptance and commitment therapy (ACT), cognitive behaviour therapy (CBT) and metacognitive training (MCT) on some outcomes (power < 80%). CONCLUSION: Psychological interventions can be helpful for acute inpatients with schizophrenia-spectrum disorders. However, risk of bias was often high or unclear, and some analyses were underpowered. Further research should use more rigorous RCT designs and publish meta-analysable data on positive symptoms, general psychopathology, relapse/ re-hospitalisation, social functioning and treatment compliance.

The influence of positive and negative affect on emotional attention.

BACKGROUND AND OBJECTIVES: Mechanisms of engagement and disengagement of attention to emotional information are thought to contribute to the onset and maintenance of anxiety and depression, a conclusion based largely on findings in analogue subclinical samples. However, we argue that traditionally defined analogue samples can be misleading. Firstly, research has challenged the adequacy of conventional measures of subclinical traits by illustrating that supposedly distinct scales are highly inter-correlated and do not therefore measure independent constructs. Secondly, recent research in clinical groups has revealed results opposite to those expected from the analogue literature, suggesting speeded, rather than impaired, disengagement from threat. METHODS: We present analogue findings, from a sample of 70 healthy participants, allowing a purer distinction between the phenomenology of anxiety versus depression using the orthogonal traits of positive and negative affect to classify individuals. RESULTS: Using emotional peripheral cueing we found that, at short cue durations, dysphoric individuals' (those with low positive and high negative affect) attention to facial expressions was slowed by emotional compared to neutral invalid cues. LIMITATIONS: Limitations included a small sample size and limited generalisability due to sampling from a student population. CONCLUSIONS: The data suggest that, in line with the previous subclinical literature, dysphoric individuals are slow to disengage attention from emotional information at early stages of processing and are consistent with the possibility that patterns of orienting of attention might be qualitatively different in subclinical versus clinical populations.

The effect of core clinician interpersonal behaviours on depression.

BACKGROUND: It is well-established that core clinician interpersonal behaviours are important when treating depression, but few studies have evaluated whether outcome is determined by clinicians׳ general behaviour rather than by the perception of the individual being treated. METHODS: In the NIMH TDCRP, 157 patients rated their clinician׳s genuineness, positive regard, empathy and unconditional regard during cognitive behavioural therapy, interpersonal therapy or clinical management with placebo. The association between averaged ratings for each of 27 clinicians and their patients׳ self- and observer-rated depression outcomes was evaluated, adjusting for the deviation of individual patient ratings from the average for their clinician and other potential confounders. RESULTS: Clinicians in the clinical management condition were rated on average as less genuine and less empathic than those in the psychotherapy conditions. Clinicians׳ average genuineness, positive regard and empathy were significantly associated with lower depression severity during treatment, but not with recovery from depression, after adjusting for the deviation of the individual patient׳s rating of their clinician from the average for that clinician, treatment condition and baseline depression severity. Clinician unconditional regard was not significantly associated with outcome. LIMITATIONS: Using averaged ratings of clinician behaviour likely reduced statistical power. CONCLUSIONS: Clinicians׳ ability to demonstrate genuineness, positive regard and empathy may represent a stable personal characteristic that influences the treatment of depression beyond the individual clinician-patient relationship or an individual patient׳s perception of their clinician. However, clinicians׳ ability to demonstrate these behaviours may be poorer when delivering an intervention without a specific rationale or treatment techniques.

Treatment completion in psychotherapy for borderline personality disorder: a systematic review and meta-analysis.

OBJECTIVE: Psychotherapy for borderline personality disorder (BPD) has been associated with problematically low treatment completion rates. METHOD: PsycInfo and Medline were systematically searched to identify studies providing information on treatment completion in psychotherapy models that have been shown to be effective for BPD. A meta-analysis of treatment completion rates and a narrative analysis of factors predicting dropout were conducted. RESULTS: Forty-one studies were included, with completion rates ranging from 36% to 100%- a substantial between-study heterogeneity. Random effects meta-analyses yielded an overall completion rate of 75% (95% CI: 68-82%) for interventions of <12 months duration, and 71% (95% CI: 65-76%) for longer interventions. Egger's test for publication bias was significant for both analyses (P ≤ 0.01). Study characteristics such as treatment model and treatment setting did not explain between-study heterogeneity. In individual studies, factors predicting dropout status included commitment to change, the therapeutic relationship and impulsivity, whilst sociodemographics were consistently non-predictive. CONCLUSION: Borderline personality disorder should no longer be associated with high rates of dropout from treatment. However, the substantial variation in completion rates between studies remains unexplained. Research on the psychological processes involved in dropping out of treatment could further improve dropout rates.

Patients' subjective initial response and the outcome of inpatient and day hospital treatment.

OBJECTIVE: This study aimed to establish whether psychiatric patients' subjective initial response (SIR) to hospital and day hospital treatment predicts outcomes over a one-year follow-up period. METHOD: We analysed data from 765 patients who were randomised to acute psychiatric treatment in a hospital or day hospital. SIR was assessed on day 3 after admission. Outcomes were psychiatric symptom levels and social disability at discharge, and at 3 and 12 months after discharge. RESULTS: After controlling for socio-demographic and clinical characteristics, a more positive SIR was significantly associated with lower symptom levels at discharge and 3 months after discharge and lower social disability at 3 months and 12 months after discharge. CONCLUSION: SIR can predict outcomes of complex interventions over a one-year period. Patients' initial views of acute hospital and day treatment should be elicited and considered as important.