Help-seeking pathways in early psychosis.

INTRODUCTION: Understanding the help-seeking pathways of patients with a putative risk of developing psychosis helps improving development of specialised care services. This study aimed at obtaining information about: type of health professionals contacted by patients at putative risk for psychosis on their help-seeking pathways; number of contacts; type of symptoms leading to contacts with health professionals; interval between initial contact and referral to a specialised outpatient service. METHOD: The help-seeking pathways were assessed as part of a prospective study in 104 patients with suspected at-risk states for psychosis. RESULTS: The mean number of contacts prior to referral was 2.38. Patients with psychotic symptoms more often contacted mental health professionals, whereas patients with insidious and more unspecific features more frequently contacted general practitioners (GPs). CONCLUSIONS: GPs have been found to under-identify the insidious features of emerging psychosis (Simon et al. (2005) Br J Psychiatry 187:274-281). The fact that they were most often contacted by patients with exactly these features calls for focussed and specialised help for primary care physicians. Thus, delays along the help-seeking pathways may be shortened. This may be of particular relevance for patients with the deficit syndrome of schizophrenia.

Efficacy of psychological therapy in schizophrenia: conclusions from meta-analyses.

Over the past years, evidence for the efficacy of psychological therapies in schizophrenia has been summarized in a series of meta-analyses. The present contribution aims to provide a descriptive survey of the evidence for the efficacy of psychological therapies as derived from these meta-analyses and to supplement them by selected findings from an own recent meta-analysis. Relevant meta-analyses and randomized controlled trials were identified by searching several electronic databases and by hand searching of reference lists. In order to compare the findings of the existing meta-analyses, the reported effect sizes were extracted and transformed into a uniform effect size measure where possible. For the own meta-analysis, weighted mean effect size differences between comparison groups regarding various types of outcomes were estimated. Their significance was tested by confidence intervals, and heterogeneity tests were applied to examine the consistency of the effects. From the available meta-analyses, social skills training, cognitive remediation, psychoeducational coping-oriented interventions with families and relatives, as well as cognitive behavioral therapy of persistent positive symptoms emerge as effective adjuncts to pharmacotherapy. Social skills training consistently effectuates the acquisition of social skills, cognitive remediation leads to short-term improvements in cognitive functioning, family interventions decrease relapse and hospitalization rates, and cognitive behavioral therapy results in a reduction of positive symptoms. These benefits seem to be accompanied by slight improvements in social functioning. However, open questions remain as to the specific therapeutic ingredients, to the synergistic effects, to the indication, as well as to the generalizability of the findings to routine care.

The significance of coping as a therapeutic variable for the outcome of psychological therapy in schizophrenia.

Although there is now strong evidence confirming the efficacy of psychological therapies in schizophrenia, the therapeutic processes which they activate remain widely unknown. In order to effectively implement them in clinical practice, identification of these processes is essential. In a controlled study, the efficacy of a coping-oriented therapy approach for schizophrenia patients was tested. Furthermore, the study aimed at establishing preliminary hypotheses on the therapeutically relevant factors. Treatment effects were found in the prominence of psychopathology, the extent of cognizance of the disorder, and the level of social functioning. Moreover, a better psychopathological and social outcome as measured 12 and 18 months after completion of therapy was best predicted by the patients' mastery of active, problem-focused coping strategies immediately after completion of therapy. The findings underscore the clinical relevance of specific coping styles and corroborate the appropriateness of focusing on aspects of coping behavior in psychological interventions for schizophrenia patients.

Acupuncture for alcohol withdrawal: a randomized controlled trial.

BACKGROUND AND AIMS: Previous trials on acupuncture in alcohol addiction were in outpatients and focused on relapse prevention. Rates of dropout were high and interpretation of results difficult. We compared auricular laser and needle acupuncture with sham laser stimulation in reducing the duration of alcohol withdrawal. METHODS: Inpatients undergoing alcohol withdrawal were randomly allocated to laser acupuncture (n = 17), needle acupuncture (n = 15) or sham laser stimulation (n = 16). Attempts were made to blind patients, therapists and outcome assessors, but this was not feasible for needle acupuncture. The duration of withdrawal symptoms (as assessed using a nurse-rated scale) was the primary outcome; the duration of sedative prescription was the secondary outcome. RESULTS: Patients randomized to laser and sham laser had identical withdrawal symptom durations (median 4 days). Patients randomized to needle stimulation had a shorter duration of withdrawal symptoms (median 3 days; P = 0.019 versus sham intervention), and tended to have a shorter duration of sedative use, but these differences diminished after adjustment for baseline differences. CONCLUSIONS: The data from this pilot trial do not suggest a relevant benefit of auricular laser acupuncture for alcohol withdrawal. A larger trial including adequate sham interventions is needed, however, to reliably determine the effectiveness of any type of auricular acupuncture in this condition.

Temporal modulation of cerebral hemodynamics under prefrontal challenge in schizophrenia: a transcranial Doppler sonography study.

Transcranial Doppler sonography (TCD) is a non-invasive method to assess cerebral blood flow velocity (CBFV) and hence cerebral blood flow during cognitive activation. Major cognitive dysfunctions have been consistently reported in patients with schizophrenia, and important deficits have been observed with respect to prefrontal functions. However, prefrontal activation in schizophrenics has not been investigated with TCD despite its potential to examine short-term changes of cerebral blood flow. The Wisconsin Card Sorting Test (WCST) and the Tower of Hanoi puzzle were administered to 11 right-handed schizophrenics and 20 healthy controls. The middle and anterior cerebral arteries were pairwise insonated. Schizophrenics showed decreased CBFV during the initial phase of both prefrontal functions and the steady-state phase of the Tower of Hanoi. In healthy controls, there was a succession of three significantly different phases of mean CBFV during the Tower of Hanoi, and there was no such modulation in schizophrenics. Immediately after category shift in the WCST, there was an increase of mean CBFV in healthy controls, but not in schizophrenics. In conclusion, transcranial Doppler sonography was able to detect differing specific alterations of CBFV during two prefrontal tasks in healthy controls and patients with schizophrenia. Importantly, the results of this study imply a degraded pattern of CBFV changes over time in schizophrenia during prefrontal activation.