Cognitive behavior therapy in early psychosis with a focus on depression and low self-esteem: A randomized controlled trial.

BACKGROUND: Patients in early phases of psychosis often struggle with depressive symptoms and low self-esteem. The main aims of the present study were to examine whether cognitive behavior therapy (CBT) compared to treatment as usual (TAU) would reduce depressive symptoms (primary outcome) and increase self-esteem (secondary outcome). Furthermore, we wanted to examine whether CBT reduces symptoms measured with the PANSS (positive, negative, cognitive, or excited symptoms) or increases general functioning compared to TAU. METHODS: A total of 63 early psychosis patients were included and randomly assigned to receive either CBT (maximum 26 sessions) or TAU for a period of up to six months. A linear mixed model was used for longitudinal analysis, with a focus on whether patients in the CBT group or the TAU group changed differently to one another between the baseline and 15-month follow-up. RESULTS: There were no differences between the CBT group and TAU group regarding improvements in depressive symptoms measured with the Calgary Depression Scale for Schizophrenia (P = 0.188) or self-esteem measured with the Rosenberg Self-Esteem Scale (P = 0.580). However, patients in the CBT group improved significantly more on negative symptoms (P = 0.002) and social functioning (P = 0.001). CONCLUSIONS: We did not find CBT to be more effective than TAU in reducing depressive symptoms or increasing self-esteem in patients with early psychosis. However, CBT seems to improve negative symptoms and functioning. These results still need to be replicated in further studies as the present one was merely an exploratory analysis. ClinicalTrials.gov Identifier: NCT01511406.

Depressive symptoms in first-episode psychosis: a 10-year follow-up study.

AIMS: The present study examined if any patient characteristics at baseline predicted depressive symptoms at 10 years and whether patients prone to depressive symptoms in the first year of treatment had a different prognosis in the following years. METHOD: A total of 299 first-episode psychosis (FEP) patients with schizophrenia spectrum disorders were assessed for depressive symptoms with PANSS depression item (g6) at baseline, and 1, 2, 5 and 10 years of follow up. At 10 years, depressive symptoms were also assessed with Calgary Depression Scale for Schizophrenia (CDSS). A PANSS g6 ≥ 4 and CDSS score ≥ 6 were used as a cut-off score for depression. RESULTS: A total of 122 (41%) patients were scored as depressed at baseline, 75 (28%) at 1 year, 50 (20%) at 2 years, 33 (16%) at 5 years, and 35 (19%) at 10 years of follow up. Poor childhood social functioning and alcohol use at baseline predicted depression at 10 years of follow up. Thirty-eight patients were depressed at both baseline and 1 year follow up. This group had poorer symptomatic and functional outcome in the follow-up period compared to a group of patients with no depression in the first year of treatment. CONCLUSION: Depressive symptoms are frequent among FEP patients at baseline but decrease after treatment because their general symptoms have been initiated. Patients with poor social functioning in childhood and alcohol use at baseline are more prone to have depressive symptoms at 10 years of follow up. Patients struggling with depressive symptoms in the first year of treatment should be identified as having poorer long-term prognosis.

Unhelpful metacognitive beliefs in early psychosis are associated with affective symptoms and childhood social adjustment.

BACKGROUND: Previous studies have shown that individuals with schizophrenia exhibit higher levels of unhelpful metacognitive beliefs than healthy controls, but no studies have explored metacognitive beliefs in early psychosis. AIMS: We examined i) differences in levels of unhelpful metacognitive beliefs between psychosis spectrum disorders, and healthy controls, and ii) to what extent demographic and clinical characteristics predicted levels of metacognitive beliefs in the early treated phases of psychotic disorders. METHOD: Patients were included within two years of first treatment for a psychotic disorder (N=92). They were assessed on premorbid adjustment, psychotic symptoms, anxiety/depression, and self-reported metacognitive beliefs (MCQ-30). Ninety-seven controls also completed MCQ-30. Predictors of metacognitive beliefs were explored with multiple linear regression analyses. RESULTS: Patients scored significantly higher than controls on all metacognitive subscales except positive beliefs about worry. The regression model explained 14-38% of the variance on each metacognitive subscale. Current affective symptoms explained a significant amount of variance on all subscales, except positive beliefs about worry. Childhood (premorbid) social adjustment predicted a significant amount of the variance on all subscales, except cognitive confidence. Duration of untreated psychosis contributed significantly to more unhelpful beliefs about cognitive confidence. Negative symptoms predicted lower scores on cognitive self-consciousness. CONCLUSION: Affective symptoms and childhood social adjustment could be important predictors of unhelpful metacognitive beliefs in the early treated phases of psychosis, indicating potential psychopathological relationships that warrant further investigation for clinical relevance.

Depressive symptoms in first episode psychosis: a one-year follow-up study.

BACKGROUND: Depressive symptoms are common in patients with first episode psychosis (FEP) and have serious consequences for them. The main aims of this study were to examine the course of depression in FEP patients and explore whether any patient characteristics at baseline predicts depressive symptoms after one year. METHOD: A total of 198 FEP patients with schizophrenia spectrum disorders were assessed for depressive symptoms with Calgary Depression Scale for Schizophrenia (CDSS) at baseline and 127 were followed for one year. A CDSS score [greater than or equal to] 6 was used as a cut-off score for depression. RESULTS: Approximately 50% of the patients were depressed (CDSS[greater than or equal to]6) at baseline. At follow-up approximately 35% had depression. The course of depressive symptoms varied, 26% was depressed at both baseline and follow-up, 9% became depressed during the follow-up, 22% remitted from depression during the 12 months and 43% was neither depressed at baseline nor at follow-up. Poor childhood social functioning, long duration of untreated psychosis (DUP) and depressive symptoms at baseline predicted depression at 12 months follow-up. CONCLUSION: Depressive symptoms are frequent in the first year after onset of psychosis. Patients with poor social functioning in childhood, long DUP and depressive symptoms at baseline are more prone to have depressive symptoms after one year. These patients should be identified and proper treatment provided.