Can metacognitive interventions improve insight in schizophrenia spectrum disorders? A systematic review and meta-analysis

AbstractBackgroundPatients with schizophrenia spectrum disorders (SSD) tend to lack insight, which is linked to poor outcomes. The effect size of previous treatments on insight changes in SSD has been small. Metacognitive interventions may improve insight in SSD, although this remains unproved.MethodsWe carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effects of metacognitive interventions designed for SSD, namely Metacognitive Training (MCT) and Metacognitive Reflection and Insight Therapy (MERIT), on changes in cognitive and clinical insight at post-treatment and at follow-up.ResultsTwelve RCTs, including 10 MCT RCTs (n = 717 participants) and two MERIT trials (n = 90), were selected, totalling N = 807 participants. Regarding cognitive insight six RCTs (n = 443) highlighted a medium effect of MCT on self-reflectiveness at post-treatment, d = 0.46, p < 0.01, and at follow-up, d = 0.30, p < 0.01. There was a small effect of MCT on self-certainty at post-treatment, d = −0.23, p = 0.03, but not at follow-up. MCT was superior to controls on an overall Composite Index of cognitive insight at post-treatment, d = 1.11, p < 0.01, and at follow-up, d = 0.86, p = 0.03, although we found evidence of heterogeneity. Of five MCT trials on clinical insight (n = 244 participants), which could not be meta-analysed, four of them favoured MCT compared v. control. The two MERIT trials reported conflicting results.ConclusionsMetacognitive interventions, particularly Metacognitive Training, appear to improve insight in patients with SSD, especially cognitive insight shortly after treatment. Further long-term RCTs are needed to establish whether these metacognitive interventions-related insight changes are sustained over a longer time period and result in better outcomes.

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S41. RANDOMISED CONTROLLED TRIAL OF METACOGNITIVE TRAINING COMPARED WITH PSYCHOEDUCATION IN PATIENTS WITH SCHIZOPHRENIA SPECTRUM DISORDERS: EFFECTS ON INSIGHT

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.107 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S47-S48

Author(s):

Javier-David Lopez-Morinigo ◽

Adela Sánchez Escribano-Martínez ◽

Verónica González Ruiz-Ruano ◽

Laura Mata-Iturralde ◽

Sergio Sánchez-Alonso ◽

...

Keyword(s):

Primary Outcome ◽

Controlled Trial ◽

Group Differences ◽

Schizophrenia Spectrum Disorders ◽

Metacognitive Training ◽

Cognitive Insight ◽

Schizophrenia Spectrum ◽

Spectrum Disorders ◽

Randomised Controlled

Abstract Background Insight in schizophrenia spectrum disorders (SSD) has been linked with positive outcomes. However, the effect size of previous treatments on insight has been relatively small to date. The metacognitive basis of insight in SSD has led to speculation that metacognitive training (MCT) may improve insight and clinical outcomes in SSD. Methods Design: Single-center, assessor-blind, parallel-group, randomised controlled trial (RCT). Sample: Participants are recruited from the outpatient clinic of Hospital Universitario Fundación Jiménez Díaz (Madrid, Spain) over June-December 2019. Inclusion criteria: i) age: 18–64 years, both inclusive, at the study inception; ii) diagnosis: SSD based on the Mini International Neuropsychiatric Interview (Sheehan et al., 1998) and iii) IQ>70 according to the Wechsler Adults Intelligence Scale-IV (Wechsler, 1981). Those with organic and drugs-induced psychosis, poor level of Spanish and/or lack of cooperativeness are excluded. Intervention: Participants are randomised to receive eight weekly group sessions of MCT or group psychoeducation (PSE) and they will be assessed at: T0) at baseline; T1) after treatment and T2) at 1-year follow-up, although follow-up data are not available yet. Co-primary outcome measures: clinical and cognitive insight dimensions, which will be measured by the Schedule for Assessment of Insight (Expanded version) (SAI-E) (Kemp & David, 1997), and the Beck Cognitive Insight Scale (BCIS) (Beck et al., 2004), respectively. Secondary outcome measures: i)Symptom severity-Positive and Negative Syndrome Scale (Kay et al., 1987); ii)Functioning-General Assessment of Functioning (Endicott et al., 1976), World Health Organization Disability Scale (WHO, 2012) and Satisfaction Life Domains Scale (Carlson et al., 2009), and only at follow-up (T2) iii)Suicidal Behaviour and iv) Hospitalizations. Power calculations: To reach a power of β=80% and detect a between-group difference of two points on the SAI-E total scores, which is considered to be clinically meaningful -effect size of 0.33-, the estimated sample size at the end of the study is n=126. Statistics: Student’s T-test and Mann-Whitney U tests were used as appropriate to compare between-group differences before- and after-treatment, i.e., the changes from baseline to post-treatment scores. The protocol of the study is registered at ClinicalTrials.gov (NCT04104347). Results n=49 subjects have been assessed at baseline so far (26 males, age: 47.0±10.2 years, diagnosis of schizophrenia -F20-ICD10-, n=36, 73.5%). Fifteen individuals (MCT: n=8; controls: n=7) have completed the treatment and the post-treatment assessment (T1). ‘After-treatment-T1 - baseline-T0’ scores difference means/medians between-group differences (MCT vs. PSE) were: SAI-E total insight 1.00 vs. -2.00, p=0.050; SAI-E illness awareness 0.62±2.20 vs. -0.43±1.62, p=0.316; SAI-E symptom relabelling 0.37±3.38 vs. -1.86±2.34, p=0.167; SAI-E treatment compliance 0.00 vs. 0.00, p>0.05,ns; BCIS self-reflectiveness 0.50±3.78 vs. -1.43±2.22, p=0.259, BCIS self-certainty 1.62±2.97 vs. 0.00±2.44, p=0.298 and BCIS Composite Index -1.13±5.62 vs. -2.17±3.49, p=0.698. Discussion This is the first RCT testing the effect of group MCT on insight (as primary outcome) in a sample of unselected patients with SSD in comparison with psychoeducation. Two main findings emerged from the results. First, MCT appears to improve clinical and cognitive insight in SSD. Second, MCT was shown to be superior to PSE in changing insight. Whether the above MCT-related insight improvement is maintained at longer-term and whether this has an impact on clinical and social outcomes are yet to be established, which will be properly looked at in this trial.

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Short-acting intramuscular second-generation antipsychotic drugs for acutely agitated patients with schizophrenia spectrum disorders. A systematic review and network meta-analysis

Schizophrenia Research ◽

10.1016/j.schres.2021.01.021 ◽

2021 ◽

Vol 229 ◽

pp. 3-11

Author(s):

Giulia Paris ◽

Irene Bighelli ◽

Giacomo Deste ◽

Spyridon Siafis ◽

Johannes Schneider-Thoma ◽

...

Keyword(s):

Systematic Review ◽

Antipsychotic Drugs ◽

Second Generation ◽

Meta Analysis ◽

Schizophrenia Spectrum Disorders ◽

Short Acting ◽

Schizophrenia Spectrum ◽

Second Generation Antipsychotic ◽

Spectrum Disorders

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Opioid Use Disorder Comorbidity in Individuals With Schizophrenia-Spectrum Disorders: A Systematic Review and Meta-Analysis

The Canadian Journal of Addiction ◽

10.1097/cxa.0000000000000128 ◽

2021 ◽

Vol 12 (4) ◽

pp. 26-37

Author(s):

Marlon Danilewitz ◽

Anees Bahji

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Opioid Use Disorder ◽

Schizophrenia Spectrum Disorders ◽

Opioid Use ◽

Schizophrenia Spectrum ◽

Spectrum Disorders

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Depressive psychopathology in first-episode schizophrenia spectrum disorders: a systematic review, meta-analysis and meta-regression

Psychological Medicine ◽

10.1017/s0033291719002344 ◽

2019 ◽

Vol 49 (15) ◽

pp. 2463-2474 ◽

Cited By ~ 5

Author(s):

Sarah E. Herniman ◽

Kelly Allott ◽

Lisa J. Phillips ◽

Stephen J. Wood ◽

Jacqueline Uren ◽

...

Keyword(s):

Systematic Review ◽

Depressive Disorder ◽

Meta Analysis ◽

First Episode ◽

Schizophrenia Spectrum Disorders ◽

Schizophrenia Spectrum ◽

Pooled Prevalence ◽

Meta Regression ◽

Spectrum Disorders ◽

First Episode Schizophrenia

AbstractBackgroundDespite knowing for many decades that depressive psychopathology is common in first-episode schizophrenia spectrum disorders (FES), there is limited knowledge regarding the extent and nature of such psychopathology (degree of comorbidity, caseness, severity) and its demographic, clinical, functional and treatment correlates. This study aimed to determine the pooled prevalence of depressive disorder and caseness, and the pooled mean severity of depressive symptoms, as well as the demographic, illness, functional and treatment correlates of depressive psychopathology in FES.MethodsThis systematic review, meta-analysis and meta-regression was prospectively registered (CRD42018084856) and conducted in accordance with PRISMA and MOOSE guidelines.ResultsForty studies comprising 4041 participants were included. The pooled prevalence of depressive disorder and caseness was 26.0% (seven samples, N = 855, 95% CI 22.1–30.3) and 43.9% (11 samples, N = 1312, 95% CI 30.3–58.4), respectively. The pooled mean percentage of maximum depressive symptom severity was 25.1 (38 samples, N = 3180, 95% CI 21.49–28.68). Correlates of depressive psychopathology were also found.ConclusionsAt least one-quarter of individuals with FES will experience, and therefore require treatment for, a full-threshold depressive disorder. Nearly half will experience levels of depressive symptoms that are severe enough to warrant diagnostic investigation and therefore clinical intervention – regardless of whether they actually fulfil diagnostic criteria for a depressive disorder. Depressive psychopathology is prominent in FES, manifesting not only as superimposed comorbidity, but also as an inextricable symptom domain.

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