scholarly journals Predictors and moderators of treatment outcome in patients receiving multi-element psychosocial intervention for early psychosis: Results from the GET UP pragmatic cluster randomised controlled trial

2017 ◽  
Vol 210 (5) ◽  
pp. 342-349 ◽  
Author(s):  
Antonio Lasalvia ◽  
Chiara Bonetto ◽  
Jacopo Lenzi ◽  
Paola Rucci ◽  
Laura Iozzino ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Psychosocial Intervention ◽  
Controlled Trial ◽  
A Priori ◽  
Specific Treatment ◽  
Cluster Randomised Controlled Trial ◽  
Random Regression ◽  
First Episode ◽  
Treatment As Usual ◽  
Treatment Type

BackgroundThe GET UP multi-element psychosocial intervention proved to be superior to treatment as usual in improving outcomes in patients with first-episode psychosis (FEP). However, to guide treatment decisions, information on which patients may benefit more from the intervention is warranted.AimsTo identify patients' characteristics associated with (a) a better treatment response regardless of treatment type (non-specific predictors), and (b) a better response to the specific treatment provided (moderators).MethodSome demographic and clinical variables were selecteda priorias potential predictors/moderators of outcomes at 9 months. Outcomes were analysed in mixed-effects random regression models. (Trial registration: ClinicalTrials.gov, NCT01436331.)ResultsAnalyses were performed on 444 patients. Education, duration of untreated psychosis, premorbid adjustment and insight predicted outcomes regardless of treatment. Only age at first contact with the services proved to be a moderator of treatment outcome (patients aged ≥35 years had greater improvement in psychopathology), thus suggesting that the intervention is beneficial to a broad array of patients with FEP.ConclusionsExcept for patients aged over 35 years, no specific subgroups benefit more from the multi-element psychosocial intervention, suggesting that this intervention should be recommended to all those with FEP seeking treatment in mental health services.

A multicentre randomized controlled trial on trans-generational attention deficit/hyperactivity disorder (ADHD) in mothers and children (AIMAC): an exploratory analysis of predictors and moderators of treatment outcome

2019 ◽  
Vol 47 (1) ◽  
pp. 49-65 ◽  
Author(s):  
Charlotte Jaite ◽  
Betteke Maria van Noort ◽  
Timo D. Vloet ◽  
Erika Graf ◽  
Viola Kappel ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Specific Treatment ◽  
Externalizing Symptoms ◽  
Control Treatment ◽  
Comorbid Depression ◽  
Adhd Treatment ◽  
Mothers And Children ◽  
Maternal Adhd

Abstract. Objective: We examined predictors and moderators of treatment outcome in mothers and children diagnosed with ADHD in a large multicentre RCT. Method: In total, 144 mother-child dyads with ADHD were randomly assigned to either a maternal ADHD treatment (group psychotherapy and open methylphenidate medication, TG) or to a control treatment (individual counselling without psycho- or pharmacotherapy, CG). After maternal ADHD treatment, parent-child training (PCT) for all mother-child dyads was added. The final analysis set was based on 123 dyads with completed primary outcome assessments (TG: n = 67, CG: n = 56). The primary outcome was the change in each child’s externalizing symptoms. Multiple linear regression analyses were performed. Results: The severity of the child’s externalizing problem behaviour in the family at baseline predicted more externalizing symptoms in the child after PCT, independent of maternal treatment. When mothers had a comorbid depression, TG children showed more externalizing symptoms after PCT than CG children of depressive mothers. No differences between the treatment arms were seen in the mothers without comorbid depression. Conclusions: Severely impaired mothers with ADHD and depressive disorder are likely to need additional disorder-specific treatment for their comorbid psychiatric disorders to effectively transfer the contents of the PCT to the home situation (CCTISRCTN73911400).

scholarly journals Influence of age on outcome of psychological treatments in first-episode psychosis

2006 ◽  
Vol 188 (3) ◽  
pp. 250-254 ◽  
Author(s):  
Gillian Haddock ◽  
Shôn Lewis ◽  
Richard Bentall ◽  
Graham Dunn ◽  
Richard Drake ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Behavioural Therapy ◽  
First Episode ◽  
Treatment As Usual ◽  
Psychological Treatments ◽  
Treatment Providers ◽  
Cognitive Behavioural ◽  
Episode Psychosis ◽  
Supportive Counselling ◽  
Randomised Controlled

BackgroundPsychological treatments have been shown to be effective in patients with psychosis. However, the studies published to date have included participants across wide age ranges, so few conclusions can be reached about the effectiveness of such treatments in relation to age.AimsTo evaluate outcomes by age in a randomised controlled trial designed to evaluate the effectiveness of cognitive-behavioural therapy (CBT), supportive counselling and treatment as usual.MethodOutcomes were evaluated in terms of symptoms, social functioning, insight and therapeutic alliance according to age at 3- and 18-month follow-up.ResultsYounger participants responded better to supportive counselling than to treatment as usual and CBTover 3 months. Older participants responded better to CBT than to supportive counselling over 18 months. Younger participants showed a greater increase in insight after CBT compared with treatment as usual and supportive counselling, and were more difficult to engage in therapy.ConclusionsYoung people may have different needs with regard to engagement in psychological treatments. Treatment providers need to take age-specific factors into account.

scholarly journals Care to Quit: A stepped wedge cluster randomised controlled trial to implement best practice smoking cessation care in cancer centres

2021 ◽  
Author(s):  
Christine L Paul ◽  
Graham Warren ◽  
Shalini Vinod ◽  
Bettina Meiser ◽  
Emily Stone ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Best Practice ◽  
Controlled Trial ◽  
Critical Mass ◽  
Performance Status ◽  
Theoretical Domains Framework ◽  
Cluster Randomised Controlled Trial ◽  
Stepped Wedge ◽  
Treatment As Usual ◽  
Patients With Cancer

Abstract Background Cigarette smoking in people with cancer is associated with negative treatment related outcomes including increased treatment toxicity and complications, medication side effects, decreased performance status and morbidity. Evidence based smoking cessation care is not routinely provided to patients with cancer. The purpose of this study is to determine the effectiveness of a smoking cessation implementation intervention on abstinence from smoking in people diagnosed with cancer.Methods A stepped wedge cluster randomized design will be used. All sites begin in the control condition providing treatment as usual. In a randomly generated order, sites will move to the intervention condition. Based on the Theoretical Domains Framework, implementation of Care to Quit will include i) building the capability and motivation of a critical mass of key clinical staff and identifying champions; and ii) identifying and implementing cessation care models/pathways. 2160 patients with cancer (diagnosed in the prior six months), aged 18+, who report recent combustible tobacco use (past 90 days or in the 30 days prior to cancer diagnosis) and are accessing anti-cancer therapy, will be recruited at nine sites. Assessments will be conducted at baseline and 7-month follow-up. The primary outcome will be 6-month abstinence from smoking. Secondary outcomes include biochemical verification of abstinence from smoking, duration of quit attempts, tobacco consumption, nicotine dependence, variables, provision and receipt of smoking cessation care, mental health and quality of life and cost effectiveness of the intervention.Discussion This study will implement best practice smoking cessation care in cancer centres and has the potential for wide dissemination.Trial registration The trial is registered with ANZCTR (www.anzctr.org.au): ACTRN (submitted, awaiting approval due to ANZCTR delays) prior to the accrual of the first participant and will be updated regularly as per registry guidelines.

scholarly journals The Impact of an Early Eclectic Rehabilitative Intervention on Symptoms in First Episode Depression among Employed People

2013 ◽  
Vol 2013 ◽  
pp. 1-8
Author(s):  
Tero Raiskila ◽  
Sanna Blanco Sequeiros ◽  
Jorma Kiuttu ◽  
Marja-Liisa Kauhanen ◽  
Kristian Läksy ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Intervention Group ◽  
First Episode ◽  
Control Group ◽  
Treatment As Usual ◽  
Intervention Treatment ◽  
Working Age ◽  
Rehabilitative Intervention ◽  
One Year ◽  
The Impact

Objective. To evaluate the effect of an early vocational-orientated eclectic intervention on beck depression inventory (BDI) scores compared to treatment as usual in first ever depressive episode among employed people.Design. A randomized controlled trial comparing the rehabilitative intervention and the conventional treatment.Subjects. The subjects came from occupational health care units.Methods. Employees were sent to a rehabilitation center after being screened for depression using the BDI. They were diagnosed using the structured clinical interview for DSM-IV. The participating subjects (N=283) were randomized into intervention and control groups. The intervention group received eclectic early depression intervention treatment (N=134) and the control group was treated in the conventional way (N=100). They were followed for one year.Results. The mean decrease in BDI scores within the intervention group was from 20.8 to 11.6 and within the control group from 19.3 to 10.8. BDI score decreased by 10 or more points in 64% of the participants in the intervention group and in 53% of the control group (P=0.013).Conclusions. There was some evidence that early eclectic intervention in first ever episode depression may be more effective than conventional treatments among working age people in employment.

scholarly journals The Early Youth Engagement in first episode psychosis (EYE-2) study: pragmatic cluster randomised controlled trial of implementation, effectiveness and cost-effectiveness of a team-based motivational engagement intervention to improve engagement

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kathryn Greenwood ◽  
Rebecca Webb ◽  
Jenny Gu ◽  
David Fowler ◽  
Richard de Visser ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Young People ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
First Episode ◽  
Youth Engagement ◽  
Cluster Randomised ◽  
Episode Psychosis ◽  
Randomised Controlled ◽  
Engagement Intervention

Abstract Background Early Intervention in Psychosis (EIP) services improve health outcomes for young people with psychosis in the medium–long term, but 25% of young people disengage in the first 12 months with costs to their mental health, families, society and the NHS. This study will evaluate the effectiveness, cost-effectiveness and implementation of a team-based motivational Early Youth Engagement (EYE-2) intervention. Method The study design is a cluster randomised controlled trial (RCT) with economic evaluation, comparing the EYE-2 intervention + standardised EIP service to standardised EIP service alone, with randomisation at the team level. A process evaluation will evaluate the delivery of the intervention qualitatively and quantitatively across contexts. The setting is 20 EIP teams in 5 sites: Manchester, South London, East Anglia, Thames Valley and Hampshire. Participants are young people (14–35 years) with first episode psychosis, and EIP staff. The intervention is the team-based motivational engagement (EYE-2) intervention, delivered alongside standardised EIP services, and supported by additional training, website, booklets and social groups. The comparator is the standardised EIP service. Both interventions are delivered by EIP clinicians. The primary outcome is time to disengagement (time in days from date of allocation to care coordinator to date of last contact following refusal to engage with EIP service, or lack of response to EIP contact for a consecutive 3-month period). Secondary outcomes include mental and physical health, deaths, social and occupational function, recovery, satisfaction and service use at 6, 12, 18 and 24 months. A 12-month within-trial economic evaluation will investigate cost-effectiveness from a societal perspective and from an NHS perspective. Discussion The trial will provide the first test of an engagement intervention in standardised care, with the potential for significant impact on the mental health and wellbeing of young people and their families, and economic benefits for services. The intervention will be highly scalable, supported by the toolkit including manuals, commissioning guide, training and resources, adapted to meet the needs of the diverse EIP population, and based on an in-depth process evaluation. Trial registration ISRCTN 51629746 prospectively registered 7th May 2019. Date assigned 10th May 2019.

scholarly journals Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial

2018 ◽  
Vol 212 (3) ◽  
pp. 161-168 ◽  
Author(s):  
Angela Hassiotis ◽  
Michaela Poppe ◽  
Andre Strydom ◽  
Victoria Vickerstaff ◽  
Ian S. Hall ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Randomised Controlled Trial ◽  
Staff Training ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Challenging Behaviour ◽  
Treatment As Usual ◽  
Cluster Randomised ◽  
Positive Behaviour Support ◽  
Randomised Controlled

BackgroundStaff training in positive behaviour support (PBS) is a widespread treatment approach for challenging behaviour in adults with intellectual disability.AimsTo evaluate whether such training is clinically effective in reducing challenging behaviour during routine care (trial registration: NCT01680276).MethodWe carried out a multicentre, cluster randomised controlled trial involving 23 community intellectual disability services in England, randomly allocated to manual-assisted staff training in PBS (n = 11) or treatment as usual (TAU, n = 12). Data were collected from 246 adult participants.ResultsNo treatment effects were found for the primary outcome (challenging behaviour over 12 months, adjusted mean difference = −2.14, 95% CI: −8.79, 4.51) or secondary outcomes.ConclusionsStaff training in PBS, as applied in this study, did not reduce challenging behaviour. Further research should tackle implementation issues and endeavour to identify other interventions that can reduce challenging behaviour.Declaration of interestNone.

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