Psychosocial interventions for relapse prevention in schizophrenia: New evidence

IntroductionSystematic reviews and meta-analyses report low-quality evidence to suggest a significant differential effectiveness between standard psychosocial interventions in reducing substance consumption. They highlight the presence of several types of treatments that usually integrate different approaches in a multimodal manner. CBT-based interventions seem to be the most effective ones in terms of dropouts and relapse prevention, particularly in cocaine addiction.ObjectivesWe discuss recent advances in experimental and clinical studies on cocaine addiction. We especially try to integrate emerging cognitive neuroscience evidences and results of the meta-analyses of the effectiveness of psychosocial interventions.AimsThe primary aim of this study is to explore the feasibility of a new multimodal intervention for cocaine addiction, namely MACA (Metacognitve Awareness in Cocaine Addiction). Secondary aims are to discuss: (i) rationale of integrating different approaches; (ii) preliminary results of a previous pilot-study; (iii) feasibility of present study using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework.MethodsWe describe and evaluate our model that comprises:– an individual short intervention based on dilemma-focused therapy;– a psycho-educational group based on standard CBT treatments;– a relapse-prevention group based on mindfulness protocols for addiction;– a follow-up online self-administered course and automatic personalized feedback.ResultsExisting literature seems to support the need for new integrated programs. RE-AIM feasibility analysis shows promising results in integrating the proposed approaches in terms of symptoms reduction, relapse prevention and cost-benefit ratio.ConclusionsPreliminary evidence supports potential for the MACA program in treating cocaine addiction. The research design of a wait-list controlled trial with pre- and post-treatment assessment is discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Telephone-delivered psychosocial interventions targeting key health priorities in adults with a psychotic disorder: systematic review

Psychological Medicine ◽

10.1017/s0033291718001125 ◽

2018 ◽

Vol 48 (16) ◽

pp. 2637-2657 ◽

Cited By ~ 7

Author(s):

Amanda L. Baker ◽

Alyna Turner ◽

Alison Beck ◽

Katherine Berry ◽

Gillian Haddock ◽

...

Keyword(s):

Systematic Review ◽

Medication Adherence ◽

Psychotic Disorder ◽

Health Behaviour ◽

Relapse Prevention ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Grey Literature ◽

Psychosocial Interventions ◽

Health Priorities

AbstractBackgroundThe mental and physical health of individuals with a psychotic illness are typically poor. Access to psychosocial interventions is important but currently limited. Telephone-delivered interventions may assist. In the current systematic review, we aim to summarise and critically analyse evidence for telephone-delivered psychosocial interventions targeting key health priorities in adults with a psychotic disorder, including (i) relapse, (ii) adherence to psychiatric medication and/or (iii) modifiable cardiovascular disease risk behaviours.MethodsTen peer-reviewed and four grey literature databases were searched for English-language studies examining psychosocial telephone-delivered interventions targeting relapse, medication adherence and/or health behaviours in adults with a psychotic disorder. Study heterogeneity precluded meta-analyses.ResultsTwenty trials [13 randomised controlled trials (RCTs)] were included, involving 2473 participants (relapse prevention = 867; medication adherence = 1273; and health behaviour = 333). Five of eight RCTs targeting relapse prevention and one of three targeting medication adherence reported at least 50% of outcomes in favour of the telephone-delivered intervention. The two health-behaviour RCTs found comparable levels of improvement across treatment conditions.ConclusionsAlthough most interventions combined telephone and face-to-face delivery, there was evidence to support the benefit of entirely telephone-delivered interventions. Telephone interventions represent a potentially feasible and effective option for improving key health priorities among people with psychotic disorders. Further methodologically rigorous evaluations are warranted.

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CAN A “RELAPSE PREVENTION” MODULE FACILITATE THE TRANSFER OF TRAINING?

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465802003119 ◽

2002 ◽

Vol 30 (3) ◽

pp. 361-364 ◽

Cited By ~ 15

Author(s):

Derek Milne ◽

Colin Westerman ◽

Seirian Hanner

Keyword(s):

Relapse Prevention ◽

Transfer Of Training ◽

Relative Effectiveness ◽

Psychosocial Interventions ◽

Training Programme ◽

Health Staff ◽

Mental Health Staff ◽

Standard Training ◽

Work Environment Factors ◽

Experimental Group

The objective of this pilot study was to evaluate the relative effectiveness of two approaches to staff training. Multidisciplinary mental health staff, receiving a standard training programme (N = 45), were compared on multiple measures with an experimental group (N = 11), receiving a programme featuring a “relapse prevention” module. This module was designed to improve the transfer of the training. The staff receiving the relapse prevention module reported significantly greater generalization of the training. Participant variables, the delivery of the training and work environment factors did not appear to explain this favourable finding. It is concluded tentatively that a relapse prevention module shows promise as a facilitator of the transfer of training in psychosocial interventions for severe mental illness.

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Psychosocial treatments for relapse prevention in schizophrenia: study protocol for a systematic review and network meta-analysis of randomised evidence

BMJ Open ◽

10.1136/bmjopen-2019-035073 ◽

2020 ◽

Vol 10 (1) ◽

pp. e035073

Author(s):

Irene Bighelli ◽

Alessandro Rodolico ◽

Gabi Pitschel-Walz ◽

Wulf-Peter Hansen ◽

Corrado Barbui ◽

...

Keyword(s):

Relapse Prevention ◽

Ethical Issues ◽

Meta Analysis ◽

Psychosocial Interventions ◽

Risk Of Bias ◽

Psychosocial Treatment ◽

Sensitivity Analyses ◽

Treatment As Usual ◽

Psychosocial Treatments ◽

Number Of Patients

IntroductionThere is evidence that different psychosocial interventions could reduce the risk of relapse in schizophrenia, but a comprehensive evidence based on their relative efficacy is lacking. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs) to rank psychosocial treatments for relapse prevention in schizophrenia according to their efficacy, acceptability and tolerability.Methods and analysisWe will include all RCTs comparing a psychosocial treatment aimed at preventing relapse in patients with schizophrenia with another psychosocial intervention or with a no treatment condition (waiting list, treatment as usual). We will include studies on adult patients with schizophrenia, excluding specific subpopulations (eg, acutely ill patients). Primary outcome will be the number of patients experiencing a relapse. Secondary outcomes will be acceptability (dropout), change in overall, positive, negative and depressive symptoms, quality of life, adherence, functioning and adverse events. Published and unpublished studies will be sought through database searches, trial registries and websites. Study selection and data extraction will be conducted by at least two independent reviewers. We will conduct random-effects NMA to synthesise all evidence for each outcome and obtain a comprehensive ranking of all treatments. NMA will be conducted in R within a frequentist framework. The risk of bias in studies will be evaluated using the Cochrane Risk of Bias tool and the credibility of the evidence will be evaluated using Confidence in Network Meta-Analysis (CINeMA). Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings.Ethics and disseminationNo ethical issues are foreseen. Results from this study will be published in peer-reviewed journals and presented at relevant conferences.PROSPERO registration numberCRD42019147884.

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Schizophrenia: early warning signs

Advances in Psychiatric Treatment ◽

10.1192/apt.6.2.93 ◽

2000 ◽

Vol 6 (2) ◽

pp. 93-101 ◽

Cited By ~ 87

Author(s):

Max Birchwood ◽

Elizabeth Spencer ◽

Dermot McGovern

Keyword(s):

Early Warning ◽

Relapse Prevention ◽

Psychosocial Interventions ◽

Warning Signs ◽

Residual Symptoms ◽

Strong Interest ◽

Early Warning Signs ◽

Social Disablement ◽

Highly Correlated

Relapse in schizophrenia remains common and cannot be entirely eliminated even by the best combination of biological and psychosocial interventions (Linszen et al, 1998). Relapse prevention is crucial as each relapse may result in the growth of residual symptoms (Shepherd et al, 1989) and accelerating social disablement (Hogarty et al, 1991). Many patients feel ‘entrapped’ by their illnesses, a factor highly correlated with depression (Birchwood et al, 1993), and have expressed a strong interest in learning to recognise and prevent impending psychotic relapse.

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Addressing unmet needs in opiate dependence: supporting detoxification and advances in relapse prevention

BJPsych Advances ◽

10.1192/bja.2020.98 ◽

2021 ◽

pp. 1-11

Author(s):

Katherine Herlinger ◽

Anne Lingford-Hughes

Keyword(s):

Relapse Prevention ◽

Psychosocial Interventions ◽

Opiate Dependence ◽

Opioid Substitution Therapy ◽

Harm Minimisation ◽

Pharmacological Management ◽

Current State ◽

The Uk ◽

Opioid Substitution

SUMMARY Despite record-breaking numbers of opiate related deaths in the UK in 2019, pharmacological management of opiate dependence has evolved little since the advent of methadone in 1965. Along with harm minimisation and psychosocial interventions, the mainstay of pharmacological treatment remains opioid substitution therapy (OST) using methadone or buprenorphine, with many patients receiving OST for many years. Even with these treatments, opiate users continue to face mortality risks 12 times higher than the general population, and emerging evidence suggests that individuals who remain on long-term OST present with a range of physical and cognitive impairments. Therefore, with a growing ageing opiate dependent population who would benefit from detoxification from OST, this article provides an overview of the current state of opiate dependence in clinical practice, explores the reasons why availability and acceptability of detoxification pathways are declining, and discusses emerging pharmacological therapies that could provide benefit in relapse prevention.

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Systematic effects in observed parallaxes

International Astronomical Union Colloquium ◽

10.1017/s0252921100073887 ◽

1978 ◽

Vol 48 ◽

pp. 31-35

Author(s):

R. B. Hanson

Keyword(s):

Error Estimates ◽

Zero Point ◽

Absolute Zero ◽

Apparent Magnitude ◽

Coherent System ◽

Preliminary Results ◽

General Catalogue ◽

Systematic Effects ◽

New Evidence ◽

Right Ascension

Several outstanding problems affecting the existing parallaxes should be resolved to form a coherent system for the new General Catalogue proposed by van Altena, as well as to improve luminosity calibrations and other parallax applications. Lutz has reviewed several of these problems, such as: (A) systematic differences between observatories, (B) external error estimates, (C) the absolute zero point, and (D) systematic observational effects (in right ascension, declination, apparent magnitude, etc.). Here we explore the use of cluster and spectroscopic parallaxes, and the distributions of observed parallaxes, to bring new evidence to bear on these classic problems. Several preliminary results have been obtained.

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MERLIN Finds New Evidence of Ranolazine Safety

Internal Medicine News ◽

10.1016/s1097-8690(07)70525-5 ◽

2007 ◽

Vol 40 (9) ◽

pp. 36

Author(s):

BRUCE JANCIN

Keyword(s):

New Evidence

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