- Email: [email protected]
TC18C MRI OF BRAIN VOLUMES AT THE PRODROME AND FIRST EPISODE STAGES OF SCHIZOPHRENIA
Oral Session FC6: CBT in early psychosis Discussion: These data are in agreement with volumetric findings observed in these cortical areas in schizophrenia. These promising data, while preliminary, indicate altered cortical thickness in those at risk for schizophrenia, independent of psychosis. TC18C MRI OF BRAIN VOLUMES AT THE PRODROME AND FIRST EPISODE STAGES OF SCHIZOPHRENIA D.O. Perkins1 *, H.B. Gu1 , R.B. Zipursky2 , G. Gerig1 , J.A. Lieberman3 . 1 University of North Carolina, Chapel Hill, NC, United States, 2 University of Toronto, Toronto, Canada, 3 Columbia University, New York, NY, United States Presenting author contact: [email protected] Introduction: Neuroimaging and post-mortem studies find neuroanatomical abnormalities in patients with schizophrenia, most consistently increased ventricular and decreased gray matter volumes. Determining when in the course of brain development such structural brain abnormalities occurred is critical to understanding the neurobiology of schizophrenia. It may be that these brain structural chances occur as a result of a neurodevelopmental process active very early in life and/or as a result of a limited neuroprogressive process active during the initial symptomatic stages of illness. Method: In order to evaluate when brain structural changes develop in schizophrenia we investigated brain morphology in individuals at-risk for psychosis due to the presence of attenuated positive symptoms (COPS criteria). Images were obtained using GE Signa 1.5 T scanners. A semiautomated segmentation algorithm using the axial dual echo slices was performed using operator-defined values of pixels within defined regions of interest. Results: We will present the results of the comparison of whole brain, gray, and white matter volumes, and regional volumes in 48 at-risk, 56 healthy, and 65 first episode subjects at baseline. In addition we compared baseline brain volumes between those who do and do not develop psychosis by one year follow-up. Finally, in a subset of at-risk and healthy subjects we examined the trajectory of brain volume changes over time. Discussion: The results of this study will inform our understanding of the timing of emergence of structural brain alterations associated with the development of psychosis.
Friday 6th October, 2006 Oral Session FC6: CBT in early psychosis FC6A COGNITIVE THERAPY FOR THE PREVENTION OF PSYCHOSIS IN PEOPLE AT ULTRA-HIGH RISK: RESULTS OF A RANDOMISED CONTROLLED TRIAL A.P. Morrison *. University of Manchester, Manchester, United Kingdom Presenting author contact: [email protected] There have been recent advances in the ability to identify people at high risk of developing psychosis. This has led to interest in the possibility of preventing the development of psychosis, although there are clearly ethical dilemmas associated with such a preventative approach. A randomised controlled trial compared cognitive therapy (CT) with treatment as usual in 58 patients at ultra-high risk of developing a first episode of psychosis. CT was provided within the first six
S59 months, and all patients were monitored on a monthly basis for 12 months. Logistic regression demonstrated that CT significantly reduced the likelihood of making progression to psychosis as defined on a semi-structured psychiatric interview over one year. In addition, it significantly reduced the likelihood of being prescribed antipsychotic medication and of meeting criteria for a DSM-IV diagnosis of a psychotic disorder. Participants were also followed up over a threeyear period (follow up rate at 3 years was 47%). Logistic regression demonstrated that CT significantly reduced likelihood of being prescribed antipsychotic medication over a three-year period, but it did not affect transition to psychosis defined using the PANSS or probable DSM-IV diagnosis. However, exploratory analyses revealed that CT significantly reduced the likelihood of making progression to psychosis as defined on the PANSS over 3 years after controlling for baseline cognitive factors. There appear to be some enduring benefits of CT over both one and three years, suggesting it is an efficacious intervention for people at high risk of developing psychosis. The design of a new multi-centre trial will also be described. FC6B AN OVERVIEW OF CBT AS A PREVENTATIVE APPROACH TO PSYCHOSIS P. French *. BSTMHT, Manchester, United Kingdom Presenting author contact: [email protected] A specific manualised CBT approach (French & Morrison 2004) for use with At Risk Mental States (ARMS) has been developed and evaluated within a randomised controlled trial in the UK (EDDIE) Morrison et al 2004. The initial trial had some limitations in that it was a single site with relatively small numbers, however, the results indicated that it was possible to delay transition to psychosis over a twelve month time follow up period. Since that time there has been further interest in the application of this approach, other international research groups are currently in the process of evaluating this approach and it is also being evaluated by members of the original group in a larger multi site randomised trial. These other research groups will present their application of this approach within their trials. This presentation will discuss the psychological treatment utilised in the CBT trials presented throughout this symposium (French & Morrison 2004). It will highlight the rationale for using CBT with At Risk Mental States (ARMS) and the development of this treatment methodology. Cases will be utilised to demonstrate the application of this intervention and it is intended to set the scene for the following papers within the symposium. FC6C RECOVERY GROUPS FOR PEOPLE WITH PSYCHOSIS V.M. Drury *, V. Day. Walsall t-PCT; Sandwell Mental Health and Social Care Trust, West Midlands, United Kingdom Presenting author contact: [email protected] People with mental health problems have real prospects of recovery if they are supported by services that are driven by the right values and attitudes, and local initiatives are in place to improve social inclusion and to reduce stigma (DOH, 2000). The study’s objective was to assess the impact of a group based intervention, along side standard psychiatric care, on people’s self esteem, attitudes towards recovery, empowerment and control over their illness. Thirty people recovering from a psychosis or depression with psychotic symptoms were screened for their readiness to take part in
Friday 6th October, 2006 Oral Session FC6: CBT in early psychosis FC6A COGNITIVE THERAPY FOR THE PREVENTION OF PSYCHOSIS IN PEOPLE AT ULTRA-HIGH RISK: RESULTS OF A RANDOMISED CONTROLLED TRIAL A.P. Morrison *. University of Manchester, Manchester, United Kingdom Presenting author contact: [email protected] There have been recent advances in the ability to identify people at high risk of developing psychosis. This has led to interest in the possibility of preventing the development of psychosis, although there are clearly ethical dilemmas associated with such a preventative approach. A randomised controlled trial compared cognitive therapy (CT) with treatment as usual in 58 patients at ultra-high risk of developing a first episode of psychosis. CT was provided within the first six
S59 months, and all patients were monitored on a monthly basis for 12 months. Logistic regression demonstrated that CT significantly reduced the likelihood of making progression to psychosis as defined on a semi-structured psychiatric interview over one year. In addition, it significantly reduced the likelihood of being prescribed antipsychotic medication and of meeting criteria for a DSM-IV diagnosis of a psychotic disorder. Participants were also followed up over a threeyear period (follow up rate at 3 years was 47%). Logistic regression demonstrated that CT significantly reduced likelihood of being prescribed antipsychotic medication over a three-year period, but it did not affect transition to psychosis defined using the PANSS or probable DSM-IV diagnosis. However, exploratory analyses revealed that CT significantly reduced the likelihood of making progression to psychosis as defined on the PANSS over 3 years after controlling for baseline cognitive factors. There appear to be some enduring benefits of CT over both one and three years, suggesting it is an efficacious intervention for people at high risk of developing psychosis. The design of a new multi-centre trial will also be described. FC6B AN OVERVIEW OF CBT AS A PREVENTATIVE APPROACH TO PSYCHOSIS P. French *. BSTMHT, Manchester, United Kingdom Presenting author contact: [email protected] A specific manualised CBT approach (French & Morrison 2004) for use with At Risk Mental States (ARMS) has been developed and evaluated within a randomised controlled trial in the UK (EDDIE) Morrison et al 2004. The initial trial had some limitations in that it was a single site with relatively small numbers, however, the results indicated that it was possible to delay transition to psychosis over a twelve month time follow up period. Since that time there has been further interest in the application of this approach, other international research groups are currently in the process of evaluating this approach and it is also being evaluated by members of the original group in a larger multi site randomised trial. These other research groups will present their application of this approach within their trials. This presentation will discuss the psychological treatment utilised in the CBT trials presented throughout this symposium (French & Morrison 2004). It will highlight the rationale for using CBT with At Risk Mental States (ARMS) and the development of this treatment methodology. Cases will be utilised to demonstrate the application of this intervention and it is intended to set the scene for the following papers within the symposium. FC6C RECOVERY GROUPS FOR PEOPLE WITH PSYCHOSIS V.M. Drury *, V. Day. Walsall t-PCT; Sandwell Mental Health and Social Care Trust, West Midlands, United Kingdom Presenting author contact: [email protected] People with mental health problems have real prospects of recovery if they are supported by services that are driven by the right values and attitudes, and local initiatives are in place to improve social inclusion and to reduce stigma (DOH, 2000). The study’s objective was to assess the impact of a group based intervention, along side standard psychiatric care, on people’s self esteem, attitudes towards recovery, empowerment and control over their illness. Thirty people recovering from a psychosis or depression with psychotic symptoms were screened for their readiness to take part in