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London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis

III: Follow-up and economic evaluation at 18 months

Published online by Cambridge University Press:  03 January 2018

Elizabeth Kuipers ,
David Fowler ,
Phiuppa Garety ,
Daniel Chisholm ,
Daniel Freeman ,
Graham Dunn ,
Paul Bebbington  and
Clare Hadley
Elizabeth Kuipers*
Affiliation:
Department of Clinical Psychology, Institute of Psychiatry, London
David Fowler
Affiliation:
School of Health Policy and Practice, University of East Anglia, Norwich
Phiuppa Garety
Affiliation:
United Medical and Dental School, Department of Psychology, St. Thomas' Hospital, London
Daniel Chisholm
Affiliation:
Centre for Economics of Mental Health, Institute of Psychiatry, London
Daniel Freeman
Affiliation:
Department of Clinical Psychology, Institute of Psychiatry, London
Graham Dunn
Affiliation:
School of Epidemiology and Health Sciences, University of Manchester, Stopford Building, Manchester
Paul Bebbington
Affiliation:
Department of Psychiatry and Behavioural Sciences, University College London
Clare Hadley
Affiliation:
Department of Clinical Psychology, Leeds University, Leeds
*
Professor Elizabeth Kuiperi, Department of Clinical Psychology, Institute of Psychiatry, De Oespigny Park, London, SES 8AF
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Abstract

Background

A randomised controlled trial of cognitive — behavioural therapy (CBT) for people with medication-resistant psychosis showed improvements in overall symptomatology after nine months of treatment; good outcome was strongly predicted by a measure of cognitive flexibility concerning delusions. The present paper presents a follow-up evaluation 18 months after baseline.

Method

Forty-seven (78% of original n=60) participants were available for follow-up at 18 months, and were reassessed on all the original outcome measures (see Part I). An economic evaluation was also completed.

Results

Those in the CBT treatment group showed a significant and continuing improvement in Brief Psychiatric Rating Scale scores, whereas the control group did not change from baseline. Delusional distress and the frequency of hallucinations were also significantly reduced in the CBT group. The costs of CB Tappear to have been offset by reductions in service utilisation and associated costs during follow-up.

Conclusions

Improvement in overall symptoms was maintained in the CBT group 18 months after baseline and nine months after intensive therapy was completed. CBT may be a specific and cost-effective intervention in medication-resistant psychosis.

Type
Papers
Information
The British Journal of Psychiatry , Volume 173 , Issue 1 , July 1998 , pp. 61 - 68
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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Footnotes

†

Part I, ‘Effects of the treatment phase’, published in October 1997 (171. 319–327); part II, ‘Predictors of outcome’, published in November 1997 (171, 420–426).

References

Amador, X. , F. Strauss, D. H. Yale, S. , A. et al (1993) Assessment of insight in psychosis. American Journal of Psychiatry, 150, 873–879.Google ScholarPubMed
Beck, A. Ward, C. H. Mundelson, M. et al (1961) An inventory for measuring depression. Archives of General Psychiatary, 4, 561–571.CrossRefGoogle ScholarPubMed
Beck, A. Weissman, A. W. Letter, D. et al (1974) The assessment of pessimism: the hopelessness sale. Journal of Consulting and Clinical Psychology, 42, 861–865.CrossRefGoogle Scholar
Beck, A. Epstein, N. Brown, G. et al (1988) An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 693–897.CrossRefGoogle ScholarPubMed
Beecham, J. & Knapp, M. R. J. (1992) Coning psychiatric interventions. I. Measuring Mental Health Meeds (eds Thornicroft, G. Brewin, C. & Wing, J.), pp. 163–183. London: Gaskell.Google Scholar
Birchwood, M. Smith, J. Cochrane, R. et al (1990) The social functioning scale. The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. British Journal of Psychiatry, 157, 853–859.CrossRefGoogle ScholarPubMed
Brett-Jones, J. Garety, P. A. & Hemsley, D. (1907) Measuring delusional experiences: a method and its application. British Journal of Clinical Psychology, 26, 257–265.CrossRefGoogle Scholar
Buchanan, A. Reed, A. Wessely, S. et al (1993) Acting on delusions. II: The phenomenological correlates of acting on delusions. British Journal of Psychiatry, 163, 77–81.CrossRefGoogle ScholarPubMed
Drury, V. Birchwood, M. Cochrane, R. et al (1996a) Cognitive therapy and recovery from acute psychosis: a controlled trial, I: Impact on psychotic symptoms. British Journal of Psychiatry, 169, 593–601.CrossRefGoogle Scholar
Drury, V. Birchwood, M. Cochrane, R. et al (1996b) Cognitive therapy and recovery from psychosis: a controlled trial. II: Impact on recovery time. British Journal of Psychiatry, 169, 602–607.CrossRefGoogle ScholarPubMed
Fowler, D. Cerety, P. A. & Kuipers, L. (1995) Cognitive Behaviour Therapy for Psychosis: Theory and Practice. Chichester: Wiley.Google Scholar
Garety, P. Kuipen, L. Fowler, D. et al (1994) Cognitive behavioural therapy for drug-resistant psychosis. British Journal of Medical Psychology, 67, 259–271.CrossRefGoogle ScholarPubMed
Garety, P. Fowler, D. Kulpen, E. et al (1997) London — East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis II: Predictors of outcome. British Journal of Psychiatry, 171, 420–426.CrossRefGoogle ScholarPubMed
Healey, A. Knapp, M. R. J. Artin, J. et al (1997) Cost-effectiveness evaluation of compliance therapy for people with psychosis. British Journal of Psychiatry, 172, 420–424.CrossRefGoogle Scholar
Hustig, H. H. & Hafner, R. J. (1990) Persistent auditory hallucinations and their relationship to delusions and mood. Journal of Nervous and Mental Disease, 178, 264–267 CrossRefGoogle ScholarPubMed
Kuipers, E. Garety, P. Fowler, D. et al (1997) London-East Anglia randomised controlled trial of cognitive — behavioural therapy for psychosis. I: Effects of the treatment phase. British Journal of Psychiatry, 171, 319–327.CrossRefGoogle ScholarPubMed
Matthews, J. N. S. Altman, D. G. Campbell, M. J. et al (1990) Analysis of serial measurements in medical research. British Medical Journal, 300, 230–235 CrossRefGoogle ScholarPubMed
Nelston, H. E. (1982) National Adult Reading Test (NART) far the Assessment of Premorbid Intelligence in Patients with Dementia: Test Manual. Windsor: NFER-Nelson.Google Scholar
Netten, A. & Dennett, J. (1996) Unit Costs of Health and Social Care. Canterbury: Personal Social Services Research Unit, University of Kent.Google Scholar
Overall, J. E. & Gorham, D. R. (1962) The Brief Psychiatric Rating Scale Psychological Reports, 10, 799–812 Google Scholar
Robson, P. (1989) Development of anew self-report questionnaire to measure self-esteem Psychological Medicine, 19, 513–518.Google Scholar
Shapiro, D. A. (1996) Outcome research. I. Behavioural and Mental Health Research. 2nd edn (eds Parry, G. & Watts, F.). Hove: Lawrence Erlbaum.Google Scholar
Terrier, N. Lowson, K. & Barrowtclough, C. (1991) Some aspects of family interventions in schizophrenia, I: Financial considerations. British Journal of Psychiatry, 159, 481–484.CrossRefGoogle Scholar
Terrier, N. Beckett, P. Harwood, S. et al (1991) A trial of two cognitive-behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients. I: Outcome. British Journal of Psychiatry, 162, 524–532 CrossRefGoogle Scholar
Williams, J. M. G. (1992) The Psychological Treatment of Depression. A Guide to Theory and Practice of Cognitive Behaviour Therapy. London: Routledge.Google Scholar
World Health Organization (1992) SCAN Schedules for Clinical Assessment in Neuropsychiatry. Geneva: WHO.Google Scholar
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