Cognitive-behavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication

Randomised controlled trial

VALMAGGIA, LUCIA R.
VAN DER GAAG, MARK
TARRIER, NICHOLAS
PIJNENBORG, MARIEKE
SLOOFF, CEES J.

LUCIA R. VALMAGGIA, DClinPsy, PhD, Department of Psychological Medicine, Institute of Psychiatry, London, UK and Department of Psychiatry and Neuropsychiatry, Maastricht University, The Netherlands; MARK VAN DER GAAG, DClinPsy, PhD, Parnassia Institute, The Hague and University of Groningen, The Netherlands; NICHOLAS TARRIER, DClinPsy, PhD, Academic Division of Clinical Psychology, School of Psychiatry and Behavioural Sciences, University of Manchester, UK; MARIEKE PIJNENBORG, DClinPsy, CEES J. SLOOFF, MD, PhD, University of Groningen and Department of Psychotic Disorders, GGZ-Drenthe, Assen, The Netherlands

Correspondence: Lucia R. Valmaggia, Department of Psychological Medicine, PO 67, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Tel/fax: +44 (0)20 7848 0952; e-mail: [email protected]

(First received 23 March 2004, final revision 14 September 2004, accepted 30 September 2004)

British Journal of Psychiatry 186:p 324-330, April 2005.

Background

There is increasing evidence that cognitive-behavioural therapy can be an effective intervention for patients experiencing drug-refractory positive symptoms of schizophrenia.

Aims

To investigate the effects of cognitive-behavioural therapy on inpatients with treatment-refractory psychotic symptoms.

Method

Manualised therapy was compared with supportive counselling in a randomised controlled study. Both interventions were delivered by experienced psychologists over 16 sessions of treatment. Therapy fidelity was assessed by two independent raters. Participants underwent masked assessment at baseline, after treatment and at 6 months' follow-up. Main outcome measures were the Positive and Negative Syndrome Scale and the Psychotic Symptoms Rating Scale. The analysis was by intention to treat.

Results

Participants receiving cognitive-behavioural therapy had improved with regard to auditory hallucinations and illness insight at the post-treatment assessment, but these findings were not maintained at follow-up.

Conclusions

Cognitive-behavioural therapy showed modest short-term benefits over supportive counselling for treatment-refractory positive symptoms of schizophrenia.

Declaration of interest

None. Funding detailed in Acknowledgements.