Talk Therapy of Limited Use for Psychosis

Adding cognitive therapy to regular patient monitoring was no better at preventing the emergence of psychotic symptoms than monitoring alone, researchers found.

It does, however, appear to lessen the severity of psychotic disorders in at-risk patients, Anthony Morrison, MD, of the University of Manchester in England, and colleagues, reported online in BMJ.

"A reduction in severity of psychotic symptoms is clearly desirable in young people at risk," they wrote. "The lack of an effect on transition to psychosis is, however, disappointing."
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To test whether cognitive therapy could prevent a transition to psychosis in at-risk patients - those with transient psychotic symptoms or family history of illness, for example - Morrison and colleagues enrolled 288 patients, ages 14 to 35, at five U.K. centers.

About 67% of patients had at least one DSM-IV diagnosis at study entry, particularly major depressive disorder.

Half were assigned to cognitive therapy plus monitoring, the other half to monitoring only. Monitoring, however, was an "enhancement" over routine care, the researchers said, because it ensured patients had a general practitioner whom they could regularly contact.

People with long-lasting depression may benefit from talk therapy when other treatment methods such as antidepressant drugs alone aren't working, suggests a new study. But the topic needs more research, the authors say - and they also point out that talk therapy isn't accessible or affordable for everyone.

About 15 million adults in America suffer from major depressive disorder - serious cases of depression that last more than two weeks - in any given year, according to the National Institute of Mental Health. Most people who are diagnosed with major depressive disorder get prescribed an antidepressant rather than going straight into talk therapy, explained Dr. Ranak Trivedi, the lead author on the current study from the University of Washington School of Public Health.

But up to half of those people might not feel any better after they start taking the medication, she said.

Guidelines point doctors to a few different options for treating patients who don't respond to their first antidepressant drug. The doctor can add a new antidepressant to the first one, or switch drugs completely. Sometimes it takes several attempts to find the drug or drugs that will help the patient feel better. They can also refer the patient to talk therapy, either in addition to medication or instead of medication.

Patients were followed for at least 12 months; those in the intervention group had mean of about 9 sessions over six months, each lasting about an hour.

Schizophrenia Ireland has published a new document outlining the benefits of psychological or talk therapies in the treatment of psychosis as part of Lucia Week, the national schizophrenia awareness week.