CBTp for people with treatment refractory schizophrenia on clozapine: a systematic review and meta-analysis
Author(s)
Todorovic, Aleksandar
Lal, Sweta
Dark, Frances
De Monte, Veronica
Kisely, Steve
Siskind, Dan
Griffith University Author(s)
Year published
2020
Metadata
Show full item recordAbstract
Background: Cognitive behavioural therapy for psychosis (CBTp), an effective treatment for people with schizophrenia, may have a role in clozapine refractory schizophrenia. Aims: A systematic-review and meta-analysis on the impact of CBTp on psychotic symptoms in people on clozapine. Methods: We searched PubMed, Embase, PsycInfo, CINAHL and Cochrane for randomised control trials of CBTp as augmentation in people with treatment-refractory schizophrenia on clozapine and conducted pair-wise meta-analyses. Results: Four studies met inclusion criteria. On pairwise meta-analyses, the primary outcome of total psychotic symptoms was ...
View more >Background: Cognitive behavioural therapy for psychosis (CBTp), an effective treatment for people with schizophrenia, may have a role in clozapine refractory schizophrenia. Aims: A systematic-review and meta-analysis on the impact of CBTp on psychotic symptoms in people on clozapine. Methods: We searched PubMed, Embase, PsycInfo, CINAHL and Cochrane for randomised control trials of CBTp as augmentation in people with treatment-refractory schizophrenia on clozapine and conducted pair-wise meta-analyses. Results: Four studies met inclusion criteria. On pairwise meta-analyses, the primary outcome of total psychotic symptoms was not significantly altered by CBTp at either therapy endpoint or six to twelve months follow-up. Secondary outcomes showed that CBT improved positive symptoms at both therapy endpoint (SMD −0.33, 95%CI −0.50 to −0.16, p = 0.002, I2 = 0%) and six to twelve months follow-up (SMD −0.20, 95%CI −0.38 to −0.02, p = 0.03, I2 = 0%) though did not alter negative psychotic symptoms at either timepoint. Conclusions: CBTp may lead to small benefits for positive symptoms refractory to clozapine. Given the low risks associated with CBTp, and the limited alternative options for clozapine refractory schizophrenia, this approach should be considered in this population.
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View more >Background: Cognitive behavioural therapy for psychosis (CBTp), an effective treatment for people with schizophrenia, may have a role in clozapine refractory schizophrenia. Aims: A systematic-review and meta-analysis on the impact of CBTp on psychotic symptoms in people on clozapine. Methods: We searched PubMed, Embase, PsycInfo, CINAHL and Cochrane for randomised control trials of CBTp as augmentation in people with treatment-refractory schizophrenia on clozapine and conducted pair-wise meta-analyses. Results: Four studies met inclusion criteria. On pairwise meta-analyses, the primary outcome of total psychotic symptoms was not significantly altered by CBTp at either therapy endpoint or six to twelve months follow-up. Secondary outcomes showed that CBT improved positive symptoms at both therapy endpoint (SMD −0.33, 95%CI −0.50 to −0.16, p = 0.002, I2 = 0%) and six to twelve months follow-up (SMD −0.20, 95%CI −0.38 to −0.02, p = 0.03, I2 = 0%) though did not alter negative psychotic symptoms at either timepoint. Conclusions: CBTp may lead to small benefits for positive symptoms refractory to clozapine. Given the low risks associated with CBTp, and the limited alternative options for clozapine refractory schizophrenia, this approach should be considered in this population.
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Journal Title
Journal of Mental Health
Note
This publication has been entered as an advanced online version in Griffith Research Online.
Subject
Clinical Sciences
Psychology
Social Sciences
Psychology, Clinical
Treatment refractory schizophrenia
clozapine