Revisiones sistemáticas relacionados a este tópico

loading
82 Referencias (81 articles) Revertir Estudificar

Revisión sistemática

No clasificado

Exercise to treat psychopathology and other clinical outcomes in schizophrenia: A systematic review and meta-analysis.

Revista European psychiatry : the journal of the Association of European Psychiatrists
Año 2023
Enlaces Pubmed DOI PubMed Central

Este artículo está incluido en 1 Síntesis amplia 27 Síntesis amplias (1 referencia)

Este artículo incluye 28 Estudios primarios 27 Estudios primarios (28 referencias)

Cargando información sobre las referencias
BACKGROUND: Psychopathology and side effects of antipsychotic drugs contribute to worsening physical health and long-term disability, and increasing the risk of mortality in these patients. The efficacy of exercise on these factors is not fully understood, and this lack of knowledge may hamper the routine application of physical activity as part of the clinical care of schizophrenia. AIMS: To determine the effect of exercise on psychopathology and other clinical markers in patients with schizophrenia. We also looked at several moderators. METHOD: MEDLINE, Web of Science, Scopus, CINAHL, SPORTDiscus, PsycINFO, and Cochrane Library databases were systematically searched from inception to October 2022. Randomized controlled trials of exercise interventions in patients 18–65 years old diagnosed with schizophrenia disorder were included. A multilevel random-effects meta-analysis was conducted to pool the data. Heterogeneity at each level of the meta-analysis was estimated via Cochran’s <i>Q</i>, <i>I</i>², and <i>R</i>². RESULTS: Pooled effect estimates from 28 included studies (1,460 patients) showed that exercise is effective to improve schizophrenia psychopathology (Hedges’ <i>g</i> = 0.28, [95% CI 0.14, 0.42]). Exercise presented stronger effects in outpatients than inpatients. We also found exercise is effective to improve muscle strength and self-reported disability. CONCLUSIONS: Our meta-analysis demonstrated that exercise could be an important part in the management and treatment of schizophrenia. Considering the current evidence, aerobic and high-intensity interval training exercises may provide superior benefits over other modalities. However, more studies are warranted to determine the optimal type and dose of exercise to improve clinical outcomes in people with schizophrenia. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Revisión sistemática

No clasificado

Cognitive behavioural therapy (group) for schizophrenia.

Revista The Cochrane database of systematic reviews
Año 2022
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 37 Estudios primarios 24 Estudios primarios (37 referencias)

Cargando información sobre las referencias
BACKGROUND: Schizophrenia is a disabling psychotic disorder characterised by positive symptoms of delusions, hallucinations, disorganised speech and behaviour; and negative symptoms such as affective flattening and lack of motivation. Cognitive behavioural therapy (CBT) is a psychological intervention that aims to change the way in which a person interprets and evaluates their experiences, helping them to identify and link feelings and patterns of thinking that underpin distress. CBT models targeting symptoms of psychosis (CBTp) have been developed for many mental health conditions including schizophrenia. CBTp has been suggested as a useful add-on therapy to medication for people with schizophrenia. While CBT for people with schizophrenia was mainly developed as an individual treatment, it is expensive and a group approach may be more cost-effective. Group CBTp can be defined as a group intervention targeting psychotic symptoms, based on the cognitive behavioural model. In group CBTp, people work collaboratively on coping with distressing hallucinations, analysing evidence for their delusions, and developing problem-solving and social skills. However, the evidence for effectiveness is far from conclusive. OBJECTIVES: To investigate efficacy and acceptability of group CBT applied to psychosis compared with standard care or other psychosocial interventions, for people with schizophrenia or schizoaffective disorder. SEARCH METHODS: On 10 February 2021, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, four other databases and two trials registries. We handsearched the reference lists of relevant papers and previous systematic reviews and contacted experts in the field for supplemental data. SELECTION CRITERIA: We selected randomised controlled trials allocating adults with schizophrenia to receive either group CBT for schizophrenia, compared with standard care, or any other psychosocial intervention (group or individual). DATA COLLECTION AND ANALYSIS: We complied with Cochrane recommended standard of conduct for data screening and collection. Where possible, we calculated risk ratio (RR) and 95% confidence interval (CI) for binary data and mean difference (MD) and 95% CI for continuous data. We used a random-effects model for analyses. We assessed risk of bias for included studies and created a summary of findings table using GRADE. MAIN RESULTS: The review includes 24 studies (1900 participants). All studies compared group CBTp with treatments that a person with schizophrenia would normally receive in a standard mental health service (standard care) or any other psychosocial intervention (group or individual). None of the studies compared group CBTp with individual CBTp. Overall risk of bias within the trials was moderate to low. We found no studies reporting data for our primary outcome of clinically important change. With regard to numbers of participants leaving the study early, group CBTp has little or no effect compared to standard care or other psychosocial interventions (RR 1.22, 95% CI 0.94 to 1.59; studies = 13, participants = 1267; I2 = 9%; low-certainty evidence). Group CBTp may have some advantage over standard care or other psychosocial interventions for overall mental state at the end of treatment for endpoint scores on the Positive and Negative Syndrome Scale (PANSS) total (MD -3.73, 95% CI -4.63 to -2.83; studies = 12, participants = 1036; I2 = 5%; low-certainty evidence). Group CBTp seems to have little or no effect on PANSS positive symptoms (MD -0.45, 95% CI -1.30 to 0.40; studies =8, participants = 539; I2 = 0%) and on PANSS negative symptoms scores at the end of treatment (MD -0.73, 95% CI -1.68 to 0.21; studies = 9, participants = 768; I2 = 65%). Group CBTp seems to have an advantage over standard care or other psychosocial interventions on global functioning measured by Global Assessment of Functioning (GAF; MD -3.61, 95% CI -6.37 to -0.84; studies = 5, participants = 254; I2 = 0%; moderate-certainty evidence), Personal and Social Performance Scale (PSP; MD 3.30, 95% CI 2.00 to 4.60; studies = 1, participants = 100), and Social Disability Screening Schedule (SDSS; MD -1.27, 95% CI -2.46 to -0.08; studies = 1, participants = 116). Service use data were equivocal with no real differences between treatment groups for number of participants hospitalised (RR 0.78, 95% CI 0.38 to 1.60; studies = 3, participants = 235; I2 = 34%). There was no clear difference between group CBTp and standard care or other psychosocial interventions endpoint scores on depression and quality of life outcomes, except for quality of life measured by World Health Organization Quality of Life Assessment Instrument (WHOQOL-BREF) Psychological domain subscale (MD -4.64, 95% CI -9.04 to -0.24; studies = 2, participants = 132; I2 = 77%). The studies did not report relapse or adverse effects. AUTHORS' CONCLUSIONS: Group CBTp appears to be no better or worse than standard care or other psychosocial interventions for people with schizophrenia in terms of leaving the study early, service use and general quality of life. Group CBTp seems to be more effective than standard care or other psychosocial interventions on overall mental state and global functioning scores. These results may not be widely applicable as each study had a low sample size. Therefore, no firm conclusions concerning the efficacy of group CBTp for people with schizophrenia can currently be made. More high-quality research, reporting useable and relevant data is needed.

Revisión sistemática

No clasificado

Psychosocial interventions for people with both severe mental illness and substance misuse

Revista The Cochrane database of systematic reviews
Año 2019
Enlaces Pubmed DOI PubMed Central

Este artículo está incluido en 4 Síntesis amplias 57 Síntesis amplias (4 referencias)

Este artículo incluye 58 Estudios primarios 57 Estudios primarios (58 referencias)

Cargando información sobre las referencias
Background: Even low levels of substance misuse by people with a severe mental illness can have detrimental effects. Objectives: To assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. Search methods: The Information Specialist of the Cochrane Schizophrenia Group (CSG) searched the CSG Trials Register (2 May 2018), which is based on regular searches of major medical and scientific databases. Selection criteria: We included all randomised controlled trials (RCTs) comparing psychosocial interventions for substance misuse with standard care in people with serious mental illness. Data collection and analysis: Review authors independently selected studies, extracted data and appraised study quality. For binary outcomes, we calculated standard estimates of risk ratio (RR) and their 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous outcomes, we calculated the mean difference (MD) between groups. Where meta-analyses were possible, we pooled data using a random-effects model. Using the GRADE approach, we identified seven patient-centred outcomes and assessed the quality of evidence for these within each comparison. Main results: Our review now includes 41 trials with a total of 4024 participants. We have identified nine comparisons within the included trials and present a summary of our main findings for seven of these below. We were unable to summarise many findings due to skewed data or because trials did not measure the outcome of interest. In general, evidence was rated as low- or very-low quality due to high or unclear risks of bias because of poor trial methods, or inadequately reported methods, and imprecision due to small sample sizes, low event rates and wide confidence intervals. 1. Integrated models of care versus standard care (36 months). No clear differences were found between treatment groups for loss to treatment (RR 1.09, 95% CI 0.82 to 1.45; participants = 603; studies = 3; low-quality evidence), death (RR 1.18, 95% CI 0.39 to 3.57; participants = 421; studies = 2; low-quality evidence), alcohol use (RR 1.15, 95% CI 0.84 to 1.56; participants = 143; studies = 1; low-quality evidence), substance use (drug) (RR 0.89, 95% CI 0.63 to 1.25; participants = 85; studies = 1; low-quality evidence), global assessment of functioning (GAF) scores (MD 0.40, 95% CI -2.47 to 3.27; participants = 170; studies = 1; low-quality evidence), or general life satisfaction (QOLI) scores (MD 0.10, 95% CI -0.18 to 0.38; participants = 373; studies = 2; moderate-quality evidence). 2. Non-integrated models of care versus standard care. There was no clear difference between treatment groups for numbers lost to treatment at 12 months (RR 1.21, 95% CI 0.73 to 1.99; participants = 134; studies = 3; very low-quality evidence). 3. Cognitive behavioural therapy (CBT) versus standard care. There was no clear difference between treatment groups for numbers lost to treatment at three months (RR 1.12, 95% CI 0.44 to 2.86; participants = 152; studies = 2; low-quality evidence), cannabis use at six months (RR 1.30, 95% CI 0.79 to 2.15; participants = 47; studies = 1; very low-quality evidence) or mental state insight (IS) scores by three months (MD 0.52, 95% CI -0.78 to 1.82; participants = 105; studies = 1; low-quality evidence). 4. Contingency management versus standard care. We found no clear differences between treatment groups for numbers lost to treatment at three months (RR 1.55, 95% CI 1.13 to 2.11; participants = 255; studies = 2; moderate-quality evidence), number of stimulant positive urine tests at six months (RR 0.83, 95% CI 0.65 to 1.06; participants = 176; studies = 1) or hospitalisations (RR 0.21, 95% CI 0.05 to 0.93; participants = 176; studies = 1); both low-quality evidence. 5. Motivational interviewing (MI) versus standard care. We found no clear differences between treatment groups for numbers lost to treatment at six months (RR 1.71, 95% CI 0.63 to 4.64; participants = 62; studies = 1). A clear difference, favouring MI, was observed for abstaining from alcohol (RR 0.36, 95% CI 0.17 to 0.75; participants = 28; studies = 1) but not other substances (MD -0.07, 95% CI -0.56 to 0.42; participants = 89; studies = 1), and no differences were observed in mental state general severity (SCL-90-R) scores (MD -0.19, 95% CI -0.59 to 0.21; participants = 30; studies = 1). All very low-quality evidence. 6. Skills training versus standard care. At 12 months, there were no clear differences between treatment groups for numbers lost to treatment (RR 1.42, 95% CI 0.20 to 10.10; participants = 122; studies = 3) or death (RR 0.15, 95% CI 0.02 to 1.42; participants = 121; studies = 1). Very low-quality, and low-quality evidence, respectively. 7. CBT + MI versus standard care. At 12 months, there was no clear difference between treatment groups for numbers lost to treatment (RR 0.99, 95% CI 0.62 to 1.59; participants = 327; studies = 1; low-quality evidence), number of deaths (RR 0.60, 95% CI 0.20 to 1.76; participants = 603; studies = 4; low-quality evidence), relapse (RR 0.50, 95% CI 0.24 to 1.04; participants = 36; studies = 1; very low-quality evidence), or GAF scores (MD 1.24, 95% CI -1.86 to 4.34; participants = 445; studies = 4; very low-quality evidence). There was also no clear difference in reduction of drug use by six months (MD 0.19, 95% CI -0.22 to 0.60; participants = 119; studies = 1; low-quality evidence). Authors' conclusions: We included 41 RCTs but were unable to use much data for analyses. There is currently no high-quality evidence to support any one psychosocial treatment over standard care for important outcomes such as remaining in treatment, reduction in substance use or improving mental or global state in people with serious mental illnesses and substance misuse. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high-quality trials are required which address these concerns and improve the evidence in this important area. Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Revisión sistemática

No clasificado

Augmentation strategies for clozapine refractory schizophrenia: A systematic review and meta-analysis.

Revista The Australian and New Zealand journal of psychiatry
Año 2018
Enlaces Pubmed DOI

Este artículo está incluido en 1 Síntesis amplia 46 Síntesis amplias (1 referencia)

Este artículo incluye 46 Estudios primarios 46 Estudios primarios (46 referencias)

Cargando información sobre las referencias
BACKGROUND: Although clozapine is the most effective medication for treatment refractory schizophrenia, only 40% of people will meet response criteria. We therefore undertook a systematic review and meta-analysis of global literature on clozapine augmentation strategies. METHODS: We systematically reviewed PubMed, PsycINFO, Embase, Cochrane Database, Chinese Biomedical Literature Service System and China Knowledge Resource Integrated Database for randomised control trials of augmentation strategies for clozapine resistant schizophrenia. We undertook pairwise meta-analyses of within-class interventions and, where possible, frequentist mixed treatment comparisons to differentiate treatment effectiveness RESULTS: We identified 46 studies of 25 interventions. On pairwise meta-analyses, the most effective augmentation agents for total psychosis symptoms were aripiprazole (standardised mean difference: 0.48; 95% confidence interval: −0.89 to −0.07) fluoxetine (standardised mean difference: 0.73; 95% confidence interval: −0.97 to −0.50) and, sodium valproate (standardised mean difference: 2.36 95% confidence interval: −3.96 to −0.75). Memantine was effective for negative symptoms (standardised mean difference: −0.56 95% confidence interval: −0.93 to −0.20). However, many of these results included poor-quality studies. Single studies of certain antipsychotics (penfluridol), antidepressants (paroxetine, duloxetine), lithium and <i>Ginkgo biloba</i> showed potential, while electroconvulsive therapy was highly promising. Mixed treatment comparisons were only possible for antipsychotics, and these gave similar results to the pairwise meta-analyses. CONCLUSIONS: On the basis of the limited data available, the best evidence is for the use of aripiprazole, fluoxetine and sodium valproate as augmentation agents for total psychosis symptoms and memantine for negative symptoms. However, these conclusions are tempered by generally short follow-up periods and poor study quality. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Revisión sistemática

No clasificado

A meta-analysis of social skills training and related interventions for psychosis.

Revista Schizophrenia bulletin
Año 2018
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 2 Estudios primarios 2 Estudios primarios (2 referencias)

Cargando información sobre las referencias
OBJECTIVE: Evidence suggests that social skills training (SST) is an efficacious intervention for negative symptoms in psychosis, whereas evidence of efficacy in other psychosis symptom domains is limited. The current article reports a comprehensive meta-analytic review of the evidence for SST across relevant outcome measures, control comparisons, and follow-up assessments. The secondary aim of this study was to identify and investigate the efficacy of SST subtypes. METHODS: A systematic literature search identified 27 randomized controlled trials including <i>N</i> = 1 437 participants. Trials assessing SST against active controls, treatment-as-usual (TAU), and waiting list control were included. Risk of bias was assessed using the Cochrane risk of bias assessment tool. A series of 70 meta-analytic comparisons provided effect sizes in Hedges’ g. Heterogeneity and publication bias were assessed. RESULTS: SST demonstrated superiority over TAU (<i>g</i> = 0.3), active controls (<i>g</i> = 0.2–0.3), and comparators pooled (<i>g</i> = 0.2–0.3) for negative symptoms, and over TAU (<i>g</i> = 0.4) and comparators pooled (<i>g</i> = 0.3) for general psychopathology. Superiority was indicated in a proportion of comparisons for all symptoms pooled and social outcome measures. SST subtype comparisons were underpowered, although social-cognitive approaches demonstrated superiority vs comparators pooled. SST treatment effects were maintained at proportion of follow-up comparisons. CONCLUSIONS: SST demonstrates a magnitude of effect for negative symptoms similar to those commonly reported for cognitive-behavioral therapy (CBT) for positive symptoms, although unlike CBT, SST is not routinely recommended in treatment guidelines for psychological intervention. SST may have potential for wider implementation. Further stringent effectiveness research alongside wider pilot implementation of SST in community mental health teams is warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Revisión sistemática

No clasificado

Cognitive behavioural therapy plus standard care versus standard care plus other psychosocial treatments for people with schizophrenia.

Revista The Cochrane database of systematic reviews
Año 2018
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 28 Estudios primarios 22 Estudios primarios (28 referencias)

Cargando información sobre las referencias
BACKGROUND: Cognitive behavioural therapy (CBT) is a psychosocial treatment that aims to help individuals re-evaluate their appraisals of their experiences that can affect their level of distress and problematic behaviour. CBT is now recommended by the National Institute for Health and Care Excellence (NICE) as an add-on treatment for people with a diagnosis of schizophrenia. Other psychosocial therapies that are often less expensive are also available as an add-on treatment for people with schizophrenia. This review is also part of a family of Cochrane Reviews on CBT for people with schizophrenia. OBJECTIVES: To assess the effects of CBT compared with other psychosocial therapies as add-on treatments for people with schizophrenia. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Study Based Register of Trials (latest 6 March, 2017). This register is compiled by systematic searches of major resources (including AMED, BIOSIS CINAHL, Embase, MEDLINE, PsycINFO, PubMed, and registries of clinical trials) and their monthly updates, handsearches, grey literature, and conference proceedings, with no language, date, document type, or publication status limitations for inclusion of records into the register. SELECTION CRITERIA: We selected randomised controlled trials (RCTs) involving people with schizophrenia who were randomly allocated to receive, in addition to their standard care, either CBT or any other psychosocial therapy. Outcomes of interest included relapse, global state, mental state, adverse events, social functioning, quality of life and satisfaction with treatment. We included trials meeting our inclusion criteria and reporting useable data. DATA COLLECTION AND ANALYSIS: We reliably screened references and selected trials. Review authors, working independently, assessed trials for methodological quality and extracted data from included studies. We analysed dichotomous data on an intention-to-treat basis and continuous data with 60% completion rate. Where possible, for binary data we calculated risk ratio (RR), for continuous data we calculated mean difference (MD), all with 95% confidence intervals (CIs). We used a fixed-effect model for analyses unless there was unexplained high heterogeneity. We assessed risk of bias for the included studies and used the GRADE approach to produce a 'Summary of findings' table for our main outcomes of interest. MAIN RESULTS: The review now includes 36 trials with 3542 participants, comparing CBT with a range of other psychosocial therapies that we classified as either active (A) (n = 14) or non active (NA) (n = 14). Trials were often small and at high or unclear risk of bias. When CBT was compared with other psychosocial therapies, no difference in long-term relapse was observed (RR 1.05, 95% CI 0.85 to 1.29; participants = 375; studies = 5, low-quality evidence). Clinically important change in global state data were not available but data for rehospitalisation were reported. Results showed no clear difference in long term rehospitalisation (RR 0.96, 95% CI 0.82 to 1.14; participants = 943; studies = 8, low-quality evidence) nor in long term mental state (RR 0.82, 95% CI 0.67 to 1.01; participants = 249; studies = 4, low-quality evidence). No long-term differences were observed for death (RR 1.57, 95% CI 0.62 to 3.98; participants = 627; studies = 6, low-quality evidence). Only average endpoint scale scores were available for social functioning and quality of life. Social functioning scores were similar between groups (long term Social Functioning Scale (SFS): MD 8.80, 95% CI -4.07 to 21.67; participants = 65; studies = 1, very low-quality evidence), and quality of life scores were also similar (medium term Modular System for Quality of Life (MSQOL): MD -4.50, 95% CI -15.66 to 6.66; participants = 64; studies = 1, very low-quality evidence). There was a modest but clear difference favouring CBT for satisfaction with treatment - measured as leaving the study early (RR 0.86, 95% CI 0.75 to 0.99; participants = 2392; studies = 26, low quality evidence). AUTHORS' CONCLUSIONS: Evidence based on data from randomised controlled trials indicates there is no clear and convincing advantage for cognitive behavioural therapy over other - and sometimes much less sophisticated and expensive - psychosocial therapies for people with schizophrenia. It should be noted that although much research has been carried out in this area, the quality of evidence available is mostly low or of very low quality. Good quality research is needed before firm conclusions can be made.

Revisión sistemática

No clasificado

Más allá de la asesoría individual cara a cara: Una revisión sistemática sobre modos alternativos de entrevistas motivacionales en el tratamiento y prevención del abuso de sustancias.

automatic
Autores Jiang S , Wu L , Gao X
Revista Addictive behaviors
Año 2017
Enlaces Pubmed DOI

Este artículo incluye 24 Estudios primarios 24 Estudios primarios (24 referencias)

Cargando información sobre las referencias
OBJETIVOS: Esta revisión sistemática tuvo como objetivo sintetizar la evidencia sobre la efectividad de la entrevista motivacional (IM), impartida en modos distintos del asesoramiento individual cara a cara, en la prevención y el tratamiento de los comportamientos relacionados con el abuso de sustancias. MÉTODOS: Se realizaron búsquedas en ensayos clínicos aleatorios (ECA) que evaluaron la efectividad de los modos alternativos de IM (con excepción del asesoramiento individual cara a cara) en la prevención de la enfermedad de Parkinson Y el tratamiento del abuso de sustancias. Los estudios elegibles fueron calificados en calidad metodológica y sus hallazgos fueron sintetizados cualitativamente. RESULTADOS: Un total de 25 artículos (en 22 ECA) fueron elegibles para esta revisión. Más allá del asesoramiento cara a cara, el teléfono fue el medio más utilizado para la administración del IM (11 estudios), seguido por la comunicación por Internet (4 estudios) y el servicio de mensajes cortos (SMS) (2 estudios). Mail fue incorporado como suplemento en uno de los estudios para el teléfono MI. En contraste con el asesoramiento individual de uno a uno, el grupo MI fue adoptado en 5 estudios. La efectividad del MI telefónico en el tratamiento del abuso de sustancias fue apoyada por todos los ECA publicados que localizamos. MI basado en Internet fue eficaz en la prevención y el tratamiento del alcoholismo, pero su resultado parecía ser inconsistente para el abandono del hábito de fumar y pobre para la abstinencia de drogas ilícitas. El MI basado en SMS parecía ser útil para controlar el tabaco y el consumo de alcohol. El Grupo MI se intentó por dejar de fumar alcohol y drogas, con resultados mixtos sobre sus resultados. CONCLUSIONES: En conjunto, los estudios revisados ​​indican que el MI telefónico es un modo prometedor de intervención en el tratamiento y prevención del abuso de sustancias. La eficacia de otros modos alternativos (SMS basado en SMS, MI basado en Internet y grupo MI) sigue siendo poco concluyente dado los hallazgos polémicos y un número limitado de estudios. Mediante la síntesis de la evidencia actualmente disponible, esta revisión sistemática sugirió que el MI telefónico podría ser considerado como una alternativa al MI cara a cara para tratar y prevenir el abuso de sustancias. Se necesitan más investigaciones para investigar la efectividad del MI basado en SMS, Internet MI, grupo MI y otros modos alternativos. Los estudios con rigor metodológico e incorporación de medidas de fidelidad MI tienen un gran potencial para avanzar en la comprensión en este campo.

Revisión sistemática

No clasificado

Home Idiomas Ingresar a Epistemonikos Búsqueda avanzada Una revisión sistemática examinar los factores que predicen resultados favorables en las intervenciones cognitivas conductuales para la psicosis.

automatic
Autores O'Keeffe J , Conway R , McGuire B
Revista Schizophrenia research
Año 2017
Enlaces Pubmed DOI

Este artículo incluye 10 Estudios primarios 10 Estudios primarios (10 referencias)

Cargando información sobre las referencias
La psicosis es una condición de salud mental debilitante que afecta a aproximadamente 4 personas por 1000. La terapia cognitivo-conductual para la psicosis (CBTp) ha demostrado ser un tratamiento eficaz para la psicosis y es recomendada por varias guías nacionales. CBTp no funciona igual de bien con todos, sin embargo, con un 50% de los clientes que reciben poco beneficio. Esta revisión se propone evaluar sistemáticamente la literatura y la calidad metodológica de una serie de estudios, que examinan los factores que predicen el resultado exitoso en TCC. Se revisaron electrónicamente las bases de datos CINAHL, Cochrane, EBSCO, EMBASE, ISI Web of Science, MEDLINE (Ovid), PsycARTICLES, PsycINFO, PubMed y Scopus. Artículos en inglés en revistas revisadas por pares fueron revisados. Los términos de búsqueda "psicosis", "trastorno psicótico", "terapia cognitiva conductual", "terapia cognitiva", "ensayo controlado aleatorio", "predictor" y "resultado del tratamiento" en varias combinaciones se usaron según se necesitaba. Sólo se incluyeron ensayos controlados aleatorios (ECA). Los resultados sugieren que el sexo femenino, la edad avanzada y la mayor perspicacia clínica en la línea de base, cada uno predijo un mejor resultado en las intervenciones de TCC con pacientes psicóticos, como lo hizo una duración más corta de la enfermedad y mayor nivel de instrucción. Varios otros factores, como una mayor gravedad de los síntomas en la línea de base, eran sugestivos de capacidad predictiva, pero se indicó más investigación para aclarar. Los proveedores de atención de salud mental deben considerar estos hallazgos al ofrecer CBTp. La responsabilidad también está en los proveedores de atención médica para equipar mejor no respondedores a CBTp. La investigación adicional de un número limitado de factores predictivos, con un conjunto acordado de medidas de resultado, permitiría a los futuros investigadores comparaciones más directas entre los estudios.

Revisión sistemática

No clasificado

Treatments for Schizophrenia in Adults: A Systematic Review

Libro AHRQ Comparative Effectiveness Reviews
Año 2017
Enlaces Pubmed

Este artículo incluye 77 Estudios primarios 74 Estudios primarios (77 referencias)

Cargando información sobre las referencias
OBJECTIVES: This systematic review (SR) provides evidence on pharmacological and psychosocial treatments for schizophrenia. DATA SOURCES: MEDLINE®, the Cochrane Library databases, PsycINFO®, and included studies through February 2017. STUDY SELECTION: We included studies comparing second-generation antipsychotics (SGA) with each other or with a first-generation antipsychotic (FGA) and studies comparing psychosocial interventions with usual care in adults with schizophrenia. DATA EXTRACTION: We extracted study design, year, setting, country, sample size, eligibility criteria, population, clinical and intervention characteristics, results, and funding source. RESULTS: We included 1 SR of 138 trials (N=47,189) and 24 trials (N=6,672) for SGAs versus SGAs, 1 SR of 111 trials (N=118,503) and 5 trials (N=1,055) for FGAs versus SGAs, and 13 SRs of 271 trials (N=25,050) and 27 trials (n=6,404) for psychosocial interventions. Trials were mostly fair quality and strength of evidence was low or moderate. For drug therapy, the majority of the head-to-head evidence was on older SGAs, with sparse data on SGAs approved in the last 10 years (asenapine, lurasidone, iloperidone, cariprazine, brexpiprazole) and recent long-acting injection (LAI) formulations of aripiprazole and paliperidone. Older SGAs were similar in measures of function, quality of life, mortality, and overall adverse events, except that risperidone LAI had better social function than quetiapine. Core illness symptoms were improved more with olanzapine and risperidone than asenapine, quetiapine, and ziprasidone, and more with paliperidone than lurasidone and iloperidone; all were superior to placebo. Risperidone LAI and olanzapine had less withdrawal due to adverse events. Compared with olanzapine and risperidone, haloperidol, the most studied FGA, had similar improvement in core illness symptoms, negative symptoms, symptom response, and remission but greater incidence of adverse event outcomes. In comparison with usual care, most psychosocial interventions reviewed were more effective in improving intervention-targeted outcomes, including core illness symptoms. Various functional outcomes were improved more with assertive community treatment, cognitive behavioral therapy, family interventions, psychoeducation, social skills training, supported employment, and early interventions for first episode psychosis (FEP) than with usual care. Quality of life was improved more with cognitive behavioral therapy and early interventions for FEP than usual care. Relapse was reduced with family interventions, psychoeducation, illness self-management, family interventions, and early interventions for FEP. CONCLUSIONS: Most comparative evidence on pharmacotherapy relates to the older drugs, with clozapine, olanzapine, and risperidone superior on more outcomes than other SGAs. Older SGAs were similar to haloperidol on benefit outcomes but had fewer adverse event outcomes. Most psychosocial interventions improved functional outcomes, quality of life, and core illness symptoms, and several reduced relapse compared with usual care.

Revisión sistemática

No clasificado

Rehabilitation interventions to promote recovery from schizophrenia: A systematic review

Autores Morin L , Franck N
Revista Frontiers in psychiatry
Año 2017
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 19 Estudios primarios 19 Estudios primarios (19 referencias)

Cargando información sobre las referencias
Only one out of seven patients recovers after a first episode of psychosis despite psychiatric care. Rehabilitation interventions have been developed to improve functional outcomes and to promote recovery. We conducted a systematic review of the effectiveness of the main psychiatric rehabilitation interventions following a search of the electronic databases Pubmed, ScienceDirect, and Google Scholar using combinations of terms relating to cognitive remediation, psychoeducation, cognitive-behavioral therapies, and schizophrenia. Eighty articles relevant to the topic of interest were found. According to results, cognitive remediation has been found to be effective in reducing the impact of cognitive impairment, social skills in the learning a variety of skills and to a lesser extent in reducing negative symptoms, psychoeducation in improving compliance and reducing relapses, and cognitive therapy in reducing the intensity of or distress related to positive symptoms. All psychosocial rehabilitation interventions should be considered as evidence-based practices for schizophrenia and need to become a major part of the standard treatment of the disease.