Who stays, who benefits? Predicting dropout and change in cognitive behaviour therapy for psychosis
Who stays, who benefits? Predicting dropout and change in cognitive behaviour therapy for psychosis
复制标题
DOI：
10.1016/j.psychres.2014.02.012
复制
发表时间：
2014-05-15
影响因子：
11.3
通讯作者：
Mehl, Stephanie
中科院分区：
文献类型：
--
作者：
Lincoln, Tania M.;Rief, Winfried;Mehl, Stephanie
本研究对一项比较CBTp与等候名单组的随机对照有效性试验的退学和完成者数据进行了二次分析，调查了结果的预测因素（Lincoln et al., 2012）。80名寻求门诊治疗的DSM-IV精神病患者被纳入研究。在基线时评估预测因子。在治疗后和1年随访时评估症状结局。预测因子组相互作用表明，较长的障碍持续时间预测CBTp阴性症状的改善较少，但在等候名单组中没有，而仅在等候名单组中，草率下结论与较差的结果相关。没有CBTp特异性的改善阳性症状的预测因子。然而，在联合样本（立即CBTp+延迟CBTp组）中，基线变量预测治疗后和治疗前症状控制后1年随访时阳性和阴性症状差异的显著量。缺乏洞察力和社会功能低下是辍学的主要预测因素，预测准确率为87%。研究结果表明，较高的基线症状严重程度、较差的功能、神经认知缺陷、推理偏差和合并症对CBTp期间的改善没有障碍。然而，与之前的预测研究一致，研究结果表明患者需要更早接受治疗。2014爱思唯尔爱尔兰有限公司版权所有。
This study investigates the predictors of outcome in a secondary analysis of dropout and completer data from a randomized controlled effectiveness trial comparing CBTp to a wait-list group (Lincoln et al., 2012). Eighty patients with DSM-IV psychotic disorders seeking outpatient treatment were included. Predictors were assessed at baseline. Symptom outcome was assessed at post-treatment and at 1-year follow-up. The predictor x group interactions indicate that a longer duration of disorder predicted less improvement in negative symptoms in the CBTp but not in the wait-list group whereas jumping-to-conclusions was associated with poorer outcome only in the wait-list group. There were no CBTp specific predictors of improvement in positive symptoms. However, in the combined sample (immediate CBTp+the delayed CBTp group) baseline variables predicted significant amounts of positive and negative symptom variance at post-therapy and 1-year follow-up after controlling for pre-treatment symptoms. Lack of insight and low social functioning were the main predictors of drop-out, contributing to a prediction accuracy of 87%. The findings indicate that higher baseline symptom severity, poorer functioning, neurocognitive deficits, reasoning biases and comorbidity pose no barrier to improvement during CBTp. However, in line with previous predictor-research, the findings imply that patients need to receive treatment earlier. (C) 2014 Elsevier Ireland Ltd. All rights reserved.