Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial.
Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial.
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DOI：
10.1136/bmj.c6325
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发表时间：
2010-11-24
期刊：
影响因子：
--
通讯作者：
Tarrier N
中科院分区：
文献类型：
--
作者：
Barrowclough C;Haddock G;Wykes T;Beardmore R;Conrod P;Craig T;Davies L;Dunn G;Eisner E;Lewis S;Moring J;Steel C;Tarrier N
目的 评估除了标准护理之外，综合动机访谈和认知行为疗法对精神病和共病药物使用问题患者的有效性。设计两个中心、开放、评估者盲法随机对照试验。在英国设置二级护理。参与者 327 名临床诊断为精神分裂症、精神分裂样障碍或分裂情感性障碍的患者，并根据《精神障碍诊断与统计手册》第四版诊断为依赖或滥用药物、酒精或两者。干预干预措施是综合动机访谈和认知行为治疗加上标准护理，并与单独的标准护理进行比较。治疗的第一阶段——“动机建立”——关注患者的参与，然后探索和解决改变物质使用的矛盾心理。第二阶段——“行动”——使用认知行为方法支持和促进变革。一年内进行了多达 26 次治疗。主要结局指标 主要结局是治疗完成后 12 个月内全因死亡或入院。次要结果是物质使用的频率和数量（使用时间线回溯法评估）、改变的准备程度、使用的负面后果感知、精神病症状评级、复发次数和持续时间、12 个月和 24 个月时的功能和故意自我伤害的整体评估，以及 6 个月和 18 个月时的额外时间线回溯评估。分析是按意向治疗进行的，并产生了可靠的治疗效果估计。结果 327 名参与者被随机分配至干预组 (n=164) 或照常治疗组 (n=163)。 24 个月时，有 326 名患者（99.7%）接受了主要结局评估，246 名患者（75.2%）接受了主要次要结局评估。治疗对随访期间的入院或死亡没有有益影响，治疗组中有 23.3% (38/163) 和对照组有 20.2% (33/163) 死亡或入院（调整后比值比 1.16，95% 置信区间 0.68 至 1.99；P=0.579）。治疗对物质使用频率或误用的负面后果没有影响，但对每个物质使用日的使用量有统计学上的显着影响（主要物质的调整后 OR 为 1.50，95% CI 1.08 至 2.09；P=0.016；所有物质为 1.48，95% CI 1.07 至 2.05；P=0.017）。治疗对 12 个月时改变使用的意愿有统计学上的显着影响（调整 OR 2.05，95% CI 1.26 至 3.31；P=0.004），但在 24 个月时未维持这种影响（0.78，95% CI 0.48 至 1.28；P=0.320）。治疗对复发、精神病症状、功能和自残等临床结果没有影响。结论 对精神病和药物滥用患者进行综合动机访谈和认知行为治疗并不能改善住院、症状结果或功能方面的结果。这种方法确实减少了治疗完成后至少一年的物质使用量。试验注册 当前对照试验：ISRCTN14404480。
Objectives To evaluate the effectiveness of integrated motivational interviewing and cognitive behavioural therapy in addition to standard care for patients with psychosis and a comorbid substance use problem. Design Two centre, open, rater blind randomised controlled trial. Setting Secondary care in the United Kingdom. Participants 327 patients with a clinical diagnosis of schizophrenia, schizophreniform disorder, or schizoaffective disorder and a diagnosis of dependence on or misuse of drugs, alcohol, or both according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Intervention The intervention was integrated motivational interviewing and cognitive behavioural therapy plus standard care, which was compared with standard care alone. Phase one of therapy—“motivation building”—concerns engaging the patient, then exploring and resolving ambivalence for change in substance use. Phase two—“action”—supports and facilitates change using cognitive behavioural approaches. Up to 26 therapy sessions were delivered over one year. Main outcome measures The primary outcome was death from any cause or admission to hospital in the 12 months after completion of therapy. Secondary outcomes were frequency and amount of substance use (assessed using the timeline followback method), readiness to change, perceived negative consequences of use, psychotic symptom ratings, number and duration of relapses, and global assessment of functioning and deliberate self harm at 12 and 24 months, with additional timeline followback assessments at 6 and 18 months. Analysis was by intention to treat and robust treatment effect estimates were produced. Results 327 participants were randomly allocated to either the intervention (n=164) or treatment as usual (n=163). At 24 months, 326 (99.7%) were assessed on the primary outcome and 246 (75.2%) on the main secondary outcomes. Treatment had no beneficial effect on hospital admissions or death during follow-up, with 23.3% (38/163) of the therapy group and 20.2% (33/163) of controls deceased or admitted (adjusted odds ratio 1.16, 95% confidence interval 0.68 to 1.99; P=0.579). Therapy had no effect on the frequency of substance use or the perceived negative consequences of misuse, but did have a statistically significant effect on amount used per substance using day (adjusted ORs for main substance 1.50, 95% CI 1.08 to 2.09; P=0.016; and all substances 1.48, 95% CI 1.07 to 2.05; P=0.017). Treatment had a statistically significant effect on readiness to change use at 12 months (adjusted OR 2.05, 95% CI 1.26 to 3.31; P=0.004) that was not maintained at 24 months (0.78, 95% CI 0.48 to 1.28; P=0.320). There were no effects of treatment on clinical outcomes such as relapses, psychotic symptoms, functioning, and self harm. Conclusions Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and substance misuse do not improve outcome in terms of hospitalisation, symptom outcomes, or functioning. This approach does reduce the amount of substance used for at least one year after completion of therapy. Trial registration Current Controlled Trials: ISRCTN14404480.
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DOI：
10.15288/jsa.2004.65.774
发表时间：
2004-11-01
期刊：
JOURNAL OF STUDIES ON ALCOHOL
影响因子：
--
作者：
Carey, KB;Carey, MP;Henson, JM
通讯作者：
Henson, JM
影响因子：
17.7
作者：
Barrowclough, C;Haddock, G;McGovern, J
通讯作者：
McGovern, J
影响因子：
4.4
作者：
Barrowclough, Christine;Haddock, Gillian;Wykes, Til
通讯作者：
Wykes, Til
影响因子：
3.4
作者：
Carey, KB
通讯作者：
Carey, KB
影响因子：
6
作者：
Baker, A;Lewin, T;Terry, M
通讯作者：
Terry, M