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The American Journal of Psychiatry Oct 2017Antipsychotic drug efficacy may have decreased over recent decades. The authors present a meta-analysis of all placebo-controlled trials in patients with acute... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Antipsychotic drug efficacy may have decreased over recent decades. The authors present a meta-analysis of all placebo-controlled trials in patients with acute exacerbations of schizophrenia, and they investigate which trial characteristics have changed over the years and which are moderators of drug-placebo efficacy differences.
METHOD
The search included multiple electronic databases. The outcomes were overall efficacy (primary outcome); responder and dropout rates; positive, negative, and depressive symptoms; quality of life; functioning; and major side effects. Potential moderators of efficacy were analyzed by meta-regression.
RESULTS
The analysis included 167 double-blind randomized controlled trials with 28,102 mainly chronic participants. The standardized mean difference (SMD) for overall efficacy was 0.47 (95% credible interval 0.42, 0.51), but accounting for small-trial effects and publication bias reduced the SMD to 0.38. At least a "minimal" response occurred in 51% of the antipsychotic group versus 30% in the placebo group, and 23% versus 14% had a "good" response. Positive symptoms (SMD 0.45) improved more than negative symptoms (SMD 0.35) and depression (SMD 0.27). Quality of life (SMD 0.35) and functioning (SMD 0.34) improved even in the short term. Antipsychotics differed substantially in side effects. Of the response predictors analyzed, 16 trial characteristics changed over the decades. However, in a multivariable meta-regression, only industry sponsorship and increasing placebo response were significant moderators of effect sizes. Drug response remained stable over time.
CONCLUSIONS
Approximately twice as many patients improved with antipsychotics as with placebo, but only a minority experienced a good response. Effect sizes were reduced by industry sponsorship and increasing placebo response, not decreasing drug response. Drug development may benefit from smaller samples but better-selected patients.
Topics: Antipsychotic Agents; Bayes Theorem; Depression; Drug-Related Side Effects and Adverse Reactions; Humans; Multivariate Analysis; Patient Dropouts; Psychotic Disorders; Quality of Life; Schizophrenia; Schizophrenia, Paranoid; Schizophrenic Psychology; Treatment Outcome
PubMed: 28541090
DOI: 10.1176/appi.ajp.2017.16121358 -
Schizophrenia Research Apr 2016Aggression in the context of schizophrenia has significant detrimental personal, clinical and societal implications. Whilst understanding the precise pathways to... (Review)
Review
Aggression in the context of schizophrenia has significant detrimental personal, clinical and societal implications. Whilst understanding the precise pathways to aggression in people with a diagnosis of schizophrenia is critical for risk management and treatment, these pathways remain unclear. A paranoid belief that others intend harm is one psychotic symptom that might contribute to aggressive behaviours. This is the first review to investigate the relationship between paranoia and aggression in psychosis. A systematic review of published literature pertinent to the relationship between paranoia and aggression was conducted. A search of online databases from inception to November 2014 was performed with keywords related to 'schizophrenia', 'paranoia' and 'aggression'. Fifteen studies, primarily cross-sectional in design (n=9), met eligibility criteria. Studies reviewed showed mixed support for an association between paranoia and aggression in both inpatients and community settings. However, when study quality was taken into account, more methodologically rigorous studies tended to show a positive association between factors. Mixed findings are most likely due to important methodological shortcomings, including heterogeneous samples and studies using a diverse range of aggression/violence measures. In light of methodological limitations of individual studies reviewed, further investigation of the relationship between paranoia and aggression in psychosis using robust methodology is needed before definitive clinical recommendations regarding the hypothesised relationship between paranoia and aggression can be made. This paper sets out key recommendations for future studies, including operationalizing the specific components of aggression and paranoia under investigation and methods to delineate important mediators in the paranoia and aggression relationship.
Topics: Aggression; Humans; Paranoid Disorders; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology
PubMed: 26879588
DOI: 10.1016/j.schres.2016.02.009 -
Clinical Psychology Review Dec 2021Negative self and negative other schema have been implicated in the development of paranoia. The current study provides a meta-analysis, narrative review and quality... (Meta-Analysis)
Meta-Analysis Review
Negative self and negative other schema have been implicated in the development of paranoia. The current study provides a meta-analysis, narrative review and quality appraisal of quantitative studies investigating the relationship between negative self and negative other schema and paranoia across the paranoia continuum. A systematic search identified 43 eligible studies; 25 were included in the meta-analysis. Meta-analytic findings demonstrated a medium to large relationship between paranoia and negative self-schema (r = 0.46, 95% CI 0.39 to 0.53) and negative other schema (r = 0.48, 95% CI 0.38 to 0.56). The magnitude of associations was similar across people with and without psychosis. Findings demonstrated that associations between negative self-schema and paranoia were not always statistically significant when controlling for confounding variables, particularly depression. The association between negative other schema and paranoia tended to remain significant when controlling for confounding variables. Findings also demonstrated that negative schema may mediate relationships between adverse experiences in childhood and paranoia. Overall, findings support theoretical proposals that both negative self and negative other schema are associated with paranoia. Longitudinal studies are required to confirm the direction of effects. Findings provide support for incorporating and targeting negative self and negative other schema in psychological formulations and therapeutic work.
Topics: Humans; Longitudinal Studies; Paranoid Disorders; Psychotic Disorders; Self Concept
PubMed: 34564019
DOI: 10.1016/j.cpr.2021.102081 -
The Psychiatric Quarterly Dec 2023Aripiprazole is an atypical antipsychotic medication, and its use in treating borderline personality disorder (BPD) is debatable because it is not FDA-approved for... (Review)
Review
Aripiprazole is an atypical antipsychotic medication, and its use in treating borderline personality disorder (BPD) is debatable because it is not FDA-approved for treating BPD. This study aimed to investigate the efficacy and safety of aripiprazole in patients with BPD. On July 2, 2021, the protocol (CRD42021256647) was registered in PROSPERO. PubMed, Scopus, Web of Science, Ovid-Medline, Embase, PsycINFO, and Cochrane (CENTRAL) were searched without regard for language or publication date. We also searched trial registries on ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. Randomized clinical trials with adult patients diagnosed with BPD met the inclusion criteria. The Cochrane risk of bias for randomized trials (RoB-2) method was used to assess the quality of the included studies. We included two previously published randomized clinical trials. There were 76 patients with BPD, with 38, 12, and 26 assigned to the aripiprazole, olanzapine, and placebo groups, respectively. Most patients (88.16%) were females, with ages ranging from 22.1 to 28.14 yr. Aripiprazole has been proven to reduce anxiety, depression, anger, hostility, clinical severity, and obsessive-compulsive behavior, insecurity, melancholy, anxiety, aggressiveness/hostility, phobic anxiety, paranoid thinking, psychoticism, and somatization. The adverse effects were headache, insomnia, restlessness, tremor, and akathisia. The risk of bias was considerable in both trials, which is somewhat problematic considering that prejudice can lead to incorrect outcomes and conclusions. Aripiprazole has demonstrated encouraging outcomes in the treatment of patients with BPD. More randomized controlled studies are needed.
Topics: Adult; Female; Humans; Male; Aripiprazole; Borderline Personality Disorder; Antipsychotic Agents; Olanzapine; Anxiety Disorders
PubMed: 37566261
DOI: 10.1007/s11126-023-10045-8 -
Psychology and Psychotherapy Sep 2021The moderate association between therapeutic alliance (TA) and psychological therapy outcome is well established. Historically, the field has not focused on people with... (Meta-Analysis)
Meta-Analysis Review
AIM
The moderate association between therapeutic alliance (TA) and psychological therapy outcome is well established. Historically, the field has not focused on people with a severe mental illness. This is the first review to conduct a meta-analysis of associations between TA and therapeutic engagement as well as outcome in psychological therapy for psychosis.
ELIGIBILITY CRITERIA
Eligible studies conducted a quantitative investigation of the relationship between TA during a psychological therapy and outcome at a subsequent time-point.
METHOD
A systematic review examined the relationship between TA and engagement as well as outcome measures within psychological therapy for psychosis. Correlational meta-analyses using an aggregate random effects model were conducted.
RESULTS
Twenty-four studies were eligible for inclusion (n = 1,656) of which 13 were included in the meta-analyses. Client- and therapist-rated TA were associated with engagement in therapy (r = 0.36, p = .003; r = 0.40, p = .0053). TA was also associated with reduction in global (r = 0.29, p = .0005; r = 0.24, p = .0015) and psychotic symptoms (r = 0.17, p = .0115; r = 0.30, p = .0003). The systematic review identified no evidence or limited evidence for a relationship between TA during therapy and depression, substance use, physical health behaviours, global as well as social functioning, overall mental health recovery, and self-esteem at follow-up. Although number of studies was small, TA was related to a reduced risk of subsequent hospitalization in 40% of analyses (across two studies) and improved cognitive outcome in 50% of analyses (across three studies).
CONCLUSIONS
The observed TA-therapy engagement and TA-outcome associations were broadly consistent with those identified across non-psychotic diagnostic groups. Well-powered studies are needed to investigate the relationship between TA and process as well as outcome in psychological therapy for psychosis specifically.
PRACTITIONER POINTS
This is the first review to conduct a meta-analytic synthesis of the association between therapeutic alliance (TA) and both engagement and change in outcome in psychological therapies for psychosis. TA (as rated by therapist and client) was associated with the extent of therapeutic engagement as well as reduction in global mental health symptoms and psychotic symptoms. The significant associations between TA and engagement as well as change in outcome identified in the current review are broadly consistent with those observed across non-psychotic diagnostic groups. We consider factors that could impact upon the dynamic and potentially interdependent relationships between TA and therapeutic techniques, including attachment security and severity of paranoid ideation.
Topics: Humans; Mental Health; Psychotic Disorders; Substance-Related Disorders; Therapeutic Alliance
PubMed: 33569885
DOI: 10.1111/papt.12330 -
Schizophrenia Research Jul 2020Sleep disturbance is a common clinical issue for patients with psychosis. It has been identified as a putative causal factor in the onset and persistence of psychotic... (Review)
Review
BACKGROUND
Sleep disturbance is a common clinical issue for patients with psychosis. It has been identified as a putative causal factor in the onset and persistence of psychotic experiences (paranoia and hallucinations). Hence sleep disruption may be a potential treatment target to prevent the onset of psychosis and reduce persistent psychotic experiences. The aim of this review is to describe developments in understanding the nature, causal role, and treatment of sleep disruption in psychosis.
METHOD
A systematic literature search was conducted to identify studies, published in the last five years, investigating subjective sleep disruption and psychotic experiences.
RESULTS
Fifty-eight papers were identified: 37 clinical and 21 non-clinical studies. The studies were correlational (n = 38; 20 clinical, 18 non-clinical), treatment (n = 7; 1 non-clinical), qualitative accounts (n = 6 clinical), prevalence estimates (n = 5 clinical), and experimental tests (n = 2 non-clinical). Insomnia (50%) and nightmare disorder (48%) are the most prevalent sleep problems found in patients. Sleep disruption predicts the onset and persistence of psychotic experiences such as paranoia and hallucinations, with negative affect identified as a partial mediator of this relationship. Patients recognise the detrimental effects of disrupted sleep and are keen for treatment. All psychological intervention studies reported large effect size improvements in sleep and there may be modest resultant improvements in psychotic experiences.
CONCLUSIONS
Sleep disruption is a treatable clinical problem in patients with psychosis. It is important to treat in its own right but may also lessen psychotic experiences. Research is required on how this knowledge can be implemented in clinical services.
Topics: Delusions; Hallucinations; Humans; Paranoid Disorders; Psychotic Disorders; Schizophrenia; Sleep
PubMed: 31831262
DOI: 10.1016/j.schres.2019.11.014 -
Obesity Reviews : An Official Journal... Aug 2016Studies demonstrate an association between personality traits and obesity as well as their prognostic influence on weight course. In contrast, only few studies have... (Review)
Review
BACKGROUND
Studies demonstrate an association between personality traits and obesity as well as their prognostic influence on weight course. In contrast, only few studies have investigated the association between personality disorders (PDs) and obesity.
OBJECTIVE
The present review summarizes through a comprehensive and critical evaluation the results of 68 studies identified by database research (PubMed and PsycINFO) covering the last 35 years that investigated the association between PDs, overweight and obesity as well as the predictive value of PDs for the development of obesity and the effectiveness of weight reduction treatments.
RESULTS
Adults with any PD have a higher risk of obesity. In the female general population, there is an association between avoidant or antisocial PD and severe obesity. Further, women with paranoid or schizotypal PD have a higher risk of obesity. Clinical studies including foremost female participants showed a higher comorbidity of PDs, especially borderline PD and avoidant PD, in binge-eating disorder. Regarding both genders, patients with PD show less treatment success in conservative weight-loss treatment programmes for obesity than patients without PD.
CONCLUSIONS
In prevention and conservative weight-loss treatment strategies, more care should be taken to address the special needs of patients with comorbid PDs.
Topics: Binge-Eating Disorder; Comorbidity; Humans; Meta-Analysis as Topic; Obesity; Overweight; Personality Disorders; Prevalence; Randomized Controlled Trials as Topic
PubMed: 27230851
DOI: 10.1111/obr.12415 -
Psychiatry Research Jan 2022Paranoia is an important psychiatric symptom with a remarkable effect on daily life. Virtual reality (VR)-based treatments are influential and safe for patients with... (Review)
Review
BACKGROUND AND OBJECTIVE
Paranoia is an important psychiatric symptom with a remarkable effect on daily life. Virtual reality (VR)-based treatments are influential and safe for patients with paranoia. This study aimed to evaluate the effectiveness, and define the clinical and technical characteristics of available VR strategies for the treatment of patients with paranoia.
MATERIALS AND METHODS
Studies published up to 25/11/2021 reporting VR-based interventions for the treatment of patients with paranoia were reviewed in five databases, including PubMed, Embase, Web of Science, PsycINFO, and Scopus.
RESULTS
Out of 302 initial search results, eight were included in the present study based on the inclusion criteria. Six studies were randomized clinical trials with the interventions in the experimental group being based on VR, compared to routine interventions as controls. Two were before-after studies. The most commonly used hardware and software were head-mounted display and Unity3D, respectively. Interventions had a range of 1-16 sessions with follow-up durations of 0-6 months. All investigations showed positive results in the main target, including improved social participation, reduced level of anxiety, as well as diminished suspicious ideas and paranoid symptoms.
CONCLUSIONS
Our findings demonstrated that VR-based interventions are effective treatments. Although the use of VR technology is limited for a variety of reasons, such as cost, it improves symptoms in patients with paranoia.
Topics: Anxiety; Humans; Paranoid Disorders; Virtual Reality; Virtual Reality Exposure Therapy
PubMed: 34922239
DOI: 10.1016/j.psychres.2021.114338 -
Substance Abuse 2017Cannabis is the most widely used illicit drug in the United States and Europe. In recent years, a range of new substances with cannabis-like effects-known as synthetic... (Review)
Review
BACKGROUND
Cannabis is the most widely used illicit drug in the United States and Europe. In recent years, a range of new substances with cannabis-like effects-known as synthetic cannabinoids (SCs)-have suddenly burst on the drug scene. However, there is limited information about the clinical hazards linked to the use of these emerging substances. This review summarizes the literature to date relating the health effects of SCs.
METHOD
A systematic literature review of original case studies was performed using PubMed and Web of Science (January 1980-July 2015). Only articles in which a drug screening was reported were included in this review.
RESULTS
Forty-six articles meeting the inclusion criteria were included in this review, reporting data on 114 patients who went to hospital emergency departments after exposure to SCs. The majority of patients were adolescent or young adult males (14-25 years; 24.5 ± 10.1 years). The most common route of administration was smoking. The SCs most involved were John William Huffman (JWH) derivatives, followed by XRL-11, ADB-PINACA, AM-2201, MAM-2201, and 5F-PB-22. This analysis showed that the use of these substances may cause minor and moderate side effects similar to those of cannabis intoxication, including tachycardia, nausea, somnolence, hallucinations, paranoia, xerostomia, and injected conjunctivae among others. However, atypical cannabis intoxication effects and worse complications (such as renal injuries, aggressiveness, cerebral ischemia, myocardial infarction, etc.) were also observed, which led to a significant morbidity were also observed. Some SCs were highlighted as being involved in 24 cases of deaths.
CONCLUSIONS
In this review, the nature and frequency of the signs and symptoms of SC poisoning were estimated in order to inform health professionals about the health risks of these new and emerging substances.
Topics: Cannabinoids; Humans
PubMed: 27715709
DOI: 10.1080/08897077.2016.1219438 -
Clinical Psychology Review Mar 2023Nightmares occur across a wide range of psychiatric disorders, but outside of PTSD presentations are infrequently considered a treatment priority. We aimed to assess... (Review)
Review
Nightmares occur across a wide range of psychiatric disorders, but outside of PTSD presentations are infrequently considered a treatment priority. We aimed to assess evidence for a contributory causal role of nightmares to the occurrence of psychiatric disorders, and vice versa. A systematic review was conducted of longitudinal, experimental, and clinical trial studies. Twenty-four longitudinal, sixteen trials, and no experimental studies were identified. Methodological shortcomings were common, especially the use of single-item nightmare assessment. Thirty-five studies assessed the path from nightmares to psychiatric symptoms. Depression (n = 10 studies), PTSD (n = 10) and anxiety (n = 5) were the most commonly assessed outcomes in trials. Most were not designed to assess the effect of nightmare treatment on psychiatric symptoms. Treating nightmares led to moderate reductions in PTSD and depression, small to moderate reductions in anxiety, and potentially moderate reductions in paranoia. Nightmares increased the risk of later suicide outcomes (n = 10), but two small pilot trials indicated that treating nightmares might potentially prevent recovery of suicidal ideation. PTSD treatment led to large reductions in trauma-related nightmares (n = 3). The limited literature suggests that treating nightmares may be one route to lessening threat-based disorders in particular, suggestive of a causal relationship. Overall, however, nightmares in most disorders are greatly understudied.
Topics: Humans; Stress Disorders, Post-Traumatic; Dreams; Anxiety; Anxiety Disorders; Suicidal Ideation
PubMed: 36566699
DOI: 10.1016/j.cpr.2022.102241