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Biomedical subjects

Douglas Turkington

Publications and source records attributed to Douglas Turkington.

15 recordsLinked to original sources
PubMed2006

Cognitive behavior therapy for schizophrenia.

OBJECTIVE: A growing body of evidence supports the use of cognitive behavior therapy for the treatment of schizophrenia. A course of cognitive behavior therapy, added to the antipsychotic regimen, is now considered to be an appropriate standard of care in the United Kingdom. The objective of this article is to offer a broad perspective on the subject of cognitive behavior therapy for schizophrenia for the American reader. METHOD: The authors summarize current practice and data supporting the use of cognitive behavior therapy for schizophrenia. RESULTS: Five aspects of cognitive behavior therapy for schizophrenia are addressed: 1) evidence from randomized clinical trials, 2) currently accepted core techniques, 3) similarities to and differences from other psychosocial interventions for schizophrenia, 4) differences between the United States and United Kingdom in implementation, and 5) current directions of research. CONCLUSIONS: The strength of the evidence supporting cognitive behavior therapy for schizophrenia suggests that this technique should have more attention and support in the United States.

Antipsychotic Agents↗
PubMed2006

Outcomes of an effectiveness trial of cognitive-behavioural intervention by mental health nurses in schizophrenia.

BACKGROUND: Little is known about the medium-term durability of cognitive-behavioural therapy (CBT) in a community sample of people with schizophrenia. AIMS: To investigate whether brief CBT produces clinically important outcomes in relation to recovery, symptom burden and readmission to hospital in people with schizophrenia at 1-year follow-up. METHOD: Participants (336 of 422 randomised at baseline) were followed up at a mean of 388 days (s.d. = 53) by raters masked to treatment allocation (CBT or usual care). RESULTS: At 1-year follow-up, participants who received CBT had significantly more insight (P = 0.021) and significantly fewer negative symptoms (P = 0.002). Brief therapy protected against depression with improving insight and against relapse; significantly reduced time spent in hospital for those who did relapse and delayed time to admission. It did not improve psychotic symptoms or occupational recovery, nor have a lasting effect on overall symptoms or depression at follow-up. CONCLUSIONS: Mental health nurses should be trained in brief CBT for schizophrenia to supplement case management, family interventions and expert therapy for treatment resistance.

Cognitive Behavioral Therapy↗
PubMed2006

Cognitive behaviour therapy for schizophrenia: relationship between anxiety symptoms and therapy.

AIMS: To explore the relationship between symptoms of anxiety and cognitive behaviour therapy (CBT) in patients with schizophrenia. DESIGN: Separate subanalyses of two randomized controlled trials comparing CBT for schizophrenia against befriending in the London Newcastle (LN) study, and against treatment as usual in the insight into schizophrenia (IS) study. MAIN OUTCOME MEASURES: Assessment of anxiety symptoms using the Brief Scale for Anxiety (BSA) derived from the Comprehensive Psychopathological Rating Scale (CPRS), at baseline, end of therapy and follow-up. RESULTS: In both studies, anxiety symptoms positively correlated with overall psychopathology, hallucinations and depression. In the LN study, patients with persecutory delusions and with distress due to akathisia and incapacity due to abnormal movements scored significantly higher on the BSA. In the IS study, anxiety scores were also positively correlated with; delusions, negative symptoms, relationship problems and problems with activities of daily living, living conditions, occupation and activities. Both subanalyses showed CBT had beneficial effects on anxiety symptoms compared with the control groups. Overall prognosis was found to be better in those with low anxiety in the LN study. CONCLUSIONS: CBT improves anxiety symptoms in psychosis. We did not find an association between anxiety symptoms at baseline and outcome of cognitive therapy in this group of patients with schizophrenia.

Adolescent↗
PubMed2006

Violent self-harm in schizophrenia.

Patients with schizophrenia have a substantial lifetime suicide risk, especially by violent means. Little published work exists on self-harm (SH) in this population. The goal of this study was to examine whether patients with schizophrenia were also more likely to self-harm in a violent manner. A retrospective analysis performed on method, motive, and suicidal intent in patients with schizophrenia (n = 50) and adjustment reaction (n = 138) who presented with SH over a 3-year period found that there was no significant difference between the two groups in terms of violence of method or suicidal intent. Presence of positive symptoms of schizophrenia was not significantly associated with use of a violent method. This study suggests that the expected pattern of violent SH in schizophrenia is inaccurate and for the majority the acts are of a similar nature to those seen in adjustment reactions.

Adult↗
PubMed2005

Insight into schizophrenia: the effects of cognitive behavioural therapy on the components of insight and association with sociodemographics--data on a previously published randomised controlled trial.

Insight in schizophrenia is an evolving concept with widespread use in clinical practice. Results are presented from a multicentre randomised trial in which patients with schizophrenia and carers received a short insight-focused Cognitive Behaviour Therapy (CBT) intervention from trained nurses in the community. The CBT group demonstrated significantly greater improvement in insight into compliance with treatment and the ability to re-label their psychotic symptoms as pathological compared with the control group at post-therapy assessment. Those participants who demonstrated improved insight into having a mental illness tended to become depressed. At the end of therapy and at 1-year follow-up, there was a statistically significantly increased dropout rate in African-Caribbean and Black African participants. The Black Caribbean group showed a significantly smaller change in insight compared to the white group. At 1-year follow-up, the result on total insight and compliance was durable. The change in insight in the Black African group was significantly lower compared to the white group. The study emphasizes the role of a short insight-focused CBT intervention in improving patients' insight into compliance and its implications. The results confirm previous findings of difficulties in engaging patients of Afro-Caribbean origin and their poor response to psychological therapies as currently delivered.

Adult↗
PubMed2005

Cognitive-behaviour therapy for schizophrenia: a review.

PURPOSE OF REVIEW: Most studies demonstrating the benefits of cognitive-behaviour therapy for schizophrenia were carried out in the 1990s. The majority targeted treatment resistant positive symptoms. Recent research is now focussing on the impact of cognitive-behaviour therapy on prodromal states, acute schizophrenia, negative symptoms, loss of insight and relapse prevention. RECENT FINDINGS: There is mounting evidence to suggest that cognitive-behaviour therapy is an effective adjunct to antipsychotic medication in the management of positive symptoms of acute schizophrenia as well as negative and residual symptoms of chronic schizophrenia. The effect size at the end of therapy is strong, with durability at short-term follow up. There is also evidence that cognitive-behaviour therapy can be combined with family therapy and assertive community treatment programs targeted to reduce relapse. Cognitive-behaviour therapy improves the prognosis of patients with schizophrenia through improved adherence and symptom management leading to reduced relapse. It may prevent transition to psychosis in high-risk prodromal states. SUMMARY: In conclusion, recent literature provides fairly strong evidence that cognitive-behaviour therapy in addition to antipsychotic medication is effective in the management of acute as well as chronic schizophrenia, However, despite its proven efficacy, it remains a rare commodity, especially outside the United Kingdom.

Journal Article↗
PubMed2004

Cognitive-behavioral therapy for schizophrenia: a review.

Cognitive-behavioral therapy (CBT) has a proven role as an adjunct to antipsychotic medication and remediative approaches such as social skills training in the management of residual symptoms of chronic schizophrenia. Positive symptoms, depression, and overall symptoms appear to be viable treatment targets for CBT with a less pronounced effect on negative symptoms. The effect size at end of therapy is strong, with durability at short-term follow up. CBT can be used safely in patients with schizophrenia, and caregivers can help with homework exercises. There is also evidence that psychiatric nurses in the community can use CBT effectively with this patient group under supervision. CBT can be combined with family therapy and assertive community treatment programs targeted to reduce relapse. CBT improves the coping of patients with schizophrenia through improved adherence and symptom management. CBT techniques include development of trust, normalizing, coping strategy enhancement, reality testing, and work with dysfunctional affective and behavioral reactions to psychotic symptoms. An enhanced response to CBT would be expected when given with low dose cognitively enhancing atypical antipsychotic medication.

Assertiveness↗
PubMed2004

Cognitive behavioral therapy in the treatment of schizophrenia.

This review outlines the role that cognitive behavioral therapy can play in specifically addressing the distress associated with the symptoms of schizophrenia, such as hallucinations and delusions. Some of the features that are given greater emphasis (or are a feature of working with people with psychotic illness), engagement, understanding the onset of the illness and work with hallucinations and delusional beliefs are outlined. The evidence base for the utility of cognitive behavioral therapy is considered, and the development and further application of cognitive behavioral therapy for schizophrenia and related disorders are outlined.

Cognitive Behavioral Therapy↗
PubMed2002

Effectiveness of a brief cognitive-behavioural therapy intervention in the treatment of schizophrenia.

BACKGROUND: Little evidence exists to indicate whether community psychiatric nurses can achieve the results reported by expert cognitive-behavioural therapists in patients with schizophrenia. AIMS: To assess the effectiveness and safety of a brief cognitive-behavioural therapy (CBT) intervention in a representative community sample of patients with schizophrenia in secondary care settings. METHOD: A pragmatic randomised trial was performed involving 422 patients and carers to compare a brief CBT intervention against treatment as usual. RESULTS: Patients who received CBT (n=257) improved in overall symptomatology (P=0.015; number needed to treat [NNT]=13), insight (P<0.001; NNT=10) and depression (P=0.003; NNT=9) compared with the control group (n=165). Insight was clinically significantly improved (risk ratio=1.15, 95% CI 1.01-1.31). There was no increase in suicidal ideation. CONCLUSIONS: Community psychiatric nurses can safely and effectively deliver a brief CBT intervention to patients with schizophrenia and their carers.

Adolescent↗
PubMed2002

A randomized controlled trial of fluvoxamine in prostatodynia, a male somatoform pain disorder.

BACKGROUND: Prostatodynia is a common and often disabling condition that affects males and has the characteristics of a somatoform pain disorder. It presents with urogenital pain and urinary symptoms. Failure of conventional treatment and a successful uncontrolled pilot study with fluvoxamine in this condition prompted this study. METHOD: In a randomized double-blind trial, 42 patients with prostatodynia were assigned to receive either fluvoxamine (N = 21) or placebo (N = 21) for up to 8 weeks. Doses were adjusted according to therapeutic need. The median dose of fluvoxamine was 150 mg (range, 50-300 mg). Self-rated pain scores, urinary flow rates, and depression and anxiety scores were measured at baseline and several times throughout the study period. RESULTS: The groups were similar at baseline, and the results were examined by intent-to-treat analysis either using the last observation carried forward or, in the case of dichotomous measures, counting treatment dropouts as treatment failures. Fluvoxamine was significantly more likely to reduce pain intensity (p = .01) and normalize urinary flow rates (p = .03) with a clinically significant number needed to treat value of 1.5 (confidence interval = 1.12 to 5.50). This therapeutic effect could not be attributed to change in mood, as the 2 groups did not differ with respect to affective ratings at the end of the study. The fluvoxamine-treated group had significantly lower (p = .02) final scores on the General Health Questionnaire, indicating an overall benefit from pain relief. CONCLUSION: Fluvoxamine is a viable treatment for prostatodynia. Dose-ranging studies and longer trials are needed to evaluate this agent further.

Adult↗