Cognitive Behavioral Therapy for People with Schizophrenia

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There has been renewed interest in psychosocial interventions, including psychotherapy, in the treatment of schizophrenia. In recent years, this has included adapting cognitive behavioral therapy (CBT) techniques previously used mainly in the treatment of mood and anxiety disorders for use with individuals with more severe mental disorders. The core symptoms of schizophrenia in many people have proven to be resistant to treatment with medication alone and can be targeted for treatment with CBT. Impairments in major role function due to negative symptoms, some of which have proved especially recalcitrant to pharmacologic agents, can be addressed with CBT to improve relationships with family and friends and success at work. People with schizophrenia often struggle with comorbid mood and anxiety disorders, including past traumas, which can be successfully treated with CBT.Disseminating and implementing these treatments into a system of care that has, for more than a decade, focused on pharmacologic treatments and community support services has proven challenging especially in the United States.

This article will summarize the current literature on the use of CBT for people with schizophrenia for the primary symptoms of illness, the secondary social impairments, comorbid disorders, and enhancing the effectiveness of other treatments and services, such as medication and vocational support. Ways in which CBT techniques can be incorporated into the current mental health system will be suggested. It should be acknowledged, however, that a few recent reviews and studies have called into question the quality of the evidence or the true effectiveness for CBT in schizophrenia and other severe mental disorders and comorbid conditions.

Ann K. Morrison, MD

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Research May Explain Why Some People With Schizophrenia Do Not Respond to Treatment

New research suggests that the molecular mechanism leading to schizophrenia may be different in patients who fail to respond to anti-psychotic medication compared to patients who do respond.

The research, from King’s College London’s Institute of Psychiatry may help explain why up to one third of patients with schizophrenia do not respond to traditional anti-psychotic medication.

Schizophrenia is known to be associated with an overactive dopamine system, meaning that the brain processes abnormally high levels of dopamine. Traditional dopamine-blocking anti-psychotic medication attempts to normalise this process. However, approximately one third of patients with schizophrenia do not respond to this treatment, and until now, no study has examined whether dopamine abnormality is present in patients resistant to antipsychotic treatment.

…Researchers used PET scan imaging to investigate dopamine synthesis capacity in 12 patients with schizophrenia who did not respond to treatment, 12 who did, and 12 healthy controls. They found that schizophrenia patients whose illness was resistant to antipsychotic treatment have relatively normal levels of dopamine synthesis capacity which would explain why the dopamine blocking anti-psychotic medication was not effective in this group.

Article from HealthCanal.com

For full paper: Demjaha, A. et al. ‘Dopamine synthesis capcity in patients with treatment-resistant schizophrenia’ American Journal of Psychiatry (Nov 2012)

 

Schizophrenia and Autism Linked

Investigators at Columbia University Medical Center in New York City found several cohesive gene networks affected in schizophrenia and determined that these gene networks overlap with autism.

“Very interestingly, the networks that we find for schizophrenia and for autism are quite similar,” senior author Dennis Vitkup, PhD, told Medscape Medical News.

“This suggests that these 2 diseases, and probably many other psychiatric diseases, overlap in terms of the processes they perturb; they perturb some processes important for early brain development,” added Dr. Vitkup.

“The genes forming the networks are highly expressed in the brain, with higher brain expression during prenatal development,” the researchers say. “The identified networks are functionally related to genes previously implicated in schizophrenia, autism and intellectual disability.”

“Evidence of functional convergence among risk genes is consistent with the notion that schizophrenia and autism are both primarily diseases of neuronal communication,” Columbia University coinvestigator Joseph A. Gogos, MD, PhD, noted in a statement. “However, they have distinct clinical features, and the challenge remains to identify the critical neural circuits and mechanisms that differentiate them. This is a step in that direction,” he said.

Knowing the pathway or networks affected in schizophrenia and autism begins to “show us the footprint of the disease,” Dr. Vitkup commented. He predicts that many more genes involved in schizophrenia and autism will eventually be found — possibly as many as 1000 genes for each disorder — and many will likely fall into the networks and pathways they’ve identified.

“If you just focus on individual genes — 1 gene out of 1000 — doesn’t really mean much. But if you have a smaller number of pathways, then you can better identify the significance,” he said.

“This research,” he added, “helps us understand the pathways and biological processes that are affected, which can have clinical implications because it can help direct you toward drug targets or for prognostic purposes.”

–Megan Brooks, Medscape.com

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Sleep, Schizophrenia Link Strengthened In Animal Study

Not getting enough sleep could be linked with triggering symptoms among people with schizophrenia, suggests a new animal study published in the journal Neuron.

…They found that during non-rapid eye movement sleep (NREM sleep, which precedes REM sleep), waves of brain activity normally ripple between the hippocampus and frontal cortex regions of the brain, which play parts in the formation of memories and in decision-making, respectively.

However, when the rats’ NREM sleep was fragmented, they found that this brain wave activity was not synchronized.

…This is certainly not the first time sleep and schizophrenia have been linked. In 2010, a study in the journal Nature Reviews Neuroscience showed that circadian rhythm disruptions are often experienced by people with psychiatric conditions.

–Huffington Post

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A Message of Hope from Lance

I woke up one day with a diagnosis of schizophrenia. I could not fathom that just like being an addict in Narcotics Anonymous, I also had to learn to believe and accept my disease as a paranoid schizophrenic. “We admitted we were powerless over our addiction, that our lives had become unmanageable”.  Please believe it. I know from all of my years of drinking and drugging, self-medicating, I have a lot worse problems than just being a drug addict.

I had to accept my disease and believe that I was really sick. With Narcotics Anonymous meetings and treating my sickness with medication and doctors it has been a long 2 years and 10 months of clean time. Being in and out of hospital situations, my friends, my family, and myself doctors, social workers and other addicts helped to keep me going.  Drugs make my disease so much worse. I would never make it not accepting I have schizophrenia. I just wanted to write that down and share it with someone who is sick like me.

Lance Sheena

Mental Health Could Be Affected by Social Isolation

A new study suggests that isolation can result in reduced production of myelin— a protective nerve fiber— and could contribute to developing mental illness. Myelin acts as an “insulating material” around the areas of nerve cells that send impulses to other nerve cells. Production of the fiber is controlled by nerve cells called oligodendrocytes, but is lost in diseases such as multiple sclerosis. Abnormal myelin has, in other studies, been linked to mental illnesses including autism, anxiety, schizophrenia, and depression. The study, published in the journal Nature Neuroscience, showed that mice who were deprived of social contact had reduced myelin production. Researchers stated this demonstrates that formation of oligodendrocytes is affected by environmental changes.

–News-Medical

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Psychosis Prevention Interview With Dr. Cannon

Psychosis is a terrifying syndrome, as I know first hand. It can disrupt the lives of afflicted young people, as it usually develops just as they are becoming adults.

What if young people at risk for developing a psychotic disorder could know of the danger ahead of time, and choose to engage in preventive therapy? They would have a better chance at a healthy life. In the experimental research and care facilities of the North American Prodrome Longitudinal Study (NAPLS), directed by Dr. Tyrone Cannon of Yale University, ultra-high risk teens are offered this opportunity.

–International Mental Health Organization (IMHRO)

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CBT May Help People Avert Psychosis

A new cognitive-behavioral intervention specifically targeted at cognitive biases—the misleading or erroneous thoughts and ideas that accompany psychosis—appears to have a favorable effect on reducing the likelihood of an acute psychotic episode in individuals deemed to be at “ultra-high risk” for psychosis. That was the finding from a study, “Cognitive-Behavioral Therapy for Subjects at Ultrahigh Risk for Developing Psychosis: A Randomized, Controlled Clinical Trial,” appearing online in Schizophrenia Bulletin.

–Psychiatric News Alert

http://alert.psychiatricnews.org/2012/11/therapy-aimed-at-cognitive-biases-may.html

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The Long Term Benefit of CBT for Psychosis

Not only can cognitive behavioural therapy (CBT) provide sufferers of schizophrenia with additional benefits above and beyond those gained from taking anti-psychotic medication, but some of these benefits continue to persist two years later. Furthermore, the extra expense of providing cognitive behavioural therapy to these patients is offset by money saved from the patients spending less time in hospital.

–Research Digest, blog on brain and behavior

http://bps-research-digest.blogspot.com/2005/09/long-term-benefits-of-cbt-for.html