COGNITIVE THERAPY AND RECOVERY FROM ACUTE-PSYCHOSIS - A CONTROLLED TRIAL .1. IMPACT ON PSYCHOTIC SYMPTOMS

Background. The application of cognitive therapy (CT) to psychosis is currently being developed in the UK. This paper reports a trial of CT in acute psychosis with the objective of hastening the resolution of p ositive symptoms and reducing residual symptoms. Method. Of 117 patien ts with acute non-affective psychosis, 69 satisfied inclusion criteria and 40 proceeded to stratified randomisation. The experimental interv ention involving individual and group CT was compared with a group rec eiving matched hours of therapist input providing structured activitie s and informal support; routine pharmacotherapy was provided by clinic ians blind to group allocation. Patients were monitored weekly using s elf-report and mental state assessments during admission and over the subsequent nine months. Results. Both groups showed a decline in posit ive symptoms but this was more marked in the CT group (P <0.001). At 9 months 5% of the CT group, v. 56% of the control group, showed modera te or severe residual symptoms. Conclusion. CT appears to be a potent adjunct to pharmacotherapy and standard care for acute psychosis. Issu es concerning internal and external validity of the study and opportun ities for further research are discussed.