Treatment-Resistant to Antipsychotics: A Resistance to Everything? Psychotherapy in Treatment-Resistant Schizophrenia and Nonaffective Psychosis: A 25-Year Systematic Review and Exploratory Meta-Analysis
Background: Roughly 30% of schizophrenia patients fail to respond to at least two antipsychotic trials. Psychosis has been traditionally considered to be poorly sensitive to psychotherapy. Nevertheless, there is increasing evidence that psychological interventions could be considered in treatment-re...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-04-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fpsyt.2019.00210/full |
| _version_ | 1828522230547480576 |
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| author | Daniela Polese Daniela Polese Michele Fornaro Mario Palermo Vincenzo De Luca Vincenzo De Luca Andrea de Bartolomeis |
| author_facet | Daniela Polese Daniela Polese Michele Fornaro Mario Palermo Vincenzo De Luca Vincenzo De Luca Andrea de Bartolomeis |
| author_sort | Daniela Polese |
| collection | DOAJ |
| description | Background: Roughly 30% of schizophrenia patients fail to respond to at least two antipsychotic trials. Psychosis has been traditionally considered to be poorly sensitive to psychotherapy. Nevertheless, there is increasing evidence that psychological interventions could be considered in treatment-resistant psychosis (TRP). Despite the relevance of the issue and the emerging neurobiological underpinnings, no systematic reviews have been published. Here, we show a systematic review of psychotherapy interventions in TRP patients of the last 25 years.Methods: The MEDLINE/PubMed, ISI WEB of Knowledge, and Scopus databases were inquired from January 1, 1993, to August 1, 2018, for reports documenting augmentation or substitution with psychotherapy for treatment-resistant schizophrenia (TRS) and TRP patients. Quantitative data fetched by Randomized Controlled Trials (RCTs) were pooled for explorative meta-analysis.Results: Forty-two articles have been found. Cognitive behavioral therapy (CBT) was the most frequently recommended psychotherapy intervention for TRS (studies, n = 32, 76.2%), showing efficacy for general psychopathology and positive symptoms as documented by most of the studies, but with uncertain efficacy on negative symptoms. Other interventions showed similar results. The usefulness of group therapy was supported by the obtained evidence. Few studies focused on negative symptoms. Promising results were also reported for resistant early psychosis.Limitations: Measurement and publication bias due to the intrinsic limitations of the appraised original studies.Conclusions: CBT, psychosocial intervention, supportive counseling, psychodynamic psychotherapy, and other psychological interventions can be recommended for clinical practice. More studies are needed, especially for non-CBT interventions and for all psychotherapies on negative symptoms. |
| first_indexed | 2024-12-11T20:02:46Z |
| format | Article |
| id | doaj.art-c510f02cd55648bfa90ff4c55910d9a5 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-12-11T20:02:46Z |
| publishDate | 2019-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-c510f02cd55648bfa90ff4c55910d9a52022-12-22T00:52:28ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402019-04-011010.3389/fpsyt.2019.00210430990Treatment-Resistant to Antipsychotics: A Resistance to Everything? Psychotherapy in Treatment-Resistant Schizophrenia and Nonaffective Psychosis: A 25-Year Systematic Review and Exploratory Meta-AnalysisDaniela Polese0Daniela Polese1Michele Fornaro2Mario Palermo3Vincenzo De Luca4Vincenzo De Luca5Andrea de Bartolomeis6Treatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples “Federico II”, Naples, ItalyDepartment of Neuroscience, Psychiatric Unit, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, ItalyTreatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples “Federico II”, Naples, ItalyTreatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples “Federico II”, Naples, ItalyCentre for Addiction and Mental Health, Toronto, CanadaDepartment of Psychiatry, University of Toronto, Toronto, ON, CanadaTreatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples “Federico II”, Naples, ItalyBackground: Roughly 30% of schizophrenia patients fail to respond to at least two antipsychotic trials. Psychosis has been traditionally considered to be poorly sensitive to psychotherapy. Nevertheless, there is increasing evidence that psychological interventions could be considered in treatment-resistant psychosis (TRP). Despite the relevance of the issue and the emerging neurobiological underpinnings, no systematic reviews have been published. Here, we show a systematic review of psychotherapy interventions in TRP patients of the last 25 years.Methods: The MEDLINE/PubMed, ISI WEB of Knowledge, and Scopus databases were inquired from January 1, 1993, to August 1, 2018, for reports documenting augmentation or substitution with psychotherapy for treatment-resistant schizophrenia (TRS) and TRP patients. Quantitative data fetched by Randomized Controlled Trials (RCTs) were pooled for explorative meta-analysis.Results: Forty-two articles have been found. Cognitive behavioral therapy (CBT) was the most frequently recommended psychotherapy intervention for TRS (studies, n = 32, 76.2%), showing efficacy for general psychopathology and positive symptoms as documented by most of the studies, but with uncertain efficacy on negative symptoms. Other interventions showed similar results. The usefulness of group therapy was supported by the obtained evidence. Few studies focused on negative symptoms. Promising results were also reported for resistant early psychosis.Limitations: Measurement and publication bias due to the intrinsic limitations of the appraised original studies.Conclusions: CBT, psychosocial intervention, supportive counseling, psychodynamic psychotherapy, and other psychological interventions can be recommended for clinical practice. More studies are needed, especially for non-CBT interventions and for all psychotherapies on negative symptoms.https://www.frontiersin.org/article/10.3389/fpsyt.2019.00210/fulltreatment-resistant psychosisdopamine supersensitivitynegative symptomspsychotherapybehavioral therapygroup psychotherapy |
| spellingShingle | Daniela Polese Daniela Polese Michele Fornaro Mario Palermo Vincenzo De Luca Vincenzo De Luca Andrea de Bartolomeis Treatment-Resistant to Antipsychotics: A Resistance to Everything? Psychotherapy in Treatment-Resistant Schizophrenia and Nonaffective Psychosis: A 25-Year Systematic Review and Exploratory Meta-Analysis Frontiers in Psychiatry treatment-resistant psychosis dopamine supersensitivity negative symptoms psychotherapy behavioral therapy group psychotherapy |
| title | Treatment-Resistant to Antipsychotics: A Resistance to Everything? Psychotherapy in Treatment-Resistant Schizophrenia and Nonaffective Psychosis: A 25-Year Systematic Review and Exploratory Meta-Analysis |
| title_full | Treatment-Resistant to Antipsychotics: A Resistance to Everything? Psychotherapy in Treatment-Resistant Schizophrenia and Nonaffective Psychosis: A 25-Year Systematic Review and Exploratory Meta-Analysis |
| title_fullStr | Treatment-Resistant to Antipsychotics: A Resistance to Everything? Psychotherapy in Treatment-Resistant Schizophrenia and Nonaffective Psychosis: A 25-Year Systematic Review and Exploratory Meta-Analysis |
| title_full_unstemmed | Treatment-Resistant to Antipsychotics: A Resistance to Everything? Psychotherapy in Treatment-Resistant Schizophrenia and Nonaffective Psychosis: A 25-Year Systematic Review and Exploratory Meta-Analysis |
| title_short | Treatment-Resistant to Antipsychotics: A Resistance to Everything? Psychotherapy in Treatment-Resistant Schizophrenia and Nonaffective Psychosis: A 25-Year Systematic Review and Exploratory Meta-Analysis |
| title_sort | treatment resistant to antipsychotics a resistance to everything psychotherapy in treatment resistant schizophrenia and nonaffective psychosis a 25 year systematic review and exploratory meta analysis |
| topic | treatment-resistant psychosis dopamine supersensitivity negative symptoms psychotherapy behavioral therapy group psychotherapy |
| url | https://www.frontiersin.org/article/10.3389/fpsyt.2019.00210/full |
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