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26-03-2014 | Mental health | Article

Lack of insight linked to disengagement with CBT for psychosis


Free abstract

medwireNews: Lack of insight, poor social functioning and negative symptoms help to predict which patients will drop out of cognitive behavioural therapy (CBT) for psychosis, say researchers.

“This pattern of findings indicates that there might be a more socially isolated and difficult-to-reach subgroup of highly symptomatic patients with low insight, who are more skeptical of services and treatment offers”, write lead study author Tania Lincoln (University of Hamburg, Germany) and co-workers in Psychiatry Research.

They suggest that therapy should be adapted to try and prevent drop-out of these patients, such as by conducting home visits or otherwise changing the therapy setting.

Although not individually significant, the three factors, together with the number of previous hospitalisations, predicted which of 80 patients undertaking CBT would complete or discontinue therapy with 87% accuracy.

The study was a secondary analysis of a randomised controlled trial in which 40 patients with DSM-IV psychotic disorders underwent 4 months of CBT and another 40 patients did so after 4 months on a waiting list. Eleven patients across both groups did not complete therapy.

The researchers also looked at symptom changes during therapy. They identified five variables that predicted positive symptoms after therapy over and above the effect of baseline positive symptoms. These were higher levels of depression, more negative symptoms and poorer social skills, role functioning and theory of mind ability, and together accounted for 40% of the variance in post-therapy positive symptoms.

And three variables – poorer functioning, higher delusion conviction and more positive symptoms – predicted negative symptoms after therapy beyond the effect of baseline negative symptoms, explaining 33% of the variance.

Lincoln et al caution that their findings “do not provide a sufficient basis to pre-select patients” for CBT. But they remark that low education, neurocognitive deficits and comorbid disorders were not among the predictors of change during therapy, suggesting that these “pose no barrier to improvement during CBT.”

They also point out that just one treatment-related factor predicted improvements in negative symptoms: a shorter duration of psychosis. “On the background of the other studies with similar findings, this indicates that it is important to get patients into treatment at an earlier stage”, they conclude.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2014

By Eleanor McDermid, Senior medwireNews Reporter