Effective treatment of psychotic disorders: A Synthesis of Findings from 26 Studies

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Original Abstract of the Article

Major findings

Research on the treatment of psychotic disorders covers a wide range of areas, including medication, cognitive behavioral therapy, family therapy, and social rehabilitation. Numerous studies have been conducted to evaluate the effectiveness and safety of these treatments, each with its own characteristics, benefits, and limitations.

For example, 15 presents the results of a study examining the benefits and risks of gradually reducing and discontinuing antipsychotic medications over a long period. The study found that reducing or discontinuing antipsychotics may lead to improvements in social functioning, but also suggested a potential increase in relapse risk in the short term.

In addition, 11 analyzed predictive factors of treatment resistance in individuals experiencing their first psychotic episode. The study identified several factors associated with treatment resistance: lower premorbid functioning, lower education level, negative symptoms during the initial psychotic episode, co-occurring substance abuse, younger age at onset, lack of early response, non-adherence to treatment, and longer duration of untreated psychosis.

Furthermore, 10 explored the effectiveness of cognitive behavioral therapy for social activation (CBTsa) in individuals recently diagnosed with a psychotic disorder. CBTsa showed promising results in improving negative symptoms associated with psychotic disorders.

Treatment Summary

15 presented findings on a study that investigated the reduction and discontinuation of antipsychotic medications. The study indicated that reducing antipsychotic dosages might lead to improved social function but also raised concerns about the potential for increased relapse risk in the short term.

11 provided an analysis of predictive factors for treatment resistance in individuals experiencing their first psychotic episode. The research highlighted factors associated with treatment resistance, including premorbid functional limitations, lower educational attainment, negative symptoms during the initial psychotic episode, substance use disorders, younger age at onset, lack of initial response, treatment non-compliance, and prolonged periods without treatment.

10 investigated the effectiveness of cognitive behavioral therapy for social activation (CBTsa) in individuals newly diagnosed with a psychotic disorder. The study found that CBTsa demonstrated potential benefits in alleviating negative symptoms related to psychotic disorders.

Benefits and risks

Benefit Summary

Treatment for psychotic disorders can contribute to symptom relief, improved social functioning, relapse prevention, and enhanced quality of life. These benefits can be achieved through a variety of treatment approaches, including medication, cognitive behavioral therapy, family therapy, and social rehabilitation.

Risk Summary

Treatment for psychotic disorders carries certain risks, including potential side effects from medications and treatment resistance. There is also the possibility of treatment not being fully effective or treatment interruptions. Collaboration with a healthcare professional is crucial to minimizing these risks.

Comparison of Studies

Commonalities among studies

Many studies focus on evaluating the effectiveness of medication, cognitive behavioral therapy, family therapy, and other interventions in the treatment of psychotic disorders. They also investigate important issues like treatment resistance, relapse risk, and the sustainability of treatment outcomes.

Differences among studies

It's important to note that differences exist between studies in terms of the patient populations, types of treatments, assessment methods, and study durations. For instance, 15 conducted a long-term study, while 10 focused on a shorter-term investigation.

Consistency and contradictions in results

Research on the treatment of psychotic disorders has yielded both consistent and contradictory results. For example, 15 suggested that reducing antipsychotic dosages might improve social function, but it also indicated a possible increase in relapse risk in the short term. This could be related to factors mentioned in 11 , such as treatment non-adherence and extended periods without treatment. Further research is necessary to address these inconsistencies.

Considerations for applying findings in real life

It's crucial to understand that research findings on the treatment of psychotic disorders cannot be directly applied to everyday life. Treatment decisions should be made in consultation with a healthcare professional, taking into account the individual patient's symptoms, medical history, and lifestyle. Particularly, the predictive factors for treatment resistance identified in 11 highlight the importance of initiating treatment early and maintaining consistent therapeutic engagement.

Limitations of current research

Research on the treatment of psychotic disorders faces several challenges, including the diversity of patient populations, the complexity of treatment approaches, and the difficulty of conducting long-term follow-up studies. Moreover, 25 mentions the development of new medications, but they are still in clinical trials and not yet available for widespread use.

Future research directions

Research on the treatment of psychotic disorders must continue to focus on developing more effective and safe treatments, elucidating the mechanisms underlying treatment resistance and relapse, and establishing personalized treatment approaches for individual patients. Studies focusing on immune biomarkers, as outlined in 16 , and the development of new medications, as mentioned in 25 , offer promising directions for future research.

Conclusion

The treatment of psychotic disorders can benefit from the combined use of various approaches, including medication, cognitive behavioral therapy, family therapy, and social rehabilitation. These combined treatments offer the potential for symptom relief, improved social functioning, relapse prevention, and enhanced quality of life. However, treatment carries inherent risks, such as side effects from medications and treatment resistance. Collaboration with a healthcare professional is essential for guiding treatment decisions. Future research should aim to develop more effective and safe treatments, establish personalized treatment approaches, and enhance our understanding of the mechanisms underlying treatment resistance and relapse. Psychotic disorders are not incurable. Seeking appropriate treatment and support, and actively engaging in life are crucial steps for individuals with these conditions.

Treatment List

Medication, Cognitive Behavioral Therapy, Family Therapy, Social Rehabilitation, Antipsychotic Medications, CBTsa, Immunological Biomarkers, New Medications

Literature analysis of 26 papers
Positive Content
24
Neutral Content
1
Negative Content
1
Article Type
5
2
8
11
25
1.

Depot flupenthixol decanoate for schizophrenia or other similar psychotic disorders.

Author: QuraishiS, DavidA

Lower relapse rate
Reduced movement disorders
Insufficient evidence

There is no clear evidence that flupenthixol decanoate is more effective than other depot antipsychotics for schizophrenia. Larger, well-designed trials are needed.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

2.

Depot fluspirilene for schizophrenia.

Author: QuraishiS, DavidA

Reduced movement disorders
Insufficient evidence

There is no convincing evidence that fluspirilene decanoate is more effective than oral chlorpromazine or other depot antipsychotics for schizophrenia. More research is needed to inform clinical practice.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

3.

Duration of untreated psychosis and its relationship to clinical outcome.

Author: NormanRoss M G, LewisShôn W, MarshallMax

Remission of positive symptoms
Correlational evidence
Neurotoxic effects

Evidence suggests that longer duration of untreated psychosis (DUP) is an independent predictor of poorer treatment outcome, particularly remission of positive symptoms. More research is needed to confirm causality.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

4.

[Early detection of psychotic disorders].

Author: SchäferMiriam R, KlierClaudia M, PapageorgiouKonstantinos, FriedrichMax H, AmmingerG Paul

Prevent psychosis
Reduce treatment delays

Early intervention programs for schizophrenia and other psychotic disorders are being established globally.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : German

5.

[Cognitive-behavioral group treatment for schizophrenia and other psychotic disorders- a systematic review].

Author: Mortan SeviOya, Tekinsav SütcüSerap

Decrease anxiety
Improve hopelessness
Reduce psychosis symptoms

Cognitive-behavioral therapies plus standard treatment are effective in decreasing the symptoms of schizophrenia and other psychotic disorders (positive and negative symptoms) and/or the problems that accompany the disorder (anxiety, hopelessness).

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : Turkish

6.

Changes in insight during treatment for psychotic disorders: a meta-analysis.

Author: PijnenborgGerdina H M, van DonkersgoedRozanne J M, DavidAnthony S, AlemanAndré

Improved insight

A meta-analysis of psychological and pharmacological treatments for psychosis found that these treatments can improve insight into illness.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

7.

First rank symptoms for schizophrenia.

Author: Soares-WeiserKarla, MaayanNicola, BergmanHanna, DavenportClare, KirkhamAmanda J, GrabowskiSarah, AdamsClive E

Psychotic disorders
Schizophrenia

Early and accurate diagnosis of schizophrenia is important for better long-term outcomes. Delaying treatment can lead to more severe symptoms and slower recovery. This study aims to determine whether specific symptoms, known as First Rank Symptoms (FRS), are helpful in distinguishing schizophrenia from other psychotic disorders, as there is uncertainty about how accurate these symptoms are in making diagnoses.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

8.

Cost effectiveness of interpersonal community psychiatric treatment for people with long-term severe non-psychotic mental disorders: protocol of a multi-centre randomized controlled trial.

Author: van VeenMark, KoekkoekBauke, MulderNiels, PostulartDebby, AdangEddy, TeerenstraSteven, SchoonhovenLisette, van AchterbergTheo

Cost reduction
Health gain

The study aims to improve the care for individuals with long-term non-psychotic psychiatric disorders. A new treatment model called Interpersonal Community Psychiatric Treatment (ICPT) is being compared to standard care.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

9.

Prolonged exposure and EMDR for PTSD v. a PTSD waiting-list condition: effects on symptoms of psychosis, depression and social functioning in patients with chronic psychotic disorders.

Author: de BontP A J M, van den BergD P G, van der VleugelB M, de RoosC, de JonghA, van der GaagM, van MinnenA M

EMDR effective
PE effective
Remission from schizophrenia

Prolonged exposure (PE) and eye movement desensitization and reprocessing (EMDR) reduced PTSD symptoms and paranoid thoughts in patients with chronic psychotic disorders. More patients in the PE and EMDR groups achieved remission from their psychotic disorder.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

10.

Cognitive behavioral therapy for social activation in recent-onset psychosis: Randomized controlled trial.

Author: PosKarin, FrankeNathalie, SmitFilip, WijnenBen F M, StaringAnton B P, Van der GaagMark, MeijerCarin, de HaanLieuwe, VelthorstEva, SchirmbeckFrederike

Improved psychotic disorder treatment

Negative symptoms in psychosis are difficult to treat and contribute to poor outcomes. A cognitive-behavioral approach has shown promise for people with chronic schizophrenia. This study investigates whether a combination of group and individual therapy focused on social engagement (CBTsa) could benefit people recently diagnosed with psychosis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

12.

[Use of psychoactive substances as a treatment for psychosis].

Author: Serrano-JiménezE, de Lucas-MorenoM G

Psychotic disorder treatment

Psychotic disorders are long-term mental health problems. While medications are used to treat them, these drugs primarily focus on certain symptoms and have many side effects. We need new treatments that target other brain systems. This review will examine whether certain medications used for other conditions could be helpful in treating people with psychotic disorders.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : Spanish

13.

Treatment with psychostimulants and atomoxetine in people with psychotic disorders: reassessing the risk of clinical deterioration in a real-world setting.

Author: CorbeilOlivier, BrodeurSébastien, CourteauJosiane, BéchardLaurent, Huot-LavoieMaxime, AngelopoulosElaine, Di StefanoSamanta, MarroneErica, VanasseAlain, FleuryMarie-Josée, StipEmmanuel, LesageAlain, JooberRidha, DemersMarie-France, RoyMarc-André

ADHD treatment
Psychostimulant safety

In a real-world setting, methylphenidate, amphetamines, and atomoxetine, when used concurrently with antipsychotic medication, were associated with a decreased risk of hospital admission for psychosis in individuals with psychotic disorders.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

14.

Outpatients with psychotic disorders need physical health-promoting treatment: A cross-sectional multisite study.

Author: KaasgaardDidde Marie, StryhnLene, Veldt LarsenPia, FiskerLone, Friis ElliottAnja, HøghLene, ThunbergRolf, Knudsgaard SørensenMette, MartinsenPernille, Kjær HansenHanne, Munk-JørgensenPovl, HjorthPeter

Improved QoL
Comorbidities

This study found that a majority of outpatients with primary non-affective psychotic disorders need health-promoting interventions, but only about 40% receive such care.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

15.

Antipsychotic dose reduction and discontinuation versus maintenance treatment in people with schizophrenia and other recurrent psychotic disorders in England (the RADAR trial): an open, parallel-group, randomised controlled trial.

Author: MoncrieffJoanna, CrellinNadia, StansfeldJacki, CooperRuth, MarstonLouise, FreemantleNick, LewisGlyn, HunterRachael, JohnsonSonia, BarnesThomas, MorantNicola, PinfoldVanessa, SmithRuth, KentLyn, DartonKatherine, LongMaria, HorowitzMark, HorneRobert, VickerstaffVictoria, JhaMithilesh, PriebeStefan

Improved social functioning
Increased relapse

Maintenance antipsychotic medication for schizophrenia or recurrent psychosis carries burdens of adverse effects. This study aims to assess the benefits and harms of antipsychotic reduction compared to maintenance treatment, hypothesizing improved social functioning with a short-term increase in relapse.

Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

16.

Immunological Biomarkers as Predictors of Treatment Response in Psychotic Disorders.

Author: OrbeElif Bayram, BenrosMichael Eriksen

Personalized medicine

This review examines the potential of baseline inflammatory biomarkers as predictors of treatment response to anti-inflammatory drugs in patients with psychotic disorders. The findings suggest a correlation between biomarkers and treatment response, but further research is needed.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

19.

Clinicians' perceptions of family involvement in the treatment of persons with psychotic disorders: a nested qualitative study.

Author: HestmarkLars, RomørenMaria, HanssonKristiane Myckland, HeiervangKristin Sverdvik, PedersenReidar

Better treatment outcomes
Improved mental health
Increased stress on family
Potential for conflict

This study explores clinicians' perceptions of the benefits and disadvantages of family involvement in mental health care.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

21.

The Effects of Treatment in Psychotic Disorders-Changes in BDNF Levels and Clinical Outcomes: Systematic Review.

Author: MosiołekAnna, MosiołekJadwiga

Psychotic disorder treatment
Psychotic disorders

Brain-derived neurotrophic factor (BDNF) is a potential biomarker for psychotic disorders, as decreased levels can impair neuronal signaling and contribute to symptoms like working memory impairment. This review analyzes the influence of antipsychotic and non-pharmacological treatments on BDNF levels in patients with psychotic disorders. While some studies show an increase in BDNF levels with antipsychotic treatment, further research is needed to establish a clear correlation with clinical outcomes.

Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

23.

The duty of confidentiality during family involvement: ethical challenges and possible solutions in the treatment of persons with psychotic disorders.

Author: HanssonKristiane Myckland, RomørenMaria, WeimandBente, HeiervangKristin Sverdvik, HestmarkLars, LandeweerElleke G M, PedersenReidar

Family involvement
Confidentiality issues

This sub-study explores ethical challenges related to the duty of confidentiality as experienced by mental health professionals in the context of family involvement during severe mental illness. It investigates key measures that might contribute to improving the handling of such challenges.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

24.

Psychotic Disorders in the Elderly: Diagnosis, Epidemiology, and Treatment.

Author: FischerCorinne E, NamasivayamAndrew, Crawford-HollandLucas, HakobyanNarek, SchweizerTom A, MunozDavid G, PollockBruce G

Psychosis treatment
Dementia
Psychosis

This review discusses recent advances in understanding and treating psychosis in the elderly population. It covers topics such as late life psychiatric disorders, dementia-related psychosis, and emerging therapies. The review emphasizes the need for tailored treatment approaches for this population.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

26.

Health-related quality of life in severe psychotic disorders during integrated care: 5-year course, prediction and treatment implications (ACCESS II).

Author: RohenkohlAnja Christine, DaubmannAnne, GallinatJürgen, KarowAnne, KraftVivien, RühlFriederike, SchöttleDaniel, LambertMartin, SchröterRomy

Care model effectiveness
Patient satisfaction
Quality of life

This study focuses on the importance of long-term quality of life (QoL) assessments in patients with severe psychotic disorders. It highlights the need for robust data to support the development and implementation of effective and patient-centered care models.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

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