Abstract
BackgroundPrepulse inhibition (PPI) of the startle response refers to the ability of a weak prestimulus to transiently inhibit the response to a closely following strong sensory stimulus. PPI provides an operational index of sensorimotor gating and is reduced, on average, in people with schizophrenia, relative to healthy people. Given the variable response to Cognitive Behaviour Therapy for psychosis (CBTp) and positive associations between pre-therapy brain and cognitive functions and CBT outcome across disorders, we examined whether pre-therapy level of PPI is associated with clinical outcome following CBTp. MethodFifty-six outpatients stable on medication with at least one distressing symptom of schizophrenia and willing to receive CBTp in addition to their usual treatment were assessed on acoustic PPI. Subsequently, 28 patients received CBTp (CBTp+treatment-as-usual, 23 completers) for 6–8months and 28 continued with their treatment-as-usual (TAU-alone, 17 completers). Symptoms were assessed (blindly) at entry and follow-up. ResultsThe CBTp+TAU and TAU-alone groups did not differ demographically, clinically or in PPI at baseline. The CBTp+TAU group showed improved symptoms relative to the TAU-alone group, which showed no change, at follow-up. Pre-therapy PPI level correlated positively with post-CBTp symptom improvement. ConclusionsRelatively intact sensorimotor gating is associated with a good clinical response following a 6–8months course of NICE compliant CBTp in schizophrenia. Pharmacological or psychological interventions capable of improving PPI may enhance the effectiveness of CBTp in people with schizophrenia, particularly in those who fail to show clinical improvement with currently available antipsychotic drugs and adjunctive CBTp.
Highlights
Despite marked symptom improvement with the use of antipsychotics in acutely ill patients with schizophrenia (Kasper, 2006), the long-term outcome for up to 40% of patients remains unsatisfactory as they continue to suffer from one or more distressing symptoms despite remaining medication compliant (Conley and Kelly, 2001; Potkin et al, 2009)
We did not find a direct association between symptom improvement following Cognitive Behaviour Therapy for psychosis (CBTp) and pre-therapy cognitive performance, assessed with a number of tests commonly employed in schizophrenia research (Premkumar et al, 2011), we did observe greater hippocampal grey matter volume in CBTp responders, compared to CBTp non-responders in the same sample (Premkumar et al, 2009)
Supporting our hypothesis, the finding of this study revealed a positive association between prepulse inhibition (PPI) and symptom improvement following CBTp
Summary
Despite marked symptom improvement with the use of antipsychotics in acutely ill patients with schizophrenia (Kasper, 2006), the long-term outcome for up to 40% of patients remains unsatisfactory as they continue to suffer from one or more distressing symptoms despite remaining medication compliant (Conley and Kelly, 2001; Potkin et al, 2009). Penades et al (2010) reported a positive association between verbal memory and clinical outcome following CBTp. we did not find a direct association between symptom improvement following CBTp and pre-therapy cognitive performance, assessed with a number of tests commonly employed in schizophrenia research (Premkumar et al, 2011), we did observe greater hippocampal grey matter volume in CBTp responders, compared to CBTp non-responders in the same sample (Premkumar et al, 2009). Pharmacological or psychological interventions capable of improving PPI may enhance the effectiveness of CBTp in people with schizophrenia, in those who fail to show clinical improvement with currently available antipsychotic drugs and adjunctive CBTp
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