Behavioural Family Intervention Research Articles

Multifaceted, Brief Intensive Home-Based Exposure Treatment in Patients with Obsessive-Compulsive Disorder Who are Nonresponsive to Regular Cognitive Behavior Therapy: An Uncontrolled Pilot Study.

To test a multifaceted treatment program for patients with obsessive-compulsive disorder (OCD) who did not respond to regular cognitive behavior therapy (CBT). The treatment addresses several factors that may play a role in maintaining OCD. We designed a treatment consisting of a 6-day intensive, individual exposure in vivo with response prevention (ERP) format, with 24 therapist-assisted treatment hours at the patient's home and 12 self-controlled ERP hours, including behavioral activation and family interventions. Next, we investigated the effect (obsessive-compulsive symptoms, comorbidity, functioning, quality of life, OCD-related interaction patterns) and feasibility (dropout, treatment satisfaction, and organization) of this program using pre-post-tests, pre-follow-up tests, and qualitative data from patients, family members, and therapists. In a sample of 22 participants, obsessive-compulsive symptoms (Y-BOCS pre: 28.7, post: 15.9; Wilcoxon S-R tests P<0.01) improved significantly, as did most other effect measures. Results were largely, but not completely, preserved at 3-month follow-up. There was only 1 dropout. Patients, family members, and therapists were satisfied with the treatment. Implementation of the treatment did not pose difficulties. In nonresponders with OCD, a multifaceted, brief, intensive home-based ERP program targeting factors maintaining OCD is promising and feasible. Extra care is needed to maintain improvement.

The Effects of Online Behavioral Parenting Interventions on Child Outcomes, Parenting Ability and Parent Outcomes: A Systematic Review and Meta-analysis

The twenty-first century has seen the development and delivery of online programs of behavioral family intervention for disruptive child behavior. Typically, programs evaluate outcomes in terms of change in child functioning and change in parenting ability. Existing research has also articulated the importance of parent–child relational capacity and its role in facilitating change in child functioning, and the importance of parent emotion regulation in the interests of ensuring optimal child development. These factors were explored in a meta-analysis of k = 14 prospective longitudinal research studies of online parenting interventions for disruptive child behavior. Peer reviewed randomized controlled trials with inactive control groups that were published in English between 2000 and 2022 were included in the review if they were delivered online; offered parent self-directed treatment; included as participants families who were screened as having child behavioral difficulties on validated psychometric assessment measures; and assessed child treatment outcomes, parenting ability and parent treatment outcomes. The protocol for this study was pre-registered with PROSPERO (CRD42020215947). Statistical analyses employed random effects models and reported pooled effect sizes (Hedge’s g) within and between groups. Results emphasize the importance of child outcomes and parenting ability in program assessment, however, suggest that parents’ capacity to develop optimal parent–child relationships and regulate emotion may not be sufficiently reflected in program content. Identified continuous and categorical moderators of treatment outcome were also assessed. Results of the review are discussed in terms of their potential to influence the future development of online programs of behavioral family intervention and, therefore, child development.

Psychosocial and psychological interventions for schizophrenia relapse prevention: A bibliometric analysis.

Various psychosocial and psychological interventions have been developed to reduce schizophrenia relapse prevention. A better understanding of these active interventions is important for clinical practice and for meaningful allocation of resources. However, no bibliometric analysis of this area has been conducted. Studies were retrieved from the Web of Science Core Collection database. The publication outputs and cooperation of institutions were visualized with Origin 2021. Global cooperation was visualized using ArcGIS Pro3.0. VOSviewer was used to generate visualizations of network of authors and keywords. The number of annual publications generally showed a fluctuating upward trend over the past 20years. Germany published the most relevant articles (361, 26.76%). The Technical University of Munich was the most productive institution (70, 9.86%). Leucht Stefan published the most articles (46, 6.48%) and had the highest number of citations (4,375 citations). Schizophrenia Research published the most studies (39, 5.49%). Keywords were roughly classified into three clusters: cognitive behavioral therapy (CBT), family interventions and family psychoeducation and other factors related to interventions. The findings provided the current status of research on psychosocial and psychological interventions for schizophrenia relapse prevention from a bibliometric perspective. Recent research has mainly focused on CBT, family interventions and family psychoeducation.

Investigation of contemporary college students' mental health status and construction of a risk prediction model.

Due to academic pressure, social relations, and the change of adapting to independent life, college students are under high levels of pressure. Therefore, it is very important to study the mental health problems of college students. Developing a predictive model that can detect early warning signals of college students' mental health risks can help support early intervention and improve overall well-being. To investigate college students' present psychological well-being, identify the contributing factors to its decline, and construct a predictive nomogram model. We analyzed the psychological health status of 40874 university students in selected universities in Hubei Province, China from March 1 to 15, 2022, using online questionnaires and random sampling. Factors influencing their mental health were also analyzed using the logistic regression approach, and R4.2.3 software was employed to develop a nomogram model for risk prediction. We randomly selected 918 valid data and found that 11.3% of college students had psychological problems. The results of the general data survey showed that the mental health problems of doctoral students were more prominent than those of junior college students, and the mental health of students from rural areas was more likely to be abnormal than that of urban students. In addition, students who had experienced significant life events and divorced parents were more likely to have an abnormal status. The abnormal group exhibited significantly higher Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 scores than the healthy group, with these differences being statistically significant (P < 0.05). The nomogram prediction model drawn by multivariate analysis included six predictors: The place of origin, whether they were single children, whether there were significant life events, parents' marital status, regular exercise, intimate friends, and the PHQ-9 score. The training set demonstrated an area under the receiver operating characteristic (ROC) curve (AUC) of 0.972 [95% confidence interval (CI): 0.947-0.997], a specificity of 0.888 and a sensitivity of 0.972. Similarly, the validation set had a ROC AUC of 0.979 (95%CI: 0.955-1.000), with a specificity of 0.942 and a sensitivity of 0.939. The H-L deviation test result was χ2 = 32.476, P = 0.000007, suggesting that the model calibration was good. In this study, nearly 11.3% of contemporary college students had psychological problems, the risk factors include students from rural areas, divorced parents, non-single children, infrequent exercise, and significant life events.

Effect of cognitive behavioral group therapy on rehabilitation of community patients with schizophrenia: A short-term randomized control trial.

The efficacy of cognitive behavioral group therapy (CBGT) for cognitive dys-function and negative symptoms of schizophrenia is established, but more evidence is required. To assess the effectiveness of CBGT combined with mental health education as a treatment for schizophrenia compared with mental health education alone. In all, 120 schizophrenia out-patients were randomized into CBGT combined with mental health education or single mental health education. The primary outcomes were positive and negative symptoms, cognitive function, excitatory factor, anxiety and depression symptom improvements on the positive and negative syndrome scale score. Secondary outcome measures included social function and drug compliance. There were significant differences between CBGT combined with mental health education and single mental health education on measures of positive and negative symptoms, cognitive functions, excitatory factor, anxiety and depression symptoms, and social functions. No other significant difference in outcomes was observed. CBGT combined with mental health education may be relevant beneficial treatment method in reducing symptoms, cognitive and social functions of patients with schizophrenia.

Role of adjunctive nonpharmacological strategies for treatment of rapid-cycling bipolar disorder.

Rapid-cycling bipolar disorder (RCBD) is a phase of bipolar disorder defined by the presence of ≥ 4 mood episodes in a year. It is a common phenomenon characterized by greater severity, a predominance of depression, higher levels of disability, and poorer overall outcomes. It is resistant to treatment by conventional pharmacotherapy. The existing literature underlines the scarcity of evi-dence and the gaps in knowledge about the optimal treatment strategies for RCBD. However, most reviews have considered only pharmacological treatment options for RCBD. Given the treatment-refractory nature of RCBD, nonpharmacological interventions could augment medications but have not been adequately examined. This review carried out an updated and comprehensive search for evidence regarding the role of nonpharmacological therapies as adjuncts to medications in RCBD. We identified 83 reviews and meta-analyses concerning the treatment of RCBD. Additionally, we found 42 reports on adjunctive nonpharmacological treatments in RCBD. Most of the evidence favoured concomitant electroconvulsive therapy as an acute and maintenance treatment. There was pre-liminary evidence to suggest that chronotherapeutic treatments can provide better outcomes when combined with medications. The research on adjunctive psychotherapy was particularly scarce but suggested that psychoeducation, cognitive behavioural therapy, family interventions, and supportive psychotherapy may be helpful. The overall quality of evidence was poor and suffered from several methodological shortcomings. There is a need for more methodologically sound research in this area, although clinicians can use the existing evidence to select and individualize nonpharmacological treatment options for better management of RCBD. Patient summaries are included to highlight some of the issues concerning the implementation of adjunctive nonpharmacological treatments.

Pilot study of genome-wide DNA methylation and gene expression for treatment response to escitalopram in panic disorder.

Antidepressants, particularly selective serotonin reuptake inhibitors, are currently considered the first-line treatment for panic disorder (PD). However, little is known about the relationship between the biomarkers that may predict better treatment. To compare genome-wide methylation and gene expression patterns between responsive and non-responsive patients with PD after 4 wk of escitalopram treatment. Thirty patients with PD were enrolled in this study (responders = 13; non-responders = 17). All patients were assessed using the PD Severity Scale-Chinese version before and after treatment. The Illumina Infinium MethylationEPIC (850k) BeadChip for genome-wide methylation screening and mRNA sequencing was used in all patients with PD. A total of 701 differentially methylated positions (DMPs) were found between responders and non-responders (|Δβ| ≥ 0.06, q < 0.05), and the hyper- and hypomethylated CpG sites were 511 (72.9%) and 190 (27.1%), respectively. Relative to non-responders, there were 59 differential transcripts, of which 20 were downregulated and 39 were upregulated (q < 0.05). However, no differentially expressed genes were identified by mRNA sequencing after correcting for multiple testing (|log2(FC)| > 1, q > 0.05). This preliminary study showed that DMPs might be associated with the treatment response to escitalopram in PD; however, these DMPs need to be verified in large samples.

Actualización sobre los trastornos de la conducta alimentaria

Eating disorders (ED) (mainly anorexia, bulimia, and binge eating disorder) mainly start in adolescence and youth. They are characterized by restriction of calories and/or food types, recurrent binges, and compensatory behaviors that lead to a state of malnutrition. Patients also present with an exaggerated preoccupation with their weight and body image. ED tend to entail relapses. A multidisciplinary treatment approach is fundamental. The use of psychotropic drugs in anorexia nervosa would be limited to clinical forms of severe intensity or for the treatment of comorbid disorders. In bulimia nervosa, it would be limited to the use of fluoxetine and, most of all, associated with cognitive behavioral psychotherapy and family intervention. Psychiatric comorbidities are common (anxiety disorders, depressive episodes, substance abuse, or risk of suicide). The diagnosis is clinical and thus the main tool is a clinical interview, but a medical-nutritional evaluation is also necessary.

Behavioural family interventions versus structural family interventions for people with schizophrenia

Behavioural family interventions versus structural family interventions for people with schizophrenia

Early Intervention Model for Mental Health in Korean Youth: Mindlink

Early detection and intervention are necessary to prevent deterioration and promote recovery in patients with schizophrenia. Mindlink is the first community-based early intervention center for young people with mental illness in Korea. This service was introduced in 2012 as a national mental health pilot project in Bukgu, Gwangju Metropolitan City. Due to the increase in the number of young clients, a youth-friendly, early intervention center called Mindlink was established in 2016. Mindlink is a comprehensive mental health service provided throughout multidisciplinary collaboration. It provides intensive case management and group programs, including cognitive behavioural therapy, family intervention, psychoeducation, motivational enhancement, and physical health promotion. The Korean government has stated that the Mindlink model is effective and is currently expanding the model to other areas in Korea. An increasing number of young people with distressing mental illnesses and their family members are approaching Mindlink for help. They are seeking early psychiatric intervention despite the stigma associated with mental illnesses. Our experience with the Mindlink model suggests that investing in improving the mental health in youth and in service delivery can overcome the stigma associated with mental illnesses and other barriers to mental health services. There is currently a lack of comprehensive mental health services for youth, which is a major problem. An accessible, youth-friendly, stigma-free, community mental health center, such as Mindlink, allows early detection and management of mental illnesses in young patients. Therefore, developing early intervention centers at the national level is urgently required.

Reconnecting Homeless Adolescents and Their Families: Correlates of Participation in a Family Intervention.

Behavioral family interventions are an effective way to intervene to prevent negative developmental outcomes for adolescents. Participation in family interventions encompasses behavioral and cognitive/attitudinal dimensions, among others, indicated by retention and engagement, respectively. Two dimensions of participation, retention and engagement, in a family intervention were examined in a sample of newly homeless adolescents and their parents or guardians. Correlates of participation included parents with more income and less perceived family conflict and adolescents with higher endorsement of depression, anxiety, somatization, obsessive-compulsive, phobic, and psychotic symptoms on the Brief Symptom Inventory (BSI). Stronger therapeutic alliance was correlated with being more distressed (i.e., lower income, more hostility), being a female adolescent participant, and having greater comfort discussing sex with parents. Furthermore, parents and adolescents with greater distress and thus greater need were more apt to finish the intervention. The finding that families who were experiencing more distress had higher alliance scores suggests that there is an additional need for development of interventions for families in crisis. Both participant and provider perceptions are also important in development of a strong therapeutic alliance. This study's findings have implications for further exploration of the development of cultural humility and improving mental health literacy among facilitators of behavioral interventions.

1320-P: Building Trust between Researchers and African American and Latino Families of Children with T1D to Enhance Recruitment, Retention, and the Relevance of Research

Background: African American and Latino children with type 1 diabetes (T1D) have persistent disparities in diabetes outcomes. Diabetes outcomes can be significantly improved through behavior change interventions. However, existing behavioral family interventions for T1D have almost exclusively been implemented and evaluated among samples comprised of primarily non-Latino white families because of obstacles to building trust in studies. Challenges to building trust include relatively low percentages of youth with T1D compared to non-Latino whites, and aspects of the academic environment. Identifying and implementing strategies to build trust with minority communities will improve representation in behavioral intervention research. Methods: We describe methods used to improve recruitment and retention in an ongoing pilot randomized control trial for parents of 60 African American and Latino children. Our community-engaged approach included consultation with culturally-informed communications experts, partnering with community resources (e.g., Health Department and Cooperative Extension Program), and engaging a family advisory board to advise on study branding, recruitment methods, and intervention components. We developed and implemented community information sessions about the study and a “T1D Research and Education Day Event” to launch recruitment. We conducted in-person recruitment visits within a diabetes care center. Results: Six parents joined the advisory board. Six families attended the informational events. To date, 51 families have consented to participate in the study: 89% of the 8 eligible families in attendance enrolled at the launch event, and 66% of 67 approached in clinic enrolled (68% overall enrollment rate). Conclusions: Innovative methods for building trust with African American and Latino families have increased engagement compared to previous T1D behavioral research. Disclosure A. Butler: None. M.E. Hilliard: None. K. Fegan-Bohm: None. K. Hendrix: None. L. Karaviti: None. Funding National Institutes of Health (1DP3DK113236)

Evaluation of the Cost-effectiveness of Services for Schizophrenia in the UK Across the Entire Care Pathway in a Single Whole-Disease Model

The existing economic models for schizophrenia often have 3 limitations; namely, they do not cover nonpharmacologic interventions, they report inconsistent conclusions for antipsychotics, and they have poor methodologic quality. To develop a whole-disease model for schizophrenia and use it to inform resource allocation decisions across the entire care pathway for schizophrenia in the UK. This decision analytical model used a whole-disease model to simulate the entire disease and treatment pathway among a simulated cohort of 200 000 individuals at clinical high risk of psychoses or with a diagnosis of psychosis or schizophrenia being treated in primary, secondary, and tertiary care in the UK. Data were collected March 2016 to December 2018 and analyzed December 2018 to April 2019. The whole-disease model used discrete event simulation; its structure and input data were informed by published literature and expert opinion. Analyses were conducted from the perspective of the National Health Service and Personal Social Services over a lifetime horizon. Key interventions assessed included cognitive behavioral therapy, antipsychotic medication, family intervention, inpatient care, and crisis resolution and home treatment team. Life-time costs and quality-adjusted life-years. In the simulated cohort of 200 000 individuals (mean [SD] age, 23.5 [5.1] years; 120 800 [60.4%] men), 66 400 (33.2%) were not at risk of psychosis, 69 800 (34.9%) were at clinical high risk of psychosis, and 63 800 (31.9%) had psychosis. The results of the whole-disease model suggest the following interventions are likely to be cost-effective at a willingness-to-pay threshold of £20 000 ($25 552) per quality-adjusted life-year: practice as usual plus cognitive behavioral therapy for individuals at clinical high risk of psychosis (probability vs practice as usual alone, 0.96); a mix of hospital admission and crisis resolution and home treatment team for individuals with acute psychosis (probability vs hospital admission alone, 0.99); amisulpride (probability vs all other antipsychotics, 0.39), risperidone (probability vs all other antipsychotics, 0.30), or olanzapine (probability vs all other antipsychotics, 0.17) combined with family intervention for individuals with first-episode psychosis (probability vs family intervention or medication alone, 0.58); and clozapine for individuals with treatment-resistant schizophrenia (probability vs other medications, 0.81). The results of this study suggest that the current schizophrenia service configuration is not optimal. Cost savings and/or additional quality-adjusted life-years may be gained by replacing current interventions with more cost-effective interventions.

O3.5. EARLY TRAJECTORIES OF POSITIVE SYMPTOMS REMISSION IN FIRST EPISODE-PSYCHOSIS: A 2-YEAR FOLLOW-UP STUDY

BackgroundThe Prevention and Early intervention Program for Psychosis (PEPP) provides young people with first episode psychosis (FEP) rapid access to appropriate mental health services designed on the principles of early intervention (EI). We have previously demonstrated high rates of positive symptom (PS) remission. However, the relationship between PS, negative symptoms (NS) and functional outcomes remains unclear. Adherence to medication and early treatment response have been shown to be important independent determinants of the level of, and time to, symptom and functional remission, respectively. While trajectories of symptom severity have been shown to be heterogeneous, no previous study has investigated the prognosis of PS remission among individuals with FEP treated in an EI service. Identification of different trajectories of PS remission is a useful strategy to provide insight into clinically meaningful subgroups of patients while providing valuable information on NS and functioning for improving treatment outcomes.MethodsThe 2-year treatment at PEPP comprises different psychosocial (i.e., cognitive behavioral therapy, group intervention, family intervention, individual placement and support program) and psychopharmacological interventions (i.e., minimum effective dosage of second-generation antipsychotics). Monthly assessments were conducted from baseline to month 24. A total of 387 FEP patients, aged 14–35 years, with DSM IV affective or non-affective psychosis and little or no prior antipsychotic treatment (i.e., < 30 days) were included. PS remission was defined as absence of overt psychotic symptoms (i.e., all global SAPS items ≤ 2). A Latent Class Growth Analysis (LCGA) was used to investigate the distinct trajectories based on cumulative length of PS remission assessed at 3, 6, 9, 12, 15, 18, 21, and 24 months of treatment. Predictors of trajectories were investigated among sociodemographic, pre-treatment, as well as baseline and course clinical characteristics. Chi-square tests, one-way and mixed ANOVAs identified which baseline and longitudinal variables differed between and within trajectories. Candidate predictors that were statistically significant were then entered into a multinomial regression model to determine which factors independently predict trajectory membership.ResultsThree distinct trajectories of PS remission were identified. Excellent (68%), unstable (15%) and poor (17%) trajectory. Trajectories differed at baseline in DUP, diagnosis of affective psychosis and PS severity. Over the 24 months of treatment, negative, depressive, anxiety and mania symptoms, as well as functioning, best improved in the excellent trajectory among which patients were prescribed less antipsychotics in term of chlorpromazine equivalent than patients in other trajectories. Multinomial regression of baseline characteristics revealed that absence of early treatment response at 3 months (adjusted OR=2.53; 95%CI=1.24–5.16) independently predicted poorer trajectory.DiscussionThese results highlight the heterogeneous prognosis of PS remission suggesting that the diversity in FEP response and phenotypes may be determined by different pathophysiological underpinnings. The fact that early response was found to be a strong predictor of PS remission supports early and adequate symptom control for which medication is a critical issue. Further research applying data-driven trajectory analysis in FEP is warranted to facilitate better characterization of longer-term patterns of remission and development of targeted intervention to promote early recovery.

Parenting programme for mothers of children with separation anxiety disorder: benefits for Iranian mothers and children

ABSTRACT This study considered the effect of Triple P as a behavioural family intervention on mothers of children with separation anxiety disorder. Three hundred families with separation anxious children participated in this research which divided into intervention and control groups. The measuring tools were Parenting Scale, Depression Anxiety Stress Scale-42, Parental Bonding Instrument, Child Behavior Checklist and Client Satisfaction Questionnaire. The results showed that mothers in the intervention condition reported more improvements in parenting style and mother–child relationship than those in the control condition. Women were trained in the Triple P group also reported significantly lower rates of maternal depression, anxiety, stress and child misbehaviours than those in the control group. Iranian mothers reported high satisfaction with this intervention. In conclusion, positive parenting programme is an effective intervention in several aspects for mothers of children with separation anxiety disorder and their children.

Cognitive behavioural family intervention for people diagnosed with severe mental illness and their families: A systematic review and meta-analysis of randomized controlled trials.

WHAT IS KNOWN ON THE SUBJECT?: Cognitive behavioural therapy for psychosis (CBTp) and family intervention (FI) for psychosis are effective evidence-based interventions, but they are practically difficult to be implemented in many clinical settings. The CBTp and FI approaches have been integrated to form cognitive behavioural family intervention (CBFI). This brief intervention may be more feasible to implement in clinical practice. A few individual studies reported the effectiveness of CBFI, but no systematic review and meta-analysis have been conducted. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: CBFI was effective for reducing overall positive and negative symptoms immediately following the intervention. Compared to CBTp, the intervention seems to be more effective to reduce delusions. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The results of this review suggest that the brief CBFI is an effective family-inclusive intervention that could be integrated into clinical practice. Mental health nurses with adequate training and support may implement and develop CBFI to improve the recovery of people diagnosed with SMI and support their families. Abstract Introduction Cognitive behavioural family intervention (CBFI) may be an effective brief psychosocial intervention for people diagnosed with severe mental illness (SMI) and their families. No systematic review has summarized the effectiveness of CBFI. Aim This review aimed to systematically examine the trial evidence of the effectiveness of CBFI versus treatment as usual (TAU) on improving the outcomes of people diagnosed with SMI and their families. Method Eligible randomized controlled trials were identified from nine databases. Three investigators independently took part in selection of articles, data extraction and risk assessment. Pooled treatment effects were computed using random-effects models. Results Four studies consisting of 524 participants were included. The risk of bias was low-unclear in most areas. The pooled CBFI effect on four service user outcomes including overall positive symptoms, delusions, overall negative symptoms and general psychopathology was significantly improved at post-treatment, compared with TAU, whereas effects on hallucinations and insight were equivocal. Discussion The findings reveal that CBFI is superior to TAU in treating positive and negative symptoms immediately following the intervention. Implications for Practice Mental health nurses may practise CBFI to enrich the psychiatric nursing service and promote nurse-led intervention. However, there is currently no substantial evidence that the intervention is effective over the longer term.

Are trials of psychological and psychosocial interventions for schizophrenia and psychosis included in the NICE guidelines pragmatic? A systematic review

The NICE clinical guidelines on psychosocial interventions for the treatment of schizophrenia and psychosis in adults are based on the results of randomized controlled trials (RCTs), which may not be studies with a pragmatic design, leading to uncertainty on applicability or recommendations to everyday clinical practice. To assess the level of pragmatism of the evidence used to develop the NICE guideline for psychosocial interventions in psychoses. We conducted a systematic and critical appraisal of RCTs used to develop the 'psychological therapy and psychosocial interventions' section of the NICE guideline on the treatment and management of psychosis and schizophrenia in adults, published in 2014. For each study we assessed pragmatism using the pragmatic-explanatory continuum indicator summary-2 (PRECIS-2) and the Cochrane risk of bias tool. The mean score of PRECIS-2, averaging across nine domains, was calculated to describe the level of pragmatism of each individual study. A total of 143 studies were included in the analysis. Based on the PRECIS-2 tool, 16.8% were explanatory, 33.6% pragmatic, and 49.7% were rated in an intermediate category. Compared to explanatory studies, pragmatic studies showed a lower risk of bias. Additionally, pragmatism did not significantly improve over time, and no associations were found between pragmatism and a number of trial characteristics. However, studies with a UK leading investigator had the highest mean score of pragmatism. Cognitive behavioural therapy (CBT), art therapy, family intervention, psychoeducation, and adherence therapy, showed the higher average pragmatism scores. Two third of studies used to produce NICE recommendations on psychosocial interventions for the treatment of schizophrenia and psychosis in adults are based on studies that did not employ a pragmatic design.

Group Cognitive Behavioural Family Intervention (CBFI) for People With Schizophrenia and Their Families

Group Cognitive Behavioural Family Intervention (CBFI) for People With Schizophrenia and Their Families

Study protocol for a randomised controlled trial of CBT vs antipsychotics vs both in 14\u201318-year-olds: Managing Adolescent first episode Psychosis: a feasibility study (MAPS)

BackgroundAdolescent-onset psychosis is associated with more severe symptoms and poorer outcomes than adult-onset psychosis. The National Institute for Clinical Excellence (NICE) recommend that adolescents with first episode psychosis (FEP) should be offered a combination of antipsychotic medication (APs), cognitive behavioural therapy (CBT) and family intervention (FI). The evidence for APs in treating psychosis is limited in adolescents compared to adults. Nevertheless, it indicates that APs can reduce overall symptoms in adolescents but may cause more severe side effects, including cardiovascular and metabolic effects, than in adults. CBT and FI can improve outcomes in adults, but there are no studies of psychological interventions (PI) in patients under 18 years old. Given this limited evidence base, NICE made a specific research recommendation for determining the clinical and cost effectiveness of APs versus PI versus both treatments for adolescent FEP.Methods/designThe current study aimed to establish the feasibility and acceptability of conducting such a trial by recruiting 14–18-year-olds with a first episode of psychosis into a feasibility prospective randomised open blinded evaluation (PROBE) design, three-arm, randomised controlled trial of APs alone versus PI alone versus a combination of both treatments. We aimed to recruit 90 participants from Early Intervention and Child and Adolescent Mental Health Teams in seven UK sites. APs were prescribed by participants’ usual psychiatrists. PI comprised standardised cognitive behavioural therapy and family intervention sessions.DiscussionThis is the first study to compare APs to PI in an adolescent population with FEP. Recruitment finished on 31 October 2018. The study faced difficulties with recruitment across most sites due to factors including clinician and service-user treatment preferences.Trial registrationCurrent controlled trial with ISRCTN, ISRCTN80567433. Registered on 27 February 2017.

A Behavioral Family Intervention for Children with Overweight and Asthma.

The Childhood Health and Asthma Management Program (CHAMP) is a behavioral family lifestyle intervention for youth with overweight or obesity (OV/OB) and asthma. This pilot randomized controlled trial examined the feasibility, acceptability, and preliminary efficacy of CHAMP. A sample of 24 children (Mage = 8.67) with asthma and a BMI ≥ 85th percentile and their caregivers participated in a pilot randomized controlled trial. Families were recruited from local pediatrician offices and pediatric pulmonary and allergy clinics and randomized to CHAMP or a health education attention control condition. Children's height, weight, lung function, asthma control, and asthma-related quality of life (QOL) were collected at baseline, post-intervention, and 6-months post-treatment. Analysis of covariance and standardized mean differences were used to assess changes in outcome variables among participants attending > 50% of sessions (n = 12). Families participating in CHAMP reported high satisfaction; however, there were a number of barriers to recruitment and regular session attendance. There were no statistically significant between group differences at post-intervention or long-term follow-up. From baseline to post-intervention, there were small to large effect sizes favoring CHAMP for BMI z-scores, asthma control, and measures of lung function. There were small to medium effect sizes favoring CHAMP at long-term follow-up for BMI z-scores, asthma control, and asthma-related QOL. CHAMP had adequate acceptability in this trial. We did not find significant results favoring CHAMP in comparison to the control group, however, lessons learned provide important directions for modifications in anticipation of a larger trial.