Predict Symptom Reduction Research Articles

A person-centered, transdiagnostic schema and mode profile approach to predict outcome in time-limited schema group therapy

Objective This study employs a person-centered transdiagnostic approach to examine how schema and mode profiles predict symptom severity reduction in schema group therapy for patients with personality disorders and enduring clinical syndromes. Method We analyzed symptom reduction in 248 patients across three formats of manualized, time-limited schema group therapy. Latent profile analysis and mixed multilevel modeling were used to determine the extent to which schema/mode classes predict symptom reduction, and whether the inclusion of individual schemas and modes enhances these predictions. Results No significant differences in treatment outcomes were found across the group modalities. A three latent profile solution for schemas and modes showed external validity with clinical variables and demonstrated that declines in symptom severity varied by schema and mode class, even after adjusting for baseline symptom severity. Adding the Vulnerability to Harm schema and Vulnerable Child mode to the model increased the explained variance. Conclusion Patients with more severe personality problems show more substantial symptom reduction. Both schema and mode profiles significantly contribute to predicting post-treatment symptom levels. Understanding these profiles may help therapists tailor interventions more effectively, consistent with Young’s theoretical model. Trial registration: ISRCTN.org identifier: ISRCTN17262253.

Does treatment specific-, disorder specific- or general therapeutic competence predict symptom reduction in posttraumatic stress disorder?

ABSTRACT Background: Literature on the association between therapist competence and treatment success in posttraumatic stress disorder (PTSD) treatments is scarce and results are mixed. Aims/Objective: The relationship between different types of therapeutic competence, therapeutic alliance, and PTSD symptom reduction in patients treated with Dialectical Behaviour Therapy for PTSD (DBT-PTSD) or Cognitive Processing Therapy (CPT) was assessed. Competence types were PTSD-specific competence, treatment specific competence, and general competence in cognitive behaviour therapy (CBT). Method: Videotaped therapy sessions from N = 160 women with PTSD and emotion regulation difficulties after child abuse participating in a large randomised controlled trial (Bohus et al., 2020) were rated. Three therapeutic competence-types were assessed using specifically developed rating scales. Alliance was assessed via patient ratings with the Helping Alliance Questionnaire (HAQ). PTSD symptoms were assessed at pre- and post-treatment via clinician rating with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and via self-rating with the PTSD-Checklist for DSM-5 (PCL-5). Results: No significant association between competence and clinician or self-rated PTSD symptoms was found. PTSD specific competence predicted clinician rated PTSD symptom severity on a trend level. Alliance predicted both clinician and self-rated PTSD symptom reduction. Conclusion: Our results provide a starting point for future research on different competence types and their association with PTSD treatment gains. Therapists were highly trained and received weekly supervision, hence a restricted competence range is a possible explanation for non-existing associations between competence and PTSD symptom reduction in our sample. More research in naturalistic settings, such as dissemination studies, is needed.

Longitudinal follow-up of the randomized controlled trial of access to the trauma-focused self-management app PTSD Coach

Apps that target posttraumatic stress are rarely evaluated and long-term examination of symptom change is rare. In a waitlist-controlled randomized controlled trial, we found that the Swedish version of the self-management app PTSD Coach confers benefits on posttraumatic stress and depressive symptoms after three months use. Here, we aimed to evaluate between-group effects on functional disability as well as within-group changes on mental health, somatic illness and functional disability after access to the Swedish PTSD Coach app during 9 months. In addition, we described negative effects, helpfulness and satisfaction with the app. Among the 179 trauma-exposed adults (92 % women) randomized to instant access or delayed access to PTSD Coach, symptoms of posttraumatic stress, depression, somatic illness and functional disability decreased and were maintained within 3 to 9 months of app access. Posttraumatic stress continued to improve during follow-up. PTSD Coach was considered slightly to moderately helpful and satisfactory and 43 % reported any negative effect related to using the app. PTSD Coach is an effective self-management intervention for trauma-related distress. Future research should investigate mechanisms of change, as well as individual characteristics that predict symptom reduction after access to PTSD Coach in order to inform clinical practice.

Leveraging observational data to identify in-session patient and therapist predictors of cognitive processing therapy response and completion.

Cognitive processing therapy (CPT) is an evidence-based treatment for posttraumatic stress disorder (PTSD), but little is known about in-session process variables that predict symptom reduction and treatment completion during CPT. Examining potentially malleable factors that may promote or impede recovery can inform care delivery and enhance outcomes. The current study used observational ratings of CPT session recordings to examine in-session patient and therapist factors in cognitive, affective, and interpersonal domains to identify their relative contributions to predicting symptom outcomes and treatment completion. Participants were 70 adult survivors of interpersonal violence who received CPT. Predictors of better posttreatment PTSD outcomes included less patient fear, β = .32, and less patient avoidance of engaging with the therapist, β = .35. When using the last available PTSD score, less fear, β = .23, and avoidance, β = .28, continued to predict better outcomes, and more patient cognitive flexibility emerged as a stronger predictor of outcome, β = -.33. Predictors of a higher likelihood of treatment completion included more therapist use of Socratic dialogue, OR = 6.75, and less therapist encouragement of patient affect, OR = 0.11. Patient sadness and anger and therapist expression of empathy did not predict symptom outcomes or treatment completion versus dropout. The results highlight the importance of patients' cognitions, emotions, and engagement with their therapist in CPT as well as the role of therapist behaviors in patient completion of treatment.

Pilot study suggests DNA methylation of the glucocorticoid receptor gene (NR3C1) is associated with MDMA-assisted therapy treatment response for severe PTSD.

Previous research has demonstrated that epigenetic changes in specific hypothalamic-pituitary-adrenal (HPA) genes may predict successful psychotherapy in post-traumatic stress disorder (PTSD). A recent Phase 3 clinical trial reported high efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for treating patients with severe PTSD compared to a therapy with placebo group (NCT03537014). This raises important questions regarding potential mechanisms of MDMA-assisted therapy. In the present study, we examined epigenetic changes in three key HPA axis genes before and after MDMA and placebo with therapy. As a pilot sub-study to the parent clinical trial, we assessed potential HPA epigenetic predictors for treatment response with genomic DNA derived from saliva (MDMA, n = 16; placebo, n = 7). Methylation levels at all 259 CpG sites annotated to three HPA genes (CRHR1, FKBP5, and NR3C1) were assessed in relation to treatment response as measured by the Clinician-Administered PTSD Scale (CAPS-5; Total Severity Score). Second, group (MDMA vs. placebo) differences in methylation change were assessed for sites that predicted treatment response. Methylation change across groups significantly predicted symptom reduction on 37 of 259 CpG sites tested, with two sites surviving false discovery rate (FDR) correction. Further, the MDMA-treatment group showed more methylation change compared to placebo on one site of the NR3C1 gene. The findings of this study suggest that therapy-related PTSD symptom improvements may be related to DNA methylation changes in HPA genes and such changes may be greater in those receiving MDMA-assisted therapy. These findings can be used to generate hypothesis driven analyses for future studies with larger cohorts.

Quinolinic acid levels predict symptom reduction in bipolar depression treated with continuous Theta Burst Stimulation

Quinolinic acid levels predict symptom reduction in bipolar depression treated with continuous Theta Burst Stimulation

Validation of a French Version of the Mystical Experience Questionnaire with Retrospective Reports of the Most Significant Psychedelic Experience among French Users

ABSTRACT Mystical experiences triggered by psychedelic drugs predict symptom reduction in various psychiatric disorders, and increased well-being in healthy individuals. This work aimed at validating a French version of a tool used to measure mystical experiences: the Revised Mystical Experience Questionnaire-30 items (MEQ30). Construct validity, internal consistencies, concurrent, discriminant, and predictive validities of the French MEQ30 were examined using data about the most significant psychedelic experience of 320 French individuals. Results showed that the original four-factor (i.e., mystical, positive mood, transcendence, and ineffability) structure fit the data best, with good to excellent statistical indices. Total French MEQ30 score was strongly associated with subjective ratings of the mystical (i.e., mystical, spiritual, or religious, and personally significant) and drug intensity-related qualities of the experience, but not with non-mystical (i.e., fun, inebriating, and easy) qualities. Moreover, French MEQ30 score was a significant predictor of subjective positive changes in psychological well-being, relations with self and others, feeling of proximity or connection with nature, and creativity, whereas drug intensity-related and non-mystical qualities of the experience were not, or were only weakly associated with such changes. This French version of the MEQ30 seems to be an appropriate tool for measuring mystical experiences among French speaking individuals.

Forming a Doctor-Patient Alliance During COVID-19 to Enhance Treatment Outcomes for Obsessive-Compulsive Disorder.

Forming a Doctor-Patient Alliance During COVID-19 to Enhance Treatment Outcomes for Obsessive-Compulsive Disorder.

Acceptability and Effectiveness of Artificial Intelligence Therapy for Anxiety and Depression (Youper): Longitudinal Observational Study.

BackgroundYouper is a widely used, commercially available mobile app that uses artificial intelligence therapy for the treatment of anxiety and depression.ObjectiveOur study examined the acceptability and effectiveness of Youper. Further, we tested the cumulative regulation hypothesis, which posits that cumulative emotion regulation successes with repeated intervention engagement will predict longer-term anxiety and depression symptom reduction.MethodsWe examined data from paying Youper users (N=4517) who allowed their data to be used for research. To characterize the acceptability of Youper, we asked users to rate the app on a 5-star scale and measured retention statistics for users’ first 4 weeks of subscription. To examine effectiveness, we examined longitudinal measures of anxiety and depression symptoms. To test the cumulative regulation hypothesis, we used the proportion of successful emotion regulation attempts to predict symptom reduction.ResultsYouper users rated the app highly (mean 4.36 stars, SD 0.84), and 42.66% (1927/4517) of users were retained by week 4. Symptoms decreased in the first 2 weeks of app use (anxiety: d=0.57; depression: d=0.46). Anxiety improvements were maintained in the subsequent 2 weeks, but depression symptoms increased slightly with a very small effect size (d=0.05). A higher proportion of successful emotion regulation attempts significantly predicted greater anxiety and depression symptom reduction.ConclusionsYouper is a low-cost, completely self-guided treatment that is accessible to users who may not otherwise access mental health care. Our findings demonstrate the acceptability and effectiveness of Youper as a treatment for anxiety and depression symptoms and support continued study of Youper in a randomized clinical trial.

Mindfulness-Based Stress Reduction Interventions for Mood in Older Adults: How Do Qualitative Experiences Inform Clinical Response?

Older adulthood presents unique challenges to mental health. We explored how a mindfulness training intervention adapted for older adults addressed these challenges, contributing to a qualitative profile of mindfulness pedagogy for older adults. Mindfulness-based stress reduction (MBSR) was adapted for a geriatric community sample with elevated depressive symptoms. Intervention effects were examined through a combination of scale-based assessment and qualitative interviews. Scales measured depressive symptoms, cognitive function, quality of life, and mindful attitudes. Interviews assessed stressors, goals, perceived obstacles, outcomes, and practice habits. A grounded-theory approach was used to identify responses in each category. Multiple regression analyses were used to identify qualitative responses that best predicted symptom reduction. The program was well-tolerated, positively endorsed, and associated with reduced depressive symptoms. Qualitatively, participants who identified family and mood as their primary stressors benefitted the most from course participation. A focus on present moment awareness was associated with decreased depressive symptoms, whereas a focus on hedonics, i.e., “feeling good,” was associated with poorer treatment outcomes. Participants maintained strong future practice intentions and preferred guided meditations to self-directed practice. The adapted MBSR program was well-tolerated and efficacious in a geriatric community sample. Efficacy may be improved by emphasizing skill development outcomes rather than achievement of positive feeling states, and by prioritizing program referrals for coping with socioemotional rather than environmental stressors. Future research could extend this mixed-methods approach to deepen our understanding of the relationship between participants’ lived experiences and clinical outcomes.

Personality change and personality as predictor of change in psychotherapy: A longitudinal study in a community mental health clinic

Research suggests that personality may change due to important life events, such as psychotherapy, and that personality and attitudes may predict treatment progress. Longitudinal data in a community mental health clinic showed positive changes in Emotional Stability, Hope, Gratitude, and Motivation during the course of psychotherapy. The static approach relating baseline personality and attitudes to treatment progress did not yield fruitful results. The dynamic approach was more effective, in which we treated personality and attitudes as malleable and used changes in these variables as predictors of progress. Treatment progress correlated with an increase in Emotional Stability. Positive changes in general life attitudes (Hope, Gratitude, Quality of Life) more so than therapy-specific attitudes (Motivation, Working Alliance) predicted symptom reduction.

Explicit and implicit attachment and the outcomes of acceptance and commitment therapy and cognitive behavioral therapy for depression

BackgroundAttachment theory predicts that patients who are not securely attached may benefit less from psychological treatment. However, evidence on the predictive role of attachment in the effectiveness of treatment for depression is limited.MethodsExplicit attachment styles, levels of attachment anxiety and attachment avoidance, as well as implicit relational self-esteem and implicit relational anxiety were assessed in 67 patients with major depressive disorder (MDD) receiving Acceptance and Commitment Therapy (ACT) or Cognitive Behavioral Therapy (CBT). ANOVA and hierarchical regression analyses were performed to investigate the predictive power of explicit and implicit attachment measures on treatment outcome.ResultsExplicit attachment avoidance at pre-treatment significantly predicted reduction of depressive symptoms following treatment. Reductions in attachment anxiety and avoidance from pre- to post-treatment predicted better treatment outcomes. Neither one of the implicit measures, nor change in these measures from pre- tot post-treatment significantly predicted treatment outcome.ConclusionsOur findings show that attachment avoidance as well as reductions in avoidant and anxious attachment predict symptom reduction after psychological treatment for depression. Future research should use larger sample sizes to further examine the role of attachment orientation as moderator and mediator of treatment outcome.Trial registrationclinicaltrials.gov; NCT01517503.

Psychological Mindedness and Alexithymia Predict Symptom Reduction in Cognitive Behavior Therapy for Major Depressive Disorder

Cognitive behavior models present major depressive disorder (MDD) as a failure in emotional processing associated with disrupted metacognitive skills. Self-observation, a metacognitive ability, plays a vital role in emotion regulation. Studies have noted the role of mindfulness in cognitive behavioral therapy (CBT); however, few address psychological mindedness, the interest and ability to understand behaviors, thoughts, and feelings, or alexithymia, the inability to identify and describe emotions. Seventy-one depressed outpatients with mean age M = 42.5; (SD = 13.7) received 14 CBT sessions. Longitudinal regression showed that baseline psychological mindedness significantly predicted symptom reduction across the course of treatment (β = − 8.43, 95% CI − 14.33, − 2.52, p = 0.01). Baseline alexithymia was unrelated to remission, yet positively correlated with symptom reduction through treatment. Treatment response may correlate more strongly with analytical than affective metacognitive ability, though affective skills increased during treatment. Further research can improve our understanding of processing affective information in depression and disruptions in emotion regulation and inform the selection of CBT strategies.

Using Cluster Analysis to Explore Engagement and e-Attainment as Emergent Behavior in Electronic Mental Health.

BackgroundIn most e-mental health (eMH) research to date, adherence is defined according to a trial protocol. However, adherence to a study protocol may not completely capture a key aspect of why participants engage with eMH tools, namely, to achieve personal mental health goals. As a consequence, trial attrition reported as non-adherence or dropout may reflect e-attainment, the discontinuation of eMH engagement after personal goals have been met. Clarifying engagement patterns, such as e-attainment, and how these align with mental health trajectories, may help optimize eMH design and implementation science.ObjectiveThis study aimed to use clustering techniques to identify real-world engagement profiles in a community of eMH users and examine if such engagement profiles are associated with different mental health outcomes. The novelty of this approach was our attempt to identify actual user engagement behaviors, as opposed to employing engagement benchmarks derived from a trial protocol. The potential of this approach is to link naturalistic behaviors to beneficial mental health outcomes, which would be especially informative when designing eMH programs for the general public.MethodsBetween May 2013 and June 2018, Australian adults (N=43,631) signed up to myCompass, a self-guided eMH program designed to help alleviate mild to moderate symptoms of depression, anxiety, and stress. Recorded usage data included number of logins, frequency of mood tracking, number of started and completed learning activities, and number of tracking reminders set. A subset of users (n=168) completed optional self-assessment mental health questionnaires (Patient Health Questionnaire-9 item, PHQ-9; Generalized Anxiety Disorder Questionnaire-7 item, GAD-7) at registration and at 28 and 56 days after sign-up. Another subset of users (n=861) completed the PHQ-9 and GAD-7 at registration and at 28 days.ResultsTwo-step cluster analyses revealed 3 distinct usage patterns across both subsamples: moderates, trackers, and super users, signifying differences both in the frequency of use as well as differences in preferences for program functionalities. For both subsamples, repeated measures analysis of variances showed significant decreases over time in PHQ-9 and GAD-7 scores. Time-by-cluster interactions, however, did not yield statistical significance in both subsamples, indicating that clusters did not predict symptom reduction over time. Interestingly, users who completed the self-assessment questionnaires twice had slightly but significantly lower depression and anxiety levels at sign-up compared with users who completed the questionnaires a third time at 56 days.ConclusionsFindings suggested that although users engaged with myCompass in different but measurable ways, those different usage patterns evoked equivalent mental health benefits. Furthermore, the randomized controlled trial paradigm may unintentionally limit the scope of eMH engagement research by mislabeling early mental health goal achievers as dropouts. More detailed and naturalistic approaches to study engagement with eMH technologies may improve program design and, ultimately, program effectiveness.

Disentangling within- and between-patient effects of defensive functioning on psychotherapy outcome using mixed models

There is a great need to identify predictors of treatment response, and the analysis of defense mechanisms is a promising approach. Defensive functioning may influence psychotherapy outcome in two ways: First, when it is generally higher or lower for some patients relative to others and second, as it shifts in individual patients over time. The present study examined both within- and between patient effects of defenses using hierarchical linear modeling. Forty-seven patients diagnosed with depression, anxiety, or adjustment disorders received 25 ± 3 sessions of integrative cognitive–behavioral therapy in a university outpatient clinic. The Defense Mechanism Rating Scale (DMRS) was used to assess defenses in the 1st, 8th, 16th, and 24th session and relate them to symptom severity of depression and anxiety. A higher number of adaptive defense mechanisms was associated with less severe depressive symptoms during treatment while a higher number of immature defenses was related to more severe depressive and anxiety symptoms. An increase in adaptive and a decrease in immature defenses over the course of treatment predicted symptom reduction of depression whereas a decrease in neurotic and immature defenses was associated with reductions in anxiety symptoms. Our results empirically support defensive functioning as a mechanism of change in psychotherapy.

Application of machine learning to structural connectome to predict symptom reduction in depressed adolescents with cognitive behavioral therapy (CBT).

PurposeAdolescent major depressive disorder (MDD) is a highly prevalent, incapacitating and costly illness. Many depressed teens do not improve with cognitive behavioral therapy (CBT), a first-line treatment for adolescent MDD, and face devastating consequences of increased risk of suicide and many negative health outcomes. “Who will improve with CBT?” is a crucial question that remains unanswered, and treatment planning for adolescent depression remains biologically unguided. The purpose of this study was to utilize machine learning applied to patients' brain imaging data in order to help predict depressive symptom reduction with CBT.MethodsWe applied supervised machine learning to diffusion MRI-based structural connectome data in order to predict symptom reduction in 30 depressed adolescents after three months of CBT. A set of 21 attributes was chosen, including the baseline depression score, age, gender, two global network properties, and node strengths of brain regions previously implicated in depression. The practical and robust J48 pruned tree classifier was utilized with a 10-fold cross-validation.ResultsThe classification resulted in an 83% accuracy of predicting depressive symptom reduction. The resulting tree of size seven with only three attributes highlights the role of the right thalamus in predicting depressive symptom reduction with CBT. Additional analysis showed a significant negative correlation between the change in the depressive symptoms and the node strength of the right thalamus.ConclusionsOur results demonstrate that a machine learning algorithm that exclusively uses structural connectome data and the baseline depression score can predict with a high accuracy depressive symptom reduction in adolescent MDD with CBT. This knowledge can help improve treatment planning for adolescent depression.

Attentional Bias Modification for Social Anxiety Disorder: What do Patients Think and Why does it Matter?

In the past decade, a great deal of research has examined the efficacy and mechanisms of attentional bias modification (ABM), a computerized cognitive training intervention for anxiety and other disorders. However, little research has examined how anxious patients perceive ABM, and it is unclear to what extent perceptions of ABM influence outcome. To examine patient perceptions of ABM across two studies, using a mixed methods approach. In the first study, participants completed a traditional ABM program and received a hand-out with minimal information about the purpose of the task. In the second study, participants completed an adaptive ABM program and were provided with more extensive rationale and instructions for changing attentional biases. A number of themes emerged from qualitative data related to perceived symptom changes and mechanisms of action, acceptability, early perceptions of the program, barriers/facilitators to engagement, and responses to adaptive features. Moreover, quantitative data suggested that patients' perceptions of the program predicted symptom reduction as well as change in attentional bias. Our quantitative data suggest that it may be possible to quickly and inexpensively identify some patients who may benefit from current ABM programs, although our qualitative data suggest that ABM needs major modifications before it will be an acceptable and credible treatment more broadly. Although the current study was limited by sample size and design features of the parent trials from which these data originated, our findings may be useful for guiding hypotheses in future studies examining patient perceptions towards ABM.

Low tumor necrosis factor-α levels predict symptom reduction during electroconvulsive therapy in major depressive disorder.

ObjectiveChanges in the tumor necrosis factor‐α (TNFα) have been associated with major depressive disorder (MDD). Findings concerning the effects of electroconvulsive therapy (ECT) on the TNFα level have been contradictory. The aim was to examine the immediate and long‐term changes in the TNFα level and their associations with symptom reduction in patients with MDD during ECT.MethodThe study included 30 patients with MDD. Their TNFα levels were measured at baseline and 2 and 4 hr after the first, fifth and last ECT session. Depressive symptoms were assessed with the Montgomery‐Asberg Depression Rating Scale (MADRS).ResultsThe TNFα level decreased from baseline to the 2‐ and 4‐hr measurements. There was a correlation between the first ECT session TNFα levels and the relative symptom reduction according to the MADRS score after the ECT series. Both the first (baseline) ECT and 4‐hr TNFα levels were lower in responders than in nonresponders.Conclusion ECT consistently induced a decrease in the TNFα level after each studied session. A low TNFα level at the first ECT appeared to predict a symptom reduction. These findings suggest that TNFα might have a role in the pathogenesis in MDD and in the mechanism of action of ECT.

Pharmacogenomics of Antipsychotic Drugs

Pharmacogenomic research of antipsychotic drug (APD) response continued to produce interesting findings in the past few years. Several genetic markers have been shown to be reliably associated with APD responses including efficacy and drug-induced adverse reactions. For APD treatment response, DRD2 has been shown to predict symptom reduction and APD efficacy. For APD-induced weight gain, a recent meta-analysis supports the associations with HTR2C and MC4R variants, as well as several other genetic markers. For clozapine-induced agranulocytosis, an independent sample has confirmed the association with HLA-DQB1. In addition, a multi-marker combination approach has been studied to increase the predictive power for APD response. However, these markers’ sensitivity and specificity are not high enough to be used in routine clinical practice. They may have some value in certain situations such as treatment refractory cases, and they need to be used in conjunction with other clinical predictors. Due to the polygenetic nature of drug response, the new polygenetic risk score method appears promising in combining many genetic markers in predicting clinical response. The current review focused on pharmacodynamic genes (i.e., drug target), and did not touch upon pharmacokinetic genes such as cytochrome P450 genes (e.g., CYP2D6), which have been shown to influence APD response especially adverse reactions. Future research should use a multi-marker approach to combine both pharmacodynamic and pharmacokinetic genes, as well as known clinical factors, to increase the predictive power for APD clinical response.

Effect of Antipsychotic Type and Dose Changes on Tardive Dyskinesia and Parkinsonism Severity in Patients With a Serious Mental Illness: The Curaçao Extrapyramidal Syndromes Study XII.

To test the efficacy of current treatment recommendations for parkinsonism and tardive dyskinesia (TD) severity in patients with severe mental illness (SMI). We present an 18-year prospective study including all 223 patients with SMI (as defined by the 1987 US National Institute of Mental Health, which were based on DSM-III-R diagnostic criteria) receiving care from the only psychiatric hospital of the former Netherlands Antilles. Eight clinical assessments (1992-2009) focused on movement disorders and medication use. Tardive dyskinesia was measured by the Abnormal Involuntary Movement Scale and parkinsonism by the Unified Parkinson's Disease Rating Scale. Antipsychotics were classified into first-generation antipsychotic (FGA) versus second-generation antipsychotic (SGA) and high versus low dopamine 2 (D₂) affinity categories. The effect that switching has within each category on subsequent movement scores was calculated separately by using time-lagged multilevel logistic regression models. There was a significant association between reduction in TD severity and starting/switching to an FGA (B = -3.54, P < .001) and starting/switching to a high D₂ affinity antipsychotic (B = -2.49, P < .01). Adding an SGA to existing FGA treatment was associated with reduction in TD severity (B = -2.43, P < .01). For parkinsonism, stopping antipsychotics predicted symptom reduction (B = -7.76, P < .01 in FGA/SGA-switch model; B = -7.74, P < .01 in D₂ affinity switch model), while starting a high D₂ affinity antipsychotic predicted an increase in symptoms (B = 3.29, P < .05 in D₂ affinity switch model). The results show that switching from an FGA to an SGA does not necessarily result in a reduction of TD or parkinsonism. Only stopping all antipsychotics reduces the severity of parkinsonism, and starting an FGA or a high D₂ affinity antipsychotic may reduce the severity of TD.