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London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis

III: Follow-up and economic evaluation at 18 months

Published online by Cambridge University Press:  03 January 2018

Elizabeth Kuipers ,
David Fowler ,
Phiuppa Garety ,
Daniel Chisholm ,
Daniel Freeman ,
Graham Dunn ,
Paul Bebbington  and
Clare Hadley
Elizabeth Kuipers*
Affiliation:
Department of Clinical Psychology, Institute of Psychiatry, London
David Fowler
Affiliation:
School of Health Policy and Practice, University of East Anglia, Norwich
Phiuppa Garety
Affiliation:
United Medical and Dental School, Department of Psychology, St. Thomas' Hospital, London
Daniel Chisholm
Affiliation:
Centre for Economics of Mental Health, Institute of Psychiatry, London
Daniel Freeman
Affiliation:
Department of Clinical Psychology, Institute of Psychiatry, London
Graham Dunn
Affiliation:
School of Epidemiology and Health Sciences, University of Manchester, Stopford Building, Manchester
Paul Bebbington
Affiliation:
Department of Psychiatry and Behavioural Sciences, University College London
Clare Hadley
Affiliation:
Department of Clinical Psychology, Leeds University, Leeds
*
Professor Elizabeth Kuiperi, Department of Clinical Psychology, Institute of Psychiatry, De Oespigny Park, London, SES 8AF
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Abstract

Background

A randomised controlled trial of cognitive — behavioural therapy (CBT) for people with medication-resistant psychosis showed improvements in overall symptomatology after nine months of treatment; good outcome was strongly predicted by a measure of cognitive flexibility concerning delusions. The present paper presents a follow-up evaluation 18 months after baseline.

Method

Forty-seven (78% of original n=60) participants were available for follow-up at 18 months, and were reassessed on all the original outcome measures (see Part I). An economic evaluation was also completed.

Results

Those in the CBT treatment group showed a significant and continuing improvement in Brief Psychiatric Rating Scale scores, whereas the control group did not change from baseline. Delusional distress and the frequency of hallucinations were also significantly reduced in the CBT group. The costs of CB Tappear to have been offset by reductions in service utilisation and associated costs during follow-up.

Conclusions

Improvement in overall symptoms was maintained in the CBT group 18 months after baseline and nine months after intensive therapy was completed. CBT may be a specific and cost-effective intervention in medication-resistant psychosis.

Type
Papers
Information
The British Journal of Psychiatry , Volume 173 , Issue 1 , July 1998 , pp. 61 - 68
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

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Footnotes

†

Part I, ‘Effects of the treatment phase’, published in October 1997 (171. 319–327); part II, ‘Predictors of outcome’, published in November 1997 (171, 420–426).

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