Treatable Intervention Targets Can Reduce Psychotic Experiences in Schizophrenia

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Researchers found data that showed treatment for agoraphobic avoidance, worry, low self-esteem, and insomnia ameliorated psychotic experiences, including paranoia, in patients with schizophrenia.

According to a study published in Schizophrenia Research, several treatable conditions, including anxious avoidance, excessive worry, poor self-confidence, insomnia, and reasoning biases, contribute to psychotic episodes that consist of paranoia and hallucinations in patients with nonaffective psychosis. Study participants expressed a desire to be treated for one or more of these conditions.

Investigators of the study sought to assess the mechanisms causing these conditions, which help maintain psychotic experiences in patients with nonaffective psychosis. To inform future approaches to treatment, the investigators assessed patient preferences for modular interventions that target these maintenance factors.

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The study included 1809 patients with nonaffective psychosis who attended National Health Service mental health services in England. Participants completed self-reported measures on paranoia and hallucinations, anxious avoidance at agoraphobia levels, self-esteem assessing both negative and positive beliefs, and questionnaires on worry, insomnia, rational reasoning, and mental well-being. Patients were further asked whether or not they would want treatment in 8 areas: worrying less, feeling more self-confident, sleeping better, feeling safer, doing more activities, improving decision-making, coping better with voices, and feeling happier.

Both paranoia and hallucinations were significantly associated with higher levels of anxious avoidance, worry, negative self-beliefs, and insomnia; and with lower levels of positive self-beliefs, rational reasoning, and psychological well-being. The proportion of participants reporting severe paranoia and frequent voices was 53.4% and 48.2%, respectively. Among the causal mechanisms, severe worry was reported in 67.7% of the sample, avoidance at agoraphobic levels in 64.5%, analytic reasoning difficulties in 55.9%, insomnia in 50.1%, poor psychological well-being in 44.3%, strong negative self-beliefs in 36.6%, and weak positive self-beliefs in 19.2%. Participants experiencing current paranoia and/or hallucinations reported higher levels of causal factors compared with participants without psychotic episodes. Most participants (90.3%) wanted help in treating at least one of the 8 targeted causal areas.

Limitations of the study included the inability to know if the study sample was representative of the patients attending mental health services, and that the use of cut-offs likely underestimated the actual level of clinical need. Finally, variation of treatment targets per recovery stage was not considered in the study.

The researchers of the study concluded that participating patients had high levels of the causal mechanisms, despite receiving treatment from mental health services. Patients who currently experienced paranoia and/or hallucinations were associated with higher levels of causal factors. Interventions targeting these factors will likely reduce certain psychotic experiences.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Freeman D, Taylor KM, Moldynski A, Waite F. Treatable clinical intervention targets for patients with schizophrenia [published online July 17, 2019]. Schizophr Res. doi: 10.1016/j.schres.2019.07.016