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Brief cognitive behavioural intervention delivered by nurses reduces overall symptoms in schizophrenia

Turkington D, Kingdon D, Turner T. Effectiveness of a brief cognitive-behavioural therapy intervention in the treatment of schizophrenia. British Journal of Psychiatry 2002 June; 180: 523�7.[Abstract/Free Full Text]

QUESTION: Can community psychiatric nurses effectively deliver a brief cognitive behavioural therapy intervention for people with schizophrenia?

Key Words: cognitive behavioural therapy


Design
Randomised controlled trial.

Setting
6 psychiatric secondary care services in England, Ireland, Scotland and Wales.

Participants
422 people with schizophrenia in secondary care (defined using ICD-10 criteria). All were aged 18�65 years (mean 40 years); 23% women; 89% white. Exclusion criteria were deterioration; need for intensive home treatment; primary diagnosis of alcohol or drug dependence; organic brain disease or severe learning disability.

Intervention
Brief cognitive behavioural therapy or usual care. After 10 days of training, the intervention nurses visited patients for up to 6 hour-long sessions over 2�3 months. Carers received 3 optional sessions. All phases of cognitive behavioural therapy were included: assessment and engaging; developing explanations; case formulation; symptom management; adherence; core beliefs, and relapse prevention. Participants and their carers also received educational booklets.

Main outcome measures
Primary outcomes were overall symptoms (measured using Comprehensive Psychopathalogical Rating Scale), insight (Insight Rating Scale) and carer burden (Burden of Care Questionnaire). Secondary outcomes were schizophrenia symptoms (Schizophrenia Change Scale) and depression (Montgomery-Asberg Rating Scale).

Main results
The intervention group had improved overall symptoms, depression and insight (all p<0.05; see table). There was no increase in suicide ideation and no difference between groups in symptoms of schizophrenia or burden of care.

Conclusions
Previous research suggests that interventions delivered by expert cognitive behavioural therapists are beneficial for people with schizophrenia. This study found that community psychiatric nurses can also deliver brief cognitive behavioural interventions safely and effectively.

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