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Antipsychotic drugs v CBT versus a combination of both in people with psychosis: rc pilot & feasibility study, Morrison et al, 2018

Discussion in 'Health News and Research unrelated to ME/CFS' started by Indigophoton, Mar 30, 2018.

  1. Indigophoton

    Indigophoton Senior Member (Voting Rights)

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    Summarised by Keith Laws, Prof of Cognitive Neuropsychology, as showing that,


    Abstract:
    http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30096-8/fulltext
     
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  2. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    This is interesting but I don't think anyone should expect CBT to be any good in schizophrenia. CBT depends on persuading the person with rational arguments about ways to improve their health. In psychosis rationality has been lost so there is no reason to think CBT is relevant. At least it is good to see that someone seems to want to show this formally.

    Antipsychotic drugs aren't much cop either to be honest but for some people they do seem to work.
     
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  3. strategist

    strategist Senior Member (Voting Rights)

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    Someone seems to think this confirms CBT is better than medication.



    I have not read more than a few lines from this article and it's interesting that two opposed and incompatible interpretations are being made, much like in the PACE trial.
     
    Last edited: Mar 30, 2018
  4. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    No surprises then?
     
  5. adambeyoncelowe

    adambeyoncelowe Senior Member (Voting Rights)

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    From that classic of modern culture, The Abyss (and Don Miguel Ruiz before that): 'We all see what we want to see.'
     
  6. Londinium

    Londinium Senior Member (Voting Rights)

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    I think they're arguing that CBT+meds is better than meds. Looking at the results, the study suggests that's the case but the effect is not strong enough to meet the standard p<0.05 cut off:
    • Meds+CBT > CBT (p<0.02)
    • Meds+CBT > Meds (p=0.06, 95% confidence interval does include possibility of nil effect)
    • Meds > CBT (p=0.64) --> impossible to draw a conclusion on comparing the effectiveness of the two.
    Prof Laws is right that Meds added to CBT improves the latter but not the other way round, if one applies a strict p=0.05 cut off. But I think taking less absolutist view of that threshold would indicate that combined therapy is better than either one alone.
     
  7. Adrian

    Adrian Administrator

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    It looks like a feasibility study to see if they could do a trial with 26 patients in one arm and 24 in the other. So may be too underpowered to show a significant difference. Also subjective outcomes (possibly judged by a doctor with a 45 minute interview).
     
  8. Sid

    Sid Established Member (Voting Rights)

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    The mere notion that CBT could or should be used in a disorder as serious and impervious to rational argumentation as psychosis is pretty disturbing IMO and what is even more disturbing is that ethics committees nowadays are permitting this sort of "research". Funny how so many psych trials are like a Rorschach inkblot: each side "sees" results are supporting their side.
     
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  9. Indigophoton

    Indigophoton Senior Member (Voting Rights)

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  10. Amw66

    Amw66 Senior Member (Voting Rights)

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