Effectiveness of integrated psychological therapy (IPT) for schizophrenia patients: a research update

Standardized recovery criteria go beyond symptom remission and put special emphasis on personal and social functioning in residence, work, and leisure. Against this background, evidence-based integrated approaches combining cognitive remediation with social skills therapy show promise for improving functional recovery of schizophrenia patients. Over the past 30 years, research groups in 12 countries have evaluated integrated psychological therapy (IPT) in 36 independent studies. IPT is a group therapy program for schizophrenia patients. It combines neurocognitive and social cognitive interventions with social skills and problem-solving approaches. The aim of the present study was to update and integrate the growing amount of research data on the effectiveness of IPT. We quantitatively reviewed the results of these 36 studies, including 1601 schizophrenia patients, by means of a meta-analytic procedure. Patients undergoing IPT showed significantly greater improvement in all outcome variables (neurocognition, social cognition, psychosocial functioning, and negative symptoms) than those in the control groups (placebo-attention conditions and standard care). IPT patients maintained their mean positive effects during an average follow-up period of 8.1 months. They showed better effects on distal outcome measures when all 5 subprograms were integrated. This analysis summarizes the broad empirical evidence indicating that IPT is an effective rehabilitation approach for schizophrenia patients and is robust across a wide range of sample characteristics as well as treatment conditions. Moreover, the cognitive and social subprograms of IPT may work in a synergistic manner, thereby enhancing the transfer of therapy effects over time and improving functional recovery.

Social cognition as a mediator variable between neurocognition and functional outcome in schizophrenia: empirical review and new results by structural equation modeling

Cognitive impairments are currently regarded as important determinants of functional domains and are promising treatment goals in schizophrenia. Nevertheless, the exact nature of the interdependent relationship between neurocognition and social cognition as well as the relative contribution of each of these factors to adequate functioning remains unclear. The purpose of this article is to systematically review the findings and methodology of studies that have investigated social cognition as a mediator variable between neurocognitive performance and functional outcome in schizophrenia. Moreover, we carried out a study to evaluate this mediation hypothesis by the means of structural equation modeling in a large sample of 148 schizophrenia patients. The review comprised 15 studies. All but one study provided evidence for the mediating role of social cognition both in cross-sectional and in longitudinal designs. Other variables like motivation and social competence additionally mediated the relationship between social cognition and functional outcome. The mean effect size of the indirect effect was 0.20. However, social cognitive domains were differentially effective mediators. On average, 25% of the variance in functional outcome could be explained in the mediation model. The results of our own statistical analysis are in line with these conclusions: Social cognition mediated a significant indirect relationship between neurocognition and functional outcome. These results suggest that research should focus on differential mediation pathways. Future studies should also consider the interaction with other prognostic factors, additional mediators, and moderators in order to increase the predictive power and to target those factors relevant for optimizing therapy effects.

Integrated psychological therapy: effectiveness in schizophrenia inpatient settings related to patients' age

Elderly people with schizophrenia often suffer from cognitive impairments, which affect their social functioning. Today, only a few therapy approaches for middle-aged and older patients are available. The Integrated Psychological Therapy (IPT) combines neurocognitive and social cognitive interventions with social skills approaches. The aim of this study was to evaluate (1) whether IPT is effective in younger patients (age < 40 years) and middle-aged patients (age ≥ 40 years) and (2) whether control conditions (treatment as usual or unspecific group activities) reveal some change in outcome depending on age.

Integrated psychological therapy (IPT) for schizophrenia: is it effective?

Against the background of evidence-based treatments for schizophrenia, nowadays the implementation of specific cognitive and behavioral interventions becomes more important in the standard care of these patients. Over the past 25 years, research groups in 9 countries have carried out 30 independent evaluations of Integrated Psychological Therapy (IPT), a group program that combines neurocognitive and social cognitive interventions with social skills approaches for schizophrenic patients. The aim of the present study was to evaluate the effectiveness of IPT under varying treatment and research conditions in academic and nonacademic sites. In a first step, all 30 published IPT studies with the participation of 1393 schizophrenic patients were included in the meta-analysis. In a second step, only high-quality studies (HQS) (7 studies including 362 patients) were selected and analyzed to check whether they confirmed the results of the first step. Positive mean effect sizes favoring IPT over control groups (placebo-attention conditions, standard care) were found for all dependent variables, including symptoms, psychosocial functioning, and neurocognition. Moreover, the superiority of IPT continued to increase during an average follow-up period of 8.1 months. IPT obtained similarly favorable effects across the different outcome domains, assessment formats (expert ratings, self-reports, and psychological tests), settings (inpatient vs outpatient and academic vs nonacademic), and phases of treatment (acute vs chronic). The HQS confirmed the results of the complete sample. The analysis indicates that IPT is an effective rehabilitation approach for schizophrenia that is robust across a wide range of patients and treatment conditions.

Use of EORTC Target Definition Guidelines for Dose-Intensified Salvage Radiation Therapy for Recurrent Prostate Cancer: Results of the Quality Assurance Program of the Randomized Trial SAKK 09/10

PURPOSE Different international target volume delineation guidelines exist and different treatment techniques are available for salvage radiation therapy (RT) for recurrent prostate cancer, but less is known regarding their respective applicability in clinical practice. METHODS AND MATERIALS A randomized phase III trial testing 64 Gy vs 70 Gy salvage RT was accompanied by an intense quality assurance program including a site-specific and study-specific questionnaire and a dummy run (DR). Target volume delineation was performed according to the European Organisation for the Research and Treatment of Cancer guidelines, and a DR-based treatment plan was established for 70 Gy. Major and minor protocol deviations were noted, interobserver agreement of delineated target contours was assessed, and dose-volume histogram (DVH) parameters of different treatment techniques were compared. RESULTS Thirty European centers participated, 43% of which were using 3-dimensional conformal RT (3D-CRT), with the remaining centers using intensity modulated RT (IMRT) or volumetric modulated arc technique (VMAT). The first submitted version of the DR contained major deviations in 21 of 30 (70%) centers, mostly caused by inappropriately defined or lack of prostate bed (PB). All but 5 centers completed the DR successfully with their second submitted version. The interobserver agreement of the PB was moderate and was improved by the DR review, as indicated by an increased κ value (0.59 vs 0.55), mean sensitivity (0.64 vs 0.58), volume of total agreement (3.9 vs 3.3 cm(3)), and decrease in the union volume (79.3 vs 84.2 cm(3)). Rectal and bladder wall DVH parameters of IMRT and VMAT vs 3D-CRT plans were not significantly different. CONCLUSIONS The interobserver agreement of PB delineation was moderate but was improved by the DR. Major deviations could be identified for the majority of centers. The DR has improved the acquaintance of the participating centers with the trial protocol.

Isospin breaking in pion–deuteron scattering and the pion–nucleon scattering lengths

In recent years, high-accuracy data for pionic hydrogen and deuterium have become the primary source of information on the pion–nucleon scattering lengths. Matching the experimental precision requires, in particular, the study of isospin-breaking corrections both in pion– nucleon and pion–deuteron scattering. We review the mechanisms that lead to the cancellation of potentially enhanced virtual-photon corrections in the pion–deuteron system, and discuss the subtleties regarding the definition of the pion–nucleon scattering lengths in the presence of electromagnetic interactions by comparing to nucleon–nucleon scattering. Based on the p±p channels we find for the virtual-photon-subtracted scattering lengths in the isospin basis a1/2/ g= (170.5±2.0) · 10−3M−1p and a3/2/ g= (−86.5±1.8) · 10−3M−1p .

Praktische Durchführung der INT

Dieses Kapitel dient der Vermittlung des klinischen Wissens und der praktischen Durchführung der Integrierten Neurokognitiven Therapie (INT). Aufbauend auf dem theoretischen und empirischen Hintergrund (Kap. 1) stellt das 2. Kapitel zunächst das Therapiekonzept der INT vor. Die einzelnen Therapiebereiche (Module), die Handhabung der Therapiematerialien, die didaktische Gestaltung und die infrastrukturellen Anforderungen für die Durchführung werden praxisorientiert und anhand von Beispielen erläutert. Der Anwender kann sich dabei schrittweise mit den therapeutischen Interventionen vertraut machen und an den 30 Beispielsitzungen orientieren. Abschließende Inhalte sind die für die INT – wie für Gruppentherapien im Allgemeinen – zentralen Aspekte des Motivationsaufbaus, der Beziehungsgestaltung sowie der Gruppenprozesse.

Empirische Evidenz der INT

Die INT wurde in einer randomisierten, internationalen Multicenterstudie in der Schweiz, Deutschland und Österreich evaluiert und vom Schweizerischen Nationalfonds unterstützt (Projektnummer 3200 B0‑108133). Insgesamt nahmen 169 Personen an der Studie teil. Personen wurden in die Studie eingeschlossen, wenn sie die Diagnosekriterien für eine schizophrene oder schizoaffektive Erkrankung gemäß ICD‑10 oder DSM-IV‑R erfüllten, in ambulanter oder teilstationärer Behandlung waren, ein Alter zwischen 18 und 50 Jahren sowie eine Krankheitsdauer von mehr als zwei Jahren aufwiesen und einen Intelligenzquotienten über 80 erreichten (Reduzierter Wechsler Intelligenztest, WIP). Ausschlusskriterien waren eine akute psychotische Episode, eine primäre Substanzabhängigkeit sowie eine hirnorganische Erkrankung.