Metacognitive training complements antipsychotic therapy

By Lucy Piper, Senior medwireNews Reporter

Metacognitive training (MCT) may benefit patients with schizophrenia who only partially respond to antipsychotic treatment, study findings show.

The training aims to reduce cognitive distortion, like increased confidence in false memories, in patients with schizophrenia and help them recognize such distortion in order to reduce its impact on problem-solving and interpersonal relationships.

The researchers, led by Jérôme Favrod (University of Applied Sciences of Western Switzerland, Lausanne), found that the addition of MCT to standard antipsychotic treatment significantly improved outcomes on the Psychotic Symptom Rating Scale (PSYRATS) delusion subscale.

Among 24 patients randomly assigned to receive eight sessions of MCT in addition to standard antipsychotic therapy, scores on the delusion subscale fell by 3.96 points, from 15.04 before treatment to 11.08 afterwards. This compared with an improvement of just 1.50 points over the same period for 24 patients randomly assigned to standard antipsychotic treatment alone, reflecting a significant difference.

“This additional antipsychotic effect seems to be exerted primarily through an amelioration of delusion conviction, a dimension of psychosis on which pharmacological treatment has a very limited impact,” the authors note in European Psychiatry.

This MCT benefit was sustained over 6 months of follow-up, at which point delusion scores had dropped by an average of 7.04 points, compared with just 3.61 points in patients not receiving MCT.

Other significant improvements with MCT included a 4.54-point decrease in positive scores on the Positive and Negative Syndrome Scale following treatment, compared with a 0.86-point decrease for patients not receiving MCT.

And with regard to secondary outcomes, MCT was significantly associated with improvements in awareness of delusional ideas on the Scale to Assess Unawareness of Mental Disorder and auditory hallucinations on the PSYRATS.

The researchers acknowledge that the lack of an active control group in their study meant that the MCT group received a greater amount of therapeutic attention, but they dismiss this as a possible reason for the additional antipsychotic effect.

“Any effect linked to more treatment should have been just as observed with respect to other less specific symptoms like anxiety or depression, something which was not the case in this study,” they explain.

The team concludes: “Metacognitive training has a surplus antipsychotic effect for patients diagnosed with schizophrenia-related disorders who demonstrate only a partial response to antipsychotic treatment.”

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