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It is unclear whether outcome in schizoaffective disorders is more similar to schizophrenia or affective disorders. To provide longitudinal data on clinical course and outcome in schizoaffective disorders versus schizophrenia and affective disorders, and determine whether mood-incongruent psychotic symptoms have negative prognostic implications. A total of 210 patients with schizoaffective disorders, schizophrenia, bipolar manic disorders and depression were assessed at hospitalisation and then followed up four times over 10 years. At all four follow-ups, fewer patients with schizoaffective disorders than with schizophrenia showed uniformly poor outcome. Patients with mood-incongruent psychotic symptoms during index hospitalisation showed significantly poorer subsequent outcome (P < 0.05). Schizoaffective outcome was better than schizophrenic outcome and poorer than outcome for psychotic affective disorders. Mood-incongruent psychotic symptoms have negative prognostic implications. The results could fit a symptom dimension view of schizoaffective course.

Abstract Background and Hypothesis Early auditory processing (EAP) has increasingly become a focus of efforts to identify markers of treatment response in people with schizophrenia spectrum disorders. Assessment of baseline need provides an opportunity for cognitive remediation (CR) programs that include EAP training to personalize treatment and optimize its impact. CR has been shown to help reduce negative symptoms, but less is known about how EAP tailoring may influence this relationship. This study hypothesized a differential benefit of EAP training on negative symptom reduction for those with and without baseline EAP deficits as defined by performance on the Tone Matching Test. Study Design 150 outpatient adults diagnosed with schizophrenia or schizoaffective disorder were classified as having intact (44.7%) or impaired (55.3%) EAP and were randomly assigned to CR that either included EAP training (N = 77) or did not (N = 73). Negative symptom improvement was measured via the Positive and Negative Syndrome Scale posttreatment and 3 months later. Study Results CR resulted in significant negative symptom improvement in the sample overall. Only EAP impaired participants demonstrated significant negative symptom benefit from EAP training. EAP impaired participants who did not receive embedded auditory training had near-zero reductions in negative symptom severity. Conclusions These findings extend prior research on cognitive remediation as treatment for negative symptoms in people with schizophrenia spectrum disorders. Accumulating evidence suggests that routine assessment of EAP is critical for personalizing and optimizing a response to CR that is clinically significant for both cognitive and negative symptoms.

The treatment of severely ill patients with psychotic and personality disorders is often conducted in residential settings such as the Therapeutic Communities (TC). In these facilities a multidisciplinary model is employed to ensure integrative care of the complex psychiatric patient. Although the cost of such programs is very high, evidence of efficacy and effectiveness is scarce, especially in Italy. Aim of the study is to evaluate the efficacy of TC treatment in a group of patients with severe psychotic and personality disorders. Eighty-one patients have been assessed at baseline and after 6 and 12 months of follow-up in the following areas: global functioning, quality of life, emotion regulation, coping strategies, and insight into illness. At the end of follow-up we could find an improvement in functioning, quality of life, a greater engagement in goal-oriented behaviors, together with a lesser utilization of avoidant coping strategies. However the high dropout rates, which are associated with substance abuse and a diagnosis of personality disorders, should be acknowledged. The present study reports the efficacy of residential TC treatment for some severely ill patients with psychotic and personality disorders. Strategies aimed at increasing the motivation and preparation of patients before the program begins should be implemented in order to reduce the high dropout rates.

This study evaluated a statewide demonstration project to implement a group-based intervention called Procovery in selected inpatient and community mental health centers. Procovery is a facilitated mutual support group designed to build hope and a sense of social inclusion by raising consciousness and helping people develop an understanding of the ways one can move toward recovery in their own lives. This evaluation sought to determine both consumer outcomes and perceptions of the program and implementation efforts held by consumers and the facilitators of the intervention. A multidimensional approach was used, including a quasi-experimental design with consumers, questionnaires and focus groups with the intervention facilitators, and individual interviews with administrators. The Procovery model was shown to have a positive impact on consumers’ recoveries and was viewed favorably by consumers, facilitators, and administrators. Several barriers to effective implementation were identified. These findings and their implications for future practice and research are discussed.

Abstract Background Cognitive remediation (CR) is an effective therapy for the cognitive impact of mental illness, especially schizophrenia. Global efforts are being made to implement CR into routine mental health services with the aim of improving functional outcomes for the population of people recovering from mental illness. Implementation and dissemination of CR in heterogeneous settings require knowledge gleaned from formal implementation research and pragmatic experiential learning. This article describes cross-cultural approaches to CR implementation, focusing on initiatives in France, the United States, Australia, and Japan. Method Key leaders in the implementation of CR in France, the United States, Australia, and Japan were asked to describe the implementation and dissemination process in their settings with respect to the categories of context, implementation, outcomes, facilitators, and barriers. Results All 4 sites noted the role of collaboration to leverage the implementation of CR into mental health rehabilitation services. In France, high-level, government organizational backing enhanced the dissemination of CR. Academic and clinical service partnerships in the United States facilitated the dissemination of programs. The advocacy from service users, families, and carers can aid implementation. The support from international experts in the field can assist in initiating programs but maintenance and dissemination require ongoing training and supervision of staff. Conclusions CR is an effective intervention for the cognitive impact of schizophrenia. Programs can be implemented in diverse settings globally. Adaptations of CR centering upon the core components of effective CR therapy enhance outcomes and enable programs to integrate into diverse settings.

Abstract Background To provide precision cognitive remediation therapy (CR) for schizophrenia, we need to understand whether the mechanism for improved functioning is via cognition improvements. This mechanism has not been rigorously tested for potential moderator effects. Study Design We used data (n = 377) from a randomized controlled trial using CIRCuiTS, a therapist-supported CR, with participants from first-episode psychosis services. We applied structured equation modeling to test whether: (1) CR hours explain the goal attainment functional outcome (GAS) at posttreatment, (2) global cognitive improvement mediates GAS, and if (3) total symptoms moderate the CR hours to cognitive improvement pathway, and/or negative symptoms moderate the cognition to functioning pathway, testing moderator effects via the mediator or directly on CR hours to functioning path. Study Results CR produced significant functioning benefit for each therapy hour (Coeff = 0.203, 95% CI 0.101–0.304, P < .001). The mediated path from CR hours to cognition and cognition to functioning was small and nonsignificant (Coeff = 0.014, 95% CI = −0.010, 0.037, P = .256). Total symptoms did not moderate the path to cognition (P = .211) or the direct path to outcome (P = .896). However, negative symptoms significantly moderated the effect of cognitive improvements on functioning (P = .015) with high negative symptoms reducing the functional gains of improved cognition. Conclusions Although cognitive improvements were correlated with functioning benefit, they did not fully explain the positive effect of increased therapy hours on functioning, suggesting additional CR factors also contribute to therapy benefit. Negative symptoms interfere with the translation of cognitive improvements into functional gains so need consideration.

ObjectiveCognitive compensatory interventions aim to alleviate psychosocial disability by targeting functioning directly using aids and strategies, thereby minimizing the impact of cognitive impairment. The aim was to conduct a systematic review and meta-analysis of cognitive compensatory interventions for psychosis by examining the effects on functioning and symptoms, and exploring whether intervention factors, study design, and age influenced effect sizes.MethodsElectronic databases (Ovid Medline, PsychINFO) were searched up to October 2018. Records obtained through electronic and manual searches were screened independently by two reviewers according to selection criteria. Data were extracted to calculate estimated effects (Hedge’s g) of treatment on functioning and symptoms at post-intervention and follow-up. Study quality was assessed using Cochrane Collaboration’s risk of bias tool.ResultsTwenty-six studies, from 25 independent randomized controlled trials (RCTs) were included in the meta-analysis (1654 participants, mean age = 38.9 years, 64% male). Meta-analysis revealed a medium effect of compensatory interventions on functioning compared to control conditions (Hedge’s g = 0.46, 95% CI = 0.33, 0.60, P < .001), with evidence of relative durability at follow-up (Hedge’s g = 0.36, 95% CI = 0.19, 0.54, P < .001). Analysis also revealed small significant effects of cognitive compensatory treatment on negative, positive, and general psychiatric symptoms, but not depressive symptoms. Estimated effects did not significantly vary according to treatment factors (ie, compensatory approach, dosage), delivery method (ie, individual/group), age, or risk of bias. Longer treatment length was associated with larger effect sizes for functioning outcomes. No evidence of publication bias was identified.ConclusionCognitive compensatory interventions are associated with robust, durable improvements in functioning in people with psychotic illnesses.

Abstract Background and Hypothesis In schizophrenia spectrum disorders (SSD) personal recovery and subjective quality of life (S-QOL) are crucial and show conceptual overlap. There is limited knowledge about how these outcomes change over time. Therefore, we investigated changes in personal recovery or S-QOL for patients with SSD. We specifically focused on the influence of the patients’ durations of illness (DOI) on changes in personal recovery and S-QOL. Study Design We included 46 studies investigating longitudinal changes in quantitative assessments of personal recovery or S-QOL for patients with SSD. Outcomes were categorized in overall personal recovery, overall S-QOL connectedness, hope and optimism, identity, meaning in life, and empowerment. We evaluated effect sizes of change between baseline and follow-up assessments. We also evaluated potential moderating effects, including DOI on these changes in outcomes. Study Results We found small improvements of overall personal recovery and S-QOL, but marginal or no improvement over time in the other more specific outcome domains. Patients without a schizophrenia diagnosis, a younger age, and more recent publications positively influenced these changes. We found no significant influence of DOI on the changes in any outcome domain. Conclusions Improvement in personal recovery or S-QOL of people with SSD is modest at best. However, these studies did not fully capture the personal narratives or nonlinear process of recovery of an individual. Future research should focus on how to shift from a clinical to more person-oriented approach in clinical practice to support patients in improving their personal process of recovery. Review protocol registration CRD42022377100.

Abstract Well-being is not just the absence of mental disorder but also involves positive feelings and contentment (emotional well-being), meaningful engagement (psychological well-being), and contribution of one’s community or society (social well-being). Recovery processes, which encompass mitigation of clinical symptomatology (clinical recovery), improvement in occupational, social, and adaptive functioning (functional recovery), and development of personally valued goals and identity (personal recovery), have demonstrated to be important markers of well-being. This study examined the relative contribution of clinical, functional, and personal recovery processes on well-being among individuals with schizophrenia and explored the effect of personal recovery on people with varying levels of symptom severity and functional ability. A longitudinal quantitative research design was used in which 181 people with schizophrenia spectrum disorders were assessed at baseline and 6 months. At baseline, 28.2% of the participants were considered as flourishing. Around half of the participants (52.5%) were moderately mentally healthy, while 19.3% were identified as languishing. Results showed that clinical recovery was predictive of better well-being at 6-month postbaseline. Personal recovery was found to positively predict well-being, above and beyond the effects of clinical and functional recovery. Moderation analysis showed that the effect of personal recovery on well-being did not depend on clinical and functional recovery, which implied that people with schizophrenia can participate in the process of personal recovery and enjoy positive well-being regardless of their clinical stability and functional competence. Given the robust salutogenic effect of personal recovery, greater emphasis should be placed on developing person-centered, strength-based, recovery-oriented services.

To determine the baseline individual characteristics that predicted symptom recovery and functional recovery at 10-years following the first episode of psychosis. AESOP-10 is a 10-year follow up of an epidemiological, naturalistic population-based cohort of individuals recruited at the time of their first episode of psychosis in two areas in the UK (South East London and Nottingham). Detailed information on demographic, clinical, and social factors was examined to identify which factors predicted symptom and functional remission and recovery over 10-year follow-up. The study included 557 individuals with a first episode psychosis. The main study outcomes were symptom recovery and functional recovery at 10-year follow-up. At 10 years, 46.2% (n = 140 of 303) of patients achieved symptom recovery and 40.9% (n = 117) achieved functional recovery. The strongest predictor of symptom recovery at 10 years was symptom remission at 12 weeks (adj OR 4.47; CI 2.60-7.67); followed by a diagnosis of depression with psychotic symptoms (adj OR 2.68; CI 1.02-7.05). Symptom remission at 12 weeks was also a strong predictor of functional recovery at 10 years (adj OR 2.75; CI 1.23-6.11), together with being from Nottingham study centre (adj OR 3.23; CI 1.25-8.30) and having a diagnosis of mania (adj OR 8.17; CI 1.61-41.42). Symptom remission at 12 weeks is an important predictor of both symptom and functional recovery at 10 years, with implications for illness management. The concepts of clinical and functional recovery overlap but should be considered separately.