![]() Aim: To explore the effect sizes of current CBTp trials including targeted and nontargeted symptoms, modes of action, and effect of methodological rigor. A following meta-analysis reported CBT effect size for negative symptoms as 0.44 ( 13) eg, in groups. In another meta-analysis that analyzed delusions or hallucinations individually instead of positive psychotic findings, the effect size of CBT for hallucinations was 0.44, and CBT effect size for delusions was 0.36 with comparison to control group ( 14). Method: Thirty-four CBTp trials with data in the public domain were used as source data for a meta-analysis and investigation of the effects of trial methodology using the Clinical Trial Assessment Measure (CTAM. The effect size of CBT for positive psychotic symptoms was estimated as 0.31 in a meta-analysis when compared to the group receiving standard treatment ( 12), and another meta-analysis reported it as 0.37 ( 13), e.g., in groups. Meta-analyzes showed that CBTp had a low to medium efficiency. In recent studies, CBTp was utilized for positive symptoms, negative symptoms, general functionality, prodromal stage, individuals at risk for the development of psychosis and for comorbid psychiatric disorders such as depression, anxiety, substance abuse, and post-traumatic stress disorder. LEVEL OF EVIDENCE FOR COGNITIVE BEHAVIORAL THERAPY During the period following the “stress-vulnerability” model, the focus was shifted from “psychotic syndrome” to “psychotic symptoms” ( 7), and CBTp models were developed ( 8) ( Figure 1). Also, stress can be biological (e.g., infection), psychological, or social ( 6). The vulnerability may be due to biological origin (e.g., genetics), innate psychological characteristics, or social conditions in the intrauterine/early developmental stages. With the emergence of the “stress-vulnerability” model, it has been suggested that schizophrenia is not only a disorder with a biological origin, but it occurs from the interaction between biological and psychosocial factors. Before that, schizophrenia was considered only as a medical illness, and psychological factors were ignored. ( 1).Ĭognitive Behavioral Therapy for psychotic disorders (CBTp) interventions started to spread in the 1980 s. Psychotherapeutic approaches can be divided into individual (supportive, social skill therapies, etc.), group, and cognitive-behavioral techniques in general. For this reason, current treatments in schizophrenia include psychotherapeutic approaches in addition to antipsychotic medication. Also, the side effects of antipsychotic drugs affect the patients’ quality of life negatively and disrupt treatment compliance. In general, the second-generation antipsychotics (SGAs. ![]() Evidence for efficacy of current psychopharmacological medications is difficult to assess because of methodological problems and inconsistent results. The findings presented here predominantly focus on results of meta-analyses. Although the effectiveness of antipsychotic drugs over positive symptoms is well known, their effectiveness in areas that remain in the background but strong determinants of the general functionality such as negative and cognitive symptoms are still controversial ( 4) the authors reviewed the findings published to date by searching PubMed with the keywords negative symptoms, antipsychotics, antidepressants, glutamatergic compounds, monotherapy and add-on therapy and identifying additional articles in the reference lists of the resulting publications. It was reported that in patients with compliance to treatment, there were ongoing positive or negative symptoms close to 50%, and resistance to treatment is around 20–30%. Only about 30% of the patients using antipsychotic drugs are satisfied with the treatment in the first 18 months the remaining patients either discontinue or change their treatment during this period. The first choice of treatment in schizophrenia is antipsychotic medications. It is known that disruptive changes and symptoms appear in many domains of schizophrenia such as behaviors, emotions, and cognitive functions ( 1). Generally, signs and symptoms of schizophrenia are grouped as positive (delusion, hallucinations, disorganized behavior, and speech) and negative (reduced affect, alogia, loss of motivation, asociality, etc.). Schizophrenia is a psychiatric disorder characterized by chronic and repetitive psychosis.
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