Barcelona snapshots

Prof. David G. Fowler

David G. Fowler psiquiatra Controversias Psiquiatría Barcelona
University of Sussex, Reino Unido
Ponencia Delirios persecutorios
Fecha Viernes, 20 de Abril 2018
Hora 16:30 a 17:15
Mesa redonda Complejidades en Psiquiatría: psicosis y trastornos bipolares

BIOGRAFÍA

David Fowler is a clinical psychologist who has been involved in a programme of research on the development and evaluation of cognitive behaviour therapy for psychosis for over 25 years. He is currently Professor of Clinical Psychology at the University of Sussex and is engaged in clinical work and trials in Sussex Partnership NHS trust. He undertook some of the first pioneering studies in this area and with other UK colleagues (particularly the PRP group with Philippa Garety and Elizabeth Kuipers) he has subsequently been principal investigator in a series of high impact large randomised trials which now provide a strong evidence base for cognitive behaviour therapy which has underpinned guidance on the psychological management of psychosis in many countries. In addition David also has made a key contribution to the development of early intervention services for people with psychosis. He co-edited Early Intervention in Psychosis 2000 with Max Birchwood and developed a pathfinder early intervention service in Norfolk which became a recognised centre of excellence in the area and the basis for many influential trials. David also collaborated with Prof Tony Morrison and Dr Paul French to undertake the multicentre EDIE study on cognitive therapy in young people at risk of schizophrenia. Most recently David has been focussing on development of interventions to address social disability in early psychosis and youth mental health. He led the Medical Research Council funded ISREP trial (Fowler et al, 2009) and most recently the SUPEREDEN3 trial (Lancet psychiatry, 2018). He is also involved in a range of UK projects including evaluating a digitally assisted approach to psychological treatment of persecutory delusions in the SLOWMO trial with Phillippa Garety; the CIRCUITs trial with Til Wykes, the CIRCLE trial with Sonia Johnson, MAPS with Tony Morrison and Typpex with Peter Jones. David is currently the chief investigator for the multicentre trials PRODIGY which evaluate the effects of CBT in preventing social disability amongst young people recovering from first episode psychosis, and young people at risk of severe mental illness respectively. He has published over 200 peer reviewed papers.

RESUMEN

This talk first provides an overview of recent developments in psychological therapies for psychosis in the UK including recently completed and ongoing studies involving the author. Cognitive behavior therapy for psychosis now has a clear evidence base however the effect size is in the region of 0.4 for positive symptoms. Newer approaches focusing specifically on individual symptoms as targets and particularly persecutory delusions show promising results with stronger effect sizes. However, those cases most at need have complex and comorbid conditions. These present with severe withdrawal and inactivity; have a variety of treatment resistant positive and negative symptoms and are typically accompanied by emotional disturbance, anxiety and depression. Often these cases are also the most difficult to engage into services and interventions. Such cases present a considerable challenge, but they represent an important target, particularly in early intervention, as they are the cases with the worst long term outcomes. Despite early intervention for psychosis substantial proportions of young people with first episode psychosis do not make a social recovery, and remain withdrawn and inactive. Their problems often date back to childhood and become chronic at an early age. Without intervention the long term prognosis is often poor and the economic costs are very large. Social Recovery therapy is a new approach targeting social recovery in cases presenting with severe withdrawal and complex comorbid severe mental health problems. This approach combines cognitive behavioural therapy with systemic formulation and case management. This paper reports on two trials which evaluate Social Recovery Therapy. The SUPEREDEN3 trial addressed the problems of the subgroup of first episode psychosis cases in EI services who are treatment resistant, whom we know to have social disability stretching back into adolescence and have very poor long term prognosis. This subgroup comprises of around 40% of first episodes that our best treatments and EI cannot touch. The trial shows a definitive superiority on activity at 9 months , with a clinically significant mean gain of over 8 hours for the treatment group and promising support for effects on symptoms and the persistence of gains at follow up (Fowler et al, Lancet Psychiatry, 2018). A recent two year follow up from our previous ISREP study has also shown clear gains in involvement with work and education over the longer term (Fowler et al, Schiz Res, 2017). The PRODIGY trial focuses on At Risk Cases with social disability and severe and complex mental health problems and has recruited over 270 participants with follow ups ongoing (Fowler et al, Trials, 2017). We discuss data from all three trials and highlight implications for early detection and intervention these important groups.

REFERENCIAS

[web] Fowler D et al (2018). Social recovery therapy in combination with early intervention services for enhancement of social recovery in patients with first-episode psychosis (SUPEREDEN3): a single-blind, randomised controlled trial, Lancet Psychiatry. 2018 Jan;5(1):41-50. doi:10.1016/S2215-0366(17)30476-5. Epub 2017 Dec 11. PubMed PMID: 29242000.

[web] Fowler D et al (2017). Social Recovery Therapy in improving activity and social outcomes in early psychosis: Current evidence and longer term outcomes, Schizophr Res. 2017 Oct 22. pii: S0920-9964(17)30615-1. doi:10.1016/j.schres.2017.10.006. [Epub ahead of print] PubMed PMID: 29070442.

[web] Fowler D et al (2017). Prevention and treatment of long-term social disability amongst young people with emerging severe mental illness with social recovery therapy (The PRODIGY Trial): study protocol for a randomised controlled trial, Trials. 2017 Jul 11;18(1):315. doi: 10.1186/s13063-017-2062-9. PubMed PMID: 28693622; PubMed Central PMCID: PMC5504604.

[PDF] Waller H et al (2015). Thinking Well: A randomised controlled feasibility study of a new CBT therapy targeting reasoning biases in people with distressing persecutory delusional beliefs, J Behav Ther Exp Psychiatry. 2015 Sep;48:82-9. doi: 10.1016/j.jbtep.2015.02.007. Epub 2015 Feb 24. PubMed PMID: 25770671; PubMed Central PMCID: PMC4429971.