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PAPERS: Nicholas Tarrier, Shôn Lewis, Gillian Haddock, Richard Bentall, Richard Drake, Peter Kinderman, David Kingdon, Ronald Siddle, Julie Everitt, Karen Leadley, Andy Benn, Katy Grazebrook, Cliff Haley, Shahid Akhtar, Linda Davies, Steve Palmer, and Graham Dunn Cognitive-behavioural therapy in first-episode and early schizophrenia: 18-month follow-up of a randomised controlled trial The British Journal of Psychiatry 2004; 184: 231-239 [Abstract] [Full text] [PDF]

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Why Are the Conclusions Different to the Results?

Alex J Mitchell   (18 March 2004)

Why Are the Conclusions Different to the Results? 18 March 2004
Alex J Mitchell, Consultant Liaison Psychiatrist Leicester General Hospital Send letter to journal: Re: Why Are the Conclusions Different to the Results? alex.mitchell{at}leicspart.nhs.uk Alex J Mitchell	Although this study appears to be methodologically more rigorous than the similar study of CBT in post-acute schizophrenia (Br. J. Psychiatry, Jun 2002; 180: 523 – 527), I am a little confused by the authors’ conclusions. After clearly demonstrating no superior effect for CBT over Supportive Counselling on measures of symptom reduction or relapse rates – the authors conclude their paper by stating “We suggest the optimum psychosocial management of early schizophrenia would include a combination of CBT and family intervention”. Would it be rude to suggest that the authors take into account their own findings before making such a statement? It is also more than a little frustrating that the authors refer to their sample as being diagnosed with “early schizophrenia” throughout the paper. Examining the inclusion criteria for this study shows that patients were included who suffered schizophreniform disorders, delusional disorders and unspecified psychoses. Regarding the criterion for “early” – most clinicians would define the duration of schizophrenia from symptom onset to commencement of treatment (hence the duration of untreated psychosis concept). Unless the authors specify illness duration – the criterion of early cannot be asserted. Thus this is appears to be a study of patients within 2 years of their first episode for non-affective psychoses and not those with early schizophrenia per se. Were these issues not picked up on peer review or were essential facts omitted in editing?