• Cognitive biases
• metacognition
• metacognitive training
• psychosis
• psychotherapy
• schizophrenia

• Humans
• Metacognition
• Schizophrenia/therapy
• Cognitive Behavioral Therapy/methods
• Psychotic Disorders/therapy
• Psychotic Disorders/psychology

• Data harmonization
• Exploratory data analysis
• Machine learning
• Mental health
• Metacognitive treatment
• Personalized medicine

• Humans
• Precision Medicine/methods
• Psychotic Disorders/therapy
• Psychotic Disorders/psychology
• Male
• Female
• Adult
• Metacognition
• Retrospective Studies
• Databases, Factual
• Middle Aged
• Machine Learning
• Cognitive Behavioral Therapy/methods
• Young Adult

• ERAPerMed 2022-292 Instituto de Salud Carlos III
• German Federal Ministry of Education and Research (BMBF), Germany
• Agencia Nacional de Investigación y Desarrollo (ANID), Chile
• Agence Nationale de la Recherche (ANR), France
• National Centre for Research and Development (NCBR), Poland

• anti-psychotics
• discontinuing
• prediction
• psychotic disorders
• relapse

• 2021-00154 Swedish Research Council

• Antipsychotics
• adverse effects
• informed consent
• psychosis
• therapeutic relationship

• Humans
• Antipsychotic Agents/therapeutic use
• Antipsychotic Agents/adverse effects
• Male
• Female
• Adult
• Middle Aged
• Physician-Patient Relations
• Informed Consent/psychology
• Psychotic Disorders/drug therapy
• Young Adult
• Aged
• Surveys and Questionnaires
• Adolescent
• Patient Satisfaction

• metacognition
• physical exercise
• psychological interventions
• schizophrenia
• specificity protein

• adult
• humans
• young adult
• antipsychotic agents
• antipsychotic agents/therapeutic use
• bias
• cognitive behavioral therapy
• combined modality therapy
• combined modality therapy/methods
• psychotic disorders
• psychotic disorders/therapy
• quality of life
• randomized controlled trials as topic
• recurrence
• schizophrenia
• schizophrenia/therapy

• Humans
• Cognitive Behavioral Therapy
• Randomized Controlled Trials as Topic
• Psychotic Disorders/therapy
• Bias
• Schizophrenia/therapy
• Adult
• Quality of Life
• Recurrence
• Antipsychotic Agents/therapeutic use
• Young Adult
• Combined Modality Therapy/methods

• humans
• young adult
• antipsychotic agents
• antipsychotic agents/therapeutic use
• cognitive behavioral therapy
• cognitive behavioral therapy/methods
• neoplasm recurrence, local
• neoplasm recurrence, local/drug therapy
• randomized controlled trials as topic
• schizophrenia
• schizophrenia/drug therapy

• Humans
• Young Adult
• Antipsychotic Agents/therapeutic use
• Cognitive Behavioral Therapy/methods
• Neoplasm Recurrence, Local/drug therapy
• Randomized Controlled Trials as Topic
• Schizophrenia/drug therapy

• Humans
• Outpatients
• Reproducibility of Results
• Psychotic Disorders/therapy
• Ambulatory Care
• Psychotherapy

• Acute ward
• Cognitive behavioral therapy
• Cognitive remediation
• Family interventions
• Metacognitive training

• Humans
• Cognitive Behavioral Therapy
• Hospitalization
• Inpatients
• Psychotherapy
• Psychotic Disorders/diagnosis
• Psychotic Disorders/therapy
• Guidelines as Topic
• Meta-Analysis as Topic

• Functioning
• Meta-analysis
• Psychological interventions
• Schizophrenia
• Systematic review

• Delirios
• Delusions
• Esquizofrenia
• Metacognición
• Metacognition
• Psicoterapia
• Psychotherapy
• Schizophrenia

• Activities of daily living
• Cognitive behavioral therapy
• Delusions
• Ideas of reference
• Paranoid ideations
• Schizophrenia spectrum disorders
• Schizotypal disorders
• Social functioning
• Virtual reality
• Virtual reality exposure therapy

Background: The mistiming of predictive thought and real perception leads to postdiction in awareness. Individuals with high delusive thinking confuse prediction and perception, which results in impaired reality testing. The present observational study investigated how antipsychotic medications and cognitive-behavioral therapy (CBT) modulate postdiction in schizophrenia. We hypothesized that treatment reduces postdiction, especially when antipsychotics and CBT are combined. Methods: We enrolled patients with schizophrenia treated in a natural clinical setting and not in a randomized controlled trial. We followed up two schizophrenia groups matched for age, sex, education, and illness duration: patients on antipsychotics (n = 25) or antipsychotics plus CBT (n = 25). The treating clinician assigned the patients to the two groups. Participants completed a postdiction and a temporal discrimination task at weeks 0 and 12. Results: At week 0, postdiction was enhanced in patients relative to controls at a short prediction–perception time interval, which correlated with PANSS positive symptoms and delusional conviction. At week 12, postdiction was reduced in schizophrenia, especially when they received antipsychotics plus CBT. Patients with schizophrenia were also impaired on the temporal discrimination task, which did not change during the treatment. During the 12-week observational period, all PANSS scores were significantly reduced in both clinical groups, but the positive symptoms and emotional distress exhibited a more pronounced response in the antipsychotics plus CBT group. Conclusion: Perceptual postdiction is a putative neurocognitive marker of delusive thinking. Combined treatment with antipsychotics and CBT significantly ameliorates abnormally elevated postdiction in schizophrenia.

• cognition
• cognitive-behavioral therapy
• perception
• postdiction
• schizophrenia

People with psychosis have high rates of trauma, with a post-traumatic stress disorder (PTSD) prevalence rate of approximately 15%, which exacerbates psychotic symptoms such as delusions and hallucinations. Pilot studies have shown that trauma-focused (TF) psychological therapies can be safe and effective in such individuals. This trial, the largest to date, will evaluate the clinical effectiveness of a TF therapy integrated with cognitive behaviour therapy for psychosis (TF-CBTp) on post-traumatic stress symptoms in people with psychosis. The secondary aims are to compare groups on cost-effectiveness; ascertain whether TF-CBTp impacts on a range of other meaningful outcomes; determine whether therapy effects endure; and determine acceptability of the therapy in participants and therapists.

Rater-blind, parallel arm, pragmatic randomised controlled trial comparing TF-CBTp + treatment as usual (TAU) to TAU only. Adults (N = 300) with distressing post-traumatic stress and psychosis symptoms from five mental health Trusts (60 per site) will be randomised to the two groups. Therapy will be manualised, lasting 9 months (m) with trained therapists. We will assess PTSD symptom severity (primary outcome); percentage who show loss of PTSD diagnosis and clinically significant change; psychosis symptoms; emotional well-being; substance use; suicidal ideation; psychological recovery; social functioning; health-related quality of life; service use, a total of four times: before randomisation; 4 m (mid-therapy); 9 m (end of therapy; primary end point); 24 m (15 m after end of therapy) post-randomisation. Four 3-monthly phone calls will be made between 9 m and 24 m assessment points, to collect service use over the previous 3 months. Therapy acceptability will be assessed through qualitative interviews with participants (N = 35) and therapists (N = 5–10). An internal pilot will ensure integrity of trial recruitment and outcome data, as well as therapy protocol safety and adherence. Data will be analysed following intention-to-treat principles using generalised linear mixed models and reported according to Consolidated Standards of Reporting Trials-Social and Psychological Interventions Statement.

The proposed intervention has the potential to provide significant patient benefit in terms of reductions in distressing symptoms of post-traumatic stress, psychosis, and emotional problems; enable clinicians to implement trauma-focused therapy confidently in this population; and be cost-effective compared to TAU through reduced service use.

ISRCTN93382525 (03/08/20)

The online version contains supplementary material available at 10.1186/s13063-022-06215-x.

• Cognitive behaviour therapy
• Delusions
• Hallucinations
• Post-traumatic stress disorder (PTSD)
• Psychosis
• Schizophrenia-spectrum disorder
• Trauma
• Trauma memory reprocessing
• Trauma-focused therapy

• Sell v. United States (2003)
• competency to stand trial
• forced medication
• forensic evaluation
• involuntary medication
• involuntary treatment

• Delirios
• Delusions
• Esquizofrenia
• Metacognición
• Metacognition
• Psicoterapia
• Psychotherapy
• Schizophrenia

• Disease models
• Induced pluripotent stem cells
• Psychiatric disorders
• Regenerative medicines
• Schizophrenia
• Stem cell transplantation

• ADOLESCENT
• ANTIPSYCHOTIC AGENTS
• COGNITIVE THERAPY
• FEASIBILITY STUDIES
• PSYCHOTIC DISORDERS
• SCHIZOPHRENIA

• Adolescent
• Antipsychotic Agents/therapeutic use
• Cost-Benefit Analysis
• Feasibility Studies
• Humans
• Prospective Studies
• Psychosocial Intervention
• Psychotic Disorders/drug therapy
• Single-Blind Method

• 15/31/04 Department of Health
• HSRU1 Chief Scientist Office
• RP-2014-05-003 Department of Health

• beliefs
• causal explanations
• health professionals
• schizophrenia
• treatments

• Alternative treatments
• Minimal antipsychotics
• Not taking antipsychotics
• Psychological treatments
• Schizophrenia

• positive symptoms
• psychological intervention
• randomized controlled trials
• schizophrenia
• systematic review

• Emotion
• Functioning
• PSYRATS
• Psychosis
• Recovery
• Schizophrenia

• Affective Symptoms
• Humans
• Psychiatric Status Rating Scales
• Psychotic Disorders
• Schizophrenia
• Surveys and Questionnaires

• 10/101/02 Department of Health
• PB-PG-1112-29057 Department of Health
• PB-PG-1208-18053 Department of Health
• RP-PG-0606-1086 Department of Health

• Low-income country
• Mixed-methods study
• Recent-onset psychosis
• Subjective recovery

This review describes four cognitive approaches for the treatment of schizophrenia: cognitive-behavioral therapy for psychosis (CBTp), metacognitive therapy, metacognitive training, and metacognitive reflection insight therapy (MERIT). A central reference point of our review is a seminal paper by James Flavell, who introduced the term metacognition (“cognition about cognition”). In a way, every psychotherapeutic approach adopts a metacognitive perspective when therapists reflect with clients about their thoughts. Yet, the four approaches map onto different components of metacognition. CBTp conveys some “metacognitive knowledge” (eg, thoughts are not facts) but is mainly concerned with individual beliefs. Metacognitive therapy focuses on unhelpful metacognitive beliefs about thinking styles (eg, thought suppression). Metacognitive training brings distorted cognitive biases to the awareness of patients; a central goal is the reduction of overconfidence. MERIT focuses on larger senses of identity and highlights metacognitive knowledge about oneself and other persons. For CBTp and metacognitive training, meta-analytic evidence supports their efficacy; single studies speak for the effectiveness of MERIT and metacognitive therapy.


• cognitive-behavioral therapy
• metacognition
• metacognitive therapy
• metacognitive training
• psychosis
• schizophrenia

Impaired cognitive functioning is a core feature of schizophrenia, and is hypothesized to be due to myelination as well as interneuron defects during adolescent prefrontal cortex (PFC) development. Here we report that in the apomorphine-susceptible (APO-SUS) rat model, which has schizophrenia-like features, a myelination defect occurred specifically in parvalbumin interneurons. The adult rats displayed medial PFC (mPFC)-dependent cognitive inflexibility, and a reduced number of mature oligodendrocytes and myelinated parvalbumin inhibitory axons in the mPFC. In the developing mPFC, we observed decreased myelin-related gene expression that persisted into adulthood. Environmental enrichment applied during adolescence restored parvalbumin interneuron hypomyelination as well as cognitive inflexibility. Collectively, these findings highlight that impairment of parvalbumin interneuron myelination is related to schizophrenia-relevant cognitive deficits.

Dysfunction of GABAergic neurons in the prefrontal cortex has been reported in schizophrenia. Here, the authors use the apomorphine-susceptible rat, which displays some schizophrenia-like behaviors, and show that interneurons in the medial prefrontal cortex are hypomyelinated, which may contribute to this behavioral phenotype.

• Developing country
• Recent-onset psychosis
• Subjective recovery

• paranoia
• psychosis
• shame
• systematic review

Antipsychotic medication is currently the treatment of choice for psychosis, but few studies directly survey the first-hand experience of recipients.

To ascertain the experiences and opinions of an international sample of users of antipsychotic drugs, regarding positive and negative effects.

An online direct-to-consumer questionnaire was completed by 832 users of antipsychotics, from 30 countries – predominantly USA, UK and Australia. This is the largest such sample to date.

Over half (56%) thought, the drugs reduced the problems they were prescribed for, but 27% thought they made them worse. Slightly less people found the drugs generally ‘helpful’ (41%) than found them ‘unhelpful’ (43%). While 35% reported that their ‘quality of life’ was ‘improved’, 54% reported that it was made ‘worse’. The average number of adverse effects reported was 11, with an average of five at the ‘severe’ level. Fourteen effects were reported by 57% or more participants, most commonly: ‘Drowsiness, feeling tired, sedation’ (92%), ‘Loss of motivation’ (86%), ‘Slowed thoughts’ (86%), and ‘Emotional numbing’ (85%). Suicidality was reported to be a side effect by 58%. Older people reported particularly poor outcomes and high levels of adverse effects. Duration of treatment was unrelated to positive outcomes but significantly related to negative outcomes. Most respondents (70%) had tried to stop taking the drugs. The most common reasons people wanted to stop were the side effects (64%) and worries about long-term physical health (52%). Most (70%) did not recall being told anything at all about side effects.

Clinical implications are discussed, with a particular focus on the principles of informed consent, and involving patients in decision making about their own lives.

• Antipsychotic drugs
• TAE
• maudsley side effects
• psychosis
• second generation
• sedation
• suicidality.

• Cognitive behavioural therapy
• Psychosis
• Randomized Controlled Trial
• Thought disorder

• PB-PG-1208-18053 Department of Health

• Guideline
• psychopharmacology
• schizophrenia

• Cognitive Analytic Therapy
• case series
• feasibility
• psychosis

• Adult
• Cognitive Behavioral Therapy/methods
• Feasibility Studies
• Female
• Humans
• Male
• Outcome and Process Assessment, Health Care
• Patient Acceptance of Health Care
• Psychotic Disorders/therapy
• Young Adult

• CBT
• CBTp
• delusions
• follow-up
• paranoia

• antipsychotic medication
• cognitive-behavioural therapy
• psychosis
• psychosocial interventions
• randomized controlled trials

Adolescent-onset psychosis is associated with more severe symptoms and poorer outcomes than adult-onset psychosis. The National Institute for Clinical Excellence (NICE) recommend that adolescents with first episode psychosis (FEP) should be offered a combination of antipsychotic medication (APs), cognitive behavioural therapy (CBT) and family intervention (FI). The evidence for APs in treating psychosis is limited in adolescents compared to adults. Nevertheless, it indicates that APs can reduce overall symptoms in adolescents but may cause more severe side effects, including cardiovascular and metabolic effects, than in adults. CBT and FI can improve outcomes in adults, but there are no studies of psychological interventions (PI) in patients under 18 years old. Given this limited evidence base, NICE made a specific research recommendation for determining the clinical and cost effectiveness of APs versus PI versus both treatments for adolescent FEP.

The current study aimed to establish the feasibility and acceptability of conducting such a trial by recruiting 14–18-year-olds with a first episode of psychosis into a feasibility prospective randomised open blinded evaluation (PROBE) design, three-arm, randomised controlled trial of APs alone versus PI alone versus a combination of both treatments. We aimed to recruit 90 participants from Early Intervention and Child and Adolescent Mental Health Teams in seven UK sites. APs were prescribed by participants’ usual psychiatrists. PI comprised standardised cognitive behavioural therapy and family intervention sessions.

This is the first study to compare APs to PI in an adolescent population with FEP. Recruitment finished on 31 October 2018. The study faced difficulties with recruitment across most sites due to factors including clinician and service-user treatment preferences.

Current controlled trial with ISRCTN, ISRCTN80567433. Registered on 27 February 2017.

The online version of this article (10.1186/s13063-019-3506-1) contains supplementary material, which is available to authorized users.

• Adolescent psychosis
• Antipsychotic medication
• Cognitive behavioural therapy
• Family intervention
• First-episode psychosis
• Psychological intervention
• Randomised controlled trial
• Schizophrenia