Negative symptoms, anxiety, and depression as mechanisms of change of a 12-month trial of assertive community treatment as part of integrated care in patients with first and multi-episode schizophrenia spectrum disorders (ACCESS I trial)

Schmidt, Stefanie; Lange, M; Schöttle, D; Karow, A; Schimmelmann, Benno Karl Edgar; Lambert, M (2018). Negative symptoms, anxiety, and depression as mechanisms of change of a 12-month trial of assertive community treatment as part of integrated care in patients with first and multi-episode schizophrenia spectrum disorders (ACCESS I trial). European archives of psychiatry and clinical neuroscience, 268(6), pp. 593-602. Springer 10.1007/s00406-017-0810-1

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Assertive community treatment (ACT) has shown to be effective in improving both functional deficits and quality of life (QoL) in patients with severe mental illness. However, the mechanisms of this beneficial effect remained unclear. We examined mechanisms of change by testing potential mediators including two subdomains of negative symptoms, i.e. social amotivation as well as expressive negative symptoms, anxiety, and depression within a therapeutic ACT model (ACCESS I trial) in a sample of 120 first- and multi-episode patients with a schizophrenia spectrum disorder (DSM-IV). Path modelling served to test the postulated relationship between the respective treatment condition, i.e. 12-month ACT as part of integrated care versus standard care, and changes in functioning and QoL. The final path model resulted in 3 differential pathways that were all significant. Treatment-induced changes in social amotivation served as a starting point for all pathways, and had a direct beneficial effect on functioning and an additional indirect effect on it through changes in anxiety. Expressive negative symptoms were not related to functioning but served as a mediator between changes in social amotivation and depressive symptoms, which subsequently resulted in improvements in QoL. Our results suggest that social amotivation, expressive negative symptoms, depression, and anxiety functioned as mechanisms of change of ACCESS. An integrated and sequential treatment focusing on these mediators may optimise the generalisation effects on functioning as well as on QoL by targeting the most powerful mechanism of change that fits best to the individual patient

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > University Psychiatric Services > University Hospital of Child and Adolescent Psychiatry and Psychotherapy
04 Faculty of Medicine > University Psychiatric Services > University Hospital of Child and Adolescent Psychiatry and Psychotherapy > Research Division

UniBE Contributor:

Schmidt, Stefanie and Schimmelmann, Benno Karl Edgar

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0940-1334

Publisher:

Springer

Language:

English

Submitter:

Livia Hug

Date Deposited:

28 Mar 2018 12:02

Last Modified:

24 Oct 2019 15:29

Publisher DOI:

10.1007/s00406-017-0810-1

PubMed ID:

28540411

Uncontrolled Keywords:

Amotivation, Functioning, Mediation, Negative symptoms, Psychosis, Quality of life

BORIS DOI:

10.7892/boris.109303

URI:

https://boris.unibe.ch/id/eprint/109303

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