Evaluation of the Combined Treatment Approach "Robin" (Standardized Manual and Smartphone App) for Adolescents at Clinical High Risk for Psychosis.

Introduction: The prevention of schizophrenia and other psychotic disorders has led researchers to focus on early identification of individuals at clinical high risk (CHR) for psychosis and to treat the at-risk symptoms in the pre-psychotic period. Although at-risk symptoms such as attenuated hallucinations or delusions are common in adolescents and associated with a marked reduction in global functioning, the evidence base of effective interventions for adolescents at CHR state and even first-episode psychosis is limited. Thus, the present protocol describes a study design that combines therapy modules for CHR adolescents with a smartphone application supporting the young individuals between the therapy sessions. The treatment approach "Robin" is based on existing therapy strategies for adolescents with first episode of psychosis and the available recommendations for adults with at-risk symptoms. Methods: The evaluation aims firstly to compare the efficacy of Robin in 30 CHR adolescents aged 14-18 to an active control group (treatment as usual) from a previous study. Primary outcome measures will be at-risk symptomatology, comorbid diagnosis, functioning, self-efficacy, and quality of life. For the prospective intervention condition (16 weekly individual sessions + a minimum 4 family sessions), help-seeking adolescents with CHR for psychosis, aged 14-18, will be recruited over 3 years. At-risk and comorbid symptoms, functioning, self-efficacy, and quality of life are monitored at six time points (baseline, during the treatment period; immediately after intervention; and 6, 12, and 24 months later) and compared with the respective measures of the active control group. Discussion: To the best of our knowledge, this is the first controlled trial to test the efficacy of a specific early psychosis treatment in combination with a smartphone application for adolescents at CHR for developing psychosis. The results of the study are expected to add information that may substantially decrease the burden of CHR adolescents and increase their resilience. It may offer age-adapted and targeted strategies to guide clinicians in the treatment of these vulnerable individuals. Furthermore, research in the field of early intervention will be enriched by our findings. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03829527.

Reliability and validity of the Knowledge about Depression and Mania Inventory.

BACKGROUND: The knowledge that patients with affective disorders have about their illness is attributed increasing importance. For a number of psychiatric disorders, the imparting of information about the illness is now standard treatment. However, the relevance of knowledge about a patient's disorder has to date not been sufficiently studied. One reason for that is that only few psychometrically validated instruments for the assessment of illness knowledge exist. The aim of this study was the development and psychometric evaluation of a questionnaire to assess knowledge about affective disorders. METHODS: The Knowledge about Depression and Mania Inventory (KDMI) was evaluated with a sample of 337 patients with major depression, relatives of patients with depression and schizophrenia, and controls. RESULTS: With the 44-item KDMI, the 3 dimensions knowledge of symptoms, knowledge of treatment and knowledge of coping strategies were differentiated. From these 44 items two 22-item parallel tests were developed for follow-up assessment. The scales showed good internal consistency. There were numerous indicators of the validity and sensitivity to change of the scales. It was shown that older patients and patients with lower levels of education are less knowledgeable about affective disorders. There were significant differences in the scales of the KDMI before and after a psychoeducative group for relatives. CONCLUSIONS: The study showed that knowledge about affective disorders can be reliably and validly measured by a questionnaire. Because of its brevity the KDMI is suitable for everyday use in clinical practice, and it forms the basis for further investigation of the significance of illness knowledge, as well as for evaluation of the effects of psychotherapy in this area.

Psychosocial factors associated with knowledge about affective disorders in patients with depression.

BACKGROUND: Increasing importance is attributed to the knowledge that patients have concerning their illness. For psychiatric disorders, imparting information about the illness has become a standard part of treatment. Despite the great clinical relevance of knowledge about depression, only few empirical studies on this subject have been carried out. This study aimed to identify psychosocial factors associated with greater or lesser knowledge about affective disorders. METHODS: Sixty-one in-patients with depression were recruited and tested with the Knowledge about Depression and Mania Inventory. RESULTS: Almost all patients sought specific information about their disorder prior to admission to hospital. There were large differences in patients' knowledge about the disorder and their choice of information source. Older and less educated patients had less knowledge about affective disorders. Patients with less illness knowledge also have a less favourable illness concept, poorer interpersonal relationships and more passive coping strategies. CONCLUSIONS: The results show that knowledge about affective disorders is a central illness characteristic that has numerous implications for the ability to cope with the disorder, as well as for psychotherapeutic management. The results contribute to a clarification of the relationship between psychoeducation and psychotherapy.