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Positive Emotions Program for Schizophrenia (PEPS): a pilot intervention to reduce anhedonia and apathy.

Favrod J, Nguyen A, Fankhauser C, Ismailaj A, Hasler JD, Ringuet A, Rexhaj S, Bonsack C - BMC Psychiatry (2015)

Bottom Line: Participation in the program was accompanied by statistically significant reductions in the total scores for Avolition-Apathy and Anhedonia-Asociality on the SANS, with moderate effect sizes.Furthermore, there was a statistically significant reduction of depression on the CDSS, with a large effect size.Findings indicate that PEPS is both a feasible intervention and is associated with an apparently specific reduction of anhedonia and apathy.

View Article: PubMed Central - PubMed

Affiliation: School of nursing sciences, La Source, University of Applied Sciences and Arts of Western Switzerland, Avenue Vinet 30, 1004, Lausanne, Switzerland. j.favrod@ecolelasource.ch.

ABSTRACT

Background: Recent literature has distinguished the negative symptoms associated with a diminished capacity to experience (apathy, anhedonia) from symptoms associated with a limited capacity for expression (emotional blunting, alogia). The apathy-anhedonia syndrome tends to be associated with a poorer prognosis than the symptoms related to diminished expression. The efficacy of drug-based treatments and psychological interventions for these symptoms in schizophrenia remains limited. There is a clear clinical need for new treatments.

Methods: This pilot study tested the feasibility of a program to reduce anhedonia and apathy in schizophrenia and assessed its impact on 37 participants meeting the ICD-10 criteria for schizophrenia or schizoaffective disorders. Participants were pre- and post-tested using the Scale for the Assessment of Negative Symptoms (SANS) and the Calgary Depression Scale for Schizophrenia (CDSS). They took part in eight sessions of the Positive Emotions Program for Schizophrenia (PEPS)--an intervention that teaches participants skills to help overcome defeatist thinking and to increase the anticipation and maintenance of positive emotions.

Results: Thirty-one participants completed the program; those who dropped out did not differ from completers. Participation in the program was accompanied by statistically significant reductions in the total scores for Avolition-Apathy and Anhedonia-Asociality on the SANS, with moderate effect sizes. Furthermore, there was a statistically significant reduction of depression on the CDSS, with a large effect size. Emotional blunting and alogia remain stable during the intervention.

Discussion: Findings indicate that PEPS is both a feasible intervention and is associated with an apparently specific reduction of anhedonia and apathy. However, these findings are limited by the absence of control group and the fact that the rater was not blind to the treatment objectives.

Conclusions: PEPS is a promising intervention to improve anhedonia and apathy which need to be tested further in a controlled study.

Trial registration number: ISRCTN registry ISRCTN74048461, registered 18 may 2015.

No MeSH data available.


Related in: MedlinePlus

CONSORT 2010 Flow Diagram
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Fig1: CONSORT 2010 Flow Diagram

Mentions: Thirty-nine participants were recruited, two of whom refused to give their consent for the study. The final group was composed of 24 men and 13 women, with an average age of 41.84 years old (S.D. = 11.99). Thirty-one met the criteria for ICD-10 schizophrenia and six met the criteria for a schizoaffective disorder. Their mean duration of illness was 19.05 years (S.D. 12.85). Twenty-eight were single, eight were separated or divorced, and one was a widower. In terms of the educational level which they had achieved: six had not finished their mandatory schooling, 17 participants had finished their mandatory schooling, three had a secondary school diploma, eight had completed a professional apprenticeship and three had either a professional school or university diploma. Three participants lived independently, two lived with their families, and 32 lived in sheltered housing. None of the participants had a job on the competitive labor market. All participants except one were on antipsychotic medication. Fourteen were on antidepressant at mean fluoxetine equivalents of 29.60 mg (SD 14.01) [46]. Figure 1 present the CONSORT flowchart of the study. Twenty-eight participants completed all eight sessions, two completed seven sessions, and one participant in the four cohorts only completed four sessions. Six participants dropped-out, one refused to participate after the first assessment, one moved away, and four left the program before it finished. Two refused to continue the program, without giving an explanation according to the informed consent form. However, four provided reasons for giving up which were unconnected with the program (external stressors).Table 1 shows that participants who dropped out did not differ from those who completed the program. Participants who dropped out did not differ, either from those who completed PEPS on the SANS and CDSS at baseline. Participants were recruited between May 20th 2014 and November 30th 2015.Figure 1


Positive Emotions Program for Schizophrenia (PEPS): a pilot intervention to reduce anhedonia and apathy.

Favrod J, Nguyen A, Fankhauser C, Ismailaj A, Hasler JD, Ringuet A, Rexhaj S, Bonsack C - BMC Psychiatry (2015)

CONSORT 2010 Flow Diagram
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4588492&req=5

Fig1: CONSORT 2010 Flow Diagram
Mentions: Thirty-nine participants were recruited, two of whom refused to give their consent for the study. The final group was composed of 24 men and 13 women, with an average age of 41.84 years old (S.D. = 11.99). Thirty-one met the criteria for ICD-10 schizophrenia and six met the criteria for a schizoaffective disorder. Their mean duration of illness was 19.05 years (S.D. 12.85). Twenty-eight were single, eight were separated or divorced, and one was a widower. In terms of the educational level which they had achieved: six had not finished their mandatory schooling, 17 participants had finished their mandatory schooling, three had a secondary school diploma, eight had completed a professional apprenticeship and three had either a professional school or university diploma. Three participants lived independently, two lived with their families, and 32 lived in sheltered housing. None of the participants had a job on the competitive labor market. All participants except one were on antipsychotic medication. Fourteen were on antidepressant at mean fluoxetine equivalents of 29.60 mg (SD 14.01) [46]. Figure 1 present the CONSORT flowchart of the study. Twenty-eight participants completed all eight sessions, two completed seven sessions, and one participant in the four cohorts only completed four sessions. Six participants dropped-out, one refused to participate after the first assessment, one moved away, and four left the program before it finished. Two refused to continue the program, without giving an explanation according to the informed consent form. However, four provided reasons for giving up which were unconnected with the program (external stressors).Table 1 shows that participants who dropped out did not differ from those who completed the program. Participants who dropped out did not differ, either from those who completed PEPS on the SANS and CDSS at baseline. Participants were recruited between May 20th 2014 and November 30th 2015.Figure 1

Bottom Line: Participation in the program was accompanied by statistically significant reductions in the total scores for Avolition-Apathy and Anhedonia-Asociality on the SANS, with moderate effect sizes.Furthermore, there was a statistically significant reduction of depression on the CDSS, with a large effect size.Findings indicate that PEPS is both a feasible intervention and is associated with an apparently specific reduction of anhedonia and apathy.

View Article: PubMed Central - PubMed

Affiliation: School of nursing sciences, La Source, University of Applied Sciences and Arts of Western Switzerland, Avenue Vinet 30, 1004, Lausanne, Switzerland. j.favrod@ecolelasource.ch.

ABSTRACT

Background: Recent literature has distinguished the negative symptoms associated with a diminished capacity to experience (apathy, anhedonia) from symptoms associated with a limited capacity for expression (emotional blunting, alogia). The apathy-anhedonia syndrome tends to be associated with a poorer prognosis than the symptoms related to diminished expression. The efficacy of drug-based treatments and psychological interventions for these symptoms in schizophrenia remains limited. There is a clear clinical need for new treatments.

Methods: This pilot study tested the feasibility of a program to reduce anhedonia and apathy in schizophrenia and assessed its impact on 37 participants meeting the ICD-10 criteria for schizophrenia or schizoaffective disorders. Participants were pre- and post-tested using the Scale for the Assessment of Negative Symptoms (SANS) and the Calgary Depression Scale for Schizophrenia (CDSS). They took part in eight sessions of the Positive Emotions Program for Schizophrenia (PEPS)--an intervention that teaches participants skills to help overcome defeatist thinking and to increase the anticipation and maintenance of positive emotions.

Results: Thirty-one participants completed the program; those who dropped out did not differ from completers. Participation in the program was accompanied by statistically significant reductions in the total scores for Avolition-Apathy and Anhedonia-Asociality on the SANS, with moderate effect sizes. Furthermore, there was a statistically significant reduction of depression on the CDSS, with a large effect size. Emotional blunting and alogia remain stable during the intervention.

Discussion: Findings indicate that PEPS is both a feasible intervention and is associated with an apparently specific reduction of anhedonia and apathy. However, these findings are limited by the absence of control group and the fact that the rater was not blind to the treatment objectives.

Conclusions: PEPS is a promising intervention to improve anhedonia and apathy which need to be tested further in a controlled study.

Trial registration number: ISRCTN registry ISRCTN74048461, registered 18 may 2015.

No MeSH data available.


Related in: MedlinePlus