Effects of group metacognitive training (MCT) on mental capacity and functioning in patients with psychosis in a secure forensic psychiatric hospital: a prospective-cohort waiting list controlled study.
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Authors
Naughton, Marie
Nulty, Andrea
Abidin, Zareena
Davoren, Mary
O'Dwyer, Sarah
Kennedy, Harry G
Issue Date
2012-06-18
Type
Controlled Clinical Trial
Journal Article
Journal Article
Language
en
Keywords
Alternative Title
Abstract
Metacognitive Training (MCT) is a manualised cognitive intervention for psychosis aimed at transferring knowledge of cognitive biases and providing corrective experiences. The aim of MCT is to facilitate symptom reduction and protect against relapse. In a naturalistic audit of clinical effectiveness we examined what effect group MCT has on mental capacity, symptoms of psychosis and global function in patients with a psychotic illness, when compared with a waiting list comparison group.
Of 93 patients detained in a forensic mental health hospital under both forensic and civil mental health legislation, 19 were assessed as suitable for MCT and 11 commenced. These were compared with 8 waiting list patients also deemed suitable for group MCT who did not receive it in the study timeframe. The PANSS, GAF, MacArthur Competence Assessment Tool- Treatment (MacCAT-T) and MacArthur Competence Assessment Tool-Fitness to Plead (MacCAT-FP) were recorded at baseline and repeated after group MCT or following treatment as usual in the waiting list group.
When baseline functioning was accounted for, patients that attended MCT improved in capacity to consent to treatment as assessed by the MacCAT-T (p = 0.019). The more sessions attended, the greater the improvements in capacity to consent to treatment, mainly due to improvement in MacCAT-T understanding (p = 0.014) and reasoning . The GAF score improved in patients who attended the MCT group when compared to the waiting list group (p = 0.038) but there were no changes in PANSS scores.
Measures of functional mental capacity and global function can be used as outcome measures for MCT. MCT can be used successfully even in psychotic patients detained in a forensic setting. The restoration of elements of decision making capacity such as understanding and reasoning may be a hither-to unrecognised advantage of such treatment. Because pharmacotherapy can be optimised and there is likely to be enough time to complete the course, there are clear opportunities to benefit from such treatment programmes in forensic settings.
Of 93 patients detained in a forensic mental health hospital under both forensic and civil mental health legislation, 19 were assessed as suitable for MCT and 11 commenced. These were compared with 8 waiting list patients also deemed suitable for group MCT who did not receive it in the study timeframe. The PANSS, GAF, MacArthur Competence Assessment Tool- Treatment (MacCAT-T) and MacArthur Competence Assessment Tool-Fitness to Plead (MacCAT-FP) were recorded at baseline and repeated after group MCT or following treatment as usual in the waiting list group.
When baseline functioning was accounted for, patients that attended MCT improved in capacity to consent to treatment as assessed by the MacCAT-T (p = 0.019). The more sessions attended, the greater the improvements in capacity to consent to treatment, mainly due to improvement in MacCAT-T understanding (p = 0.014) and reasoning . The GAF score improved in patients who attended the MCT group when compared to the waiting list group (p = 0.038) but there were no changes in PANSS scores.
Measures of functional mental capacity and global function can be used as outcome measures for MCT. MCT can be used successfully even in psychotic patients detained in a forensic setting. The restoration of elements of decision making capacity such as understanding and reasoning may be a hither-to unrecognised advantage of such treatment. Because pharmacotherapy can be optimised and there is likely to be enough time to complete the course, there are clear opportunities to benefit from such treatment programmes in forensic settings.
Description
Citation
Naughton, M., Nulty, A., Abidin, Z., Davoren, M., O'Dwyer, S., & Kennedy, H. G. (2012). Effects of group metacognitive training (MCT) on mental capacity and functioning in patients with psychosis in a secure forensic psychiatric hospital: a prospective-cohort waiting list controlled study. BMC research notes, 5, 302. https://doi.org/10.1186/1756-0500-5-302
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License
Journal
BMC research notes
Volume
5
Issue
PubMed ID
DOI
10.1186/1756-0500-5-302
10.1056/NEJMoa051688
10.1016/j.psc.2007.04.001
10.1348/014466599162700
10.1097/YCO.0b013e3282f0b8ed
10.1016/j.tics.2006.03.004
10.1016/j.cpr.2006.10.004
10.1192/bjp.187.4.372
10.1017/S0033291703008389
10.1016/j.ijlp.2009.09.006
10.1016/0160-2527(82)90026-7
10.1186/1471-244X-11-43
10.5042/bjfp.2010.0423
10.1097/YCO.0b013e32833d16a8
10.1016/j.brat.2010.11.010
10.1017/S0033291708004637
10.1017/S0033291799008661
10.1056/NEJMoa051688
10.1016/j.psc.2007.04.001
10.1348/014466599162700
10.1097/YCO.0b013e3282f0b8ed
10.1016/j.tics.2006.03.004
10.1016/j.cpr.2006.10.004
10.1192/bjp.187.4.372
10.1017/S0033291703008389
10.1016/j.ijlp.2009.09.006
10.1016/0160-2527(82)90026-7
10.1186/1471-244X-11-43
10.5042/bjfp.2010.0423
10.1097/YCO.0b013e32833d16a8
10.1016/j.brat.2010.11.010
10.1017/S0033291708004637
10.1017/S0033291799008661
ISSN
1756-0500