Background Religious delusions are clinically important because they may be associated with selfharm and poorer outcomes from treatment. They have not been extensively researched. This study sought to investigate the prevalence of religious delusions in a sample of patients admitted to hospital with schizophrenia, to describe these delusions and to compare the characteristics of the patients with religious delusions with schizophrenia patients with all other types of delusion. Method A cross-sectional investigation was carried out. The prevalence of religious delusions was assessed and comparisons were made between religiously deluded patients and a control group on demographic, symptom, functioning and religious variables. One hundred and ninety-three subjects were examined of whom 24% had religious delusions. Results Patients with religious delusions had higher symptom scores (as measured by the PANSS), they were functioning less well (as measured by the GAF) and they were prescribed more medication than those patients with schizophrenia who had other types of delusion. Conclusion It is concluded that religious delusions are commonly found in schizophrenia and that by comparison with other patients who have schizophrenia, those patients with religious delusions appear to be more severely ill. This warrants further investigation.

Summary statistics, showing mean outcomescores by scheduled visit, are shown in Ta-ble 3. Results of the main intention-to-treatregression analysis for the data at 70 daysare shown in Table 4. The main effect, at-tributable to the routine care shared by allthree treatment groups, is very large over s94Table 3 Observedmeanscoresforprimaryoutcomevariablesby treatmentgroupObservedmean scoresforprimaryoutcomevariablesby treatmentgroup VisitVisit Observed Observed MeanMean s.d.s.d. MinimumMinimum MaximumMaximumPANSStotalscoreCBTBasBaseelliinnee 101 87.4787.47 17.64 17.64 5454 129 129225 53370.8370.83 14.80 14.80 4646 110 110334 43367.6567.65 17.13 17.13 3636 119 119443 37761.65 11 1717.8.855 3838 111 111555 5226868..1122 21.3821.38 3636 123 123667 78861.7361.73 19.69 19.69 18 11218 112SupportivecounsellingBasBaseelliinnee 110606 8989.22.22 1177.5.533 4949 131311224 47774.6674.66 1717.0.055 4343 121 121334 4776868..1177 16.7916.79 39 10539 105443 33367.8267.82 17.99 17.99 3838 110 110556 64467.2567.25 18.52 18.52 3636 109 109667 71159.9659.96 16.39 16.39 37 11937 119Routine careRoutinecareBasBaseelliinnee 102 87.0187.01 16.81 16.81 52 14152 141225 58872.5072.50 16.38 16.38 4848 120 120335 5007700.28.28 18.3818.38 4040 126 126443 3777272..1111 19.0219.02 4242 107 107555 5997070..1155 21.4621.46 4040 133 133666 6006464..3388 16.7916.79 4242 115 115PANSSpositivesub-scalescoreCBTBasBaseelliinnee 101 23.54 4.93 14 36225 53317.04 4.76 883 344334 4331155.28.28 44..8787 662 288443 37713.19

Meta-analyses of randomized controlled trials support the efficacy of cognitive behavioral therapy (CBT) in the treatment of symptoms of schizophrenia refractory to antipsychotic medication. This article addresses the issue of medium term durability. A five-year follow-up was undertaken of a sample of 90 subjects who participated in a randomized controlled trial of CBT and befriending (BF). Patients received routine care throughout the trial and the follow-up period. Intention to treat multivariate analysis was performed by an independent statistician following multiple imputation of missing data. Fifty-nine out of ninety patients were followed up at 5 years (CBT = 31, BF = 28). In comparison to BF and usual treatment, CBT showed evidence of a significantly greater and more durable effect on overall symptom severity (NNT=10.36, CI-10.21, 10.51) and level of negative symptoms (NNT=5.22, CI-5.06-5.37). No difference was found between CBT and BF on either overall symptoms of schizophrenia or depression. The initial cost of an adjunctive course of CBT for individuals with medication refractory schizophrenia may be justified in light of symptomatic benefits that persist over the medium term. (C) 2007 Elsevier B.V. All rights reserved.

Cet article discute du statut actuel de la recherche sur la thérapie cognitive (TC) de la schizophrénie. Après avoir passé en revue l'étendue des recherches indiquant l'efficacité de la thérapie cognitive pour ce trouble, on présente le processus thérapeutique typique. Les techniques clés en thérapie cognitive de la schizophrénie sont décrites de même que des exemples typiques de cas et des mises en garde contre des blocages éventuels en thérapie. Les techniques clés ici décrites sont l'engagement dans la relation thérapeutique, le développement d'explications, l'introduction du doute, le questionnement périphérique, les devoirs d'expérimentation comportementale, les approches axées sur les schémas, et la prévention de la rechute. La TC de la schizophrénie est considérée comme acceptable, efficace et solide en complémentarité avec les neuroleptiques et d'autres interventions de nature psychosociale.

Background The initial phase of a trial of cognitive-behavioural therapy (CBT) for acutely ill patients with schizophrenia of recent onset showed that it speeded recovery. Aims To test the hypothesis that CBT in addition to treatment as usual (TAU) during the first or second acute episode of schizophrenia will confer clinical benefit over a follow-up period. Method This was an 18-month follow-up of a multicentre prospective trial of CBT or supportive counselling administered as an adjunct to TAU, compared with TAU alone, for patients hospitalised for an acute episode of schizophrenia of recent onset. Primary outcomes were total and positive symptom scales, time to relapse and re-hospitalisation. Results There were significant advantages for CBT and supportive counselling over TAU alone on symptom measures at 18 months but no group difference was seen for relapse or re-hospitalisation. There was a significant centre-treatment interaction, reflecting centre differences in the effect of introducing either treatment, but not in the comparison of CBT and supportive counselling. Medication dosage and compliance did not explain group differences. Conclusions Adjunctive psychological treatments can have a beneficial long-term effect on symptom reduction. Declaration of interest None.

This paper describes two cases involving the use of cognitive behavioural therapy (CBT) to treat the positive symptoms of schizophrenia. In both cases the individuals were experiencing acute psychotic symptoms during their first admission to hospital. Each case illustrates how, CBT was used to tackle a particular issue pertinent to the delivery of treatment at this early stage in the development of an individual's experiences of psychotic symptoms. Case one describes therapy with a young person of 17 where developmental issues are pertinent: case two describes the use of therapy to engage a person whose symptoms have ostensibly remitted. In both cases the promotion of understanding of the origin of their experiences was vital to the conduct of therapy. The implications of these issues to conducting therapy with this client group and the methods used to overcome them are discussed with reference to the future developments of cognitive behavioural therapy for use with this client group.

It has been suggested that patients with strong religious beliefs or religious delusions have poor outcome from psychiatric treatment. The aim of the investigation was to establish if the patients’ shorter-term response to psychiatric treatment was affected by these factors. A quasi-experimental design was used, in which patients with schizophrenia were assessed soon after admission to hospital. They were categorised as (1) religious or not religious, (2) experiencing religious delusions or not, using reliable criteria. Patients were given their routine treatment and their symptoms were then re-assessed after four weeks. There was no difference in response to treatment between the religious and non-religious patients. There was no difference between patients who had religious delusions and those who had other types of delusions. Though this study does not settle the debate, it suggests that strong religious beliefs or religious delusions do not adversely affect the patient's response to treatment in the shorter term.

Patients referred with anger problems often do not attend for treatment. The aim of this study was to determine if group Cognitive Behaviour Therapy (CBT) was feasible. Patients referred for help with their anger were assessed, given 6 sessions of group CBT and re-assessed. Of 119 patients referred, 49 (41%) did not attend the initial appointment. Patients who attended for interview were invited to participate in the group CBT. Only 11 patients (9%) of those referred for therapy attended for the full course of CBT. Thirty-four patients (29%) were exposed to at least one session of CBT, while 66 patients (56%) did not attend for any therapy. Patients who attended for some or all of the CBT treatment reported reductions in the frequency and intensity of their anger outbursts. There was also a significant reduction in measures of their anger traits. It could be concluded that group CBT is an appropriate way to deliver this therapy to patients with anger problems, but it is clear that many of those referred are ambivalent about therapy and will not attend. Figures are given that will allow the planning of a randomized controlled trial to evaluate the difference between individual and group based CBT for patients with anger problems.

Patients with anger problems can cause difficulties for themselves, their families and society. Though psychological treatments are available, they are not always accessible. In order to help the victims of domestic violence, we focus here on working with perpetrators of violence. This article offers some statistics about the extent of the problem. It discusses difficulties in motivating patients for therapy and describes the cognitive model of anger. A number of intervention strategies based on this model are then discussed. The purpose is to assist clinicians with less experience of this patient group to help their patients minimize the frequency and severity of the anger incidents. Pointers for good practice are outlined.

The symptoms of schizophrenia are commonly described in two broad categories; positive symptoms and negative symptoms. Positive symptoms are considered excesses, that is, go beyond what is considered to be 'normal' behaviour or experience. Negative symptoms, are generally considered to be deficits in normal functioning and include the core negative symptoms such as flattening of affect and poverty of speech (Barnes and Liddle, 1990).KeywordsNegative SymptomPositive SymptomResource AssessmentMental Health WorkerSocial Functioning ScaleThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.