T41. MODIFIED COGNITIVE BEHAVIORAL THERAPY FOR ELDERLY PATIENTS WITH SCHIZOPHRENIA: A RANDOMIZED, CONTROLLED PILOT TRIAL

Abstract

Background: An European society growing older sets the need to explore treatment options for elderly patients. Here we aimed to gather evidence on the effectiveness of a modified cognitive behavioural therapy (mCBT) in elderly schizophrenia patients as compared to treatment as usual (TAU). Method(s): 43 schizophrenia patients > 55y (mean 60 y), were assessed in a randomized, single blind controlled pilot trial with parallel groups: TAU+mCBT vs. TAU and intention to treat (ITT) last observation carried forward (LOCF) analysis. Subjects were recruited in Germany among in- and outpatients. MCBT comprised 30 sessions in 9 month, and a 6 month follow-up including a) physical and social activation, b) problem solving c) social skills. Primary outcomes were pre/post change in either PANSS total score, UPSA-brief score or Calgary Depression Scale for Schizophrenia. Result(s): From 43 patients, 40 were randomized. 15 mCBT and 16 TAUpatients comprised the ITT sample. None of the primary outcome measures reached significance. When assessing effect sizes we found little pre-/ post change in PANSS total score (d=0.14) and the UPSA-brief (d=0.14). Depression symptoms however improved with treatment (pre/post d=0.75 and pre/FU d=0.52). Among secondary outcomes, global assessment of functioning significantly improved in the mCBT-group pre/post (d=.074) and pre/follow-up (d=.080). Discussion(s): Our results provide evidence for the feasibility of a sufficiently powered phase-III study targeting depressive symptoms and global functioning in long-term treated elderly schizophrenia patients. A history of about twenty years of pharmacological treatment does not imply there is no room for improvement in depression and global functioning following a modified cognitive behavioral therapy in this specific patient group.