Universität zu Köln

Schmidt, Stefanie J., Lange, Matthias, Schoettle, Daniel, Karow, Anne, Schimmelmann, Benno G. and Lambert, Martin (2018). Negative symptoms, anxiety, and depression as mechanisms of change of a 12-month trial of assertive community treatment as part of integrated care in patients with first- and multi-episode schizophrenia spectrum disorders (ACCESS I trial). Eur. Arch. Psych. Clin. Neurosci., 268 (6). S. 593 - 603. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1433-8491

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Abstract

Assertive community treatment (ACT) has shown to be effective in improving both functional deficits and quality of life (QoL) in patients with severe mental illness. However, the mechanisms of this beneficial effect remained unclear. We examined mechanisms of change by testing potential mediators including two subdomains of negative symptoms, i.e. social amotivation as well as expressive negative symptoms, anxiety, and depression within a therapeutic ACT model (ACCESS I trial) in a sample of 120 first- and multi-episode patients with a schizophrenia spectrum disorder (DSM-IV). Path modelling served to test the postulated relationship between the respective treatment condition, i.e. 12-month ACT as part of integrated care versus standard care, and changes in functioning and QoL. The final path model resulted in 3 differential pathways that were all significant. Treatment-induced changes in social amotivation served as a starting point for all pathways, and had a direct beneficial effect on functioning and an additional indirect effect on it through changes in anxiety. Expressive negative symptoms were not related to functioning but served as a mediator between changes in social amotivation and depressive symptoms, which subsequently resulted in improvements in QoL. Our results suggest that social amotivation, expressive negative symptoms, depression, and anxiety functioned as mechanisms of change of ACCESS. An integrated and sequential treatment focusing on these mediators may optimise the generalisation effects on functioning as well as on QoL by targeting the most powerful mechanism of change that fits best to the individual patient.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schmidt, Stefanie J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lange, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Schoettle, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Karow, Anne UNSPECIFIED UNSPECIFIED UNSPECIFIED Schimmelmann, Benno G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lambert, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-175757
DOI:	10.1007/s00406-017-0810-1
Journal or Publication Title:	Eur. Arch. Psych. Clin. Neurosci.
Volume:	268
Number:	6
Page Range:	S. 593 - 603
Date:	2018
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1433-8491
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language QUALITY-OF-LIFE; SOCIAL COGNITION; MENTAL-DISORDERS; NEUROCOGNITION; MEDIATOR; 1ST-EPISODE; PSYCHOSIS; ANHEDONIA; DETERMINANTS; ASSOCIATIONS Multiple languages Clinical Neurology; Psychiatry Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/17575