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BackgroundIt is becoming well established that CBT is both effective and cost efficient in the treatment of positive and negative symptoms of schizophrenia. However, there is a need to adapt CBT to the cultural, linguistic, and socioeconomic context of diverse cultural groups. We aimed to establish the feasibility of culturally adaptive cognitive behavior therapy for treatment of psychosis in a low-income country.MethodsThis is a rater-blind, randomized, controlled trial of the use of CBT in patients with psychosis from a low-income country. Patients with a DSM-IV diagnosis of schizophreniform disorder were assessed using Positive and Negative Syndrome Scale for Schizophrenia (PANSS), PSYRATS (Psychotic Symptom Rating Scales), and the Insight Scale. Participants were randomized into the intervention group (n = 18) and TAU group (n = 18). The intervention group received 12 weekly sessions of culturally adapted CBT for psychosis (CaCBTp).ResultsThere were no significant differences between the two groups at baseline. At three months follow-up, there was a statistically significant improvement in the CaCBTp group on PANSS general Psychopathology subscale, PANSS overall score and Insight scale, as compared to the TAU group. The CaCBTp group had lower scores on PANSS positive, PANSS negative sub-scales, and the two subscales of Psychotic Symptom Rating Scale, but differences were not statistically significant.ConclusionCulturally adapted CBT added to pharmacological treatment as usual was acceptable to patients and was helpful in reduction of severity of psychotic symptoms. Adjunctive culturally adapted CBT should be further investigated in this population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Low perceived self–efficacy (SE) for responding to school–related situations is posited to be associated with school refusal. This study examined the validity and reliability of the Malay version of the Self–Efficacy Questionnaire for School Situations (SEQ–SS) among early adolescents in Kota Bharu. The English version of the 25–item SEQ–SS was translated into Malay. Employing a cross–sectional design, students (10-11 years) from five randomly selected public primary schools were recruited via proportionate cluster sampling. Two hundred and fifteen students, 65% female, mean age of 10.3 years (SD=0.5), completed the Malay SEQ–SS. Validity was examined with exploratory factor analysis (EFA). Cronbach’s alpha was used to determine internal consistency. Means and standard deviations were used to describe the total and subscale scores. EFA analyses retained 19 items which clustered into four factors: ‘SE in socially challenging situations’, ‘SE in personally challenging situations’, ‘SE in separation situations’, and ‘SE in situations of disengagement from school’. Internal consistencies were low, approaching moderate, with Cronbach’s alpha values between 0.64 and 0.69. The four–factor solution of the Malay SEQ–SS appears to permit identification of specific domains of low SE which could inform individualized interventions targeting early adolescents in primary school.

BackgroundCognitive impairments are well established findings in schizophrenia and are associated with significant impairment of social functioning. Episodic memory, working memory and executive function test scores are typically 1 standard deviation below healthy controls. There are reports suggesting the presence of neurocognitive deficits prior to illness onset, opening the possibility of using cognitive profiles as disease markers. Interest in exploring cognitive functioning in early stages schizophrenia has continued to grow, as earlier treatments could possibly lead to improved outcomes.MethodsThis is a cross-sectional assessment of cognitive profiles in patients with early psychosis. A total of 51 patients suffering from psychosis in the age group of 18–65 years were recruited and matched with 51 healthy controls. A wide range of neurocognitive domains were assessed using standardised neuropsychological tests.ResultsThere was evidence of statistically significant impairments in cognitive functioning across a broad range of cognitive domains in early-psychosis patients, as compared to healthy controls. More pronounced deficits were seen in executive function tests.ConclusionsTo our knowledge, this is the first study to report cognitive deficits across a range of domains in patients with first episode psychosis from a low-income country. This study found deficits across multiple domains, including language, memory, attention, executive function, and visuospatial function in patients with early psychosis. Evidence of neuropsychological deficits in the early course of the disease may highlight crucial therapeutic windows for both pharmacological treatments and cognitive rehabilitation. This may improve functional outcomes in this patient group in the longer term.Disclosure of interestThe authors have not supplied their declaration of competing interest.