Towards improving psychological treatment options for patients with acute psychosis

Abstract

Individuals experiencing acute exacerbations of severe mental illnesses, such as psychosis, are often treated in locked, acute inpatient psychiatric wards. While the treatment environment and therapeutic framework on such wards have evolved from custodial to curative aims, they are still criticized as non-therapeutic. Research in this setting is particularly challenging and remains scarce, leaving patients’ treatment priorities, preferences and willingness to engage in certain treatments largely unexplored. To address these critical gaps in acute psychiatric care, three studies were conducted as part of this dissertation. Study I examined and compared the treatment priorities and intervention preferences of patients with acute psychosis in locked and open wards, alongside staff preferences. Patients prioritized treating neurocognitive and affective symptoms over positive symptoms, while staff emphasized positive symptoms. Patients also expressed a strong preference for psychosocial interventions. Study II focused on adapting Metacognitive Training (MCT), an evidence-based psychological intervention, to the acute care setting (MCT-Acute). The adaptation process was documented for reproducibility and to guide future research and clinical efforts. A case study showed that severely ill patients could engage with and benefit from MCT-Acute, through increased awareness of their cognitive biases and applying MCT-Acute’s core concepts in their everyday life. Study III assessed the feasibility, acceptability, and safety of MCT-Acute in acute psychiatric settings. Patients evaluated the intervention positively and expressed interest in more similar therapeutic options. Although adverse events were unrelated to the intervention, some patients felt the group format did not fully address their individual needs. The study confirmed MCT-Acute’s feasibility and safety, even for patients with severe symptoms. While recruitment of patients proved challenging and further research must explore the differential effects of MCT-Acute as compared to other treatments, this research underscores the need to improve the integration of patients’ and staffs’ treatment preferences into a treatment plan that also offers a variety of psychosocial treatment options already during the acute illness phase. Expanding evidence-based psychological interventions in acute care can help bridge the research and treatment gaps, improving the care experience for individuals with severe mental illnesses.