Title: Positive Memory Training for the Treatment of Depression in Schizophrenia
Funder: Department of Health (England)

Abstract: Background Schizophrenia affects about 1% of the population. Direct treatment costs to the NHS have been estimated at over £2 billion per year, approximately 3% of the NHS budget12. The development of psychological interventions for schizophrenia is a priority, both for the NHS13 and service users14. The prevalence of co-morbid depression is approximately 50%15, and is associated with a suicide rate of 5%16, an increased use of NHS resources, a lower quality of life, and an increased level of social and physical disability17. None of the current evidence based psychological treatments for depression have been evaluated for use within this group. The impact of anti-depressant medication is equivocal18. Competitive Memory Training (CoMeT) is a form of cognitive therapy for depression. Evidence suggests it is effective within a range of co-morbid mental health problems8,9,10,11. However, personal communication with these research teams suggested that the intervention needed adapting for use with people diagnosed with schizophrenia. A member of our team has developed a version of CoMeT for use with individuals suffering from auditory hallucinations and diagnosed with schizophrenia19. This study found a high level of patient acceptability. Our team have now developed a version of the intervention to target depression within all individuals diagnosed with schizophrenia. This intervention is desired by service users and has the potential to provide significant benefit to both patients and NHS services. There is a need to evaluate the effectiveness of this intervention within a randomised controlled trial. Aims To evaluate the effectiveness and cost-effectiveness of the intervention package when compared to best usual care. It is proposed that the intervention will directly reduce depression symptom severity, with secondary benefits in reduced levels of schizophrenia symptoms It is also proposed that the participants who receive CoMeT will require less psychiatric input during the course of the trial. Therefore, the project aims to benefit patient wellbeing and to provide information to be used within mental health service planning. Should the intervention prove effective, we aim to develop a training package for dissemination within the NHS. Plan of Investigation A single-blind RCT within which ninety-five participants who are diagnosed with schizophrenia/schizo-affective disorder and depression will be randomly allocated to receive either CoMeT or best usual care. Up to 12 sessions of CoMeT will be delivered within a 3-month period. Assessments will be conducted at month 0 (baseline), and at months 3, 6 and 9. The primary outcome will be level of depression symptoms at end of treatment, as measured by the Beck Depression Inventory20 (BDI). Acceptability of the intervention will be assessed through the use of a service user developed measure. Potential Benefit to Patients and the NHS The proposed intervention has the potential to provide a significant benefit to patients within a short time frame and to be cost-effective. The patient will be equipped with skills which they will be able to continue using once the intervention is complete, and may reduce the risk of relapse. The potential patient benefit includes improvements in quality of life, social and physical disability and suicide rates. The advantages of CoMeT over current psychological therapies for schizophrenia are that (i) it is relatively short-term (3 months as opposed to 6 months) (ii) it specifically targets a key psychological process in the maintenance of depression and (iii) the manualised protocol requires a lower level of therapist training in order to achieve adherence. Should future studies prove the treatment to be effective, the manualised nature of the intervention will facilitate widespread dissemination.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH