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Objective: To examine the cost-effectiveness of Hallucination focused Integrative Treatment (HIT) in patients with schizophrenia and a history of persistent auditory hallucinations. Method: Costs, in and outside the health care sector, and outcomes were registered prospectively during a period of 18 months for patients who received the HIT programme and for patients in the care as usual (CAU) condition. The Positive and Negative Syndrome Scale (PANSS) was used as main outcome measure in the cost-effectiveness analysis. Bootstrap analyses provided additional information on the skewly distributed costs. Results: Mean costs per patient in the HIT group ($18 237) were lower than the mean costs per patient in the CAU group ($21 436). Results of the PANSS were slightly in favour of the HIT group. Conclusion: There appears to be no significant cost-effectiveness advantage of the HIT programme over CAU. Additional analyses indicated that future application of the HIT programme will, in most cases, lead to a reduction of (non) medical costs.

Objective: To investigate the durability of positive effects of cognitive behaviour therapy (CBT) with coping training on psychotic symptoms and social functioning. Method: Forty patients with schizophrenia or related psychotic disorders and refractory auditory hallucinations were given CBT and coping training in an integrated single family treatment programme. In a naturalistic study patients were followed after 2 and 4 years since the start of treatment. Results: The treatment improved overall burden of 'hearing voices', with a generalization into daily functioning. Improvement with regard to fear, loss of control, disturbance of thought and interference with thinking was sustained by 60% of the patients while one-third improved further. Complete disappearance of hallucinations occurred in 18% of the patients. Conclusion: CBT with coping training can improve both overall symptomatology and quality of life, even over longer periods of time, but a status of persistent disablement indicates a continuing need for mental health care.

Objective: Early intervention in psychosis is considered important in relapse prevention. Limited results of monotherapies prompt to development of multimodular programmes. The present study tests feasibility and effectiveness of HIT, an integrative early intervention treatment for auditory hallucinations, in community psychiatry. Method: Adolescents with auditory hallucinations consecutively referred to Groningen Voices Outpatient Department. Independent research staff collected diagnosis, sociodemographics, psychiatric history, former treatment and current treatment status from medical files. The auditory Hallucinations Rating Scale, Groningen Social Disabilities Scale and five-point rating scales on characteristics and subjective burden of voices, and satisfaction with therapy were scored with semi-structured interview. Results: Good compliance and high satisfaction with HIT treatment in most cases; 65% free of voices; majority demonstrates substantial improvement on mastery, anxiety, interference with thinking and social functioning; none worsened. Conclusion: Integrative treatment as composed in the HIT-programme is feasible in community psychiatry and appears to be an effective early intervention in adolescents with schizophrenia both in reducing psychotic symptoms as improving quality of life.