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Helminthic therapy has shown considerable promise as a means of alleviating some inflammatory diseases that have proven resistant to pharmaceutical intervention. However, research in the field has been limited by a lack of availability to clinician scientists of a helminth that is relatively benign, non-communicable, affordable, and effectively treats disease. Previous socio-medical studies have found that some individuals self-treating with helminths to alleviate various diseases are using the rat tapeworm (cysticercoid developmental stage of Hymenolepis diminuta; HDC). In this study, we describe the production and use of HDCs in a manner that is based on reports from individuals self-treating with helminths, individuals producing helminths for self-treatment, and physicians monitoring patients that are self-treating. The helminth may fit the criteria needed by clinical scientists for clinical trials, and the methodology is apparently feasible for any medical center to reproduce. It is hoped that future clinical trials using this organism may shed light on the potential for helminthic therapy to alleviate inflammatory diseases. Further, it is hoped that studies with HDCs may provide a stepping stone toward population-wide restoration of the biota of the human body, potentially reversing the inflammatory consequences of biota depletion that currently affect Western society.

BackgroundThe initial phase of a trial of cognitive–behavioural therapy (CBT) for acutely ill patients with schizophrenia of recent onset showed that it speeded recovery.AimsTo test the hypothesis that CBT in addition to treatment as usual (TAU) during the first or second acute episode of schizophrenia will confer clinical benefit over a follow-up period.MethodThis was an 18-month follow-up of a multicentre prospective trial of CBT or supportive counselling administered as an adjunct to TAU, compared with TAU alone, for patients hospitalised for an acute episode of schizophrenia of recent onset. Primary outcomes were total and positive symptom scales, time to relapse and re-hospitalisation.ResultsThere were significant advantages for CBT and supportive counselling over TAU alone on symptom measures at 18 months but no group difference was seen for relapse or re-hospitalisation. There was a significant centre–treatment interaction, reflecting centre differences in the effect of introducing either treatment, but not in the comparison of CBT and supportive counselling. Medication dosage and compliance did not explain group differences.ConclusionsAdjunctive psychological treatments can have a beneficial longterm effect on symptom reduction.

Most previous studies investigating the factor structure of psychosis have focussed on chronic samples. First episode samples with longitudinal follow up are few. To investigate the stability and validity of symptom factors, a sample of 257 patients with DSM IV nonaffective psychoses were assessed using the PANSS during the acute first episode and at 3- and 18-month follow up. Exploratory factor analysis of the changes in PANSS item scores over time gave a five-factor solution. This was consistent with the solutions to factor analyses at the initial assessment and each of the follow-ups. However, there was progression over follow-up. Confirmatory factor analysis demonstrated that symptom ratings at 18-month follow-up fitted the models from existing research, in relatively chronic samples, better than the ratings at the initial assessment. A psychomotor poverty factor showed most stability over time and a positive symptom factor most change. Factors showed different associations with demographic and external variables, further supporting their validity.

Background Weight gain is commonly observed during psychotropic treatments for chronic forms of severe mental illness and is most rapid during the early treatment phases. All formats of behavioural weight intervention programmes have suggested that weight gain can be prevented or reversed in some patients. There is no data on these programmes in acutely unwell inpatients whom may be the major beneficiaries. Methods A modular behavioural intervention programme (Solutions for Wellness) used in SMI outpatients since 2002 in Ireland has been adapted for inpatient use. Preliminary data is reported from 5 centres in Ireland. Results In 47 inpatients the mean weight change was +0.26 kg (SD 2.02) with a median change of 0 kg. Mean follow-up was 23.7 (SD 21.6) days, and median 14 days (range 6–98 days). There was no difference in mean weight change in those patients involved for > 35 days compared with < 35 days (+0.26 kg; 0.25 kg; p = 0.5). Weight loss or maintenance was seen in 70% of patients. Conclusion These preliminary data are supportive of the concept that acutely unwell inpatients with SMI may engage with a behavioural weight programme. Weight change observed contrasts with the significant weight gain often seen in most subjects. Further clinical trials are warranted.

BackgroundCognitive–behavioural therapy (CBT) improves persistent psychotic symptoms.AimsTo test the effectiveness of added CBT in accelerating remission from acute psychotic symptoms in early schizophrenia.MethodA 5-week CBT programme plus routine care was compared with supportive counselling plus routine care and routine care alone in a multi-centre trial randomising 315 people with DSM–IV schizophrenia and related disorders in their first (83%) or second acute admission. Outcome assessments were blinded.ResultsLinear regression over 70 days showed predicted trends towards faster improvement in the CBT group. Uncorrected univariate comparisons showed significant benefits at 4 but not 6 weeks for CBTv. routine care alone on Positive and Negative Syndrome Scale total and positive sub-scale scores and delusion score and benefits v. supportive counselling for auditory hallucinations score.ConclusionsCBT shows transient advantages over routine care alone or supportive counselling in speeding remission from acute symptoms in early schizophrenia.