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Approximately 50% of individuals with first-episode psychosis meet criteria for a substance use disorder and these concurrent disorders are associated with worse long-term outcomes. Psychosocial interventions, including motivational interviewing as well as cognitive and behavioural therapies, have shown some evidence for effective treatment in substance use disorders; however, there is a paucity of existing studies that have successfully examined these interventions in first-episode psychosis.Participants (n = 64) received the concurrent disorders intervention, which included individual support alongside participation in at least one of two groups: a 4-week Motivational Engagement group utilizing motivational interviewing (n = 59) and an 8-week Relapse Prevention Training group emphasizing skill acquisition, which some participants entered directly (n = 5) and some participants entered following completion of the Motivational Engagement group (n = 16).Participants who completed the Motivational Engagement group (n = 59) demonstrated significantly increased motivation to change substance use (d = -.0.58; t = -3.02, p .01) and significantly decreased substance use frequency (d = 0.65; t = 3.26, p .01). For participants who completed the Relapse Prevention Training group (n = 21), substance use frequency significantly decreased (d = 0.92; t = 3.46, p .01) and self-efficacy in one's ability to maintain substance use changes significantly increased (d = -0.85; t = -3.59, p .01).This pilot evaluation suggests that motivational interviewing and relapse prevention skills training are acceptable and feasible interventions in the treatment of substance use disorders in young adults with first-episode psychosis.

The integration of compensatory and restorative cognitive interventions is an emerging area of research and practice. However, little research has been conducted in this area, with a lack of attention given to describing the process taken to integrate the two approaches in a way that is feasible and effective. In this paper, we describe the rigorous process undertaken to integrate and develop Combined Cognitive Intervention (CCI) for early psychosis. This home-based intervention was developed within the context of a larger study comparing the effectiveness of remedial and restorative approaches in which 11 patients were randomized to receive CCI, completed evaluations at baseline, 4 months and 5 months post-intervention. Outcome analyses suggested less favorable functional outcomes for CCI but comparable gains in goal attainment and symptom reduction as those observed in other treatment conditions. Qualitative feedback on challenges and successes as experienced by participants and clinicians are provided, along with a case study to illustrate the implementation of CCI. Findings are discussed within the broader context of evidence-based interventions and the provision of services to those experiencing early psychosis.

Background and Objective Complete tobacco bans in mental health facilities are thought to have the potential for adverse consequences. We evaluated staff and patient attitudes and adverse events associated with implementing Canada's largest, multi-site academic psychiatric hospital tobacco ban. Methods A total of 1,173 staff and 422 patients completed an anonymous attitudes survey at prior to implementation (baseline), and 4–6 months and 10–12 months post-implementation. The tobacco-free initiative was implemented in a phased approach, allowing the prospective measurement of changes in attitudes and adverse outcomes such as agitation over a 1-year period. Results We observed positive changes in staff and patient attitudes toward the tobacco-free policy for both staff and patients. Moreover, there was also a statistically significant decrease in patient agitation F (2, 99) = 3.25, p = .04, but no change F (2, 21) = 1.09, p = .35 in fire-related incidents. Discussion and Conclusions We observed positive changes in staff and patients attitudes and significant decrease in patient agitation during the first year of this tobacco-free hospital initiative. Scientific Significance During the first year of this tobacco-free psychiatric hospital policy, implementation of a tobacco-free environment in a large mental health and addictions setting was feasible and perceived as desirable by the majority of staff and patients surveyed and a decrease in incidents related to patient agitation was also observed. Further well-controlled studies with longer study durations are warranted. (Am J Addict 2017;26:183–191)

Aim To conduct a preliminary feasibility examination of cognitive-behavioural social skills training (CBSST) in a first-episode psychosis population. Methods Twenty two first-episode psychosis clients participated in an 18-week CBSST group adapted for a younger population. Results Adaptive functioning significantly improved following group participation and was maintained at 3-month follow-up. Conclusion The CBSST group was feasible and well accepted in the first episode programme. These preliminary findings warrant further testing in a larger trial to determine efficacy.

Cross-sectional studies of the effects of cannabis on cognition in schizophrenia have produced mixed results. Heavy and persistent cannabis use in schizophrenia is a common clinical problem, and effects of controlled abstinence from cannabis in these patients have not been carefully evaluated. The present study sought to determine the effects of cannabis abstinence on cognition in patients with schizophrenia and co-occurring cannabis dependence. We utilized a 28-day cannabis abstinence paradigm to investigate the state-dependent effects of cannabis on select cognitive outcomes in cannabis-dependent patients with schizophrenia and non-psychiatric controls. Nineteen patients and 20 non-psychiatric male cannabis-dependent participants underwent 28 days of cannabis abstinence. Cognition was assessed on day 0, 14, and 28 using a comprehensive neuropsychological battery. Clinical symptoms were assessed weekly. Abstinence was facilitated by contingency reinforcement confirmed by twice weekly urinalysis. Forty-two percent of patients and 55% of controls achieved end-point abstinence (p=0.53), which was biochemically-verified (day 28 urinary THC-COOH

Objective There is a paucity of accessible, evidence-based tools for caregivers of individuals with schizophrenia. This study examines changes in the self-assessed and caregiver-assessed outcomes of people with schizophrenia after exposure to a cognitive adaptation training (CAT) guide that addressed pragmatic, in-home approaches to offset the cognitive impacts of the illness. Method This study examined the 4-month, pre-post outcomes of a CAT guide, as compared with a popular, general manual, for families of individuals with schizophrenia. A total of 17 caregiver-supported individual dyads completed all measures, having been randomized to either a CAT-guide group or a support-manual group. Measures included medication adherence, adaptive functioning, quality of life, and caregiver burden. Semistructured interviews assessed use and utility questions. Results Caregiver-assessed improvements in community functioning with medium-high effect sizes were observed in both study conditions. Self-report ratings by supported individuals did not change from baseline to 4 months and no change was observed in medication adherence or quality of life for either condition. Caregiver-burden ratings significantly declined with a large effect size, again with no difference as a function of manual type. Conclusion and implications for practice These findings suggest that there is some promise in providing families with evidence-based information in manual form. Further research informed by this study's findings should include assessments of whether and how environmental cognitive supports can be of specific benefit to families affected by schizophrenia. (PsycINFO Database Record

Complete tobacco bans in mental health facilities are thought to have the potential for adverse consequences. We evaluated staff and patient attitudes and adverse events associated with implementing Canada's largest, multi-site academic psychiatric hospital tobacco ban.A total of 1,173 staff and 422 patients completed an anonymous attitudes survey at prior to implementation (baseline), and 4-6 months and 10-12 months post-implementation. The tobacco-free initiative was implemented in a phased approach, allowing the prospective measurement of changes in attitudes and adverse outcomes such as agitation over a 1-year period.We observed positive changes in staff and patient attitudes toward the tobacco-free policy for both staff and patients. Moreover, there was also a statistically significant decrease in patient agitation F (2, 99) = 3.25, p = .04, but no change F (2, 21) = 1.09, p = .35 in fire-related incidents.We observed positive changes in staff and patients attitudes and significant decrease in patient agitation during the first year of this tobacco-free hospital initiative.During the first year of this tobacco-free psychiatric hospital policy, implementation of a tobacco-free environment in a large mental health and addictions setting was feasible and perceived as desirable by the majority of staff and patients surveyed and a decrease in incidents related to patient agitation was also observed. Further well-controlled studies with longer study durations are warranted. (Am J Addict 2017;26:183-191).

Background Cognitive Adaptation Training (CAT) has consistently demonstrated effectiveness in enhancing community functioning in clinical trials of its 9-month application by a specialist. This is a compelling development in the field as clinicians struggle to support gains in independent functioning among patients with schizophrenia. However, outreach interventions delivered by specialists are difficult to support in many contexts where investment in mental health care is insufficient for population needs. This presentation will describe research and implementation efforts that support the delivery of CAT in routine clinical practice. Methods This program of work began with a feasibility study of a modified version of CAT. CAT was modified to decrease the duration of specialist-delivered CAT to 4 months, with the intervention subsequently supported by the individual’s case manager who received rudimentary training and could consult specialists. Twenty-three people with schizophrenia participated in this study of symptom and functional outcomes, evaluating improvements after 4 months of CAT specialist intervention and after an additional 5 months of case manager support. Also described briefly will be (i) preliminary findings from a superiority randomized controlled trial of modified CAT in an early intervention population comparing CAT (n=25) with Action Based Cognitive Remediation (n=23) and (ii) efforts to build out CAT implementation in a tertiary facility enabled through the above clinical trial resources. Results Analysis of feasibility study findings revealed significant improvements in adaptive functioning, psychiatric symptomatology, and goal attainment that were maintained throughout case management follow-up. Effect sizes for the specialist delivered period ranged from .33 (negative symptoms) to 2.01 (goal attainment scaling) with a modest decline in the follow-up period with community functioning remaining at ES=.66. Improvement in the large effect size range was also observed in community functioning in the trial of modified CAT in early intervention. In this period over 70 allied health clinicians were intensively training in CAT locally and regionally and a community of practice was established. These impacts were further extended through the development of an open-access CAT guide for families that can be used independently or with clinician support. Discussion This study supports a model for extending the accessibility of CAT in settings that might not otherwise sustain the intervention as it was originally designed. Functional impacts similar to the original clinical trials were observed in a briefer period of specialist delivered CAT and show the promise of being largely sustained over an indefinite period by rudimentary-trained case managers in a consultation model. This observation would appear to apply to both early intervention and general schizophrenia populations. Additionally, this program of work has demonstrated how research-practice synergies can foster implementation that can be sustained after initial research investments.

Cognitive adaptation training (CAT) is a home-based, manualized treatment that utilizes environmental supports to improve target behaviors and functional outcomes in persons with schizophrenia. Although clinical trials have shown CAT to be effective across functional, clinical, and treatment adherence domains, when the intervention is withdrawn clients experience significant declines. The aim of the current study was to test a modified version of CAT, which decreases the duration of intensive CAT intervention while utilizing ongoing case management-supported CAT to maintain the fundamental components of the treatment. Twenty-three people participated in an outcome study of the modified version of CAT, evaluating improvements after 4 months of CAT specialist intervention and after an additional 5 months of case manager support. Analysis revealed significant improvements in adaptive functioning, psychiatric symptomatology, and goal attainment, which were maintained throughout case management follow-up. This suggests that an intervention that has previously demonstrated good functional outcomes in randomized trials might sustain its impacts in an abbreviated format with support from existing case managers.

Cognitive remediation (CR) has demonstrated good outcomes when paired with supported employment, however little is known about its effectiveness when integrated into a supported education program. This randomized controlled trial examined the effectiveness of integrating CR within a supported education program compared with supported education without CR. Thirty-seven students with psychosis were recruited into the study in the 2012 academic year. Academic functioning, cognition, self-esteem, and symptomatology were assessed at baseline, at 4 months following the first academic term in which CR was provided, and at 8 months assessing maintenance of gains. The treatment group demonstrated better retention in the academic program and a trend of improvement across a range of academic functional domains. While both treatment and control groups showed improvement in cognitive measures, the outcomes were not augmented by CR training. CR was also associated with significant and sustained improvements in self esteem. Further research, investigating specific intervention components is required to clarify the mixed findings regarding the effectiveness of CR in an education setting.