Erica D Diminich1, Faith Dickerson2, Iruma Bello3, Corinne Cather4, David Kingdon5, Pamela J Rakhshan Rouhakhtar6, Kamber L Hart7, Chenxiang Li8, Andrea B Troxel8, Donald C Goff9. 1. Program in Public Health and the Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, United States of America. 2. Sheppard Pratt Health System, Baltimore, MD, United States of America. 3. New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America. 4. Massachusetts General Hospital, Boston, MA, United States of America. 5. Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK. 6. Human Services Psychology Department, University of Maryland Baltimore County, Baltimore, MD, United States of America. 7. Department of Psychiatry, NYU Langone Health, New York, NY, United States of America. 8. Department of Population Health, Division of Biostatistics, NYU School of Medicine, New York, NY, United States of America. 9. Department of Psychiatry, NYU Langone Health, New York, NY, United States of America; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States of America. Electronic address: Donald.Goff@nyulangone.org.
Abstract
OBJECTIVE:D-cycloserine (DCS) promotes consolidation of extinction learning. This study extends earlier work by examining whether DCS can enhance cognitive behavioral therapy (CBT) for delusions. METHODS:Adults reporting moderate or greater delusions were randomly assigned to receive 50 mg of DCS or placebo prior to 10 weekly CBT sessions. The primary outcome was change in severity of delusions measured with the Psychotic Symptom Rating Scale delusion subscale (PSYRATS-D). Secondary outcomes included persistence of response at 3 and 6 month follow-up and the effects of DCS on memory consolidation and cognitive flexibility. Fifty-eight participants were randomized and 44 completed the trial. RESULTS: The DCS and placebo groups did not differ in change from baseline to end of CBT on PSYRATS-D, nor did DCS improve memory consolidation or cognitive flexibility compared to placebo. However, at the 3 month follow-up visit (week 24), 47% of participants who completed treatment with DCS reported a 20% or greater decrease on PSYRATS-D compared to 15% in the placebo group (p = .04). Change in distress across CBT sessions interacted with treatment group to predict change from baseline to week 24 in PSYRATS-D total score (p = .03) such that response at week 24 was greatest in DCS-treated participants who experienced a decrease in distress during CBT sessions. CONCLUSIONS:DCS augmentation of CBT did not improve delusions compared to placebo during treatment; however, DCS was associated with a higher response rate at 3-month follow-up. DCS may produce a delayed therapeutic effect, associated with successful CBT sessions, but this finding requires replication.
RCT Entities:
OBJECTIVE:D-cycloserine (DCS) promotes consolidation of extinction learning. This study extends earlier work by examining whether DCS can enhance cognitive behavioral therapy (CBT) for delusions. METHODS: Adults reporting moderate or greater delusions were randomly assigned to receive 50 mg of DCS or placebo prior to 10 weekly CBT sessions. The primary outcome was change in severity of delusions measured with the Psychotic Symptom Rating Scale delusion subscale (PSYRATS-D). Secondary outcomes included persistence of response at 3 and 6 month follow-up and the effects of DCS on memory consolidation and cognitive flexibility. Fifty-eight participants were randomized and 44 completed the trial. RESULTS: The DCS and placebo groups did not differ in change from baseline to end of CBT on PSYRATS-D, nor did DCS improve memory consolidation or cognitive flexibility compared to placebo. However, at the 3 month follow-up visit (week 24), 47% of participants who completed treatment with DCS reported a 20% or greater decrease on PSYRATS-D compared to 15% in the placebo group (p = .04). Change in distress across CBT sessions interacted with treatment group to predict change from baseline to week 24 in PSYRATS-D total score (p = .03) such that response at week 24 was greatest in DCS-treated participants who experienced a decrease in distress during CBT sessions. CONCLUSIONS:DCS augmentation of CBT did not improve delusions compared to placebo during treatment; however, DCS was associated with a higher response rate at 3-month follow-up. DCS may produce a delayed therapeutic effect, associated with successful CBT sessions, but this finding requires replication.
Authors: Faith Dickerson; Emily Katsafanas; Andrea Origoni; Amalia Squire; Sunil Khushalani; Theresa Newman; Kelly Rowe; Cassie Stallings; Christina L G Savage; Kevin Sweeney; Tanya T Nguyen; Alan Breier; Donald Goff; Glen Ford; Lorraine Jones-Brando; Robert Yolken Journal: Schizophr Res Date: 2021-01-12 Impact factor: 4.939