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Introduction
No trials examining the efficacy of CBT for people who meet criteria for established psychosis and do not wish to take antipsychotic medication have been conducted, although several published case reports suggest it may be beneficial (e.g. Morrison, 1994). Developing alternatives to medication ought to be an urgent concern given the right of patients in England under the new NHS Constitution to make informed choices about their treatment, the problematic side-effects of antipsychotics, and the significant proportion of people who have a poor response. Importantly, experiencing psychosis does not necessarily imply a loss of treatment decision-making capacity (Cairns et al., 2005). Deciding not to take antipsychotic medication, a common event, does not necessarily imply a reluctance to receive some other form of effective help.
The following case study demonstrates how even short-term CBT can be a helpful and acceptable treatment for a young person meeting criteria for psychosis but not wishing to take medication. The client read a draft of this anonymized report and provided informed consent to publication.
Method
Client history
Sandy, an 18-year old man who had heard and seen an invisible figure (John) since he was 10, was referred to the Psychosis Research Unit because of limited access to psychological therapy in his local mental health service. He was highly distressed and actively seeking help. He repeatedly heard John talking and singing, and could offer a vivid and detailed description of his appearance. He believed John was real, although he could offer little explanation for his existence or why other people could not see him. He was frequently woken at night by John singing or instructing him to go to the bathroom, which he complied with. He did not wish to take antipsychotic medication and had never done so. Although he had not previously received CBT, he had received a successful intervention (family therapy, counselling and brief inpatient care) for an eating disorder over a year before. He had not disclosed his invisible companion to professionals at the time as he did not view it as a problem.
Assessment
Clinical assessment, including interview assessment with the Comprehensive Assessment of...