Brief cognitive analytic therapy for post-acute manic psychosis on a psychiatric intensive care unit

A study of the efficacy of brief cognitive analytic therapy (CAT) with a series of patients (n = 4) with treatment-resistant manic psychosis on a psychiatric intensive care unit (PICU) was carried out. In one patient such an intervention proved redundant given an improved medication regime and subsequent willingness to comply with treatment. In a second, it proved impossible, in this context at least, due to fixed grandiose and paranoid delusions. In two others, however, this approach, particularly the technique of joint 'reformulation', appeared to be remarkably containing and effective with rapid subsidence of disturbed and non-compliant behaviour. Much of the 'psychotic' psychopathology of these patients became comprehensible within this model in terms of secondary, 'self-state' or narcissistic damage and enactment of maladaptive 'procedures' and 'reciprocal roles'. Additionally, discussion of these procedures and the reciprocal roles elicited from and enacted by staff produced a marked change in attitude and behaviour by them. In one of these patients, improvement was such that transfer to an open ward was possible within a week and discharge soon after. Subsequent treatment was markedly more collaborative and enabling of good social function. It appears that CAT and its collaborative use of the 'tools' of reformulation could play an important role in the treatment of psychotic disorders in this and possibly other settings. Copyright (C) 2001 John Wiley & Sons, Ltd.