Disorders - psychosis disorders
Wang, J., Hu, M. R., Guo, X. F., Wu, R. R., Li, L. H., Zhao, J. P.
Cognitive impairment is a core feature of schizophrenia. The present randomized open study enrolled antipsychotic-naïve patients who were experiencing their first episode of schizophrenia. After baseline neurocognitive tests and clinical assessment, subjects were randomly assigned to olanzapine, risperidone and aripiprazole treatment groups. A battery of neurocognitive tests showed that risperidone produced cognitive benefits in all five cognitive domains, including verbal learning and memory, visual learning and memory, working memory, processing speed, and selective attention; olanzapine improved processing speed and selective attention; and aripiprazole improved visual learning and memory, and working memory. However, the three atypical antipsychotic drugs failed to reveal any significant differences in the composite cognitive scores at the study endpoint. In addition, the three drugs all significantly improved clinical measures without significant differences between the drugs after 6 months. These results suggest that the atypical antipsychotics, olanzapine, risperidone and aripiprazole may improve specific cognitive domains with similar global clinical efficacy. In clinical practice, it may be feasible to choose corresponding atypical antipsychotics according to impaired cognitive domains.
Neural Regeneration Research, 8(3) : 277-286
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
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Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Velden-Hegelstad, W. T., Langeveld, J., Heitmann, L., Joa, I., Johannessen, J. O.
Background: In 60%-90% of cases, psychosis disrupts vocational or academic engagement [1]. JobPrescription aims for employment/studies through Individual Placement and Support (IPS). Sixty-one participants (2010-2013) with psychotic disorders entered the project, about half on the initiative of treating clinician. 41% attained regular paid employment, 20% were in internships. The mean time from project inclusion to employment was 3.6 months (SD 0.7). However, these figures have not been compared to a control group, and the group was a mix of chronic and first-episode patients. Objective: To evaluate the effect of this intervention using a randomised controlled trial. Methods: First-episode psychosis (FEP) patients aged 15-65 are referred by TIPS early detection and randomised to treatment as usual or Job- Prescription. Single blind assessments are carried out at baseline, 3 and 24 months. Primary outcome measures are employment/study status. Secondary outcomes are quality of life and psychological well-being. Symptom levels and neuropsychological function are analysed as covariates. Results: By April 2014, 20 patients were included. Four of 8 in the control and 9 of 12 in the experimental arm are engaged in employment or studies. Preliminary results on symptoms, quality of life, and (neuro)psychological factors will be presented. Study inclusion continues until 60 participants. Discussion: Experiences from JobPrescription seem to indicate favourable results. However, threats to the RCT include a 50% refusal rate, possibly due to the risk of randomisation to the wait-list condition; and treatment as usual increasingly making use of IPS methods and thus contaminating the control arm.
Early Intervention in Psychiatry, 8 : 122
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: First episode (psychosis only)
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Treatment and intervention: Service Delivery & Improvement, Individual placement and support (IPS), vocational interventions
Okuzawa, N., Kline, E., Fuertes, J., Negi, S., Reeves, G., Himelhoch, S., Schiffman, J.
Aim: Unlike medication treatment, which may confer an unfavourable risk-benefit ratio, psychosocial intervention has been an emerging target of recent randomized controlled trials (RCTs) assessing its efficacy in delaying or preventing the onset of psychosis in individuals identified at 'clinical high risk'. Literature comparing qualitative differences in these psychotherapeutic interventions is scarce. The aim of the current study was to conduct a PRISMA systematic review evaluating the efficacy of psychotherapeutic interventions in reducing the rates of conversion to psychosis in clinical high-risk individuals. Methods: RCTs were identified in PubMed, Medline and PsycINFO databases up to 30 November 2013. Six studies (comprising 800 participants) met review inclusion criteria. Three investigators performed data extraction independently by using a pre-structured selection form, and conducted risk of bias assessment employing the Cochrane approach. Results: All six studies employed cognitive behaviour therapy as a core element. Three trials achieved a significant effect. The two trials that employed cognitive behaviour therapy enhanced for the specialized needs of clinical high-risk patients maintained significant effects at post-treatment follow up. Conclusion: Evidence from recent trials suggest that cognitive behaviour therapy may be beneficial in delaying or preventing onset of psychosis in clinical high-risk individuals, although effect sizes to date appear small. Further research is needed in larger samples to establish whether cognitive behaviour therapy is efficacious, and if additional intervention components can enhance established psychotherapies. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Early Intervention in Psychiatry, 8(4) : 307-322
- Year: 2014
- Problem: Psychosis Disorders
- Type: Systematic reviews
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Puig, O., Penades, R., Baeza, I., De-la-Serna, E., Sanchez-Gistau, V., Bernardo, M., Castro-Fornieles, J.
Objective: Cognitive impairment is an enduring and functionally relevant feature of early-onset schizophrenia (EOS). Cognitive remediation therapy (CRT) improves cognition and functional outcome in adults with schizophrenia, although data in adolescents with EOS remain scarce. The purpose of this study is to examine the efficacy of CRT in improving cognition and functional outcomes in a sample of symptomatically stable but cognitively disabled adolescents with EOS. Method: We performed a randomized, controlled trial of individually delivered CRT plus treatment-as-usual compared with treatment-as-usual (TAU). Fifty adolescents with EOS were randomly assigned to receive CRT (n = 25) or TAU (n = 25) and were included in an intention-to-treat analysis. Clinical symptoms and cognitive and functional performance were assessed before and after treatment in both groups and after 3 months in the CRT group. Cognitive domains were defined according to the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) consensus battery and averaged in a global cognitive composite score. Results: After CRT, significant improvements were found in verbal memory and executive functions, with medium-to-large effect sizes (ES). The derived cognitive composite score showed an improvement after the treatment, with a large ES. This change was reliable in more than two-thirds of the treated patients. Medium-sized ES were found for improvements after CRT in daily living and adaptive functioning, whereas large ES were observed for improvements in family burden. With the exception of functional gains, these changes were maintained after 3 months. Conclusion: CRT appears to be a useful intervention strategy for adolescents with EOS. Cognitive improvements can be achieved through CRT, although further research is warranted to determine the durability of functional gains. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Journal of the American Academy of Child & Adolescent Psychiatry, 53(8) : 859-868
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Poulton, R., Van-Ryzin, M. J., Harold, G. T., Chamberlain, P., Fowler, D., Cannon, M., Arseneault, L., Leve, L. D.
Objective: Neurodevelopmental theories of psychosis highlight the potential benefits of early intervention, prevention, and/or preemption. How early intervention should take place has not been established, nor whether interventions based on social learning principles can have preemptive effects. The objective was to test whether a comprehensive psychosocial intervention can significantly alter psychotic symptom trajectories during adolescence-a period of heightened risk for a wide range of psychopathology. Method: This study was a randomized controlled trial (RCT) of Multidimensional Treatment Foster Care (MTFC) for delinquent adolescent girls. Assessment of psychotic symptoms took place at baseline and then 6, 12, 18, and 24 months post-baseline using a standardized self-report instrument (Brief Symptom Inventory). A second source of information about psychotic symptoms was obtained at baseline or 12 months, and again at 24 months using a structured diagnostic interview (the Diagnostic Interview Schedule for Children [DISC]). Results: Significant benefits for MTFC over treatment as usual for psychosis symptoms were observed over a 24-month period. Findings were replicated across both measures. Effects were independent of substance use and initial symptom severity and persisted beyond the initial intervention period. Conclusion: Ameliorating nonclinical psychotic symptoms trajectories beginning in mid-adolescence via a multifaceted psychosocial intervention is possible. Developmental research on nonclinical psychotic symptoms and their prognostic value should be complemented by more psychosocial intervention research aimed at modifying these symptom trajectories early in their natural history. Clinical trial registration information-Juvenile Justice Girls Randomized Control Trial: Young Adult Follow-up; http://clinicaltrials.gov; NCT01341626. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Journal of the American Academy of Child & Adolescent Psychiatry, 53(12) : 1279-1287
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Other service delivery and improvement interventions
Piskulic, D., Barbato, M., Liu, L., Addington, J.
Individuals at clinical high risk (CHR) of psychosis evidence cognitive deficits. Given suggestions that deficits in cognition are related to poor functional outcome, cognition is a good treatment target. The aim of this study was to test the efficacy of cognitive remediation therapy (CRT) in improving cognition of CHR individuals. Participants were randomised to either the BF treatment or a control treatment consisting of commercial computer games (CG). The 40 hours of BF intervention or computer game activity was expected to occur 4 days a week, for an hour each day, over a period of 10-12 weeks. Participants were tested at baseline, immediately following CRT and 9 months post-baseline. The mixed effects modelling demonstrated no differences in cognition between the experimental group and the control group at any time point. For the experimental group however, there was a trend towards improvement in speed of processing between baseline and 9-month follow-up (t(29) = - 2.91, P = 0.06) and at post-CRT compared to 9-month follow-up (t(29) = - 2.99, P < 0.05). In the control group, significant improvements in working memory were observed between post-CRT and 9-month follow-up (t(29) = - 3.06, P < 0.05). Despite significant improvements in social functioning in the intervention group between baseline and 9-month follow-up (t(28) = - 3.26, P < 0.05), these improvements were not correlated with cognition. There were trends towards improvement and no trends of decline in the two groups. While CRT may be valuable for individuals at CHR, the type of intervention employed needs to be carefully considered.
Early Intervention in Psychiatry, 8 : 86
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
Piskulic, D., Barbato, M., Liu, L., Addington, J.
Background: Onset of psychotic disorders such as schizophrenia typically occurs during late adolescence or early adulthood often resulting in chronic social and occupational disability. Deficits in cognition and functional outcome (e.g. social and occupational functioning) often precede the onset of full-blown psychosis although to a lesser degree than observed in schizophrenia. Progress in risk identification methodology has enabled reliable detection of persons thought to be putatively prodromal for psychosis that is, at clinical high risk (CHR) of developing a psychotic disorder. Since CHR individuals evidence cognitive deficits, which increase around the time of conversion, cognition is an excellent treatment target. There is evidence in schizophrenia and in CHR samples, that deficits in cognition are related to poor functional outcome. Thus, treatments targeting cognition may consequently improve functional outcome. The primary aim of the project was to reduce cognitive deterioration in CHR individuals using cognitive remediation training (CRT) and test the efficacy of the PositScience Brain Fitness (BF) auditory training program in improving cognition of these individuals. Methods: This is a longitudinal, single blind, randomized controlled pilot trial of CRT in 32 CHR persons between the ages of 14 and 35 years. Participants were randomised to either the BF treatment or a control treatment consisting of commercial computer games (CG). The 40 hours of BF intervention or computer game activity was expected to occur 4 days a week, for an hour each day, over a period of 10-12 weeks. Participants were recruited from an ongoing longitudinal study of CHR individuals. The primary outcome was cognitive function assessed using the MATRICS consensus cognitive battery. The secondary outcome was social and role functioning assessed with Global Functioning: Social and Role scales. All clinical and cognitive assessments using symptom, functioning and cognitive measures were performed at baseline, post-treatment (at 3 months) and at 6-month follow-up. Results: Half of all participants completed between 20-40 training sessions. There were no significant baseline differences between the two groups on demographics, functional outcome or attenuated symptoms. Mixed effects modelling demonstrated no differences between the groups on cognitive domains at baseline or either follow up assessment. For the BF group, there was a trend towards improvement in speed of processing at 6-months (LSM=46.59, SE=2.91) compared to baseline (LSM=39.88, SE=2.16; -2.91 (29), p=0.06) and post-training follow-up (LSM=40.6, SE=2.46; -2.99 (29) p=0.05). In the CG group, significant improvements in working memory were observed between post-training (LSM=41.33, SE=3.14) and 6-month follow-up (47.48, SE=2.90; -6.14 (29), p<0.05). Additionally, there were significant improvements in social functioning in the BF group at 6-month follow-up (LSM=7.32, SE=0.54) compared to baseline (LSM=5.80, SE=0.43; -1.51 (28), p<0.05). Discussion: Although improvements in the BF group were on a trend level this finding is potentially significant from a clinical standpoint as it suggest that cognitive remediation intervention may have some benefit after 20 training sessions. Similarly, working memory benefits noted in the CG group indicate that there are some possible benefits to cognitive function from engaging in computer games that consisted of word puzzles and strategy games. Despite improvements in social functioning in BF group this was not significantly associated with improvements in cognition. Lack of significant findings may be due to underpowered study resulting from small sample size and high attrition rate.
Schizophrenia Research, 153 : S218
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy
O'Brien, M. P., Miklowitz, D. J., Candan, K. A., Marshall, C., Domingues, I., Walsh, B. C., Zinberg, J. L., De-Silva, S. D., Woodberry, K. A., Cannon, T. D.
Objective: This study investigated whether family focused therapy (FFT-CHR), an 18-session intervention that consisted of psychoeducation and training in communication and problem solving, brought about greater improvements in family communication than enhanced care (EC), a 3-session psychoeducational intervention, among individuals at clinical high risk for developing psychosis. Method: This study was conducted within a randomized controlled trial across 8 sites. We examined 10-min problem-solving discussions at baseline and 6-month reassessment among 66 adolescents and young adults and their parents. Trained coders who were blind to treatment and time of assessment achieved high levels of interrater reliability when evaluating family discussions on categories of calm-constructive and critical-conflictual behavior. Results: Individuals at high risk and their family members who participated in FFT-CHR demonstrated greater improvement from baseline to 6-month reassessment in constructive communication and decreases in conflictual behaviors during family interactions than those in EC. Participants in FFT-CHR showed greater increases from baseline to 6 months in active listening and calm communication and greater decreases in irritability and anger, complaints and criticism, and off-task comments compared to participants in EC. These changes occurred equally in high-risk participants and their family members. Conclusions: A 6-month family skills training treatment can bring about significant improvement in family communication among individuals at high risk for psychosis and their parents. Future studies should examine the association between enhancements in family communication and reduced risk for the onset of psychosis among individuals at high risk. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
Journal of Consulting & Clinical Psychology, 82(1) : 90-101
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Family therapy
Nuechterlein, K. H., Ventura, J., Subotnik, K. L., Gretchen-Doorly, D., Turner, L., Casaus, L., Luo, J., Bell, M. D., Medalia, A.
Background: Work/school functioning is often the outcome domain with the greatest continuing impairment after a first episode of schizophrenia. The level of cognitive deficit during this period is a strong rate-limiting factor in work recovery. Interventions that can improve cognitive functioning early in the course of schizophrenia are essential if we hope to prevent or limit long-term disability in this disorder. Methods: We completed a 12-month randomized controlled trial of cognitive remediation with 67 patients with a recent first episode of schizophrenia using healthy behavior training as an active comparison group. The cognitive remediation approach combined computer programs emphasizing repeated practice with elementary cognitive processes (processing speed, attention, immediate memory) and more complex, life-like situations (higher-order memory and problem solving). Two hours/week of computerized cognitive training at the clinic was supplemented with a weekly bridging group to encourage transfer of learning to work and school situations. Patients assigned to healthy behavior training had an equal amount of treatment time that involved instruction and practice in good nutrition habits, light physical exercise, and stress reduction. Supported education/ employment was provided to both treatment groups to encourage return to competitive work or schooling. Results: Consistent antipsychotic medication adherence was found to increase cognitive improvement in this period after a first psychotic episode so medication adherence and protocol completion were covaried to examine cognitive remediation effects. Compared to healthy behavior training cognitive remediation produced significant improvement in the Overall Composite score and the Attention/Vigilance domain from the MATRICS Consensus Cognitive Battery. Cognitive remediation also produced significantly greater improvement in work/school functioning than healthy behavior training. The amount of cognitive improvement was also significantly correlated with the degree of work/school functional improvement suggesting that the cognitive gains were a notable factor in this functional improvement. Discussion: Our results indicate that cognitive remediation can significantly improve cognitive deficits after a first episode of schizophrenia. When combined with supported education/employment, cognitive remediation shows an impact on work/school functioning that goes beyond the facilitating effect of that compensatory work rehabilitation approach. Additional research should focus on treatment conditions that can produce even larger gains in cognition in this initial period of schizophrenia and that facilitate further generalization of learning from cognitive training sessions to everyday functioning.
Schizophrenia Research, 153 : S224
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
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Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Cognitive remediation therapy, Physical activity, exercise, Technology, interventions delivered using technology (e.g. online, SMS)
Restek-Petrovic, B., Bogovic, A., Mihanovic, M., Grah, M., Mayer, N., Ivezic, E.
Background: The "Sveti Ivan" psychiatric hospital in Zagreb, Croatia, offers an outpatient Early Intervention Program for psychotic patients. This program consists of psycho-educational workshops and group psychodynamic psychotherapy. Two important objectives of the program are improving and maintaining adequate cognitive functioning. Aims: The current study examined changes in aspects of cognitive functioning in young patients with schizophrenia after 18 months and after 3 years of psychodynamic group psychotherapy. Methods: The study included 28 patients who attended the Early Intervention Program for young patients with psychotic disorders; 10 patients had completed only the psycho-educational part of the program (comparative group), and 18 patients continued with group psychodynamic psychotherapy (experimental group). All patients completed the Revised Beta Examination. Results: We observed a trend in the experimental group to achieve higher scores than the comparative group. The results for both groups tended to increase with time, and this increase was greater in the experimental group. Conclusions: While acknowledging the limitations of this preliminary study, we conclude that participating in psychodynamic group psychotherapy is related to increases in the cognitive functioning of patients with schizophrenia, and our results provide a sound basis for future research. © 2014 Informa Healthcare.
Nordic Journal of Psychiatry, 68(5) : 333-340
- Year: 2014
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Psychodynamic/Psychoanalysis, Psychoeducation
Miklowitz, D. J., O'Brien, M. P., Schlosser, D. A., Addington, J., Candan, K. A., Marshall, C., Domingues, I., Walsh, B. C., Zinberg, J. L., De-Silva, S. D., Friedman-Yakoobian, M., Cannon, T. D.
Objective: Longitudinal studies have begun to clarify the phenotypic characteristics of adolescents and young adults at clinical high risk for psychosis. This 8-site randomized trial examined whether a 6-month program of family psychoeducation was effective in reducing the severity of attenuated positive and negative psychotic symptoms and enhancing functioning among individuals at high risk. Method: Adolescents and young adults (mean age 17.4 +/- 4.1 years) with attenuated positive psychotic symptoms, brief and intermittent psychosis, or genetic risk with functional deterioration were randomly assigned to 18 sessions of family-focused therapy for individuals at clinical high risk (FFT-CHR) in 6 months or 3 sessions of family psychoeducation (enhanced care [EC]). FFT-CHR included psychoeducation about early signs of psychosis, stress management, communication training, and problem-solving skills training, whereas EC focused on symptom prevention. Independent evaluators assessed participants at baseline and 6 months on positive and negative symptoms and social-role functioning. Results: Of 129 participants, 102 (79.1%) were followed up at 6 months. Participants in FFT-CHR showed greater improvements in attenuated positive symptoms over 6 months than participants in EC (F1,97 = 5.49, p = .02). Negative symptoms improved independently of psychosocial treatments. Changes in psychosocial functioning depended on age: participants more than 19 years of age showed more role improvement in FFT-CHR, whereas participants between 16 and 19 years of age showed more role improvement in EC. The results were independent of concurrent pharmacotherapy. Conclusion: Interventions that focus on improving family relationships may have prophylactic efficacy in individuals at high risk for psychosis. Future studies should examine the specificity of effects of family intervention compared to individual therapy of the same duration and frequency. (PsycINFO Database Record (c) 2014 APA, all rights reserved) (journal abstract).
Journal of the American Academy of Child & Adolescent Psychiatry, 53(8) : 848-858
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Family therapy, Psychoeducation
Nieman, D. H., Ruhrmann, S., Rietdijk, J., Dragt, S., Ising, H., Klaassen, R., Cuijpers, P., Wunderink, L., Linszen, D. H., De-Haan, L., Van-Der-Gaag, M.
In many serious illnesses (e.g. cancer), early detection and treatment leads to improved prognosis. In light of limited treatment possibilities in late stages of major mental disorders, early detection and treatment in psychiatry is a promising topic. Clinical experience shows that it is easier to engage a patient in treatment if insight into illness is still largely intact. Our aim was to investigate the effectiveness of a cognitive behavioural therapy (CBT) especially developed for subjects with an at risk mental state (ARMS) for developing a first psychotic episode. 201 ARMS patients were recruited at 4 Dutch sites and randomized. The CBT was provided for 6 months, and the follow-up period was 18 months. The new CBT (CBTarms; 1) focuses on awareness of cognitive biases (e.g. jumping to conclusions) and normalisation by means of psycho-education. In the CBTarms condition, 10 patients transitioned to psychosis compared with 22 in the treatment as usual (TAU) condition (χ2(1)=5.575, P=0.03). The number needed to treat (NNT) was 9 (95% confidence interval: 4.7-89.9). At 18-month follow-up the CBTarms group was significantly more often remitted from an at-risk mental state, with a NNT of 7 (95% CI: 3.7-71.2). Compared with TAU, this new CBT showed a favourable effect on the transition to psychosis and reduction of subclinical psychotic symptoms in ARMS subjects (2). Future research is warranted into individualized risk estimation with respect to tailoring the intervention to the actual needs of the patient. We recently developed an optimised prediction model of a first psychosis in ARMS subjects considering different sources of information (3). Out of a comprehensive set of predictors, the P300 event related potential (signifying informationprocessing deficits) and premorbid adjustment were identified as the key elements in an individualized prognostic score. The prognostic score was further stratified into three risk classes establishing a prognostic index. In the class with the worst premorbid adjustment and information processing deficits, 74% of the subjects made a transition to psychosis whereas in the lowest risk class only 4% transitioned. Furthermore, in the highest risk class transition emerged on average 17 months earlier than in the lowest risk class. However, transferring our approach into clinical practice requires validation in an independent sample. A successful transfer would provide new opportunities for developing targeted intervention strategies based on a subjects' individual risk index.
Schizophrenia Research, 153 : S42-S43
- Year: 2014
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)