A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis

Addington, Jean; Epstein, Irvin; Liu, Lu; French, Paul; Boydell, Katherine M.; Zipursky, Robert B.

doi:10.1016/j.schres.2010.10.015

Cited by 201 publications

(271 citation statements)

References 28 publications

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“…A recent meta-analysis of 11 trials including 1246 participants showed that focused interventions can halve the risk of psychosis onset (RR=0.5) [71]. Treatments that have demonstrated efficacy include cognitive therapy [72], cognitive behavioural therapy (CBT) [73], antipsychotic drugs [74], combined psychological and pharmacological interventions (risperidone plus CBT) [75], nutritional interventions (omega-3 fatty acids) [76], and integrated psychological interventions (cognitive therapy, social skills training, psychoeducation for family, and cognitive remediation) [77]. However, the evidence collected from these trials is not to be considered conclusive but rather preliminary [71].…”

Section: Focused Interventionsmentioning

confidence: 99%

“…Since psychopathological boundaries are not so well-defined, patients at-risk for psychosis may fulfill diagnostic criteria for depression, anxiety, substance abuse, personality disorders, and developmental disorders [73]. More importantly, the construct holds the characteristic of pluripotency, in terms of heterogeneity of longitudinal outcomes.…”

Section: Risk Syndrome or Mental Disordermentioning

confidence: 99%

“…More importantly, the construct holds the characteristic of pluripotency, in terms of heterogeneity of longitudinal outcomes. Among non-transitioning patients, about 46% appear to remit [89], some persist in ongoing attenuated psychotic symptoms, and others progress to other disorders, mainly bipolar disorder, depression and anxiety [73]. A meta-analysis performed on a database of 2182 HR subjects revealed that the available HR criteria, in particular the BS criteria, are strongly biased toward the identification of early prodromal phases of schizophrenic psychosis (SP) (73%) rather than affective psychosis (AP) (11%) [90].…”

Section: Risk Syndrome or Mental Disordermentioning

confidence: 99%

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The Psychosis High-Risk State

Rutigliano¹,

Manalo²,

Fusar‐Poli

2016

Key Issues in Mental Health

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The disabling nature and costly impact of mental disorders, such as schizophrenia, can cause significant burden to both person and society. It is also indicated that the negative outcomes associated with psychosis may, in part, be due to the delayed detection and initiation of treatment. Preventative interventions in several arenas of medicine have advanced; however have only come to the fore in psychiatry in the last two decades. It was long-known that a preclinical phase preceded psychosis, now commonly termed as ultra high-risk (UHR) status.The advent of specialized early intervention services provided the cornerstone in taking a preventative and timely endeavor to maximize the chance of positive outcomes in psychosis.Despite the potential, the current state of the UHR concept lacks consensus in how at-risk individuals should be approached. This chapter aims to provide an overview of how preventative medicine can intersect with psychiatry by focusing on the psychosis high risk state. It describes the current criteria and screening procedures used to prospectively detect UHR individuals, as well as discussing the validity of these tools. Whilst advocating the benefits of focused interventions, this chapter also recognizes current challenges and the controversy that leaves the psychosis high risk state on fertile ground for wavering opinions.The chapter concludes with an exploration and discussion that proposes an improved conceptualization of the high risk state and how this can direct intervention, as well as suggesting future lines of research in this area.2

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Section: Focused Interventionsmentioning

confidence: 99%

Section: Risk Syndrome or Mental Disordermentioning

confidence: 99%

Section: Risk Syndrome or Mental Disordermentioning

confidence: 99%

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The Psychosis High-Risk State

Rutigliano¹,

Manalo²,

Fusar‐Poli

2016

Key Issues in Mental Health

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“…Positive reappraisal and problem solving, both considered adaptive ER strategies, are known to relate to lower depression and anxiety scores [76,77], and there is growing evidence that cognitive therapy (CT), which emphasizes problem-solving and reappraisal skills, significantly reduces both positive and negative symptoms in CHR and first-episode patients [114][115][116][117]. However, whether CT can prevent transition to psychotic illness is still an open question [118].…”

Section: Treatment Implicationsmentioning

confidence: 99%

Beyond “Cold” Cognition: Exploring Cognitive Control of Emotion as a Risk Factor for Psychosis

Tully

Niendam

2014

Curr Behav Neurosci Rep

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The past 20 years of research examining psychosis risk factors has predominantly focused on "cold" cognitive (i.e., non-affective) processes. Despite identification of potential cognitive and associated brain-based vulnerability markers, our ability to identify those individuals at highest risk for future psychosis has not substantially improved. Consequently, researchers have begun to examine emotionprocessing deficits as potential psychosis vulnerability markers. Here we propose that a particular emotionprocessing domain, cognitive control of emotion, is a potential transdiagnostic mechanism underlying the heterogeneity of clinical presentation and psychosocial impairments observed in high-risk populations. Recent investigations indicate impaired cognitive control of emotion is observable across the psychosis spectrum and relates to important clinical and psychosocial outcomes relevant to the high-risk state. Moreover, preliminary evidence indicates treatment interventions aimed at improving cognitive control of emotion could reduce psychotic symptoms and improve functioning. We highlight gaps in current knowledge and propose five key avenues for future investigations.

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“…Among the nonpharmacological interventions to treat UHR subjects, the Cognitive Behavior Therapy (CBT) has been extensively investigated and its benefits remain unclear as some studies demonstrated to successfully delay the onset of full-blown psychosis at its early prodromal stages and other studies do not show any differences in comparison with placebo [7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

Is psychodynamic psychotherapy an effective intervention for individuals at ultra-high risk (UHR) of psychosis?: a case report

Martins

Gonçalves

Arcuri

et al. 2012

J. bras. psiquiatr.

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objective: To report a case and to discuss the use of psychodynamic psychotherapy (PD-P) to treat individuals at ultra-high risk (UHR) of psychosis. Methods: An individual at UHR was followed up for 24 months. The baseline evaluation included a psychiatric interview, the Structured Interview for Prodromal Symptoms (SIPS), the Scale of Prodromal Symptoms (SOPS), and neuropsychological assessment. He underwent weekly sessions of PD-P for 12 months and was followed up for 12 months after the end of PD-P. The evaluations were at baseline, after 6-, 12-, and 24-month follow-up. No medication was prescribed during the 24-month follow-up. results: The prodromal symptoms remitted. The initial total score on the SIPS/SOPS was 37 points. After the first 12 months of PD-P, there was a reduction to 12 points on the SIPS/SOPS score, which stabilized in the 24-month follow-up. There was also a slight improvement in his performance on the neuropsychological evaluations. Conclusion: This case report suggests that PD-P can reduce prodromal symptoms; nevertheless, a better understanding of the specificity and efficacy of PD-P as an option of treatment for UHR individuals is needed. resUMo objetivo: Relatar um caso e discutir o uso da psicoterapia psicodinâmica (PD-P) no tratamento de indivíduos com risco ultra-alto (UHR) para psicose. Métodos: Um indivíduo UHR foi acompanhado por 24 meses. A avaliação inicial incluiu entrevista psiquiátrica, aplicação de instrumentos padronizados, Entrevista Estruturada Para Sintomas Prodrômicos (SIPS), a Escala de Sintomas Prodrômicos (SOPS) e avaliação neuropsicológica. O indivíduo teve sessões semanais de PD-P durante os primeiros 12 meses e continuou acompanhamento durante os 12 meses seguintes após o término da PD-P. Avaliações foram feitas no início do estudo e após 6, 12 e 24 meses de seguimento. Nenhuma medicação foi prescrita durante todo o seguimento. resultados: Os sintomas prodrômicos remitiram. Apresentou, ainda, discreta

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A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis

Cited by 201 publications

References 28 publications

The Psychosis High-Risk State

The Psychosis High-Risk State

Beyond “Cold” Cognition: Exploring Cognitive Control of Emotion as a Risk Factor for Psychosis

Is psychodynamic psychotherapy an effective intervention for individuals at ultra-high risk (UHR) of psychosis?: a case report

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