Clinical and Functional Outcomes After 2 Years in the Early Detection and Intervention for the Prevention of Psychosis Multisite Effectiveness Trial

Abstract

Objective:To test effectiveness of the Early Detection, Intervention, and Prevention of Psychosis Program in preventing the onset of severe psychosis and improving functioning in a national sample of at-risk youth.Methods:In a risk-based allocation study design, 337 youth (age 12–25) at risk of psychosis were assigned to treatment groups based on severity of positive symptoms. Those at clinically higher risk (CHR) or having an early first episode of psychosis (EFEP) were assigned to receive Family-aided Assertive Community Treatment (FACT); those at clinically lower risk (CLR) were assigned to receive community care. Between-groups differences on outcome variables were adjusted statistically according to regression-discontinuity procedures and evaluated using the Global Test Procedure that combined all symptom and functional measures.Results:A total of 337 young people (mean age: 16.6) were assigned to the treatment group (CHR + EFEP, n = 250) or comparison group (CLR, n = 87). On the primary variable, positive symptoms, after 2 years FACT, were superior to community care (2 df, p < .0001) for both CHR (p = .0034) and EFEP (p < .0001) subgroups. Rates of conversion (6.3% CHR vs 2.3% CLR) and first negative event (25% CHR vs 22% CLR) were low but did not differ. FACT was superior in the Global Test (p = .0007; p = .024 for CHR and p = .0002 for EFEP, vs CLR) and in improvement in participation in work and school (p = .025).Conclusion:FACT is effective in improving positive, negative, disorganized and general symptoms, Global Assessment of Functioning, work and school participation and global outcome in youth at risk for, or experiencing very early, psychosis.

Neural Dysfunction in Cognitive Control Circuits in Persons at Clinical High-Risk for Psychosis

“…Our conversion rate (20.7%), was similar to that in samples similar to ours in size (Yaakub et al, 2013) but larger than in some other published studies (Dandash et al, 2013;McFarlane et al, 2015). This rate is now considered as typical of prodromal research in general (Niendam et al, 2013;Yaakub et al, 2013;Katsura et al, 2014) and similar to the conversion rates in various consortia, such as the European Prediction of Psychosis Study (Salokangas et al, 2012).…”

Negative Psychosis Prevention Trials

“…1 , 9% at 2y in Morrison et al and 2.3% at 2y in McFarlane et al 3 , implying that these negative findings are likely to be secondary to small statistical power.…”

“…In the wake of the recently published ω-3 polyunsaturated fatty acids multisite trial (NEURAPRO) in the journal (McGorry et al, n=304 1 ), the three largest studies of preventative interventions in individuals at ultra high risk (UHR) for psychosis have turned out to be negative (Morrison et al, n=288 2 , McFarlane et al, n=292 3 ), suggesting that it may not currently be possible to prevent psychosis. However, the actual risk of psychosis in these interventional studies was found to be extremely low, even in the control group (11.2% in McGorry et al at 1y…”

Psychopathology and socioeconomic position: what can be done to break the vicious circle?

“…Although not specifically geared to answer this question, the study conducted by Wang et al [15] points to one possible answer. If MRI-ascertained structural brain abnormalities can help identify adolescents who experience schizophrenia, use of such neurological measures for early detection could help adequately address youths' mental health needs and improve their long-term prognosis [16]. And, by ricochet, limit the socioeconomic impact of psychiatric disorders.…”