Cognitive Behavioral Therapy for Subjects at Ultrahigh Risk for Developing Psychosis: A Randomized Controlled Clinical Trial

Gaag, Mark van der; Nieman, Dorien H.; Rietdijk, Judith; Dragt, Sara; Ising, Helga K.; Klaassen, Rianne; Koeter, Maarten W. J.; Cuijpers, Pim; Wunderink, Lex; Linszen, Don

doi:10.1093/schbul/sbs105

Cited by 171 publications

(191 citation statements)

References 33 publications

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“…9 Both our 18-month follow-up results 9 and our 4-year follow-up results 10 demonstrated a favorable effect on reducing the incidence of psychosis by ±50% compared with routine care (RC) alone.…”

Section: In the Dutch Early Detection Intervention And Evaluation Trimentioning

confidence: 68%

“…Besides the proportion of averted transitions to psychosis, 9,35 the difference in QALYs showed a clinically relevant but statistically nonsignificant effect of the intervention on the lives of at-risk individuals and at least no deterioration in their health-related quality of life.…”

Section: Clinical and Public Health Relevancementioning

confidence: 97%

“…The experimental group received RC plus CBTuhr, 15 with a maximum of 26 sessions in the first 6 months after inclusion, 9 with the aim to prevent first-episode psychosis. The mean (and median) number of sessions was 10 (95% CI 8-12), partly caused by early completers, dropouts, or early transitions.…”

Section: Interventionsmentioning

confidence: 99%

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Four-Year Cost-effectiveness of Cognitive Behavior Therapy for Preventing First-episode Psychosis: The Dutch Early Detection Intervention Evaluation (EDIE-NL) Trial

Ising

Lokkerbol

Rietdijk

et al. 2016

SCHBUL

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Background . This study aims to evaluate the long-term costeffectiveness of add-on cognitive behavior therapy (CBT) for the prevention of psychosis for individuals at ultrahigh risk (UHR) of psychosis. Method. The Dutch Early Detection and Intervention randomized controlled trial was used, comparing routine care (RC; n = 101) with routine care plus CBT for UHR (here called CBTuhr; n = 95). A cost-effectiveness analysis was conducted with treatment response (defined as proportion of averted transitions to psychosis) as an outcome and a cost-utility analysis with quality-adjusted life years (QALYs) gained as a secondary outcome. Results. The proportion of averted transitions to psychosis was significantly higher in the CBTuhr condition (with a risk difference of 0.122; b = 1.324, SE b = 0.017, z = 7.99, P < 0.001). CBTuhr showed an 83% probability of being more effective and less costly than RC by −US$ 5777 (savings) per participant. In addition, over the 4-year follow-up period, cumulative QALY health gains were marginally (but not significantly) higher in CBTuhr than for RC (2.63 vs. 2.46) and the CBTuhr intervention had a 75% probability of being the superior treatment (more QALY gains at lower costs) and a 92% probability of being costeffective compared with RC at the Dutch threshold value (US$ 24 560; €20 000 per QALY). Conclusions. Add-on preventive CBTuhr had a high likelihood (83%) of resulting in more averted transitions to psychosis and lower costs as compared with RC. In addition, the intervention had a high likelihood (75%) of resulting in more QALY gains and lower costs as compared to RC.

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Section: In the Dutch Early Detection Intervention And Evaluation Trimentioning

confidence: 68%

Section: Clinical and Public Health Relevancementioning

confidence: 97%

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Four-Year Cost-effectiveness of Cognitive Behavior Therapy for Preventing First-episode Psychosis: The Dutch Early Detection Intervention Evaluation (EDIE-NL) Trial

Ising

Lokkerbol

Rietdijk

et al. 2016

SCHBUL

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“…In addition, patients should be informed that these phenomena are commonly present in the context of depression and may have a negative impact on course and outcome. Research has shown that psycho-education or simply discussing psychotic experiences reduces their stressful effects (van der Gaag et al 2012), which in turn may be beneficial for recovery. Electroconvulsive therapy or antipsychotic medication may need to be considered or, alternatively, cognitive behavioural therapy or other psychotherapeutic approaches may be indicated.…”

Section: Discussionmentioning

confidence: 99%

Subclinical psychotic experiences and bipolar spectrum features in depression: association with outcome of psychotherapy

Wigman

Abidi

et al. 2013

Psychol. Med.

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Background. Subthreshold psychotic and bipolar experiences are common in major depressive disorder (MDD). However, it is unknown if effectiveness of psychotherapy is altered in depressed patients who display such features compared with those without. The current paper aimed to investigate the impact of the co-presence of subclinical psychotic experiences and subclinical bipolar symptoms on the effectiveness of psychological treatment, alone or in combination with pharmacotherapy.Method. In a naturalistic study, patients with MDD (n = 116) received psychological treatment (cognitive behavioural therapy or interpersonal psychotherapy) alone or in combination with pharmacotherapy. Depression and functioning were assessed six times over 2 years. Lifetime psychotic experiences and bipolar symptoms were assessed at the second time point.Results. Subclinical psychotic experiences predicted more depression over time (β = 0.20, p < 0.002), non-remission [odds ratio (OR) 7.51, p < 0.016] and relapse (OR 3.85, p < 0.034). Subthreshold bipolar symptoms predicted relapse (OR 1.16, p < 0.037).Conclusions. In general, subclinical psychotic experiences have a negative impact on the course and outcome of psychotherapy in MDD. Effects of subclinical bipolar experiences were less prominent.

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“…There have also been inconsistent findings when CBT interventions have been compared with treatment as usual for children and adolescents at risk for psychosis. One study found a significant difference [22] while the findings of another study indicated no improvement in either group [23]. There have also been no studies of the efficacy of psychodynamic psychotherapy with psychotic children and youth in spite of the use of psychodynamic principles in the understanding psychotic communication.…”

Section: Need For Research On Psychotherapy and Supportive Interventionsmentioning

confidence: 99%

Limitations of Research on Psychosis in Childhood and Adolescence:Current Controversies and Future Directions

McCarthy¹,

Libby²

2016

J Ment Disord Treat

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Cognitive Behavioral Therapy for Subjects at Ultrahigh Risk for Developing Psychosis: A Randomized Controlled Clinical Trial

Abstract: Compared with TAU, this new CBT (focusing on normalization and awareness of cognitive biases) showed a favorable effect on the transition to psychosis and reduction of subclinical psychotic symptoms in subjects at UHR to develop psychosis.

Cited by 171 publications

References 33 publications

Four-Year Cost-effectiveness of Cognitive Behavior Therapy for Preventing First-episode Psychosis: The Dutch Early Detection Intervention Evaluation (EDIE-NL) Trial

Four-Year Cost-effectiveness of Cognitive Behavior Therapy for Preventing First-episode Psychosis: The Dutch Early Detection Intervention Evaluation (EDIE-NL) Trial

Subclinical psychotic experiences and bipolar spectrum features in depression: association with outcome of psychotherapy

Limitations of Research on Psychosis in Childhood and Adolescence:Current Controversies and Future Directions

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