Opening the Black Box of Cognitive-Behavioural Case Management in Clients with Ultra-High Risk for Psychosis

Hartmann, Jessica A.; McGorry, Patrick D.; Schmidt, Stefanie; Amminger, G. Paul; Yuen, Hok Pan; Markulev, Connie; Berger, Gregor; Chen, Eric; Haan, Lieuwe de; Hickie, Ian B.; Lavoie, Suzie; McHugh, Meredith J.; Mossaheb, Nilufar; Nieman, Dorien H.; Nordentoft, Merete; Riecher-Rössler, Anita; Schäfer, Miriam R.; Schlögelhofer, Monika; Smesny, Stefan; Thompson, Andrew; Verma, Swapna; Yung, Alison R.; Nelson, Barnaby

doi:10.1159/000477551

Cited by 18 publications

(11 citation statements)

References 23 publications

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“…For example, deconstructing the efficacy of different types of CBT that are based on different protocols 83 seems necessary to inform accurate and evidence-based clinical guidelines for patients, clinicians and policy makers. Our NMA comparing the different CBT protocols is also timely, since authors have recently claimed that the "black box" of CBT should be unpacked into its specific therapeutic components 23,24,[84][85][86] .…”

Section: Discussionmentioning

confidence: 99%

Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis

et al. 2018

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Preventing psychosis in patients at clinical high risk may be a promising avenue for pre-emptively ameliorating outcomes of the most severe psychiatric disorder. However, information on how each preventive intervention fares against other currently available treatment options remains unavailable. The aim of the current study was to quantify the consistency and magnitude of effects of specific preventive interventions for psychosis, comparing different treatments in a network meta-analysis. PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials, and unpublished/grey literature were searched up to July 18, 2017, to identify randomized controlled trials conducted in individuals at clinical high risk for psychosis, comparing different types of intervention and reporting transition to psychosis. Two reviewers independently extracted data. Data were synthesized using network meta-analyses. The primary outcome was transition to psychosis at different time points and the secondary outcome was treatment acceptability (dropout due to any cause). Effect sizes were reported as odds ratios and 95% confidence intervals (CIs). Sixteen studies (2,035 patients, 57% male, mean age 20.1 years) reported on risk of transition. The treatments tested were needs-based interventions (NBI); omega-3 + NBI; ziprasidone + NBI; olanzapine + NBI; aripiprazole + NBI; integrated psychological interventions; family therapy + NBI; D-serine + NBI; cognitive behavioural therapy, French & Morrison protocol (CBT-F) + NBI; CBT-F + risperidone + NBI; and cognitive behavioural therapy, van der Gaag protocol (CBT-V) + CBT-F + NBI. The network meta-analysis showed no evidence of significantly superior efficacy of any one intervention over the others at 6 and 12 months (insufficient data were available after 12 months). Similarly, there was no evidence for intervention differences in acceptability at either time point. Tests for inconsistency were non-significant and sensitivity analyses controlling for different clustering of interventions and biases did not materially affect the interpretation of the results. In summary, this study indicates that, to date, there is no evidence that any specific intervention is particularly effective over the others in preventing transition to psychosis. Further experimental research is needed.

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Section: Discussionmentioning

confidence: 99%

Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis

et al. 2018

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“…This was a randomised, double-blind, placebo-controlled treatment trial of omega-3 PUFA plus CBCM or placebo plus CBCM. Treatment was provided for 6 months, with participants receiving further CBCM 52 on the basis of need between months 6 and 12. See Markulev et al 23 for full details of study methodology, inclusion/exclusion criteria and interventions, and McGorry et al 22 for the 6 and 12-month results.…”

Section: Methodsmentioning

confidence: 99%

NEURAPRO: a multi-centre RCT of omega-3 polyunsaturated fatty acids versus placebo in young people at ultra-high risk of psychotic disorders—medium-term follow-up and clinical course

et al. 2018

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This study reports a medium-term follow-up of a randomised, double-blind, placebo-controlled trial of omega-3 polyunsaturated fatty acids (PUFA) in ultra-high risk for psychosis (UHR) patients. Primary outcomes of interest were transition to psychosis and symptomatic and functional outcome. A secondary aim was to investigate clinical predictors of medium-term outcome. Three hundred four UHR participants were recruited across 10 specialised early psychosis services in Australia, Asia, and Europe. The intervention consisted of 1.4 g/daily of omega-3 PUFA or placebo, plus up to 20 sessions of cognitive-behavioural case management (CBCM), over the 6-month study period, with participants receiving further CBCM sessions on basis of need between months 6–12. Mean time to follow-up was 3.4 (median = 3.3; SD = 0.9) years. There was a modest increase in transitions between 12-month and medium-term follow-up (11–13%) and substantial improvement in symptoms and functioning between baseline and follow-up, with no differences between the treatment groups. Most improvement had been achieved by end of the intervention. 55% of the sample received mental health treatment between end of intervention and follow-up. Omega-3 PUFA did not provide additional benefits to good quality psychosocial intervention over the medium term. Although most improvement had been achieved by end of intervention the substantial rates of post-intervention mental health service use indicate longer-term clinical need in UHR patients. The post-intervention phase treatment or the longer-term effect of CBCM, or a combination of the two, may have contributed to maintaining the gains achieved during the intervention phase and prevented significant deterioration after this time.

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“…The subsequent randomized controlled trials have followed this approach by testing different packages, each of which was characterized by specific therapeutic components. This issue is evident, for example, in the case of different types of psychological therapies, which have been defined as "black boxes" (110). The additional and substantial problem with using pooled effect sizes in the CHR-P field is that the control group, traditionally termed as "treatment as usual" (52), is per se poorly standardized and largely dependent on local service configurations and the availability of specific resources or competences (67).…”

Section: Apples Oranges and The Production Of Clinically Meaninglesmentioning

confidence: 99%

Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence)

et al. 2019

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Background: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned. Methods: Umbrella review. A multi-step independent literature search of Web of Science until January 11, 2019, identified interventional meta-analyses in CHR-P individuals. The individual randomised controlled trials that were analysed by the meta-analyses were extracted. A review of ongoing trials and a simulation of living meta-analysis complemented the analysis. Results: Seven meta-analyses investigating preventive treatments in CHR-P individuals were included. None of them produced pooled effect sizes across psychological, pharmacological, or other types of interventions. The outcomes analysed encompassed risk of psychosis onset, the acceptability of treatments, the severity of attenuated positive/negative psychotic symptoms, depression, symptom-related distress, social functioning, general functioning, and quality of life. These meta-analyses were based on 20 randomised controlled trials: the vast majority defined the prevention of psychosis onset as their primary outcome of interest and only powered to large effect sizes. There was no evidence to favour any preventive intervention over any other (or control condition) for improving any of these clinical outcomes. Caution is required when making clinical recommendations for the prevention of psychosis in individuals at risk. Discussion: Prevention of psychosis from a CHR-P state has been, and should remain, the primary outcome of interventional research, refined and complemented by other clinically meaningful outcomes. Stagnation of knowledge should promote innovative and collaborative research efforts, in line with the progressive and incremental nature of medical knowledge. Advancements will most likely be associated with the development of new experimental therapeutics that are ongoing along with the ability to deconstruct the high heterogeneity within CHR-P populations. This would require the estimation of treatment-specific effect sizes through living individual participant data meta-analyses,

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Opening the Black Box of Cognitive-Behavioural Case Management in Clients with Ultra-High Risk for Psychosis

Cited by 18 publications

References 23 publications

Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis

Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis

NEURAPRO: a multi-centre RCT of omega-3 polyunsaturated fatty acids versus placebo in young people at ultra-high risk of psychotic disorders—medium-term follow-up and clinical course

Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence)

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