Predictors and moderators of treatment outcome in patients receiving multi-element psychosocial intervention for early psychosis: Results from the GET UP pragmatic cluster randomised controlled trial

Abstract

The GET UP multi-element psychosocial intervention proved to be superior to treatment as usual in improving outcomes in patients with first-episode psychosis (FEP). However, to guide treatment decisions, information on which patients may benefit more from the intervention is warranted.To identify patients' characteristics associated with (a) a better treatment response regardless of treatment type (non-specific predictors), and (b) a better response to the specific treatment provided (moderators).Some demographic and clinical variables were selected as potential predictors/moderators of outcomes at 9 months. Outcomes were analysed in mixed-effects random regression models. (Trial registration: ClinicalTrials.gov, NCT01436331)Analyses were performed on 444 patients. Education, duration of untreated psychosis, premorbid adjustment and insight predicted outcomes regardless of treatment. Only age at first contact with the services proved to be a moderator of treatment outcome (patients aged ⩾35 years had greater improvement in psychopathology), thus suggesting that the intervention is beneficial to a broad array of patients with FEP.Except for patients aged over 35 years, no specific subgroups benefit more from the multi-element psychosocial intervention, suggesting that this intervention should be recommended to all those with FEP seeking treatment in mental health services.

The over-35s: early intervention in psychosis services entering uncharted territory

“…What little is so far known has been gathered from services already offering a broader EIP service in predominantly urban areas prior to 2016. [3][4][5] By collecting data after the introduction of the new Access and Waiting Time Standard, 1 we were able to evaluate the effects of these changes in existing EIP services, such as CAMEO, and anticipate further challenges and opportunities.…”

“…This confirms previous evaluations in early-adopter services, which suggested that patients over the age of 35 would make up a significant proportion of referrals, ranging from 25 to 33%. [3][4][5] A higher proportion of patients over the age of 35 were referred from secondary and acute care in comparison with those aged under 35; the over-35s were more likely to have existing mental health issues.…”

“…However, the magnitude of these changes was unclear and not fully informed by previous evidence. For instance, the paucity of studies on the administrative incidence of firstepisode psychosis in people aged over 35 assessed in early intervention settings [3][4][5] complicated new workload calculations and commissioning decisions.…”

“…Five patients had a DUP of more than 10 years, and another six of more than 3. 5 month, range 1 day to 12 years; n = 157, 27 not known). The difference in DUP between under-and over-35s was statistically significant (u = 3129.5, P = 0.02).…”

Cognitive therapy of psychosis: Research and implementation

“…Delusions (Freeman et al, 2015), anxiety (Naeem et al, 2006) and depression (Sensky et al, 2000) in psychosis have also improved. Benefits have been seen for negative symptoms in CBTp studies compared to treatment as usual but with one exception (Sensky et al, 2000) not against active controls (Lasalvia et al, 2017). Beck and colleagues however have successfully reduced negative symptoms (Grant et al, 2012) using techniques to improve self-defeating attitudes linked to graded activity scheduling.…”