Selection for psychosocial treatment for youth at clinical high risk for psychosis based on the North American Prodrome Longitudinal Study individualized risk calculator

Abstract

Aim Recent findings suggest that family‐focused therapy (FFT) is effective for individuals at clinical high‐risk for psychosis (CHR‐P). As outcomes of CHR‐P individuals are quite varied, certain psychosocial interventions may be differentially effective in subgroups. The present study examined change in positive symptoms for CHR‐P individuals at different levels of predicted risk for conversion to psychosis who received either FFT, a brief form of family education termed enhanced care (EC) or treatment as usual. Methods Participants were drawn from the North American Prodromal Longitudinal Study (NAPLS2). A subset of NAPLS2 participants completed a randomized study involving FFT or EC. The present study includes participants from the FFT‐CHR sub‐study and non‐randomized NAPLS2 participants. Predicted risk of conversion was calculated using the Individualized Risk Calculator for Psychosis. Robust linear regressions evaluated whether the association between predicted risk of conversion and positive symptom change differed across intervention groups. Results A total of 94 participants from the FFT‐CHR sub‐study (FFT‐CHR n = 50, EC n = 44) and 401 non‐randomized NAPLS2 participants were included in this study. There was a treatment group by predicted risk of conversion interaction that predicted positive symptom improvement: higher risk individuals improved more with FFT‐CHR than EC or the non‐randomized NAPLS group, whereas lower‐risk individuals did not differ in positive symptom improvement across treatment groups (FFT‐CHR vs EC: P = .03, β = 20.27; FFT‐CHR vs NAPLS2: P < .001, β = 28.40). Conclusions Intensive treatments such as FFT‐CHR may be most appropriate for individuals at the highest levels of clinical risk for psychosis.

Skills program for awareness, connectedness, and empowerment: A conceptual framework of a skills group for individuals with a psychosis-risk syndrome

“…Importantly, our pilot intervention does include a wider age range of 13-18 which may also be a limitation to the study. This age range is in line with the age ranges in CHR studies (114,115). Furthermore, while the intervention is intended to target clinical heterogeneity and we see this as a strength of this approach, targeting heterogeneity (e.g., taking a broader approach to intervention, teaching skills for several psychological processes) in the sample may also be a limitation that could impact recruitment and results.…”

Prediction and Prevention in the Clinical High-Risk for Psychosis Paradigm: A Review of the Current Status and Recommendations for Future Directions of Inquiry

“…One way to overcome this is to incorporate some measure of an individual's outcome likelihood into clinical trial design and analysis. A recent study incorporated predicted risk of conversion (15) into re-examining the efficacy of FFT and found that higher risk individuals showed greater APS improvement with the FFT intervention as compared to the control group, but lower risk individuals showed no difference in APS improvement between the two intervention groups (91). A concrete step toward improving our understanding of effective interventions would be to similarly re-examine results of existing trials by incorporating conversion risk as either a measure of stratification or as a covariate in predicting the trial outcome.…”

“…Understanding an individual's probable trajectory is most helpful when there is a chance to intervene and potentially improve this trajectory. Approaching this goal could be relatively straightforward [e.g., adding risk scores to clinical trial outcome analysis or stratification (91)], although expanding the scope of inquiry and methods used to interrogate relevant questions will help support the effort to leverage predictive analytics toward improving outcomes.…”

Family‐focused therapy for individuals at high clinical risk for psychosis: A confirmatory efficacy trial

“…In secondary analyses of the NAPLS trial, Worthington et al (2021) found that CHR participants who scored higher on a baseline measure of risk of psychosis conversion—with more severe APS, recent functional deterioration, and cognitive impairment—showed greater reductions in APS in FFT‐CHR than high‐risk individuals in brief psychoeducation or low‐risk individuals in either treatment. Individuals with higher psychosis risk may be more vulnerable to (or may provoke) higher levels of family criticism and conflict than those with lower risk, and may be more likely to benefit from treatments that aim to enhance family relationships.…”