Study protocol for a randomised controlled trial of CBT vs antipsychotics vs both in 14–18-year-olds: Managing Adolescent first episode Psychosis: a feasibility study (MAPS)

Pyle, Melissa; Broome, Matthew R.; Joyce, Emmeline; MacLennan, Graeme; Norrie, John; Freeman, Daniel; Fowler, David; Haddad, Peter M.; Shiers, David; Hollis, Chris; Smith, Jo; Liew, Ashley; Byrne, Rory; French, Paul; Peters, Sarah; Hudson, Jemma; Davies, Linda; Emsley, Richard; Yung, Alison R.; Birchwood, Max; Longden, Eleanor; Morrison, Anthony P.

doi:10.1186/s13063-019-3506-1

Cited by 11 publications

(12 citation statements)

References 45 publications

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“…It is a brief and straightforward self-report measure which assesses both depression and anxiety (Hansson et al, 2009) thus reducing the burden of completion for participants. It has been used in similar populations to ours, such as adolescents, young people and adults with psychosis (Bernard et al, 2006;White et al, 2011;Pyle et al, 2019), therefore allowing comparability of our results with similar studies.…”

Section: Secondary Outcomesmentioning

confidence: 93%

Metacognitive Therapy for Individuals at High Risk of Developing Psychosis: A Pilot Study

et al. 2020

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Developing effective interventions for preventing first episode psychosis have been an important research focus in the last decade. Cognitive behavioral therapy is a currently indicated treatment for people at ultra-high risk of psychosis, however, access and resource issues limit its delivery within the NHS. Treatments which partial out potential active ingredients and are aimed at a range of psychological difficulties seen within this population have the potential to be more efficacious and efficient. We conducted a single-arm exploratory pilot trial, designed to investigate the feasibility and acceptability of Metacognitive therapy for individuals at ultra-high risk (UHR) of developing psychosis. Trial uptake was good, with 11 out of 12 referred individuals meeting for an eligibility assessment (one individual was excluded prior to the assessment). Of these, 10 individuals were eligible and included in the trial. Retention to treatment was high with 80% treatment adherence gained and an overall average of 8 sessions completed. All participants were offered follow-up assessments immediately post-treatment and at 6 months, which comprised measures of psychotic like experiences, anxiety and depression, and metacognitive processes implicated in the model. Retention to the post-treatment (12-week) follow-up was good, with 80% completion; however retention to the 6-month follow-up was lower at 60%. Clinically significant results were observed in psychotic like experiences, anxiety, depression and functioning with medium to large effect sizes. Measures related to beliefs and processes targeted within MCT showed clinically significant change with medium to large effect sizes. Our results suggest that MCT based upon a specific metacognitive model for individuals meeting ARMS criteria may be an important treatment target and warrants further attention. Limitations and possible focuses for future research are discussed.Registration: ISRCTN53190465 http://www.isrctn.com/ISRCTN53190465.

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Section: Secondary Outcomesmentioning

confidence: 93%

Metacognitive Therapy for Individuals at High Risk of Developing Psychosis: A Pilot Study

et al. 2020

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“…Participants comprised thirteen YP who took part in MAPS and eighteen family members (sixteen interviews) at three study sites: North West, Oxfordshire, Sussex (see Table 1 for participant characteristics). MAPS participants were YP aged 14–18 years experiencing FEP (full inclusion and exclusion criteria are reported elsewhere [6] ). YP were eligible to take part in the qualitative study if they had already given consent to be audio-recorded, and family members were only approached if their young person agreed.…”

Section: Methodsmentioning

confidence: 99%

“…NICE Guidelines for treatment of psychosis in children and young people (CYP) [5] specifically call for research to test the comparative efficacy and safety of antipsychotic medication and psychological intervention in CYP. The Managing Adolescent first episode Psychosis (MAPS) study addressed this call by examining the feasibility of such a trial [6] . Sixty-one adolescents aged 14–18 with FEP were randomised to one of three treatment allocations: antipsychotics only (AP), psychological intervention only (cognitive behavioural therapy [CBT] and family intervention [FI]), or a combination of both.…”

Section: Introductionmentioning

confidence: 99%

Understanding young peoples’ and family members’ views of treatment for first episode psychosis in a randomised controlled trial (MAPS)

et al. 2020

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Background There is limited evidence to inform treatment decision-making in adolescents experiencing first episode psychosis (FEP). In the MAPS trial (Managing Adolescent first Episode Psychosis: a feasibility Study), adolescents with FEP received either antipsychotic medication (AP), psychological intervention (PI), or both. We investigated treatment views of young people and family members across each treatment arm of MAPS. Methods Thirteen adolescents participating in MAPS and eighteen family members attended in-depth audio-recorded interviews to discuss trial treatments. Interviews were analysed using inductive Thematic Analysis, identifying salient themes across these accounts. Findings Family members in particular reported an urgent need for treatment regardless of type. Both AP and PI were broadly viewed as acceptable treatment approaches, but for differing reasons which participants weighed against a range of concerns. AP were often seen to reduce symptoms of psychosis, though participants expressed concerns about side effects. PI were viewed as interactive treatment approaches that helped improve understanding of psychosis and enhanced coping, although some found PI emotionally and cognitively challenging. Combining treatments was seen to maximise benefits, with a perceived interaction whereby AP facilitated engagement with PI. Interpretation Acceptability of and engagement with treatments for FEP may differ between individual young people and their family/carers. In order to be able to offer fully informed choices, and determine an optimum treatment approach for young people with FEP, definitive trial evidence should be established to determine wanted and unwanted treatment impacts. Funding NIHR HTA programme (project number 15/31/04).

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“…Purposive sampling identified a representative range of eligible qualified mental health professionals with prescribing responsibility for adolescents with first episode psychosis (FEP) in UK Child and Adolescent Mental Health Services (CAMHS) or Early Intervention for Psychosis (EIP) services across NHS Trusts hosting the MAPS trial [ 4 , 5 ]. Potential participants were identified from MAPS trial liaison information (complete lists of local CAMHS and EIP prescribers), and invited to take part by email between October 2017 and July 2018.…”

Section: Methodsmentioning

confidence: 99%

“…However, the evidence to support this guidance is largely extrapolated from studies conducted with adults, which limits its value as treatment effects observed in adults, positive or negative, may occur differently in younger people. The MAPS feasibility trial (Managing Adolescent first Episode Psychosis: a feasibility Study) was developed to address the need to improve this evidence base [ 4 , 5 ]. MAPS randomised adolescents aged 14-18 years to one of three treatment allocations: AP only, CBT and FI only, or a combination of AP and CBT/FI.…”

Section: Introductionmentioning

confidence: 99%

Clinicians’ views of treatment types for first episode psychosis delivered in a randomised controlled trial (MAPS)

et al. 2020

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Background Clinicians’ treatment beliefs could affect the feasibility of delivering different treatments in a randomised controlled trial (RCT). In MAPS (Managing Adolescent first Episode Psychosis: a feasibility Study), adolescents with first episode psychosis (FEP) were randomly allocated to receive either antipsychotic medication (AP), psychological intervention (cognitive behavioural therapy [CBT] and family intervention [FI]), or both. We conducted a nested qualitative study to investigate clinicians’ views of these treatments. Methods Purposive sampling identified seventeen clinicians from CAMHS and Early Intervention services with prescribing responsibilities for 14-18 year olds at three participating MAPS sites. Individual participants were interviewed to examine their views of treatments in the MAPS trial. Interview transcripts were analysed using inductive Thematic Analysis. Findings Clinicians viewed the decision to refer adolescents to the MAPS trial as requiring careful clinical judgement. Assessment complexity and diagnostic uncertainty had to be balanced against the urgency for treatment to reduce risk and distress. Underlying influences including duty of care and treatment beliefs underpinned decisions. Clinicians consistently valued AP as the primary treatment for FEP, with CBT and/or FI seen as helpful secondary treatment options. Nevertheless, the potential harms of prescribing AP, or not, to such a young population were highlighted as being of concern in treatment decision-making, and fostered reluctance to refer into a RCT. Interpretation The design and delivery of RCTs involving young people experiencing FEP should consider the views of responsible clinicians, recognising that perceived treatment urgency, limitations in diagnostic precision, and existing treatment beliefs may influence trial processes. Funding NIHR HTA programme (project number 15/31/04).

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Study protocol for a randomised controlled trial of CBT vs antipsychotics vs both in 14–18-year-olds: Managing Adolescent first episode Psychosis: a feasibility study (MAPS)

Cited by 11 publications

References 45 publications

Metacognitive Therapy for Individuals at High Risk of Developing Psychosis: A Pilot Study

Metacognitive Therapy for Individuals at High Risk of Developing Psychosis: A Pilot Study

Understanding young peoples’ and family members’ views of treatment for first episode psychosis in a randomised controlled trial (MAPS)

Clinicians’ views of treatment types for first episode psychosis delivered in a randomised controlled trial (MAPS)

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