Three-Year Follow-up of a Randomized Controlled Trial of Cognitive Therapy for the Prevention of Psychosis in People at Ultrahigh Risk

Abstract

There have been recent advances in the ability to identify people at high risk of developing psychosis. This has led to interest in the possibility of preventing the development of psychosis. A randomized controlled trial compared cognitive therapy (CT) over 6 months with monthly monitoring in 58 patients meeting criteria for ultrahigh risk of developing a first episode of psychosis. Participants were followed up over a 3-year period. Logistic regression demonstrated that CT significantly reduced likelihood of being prescribed antipsychotic medication over a 3-year period, but it did not affect transition to psychosis defined using the Positive and Negative Syndrome Scale (PANSS) or probable Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis. However, exploratory analyses revealed that CT significantly reduced the likelihood of making progression to psychosis as defined on the PANSS over 3 years after controlling for baseline cognitive factors. Follow-up rate at 3 years was 47%. There appear to be enduring benefits of CT over the long term, suggesting that it is an efficacious intervention for people at high risk of developing psychosis.

A Severity-Based Clinical Staging Model for the Psychosis Prodrome: Longitudinal Findings From the New York Recognition and Prevention Program

“…In turn, the stage outcome information can address whether the CHR diagnosis refers to a longterm syndrome. In addition, because prescription of antipsychotic medication has previously been found to be a barometer of symptom severity in CHR individuals 27,28 we have included it here as an adjunctive measure. Although not a part of the formal theoretical RAP model, the naturalistic pattern of treatment (based on clinician choice) built into the RAP program is particularly compatible with the use of medication as an indicator of symptom severity.…”

Conventional and alternative preventive treatments in the first stages of schizophrenia

“…This model posits that dysfunctional interpretations of anomalous experiences contribute, against a background of pre-existing biopsychosocial vulnerability, to the emergence and maintenance of psychotic symptoms 37, 38 . Results from trials of CBT in the ARMS and early schizophrenia suggest that the therapy is moderately effective in reducing transitions to psychosis 39,40,41 , reducing relapse rates 42 , speeding recovery 43 , reducing subclinical and clinical positive symptom severity 39,40,44 and improving perceived quality of life 45 . However, durability of CBT in absence of continued treatment is unclear with reports of both durable effects in the ARMS 39 and lack thereof in FEP 42,44,45 .…”

“…Results from trials of CBT in the ARMS and early schizophrenia suggest that the therapy is moderately effective in reducing transitions to psychosis 39,40,41 , reducing relapse rates 42 , speeding recovery 43 , reducing subclinical and clinical positive symptom severity 39,40,44 and improving perceived quality of life 45 . However, durability of CBT in absence of continued treatment is unclear with reports of both durable effects in the ARMS 39 and lack thereof in FEP 42,44,45 . Lack of sustained effect of CBT may in part be due to the limited duration of treatment and more longitudinal trials with longer duration of CBT treatment are therefore needed 7,42 .…”

Detecção precoce: é possível prevenir a esquizofrenia?

“…Os indivíduos submetidos à terapia comportamental tiveram um índice menor de transição para psicose (6%) em comparação com o grupo-controle (22%). Num acompanhamento de 3 anos (Morrison et al, 2007), a taxa de transição para psicose para o grupo experimental e o grupo-controle foi de 49% e 43%, respectivamente, não havendo diferença entre os grupos.…”