Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms.

By Patrick D. McGorry, A. Yung, Lisa J. Phillips, H. Yuen, S. Francey, E. Cosgrave, D. Germano, J. Bravin, T. McDonald, A. Blair and 2 more. Archives of General Psychiatry, 2002

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BACKGROUND Most disability produced by psychotic illnesses, especially schizophrenia, develops during the prepsychotic period, creating a case for intervention during this period. However, only recently has it been possible to engage people in treatment during this phase. METHODS A randomized controlled trial compared 2 interventions in 59 patients at incipient risk of progression to first-episode psychosis. We termed this group ultra-high risk to emphasize the enhanced risk vs conventional genetic high-risk studies. Needs-based intervention was compared with specific preventive intervention comprising low-dose risperidone therapy (mean dosage, 1.3 mg/d) and cognitive behavior therapy. Treatment was provided for 6 months, after which all patients were offered ongoing needs-based intervention. Assessments were performed at baseline, 6 months, and 12 months. RESULTS By the end of treatment, 10 of 28 people who received needs-based intervention progressed to first-episode psychosis vs 3 of 31 from the specific preventive intervention group (P=.03). After 6-month follow-up, another 3 people in the specific preventive intervention group became psychotic, and with intention-to-treat analysis, the difference was no longer significant (P=.24). However, for risperidone therapy-adherent patients in the specific preventive intervention group, protection against progression extended for 6 months after cessation of risperidone use. CONCLUSIONS More specific pharmacotherapy and psychotherapy reduces the risk of early transition to psychosis in young people at ultra-high risk, although their relative contributions could not be determined. This represents at least delay in onset (prevalence reduction), and possibly some reduction in incidence.

Subfields: Molecular Biology, Psychiatry and Mental health, Philosophy

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Citations in the corpus

Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. (2008, result): “Three preliminary studies support the notion that early intervention with either or both approaches is associated with prodromal symptom reduction and possibly with reduced or delayed risk for onset of psychosis.(42,55,56) Although most investigators in the prodromal field advocate a highly conserva”
Cognitive therapy for the prevention of psychosis in people at ultra-high risk (2004, background): “The only other treatment study reported with this population found similar difficulty in maintaining masking (McGorry et al, 2002), and this is a common difficulty in psychological intervention trials.”
Elevated striatal dopamine function linked to prodromal signs of schizophrenia. (2009, result): “Results of recent clinical trials suggest that treatment with antipsychotic medication may reduce the severity of attenuated psychotic symptoms and the risk of schizophrenia in patients with ARMS.(46,47) Our finding of dopaminergic overactivity in the ARMS group indicates why drugs that act on the d”
Hippocampal and amygdala volumes according to psychosis stage and diagnosis: a magnetic resonance imaging study of chronic schizophrenia, first-episode psychosis, and ultra-high-risk individuals. (2006, background): “Although none of the UHR patients were receiving psychotropic medications at the time of MRI, more than 50.4% entered an intervention study after MRI.”