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16-11-2011 | Psychology | Article

Integrated psychological intervention benefits patients at risk for psychosis


Free abstract

MedWire News: An integrated psychologic intervention (IPI) may help delay or prevent the onset of psychosis among patients in an early initial prodromal state (EIPS), research suggests.

"Young people with self-experienced cognitive thought and perception deficits (basic symptoms) may present with an EIPS of psychosis in which most of the disability and neurobiologic deficits of schizophrenia have not yet occurred," explain Andreas Bechdolf (University of Cologne, Germany) and team.

They add that "the EIPS population may… be more responsive to preventive interventions than people who already fulfil ultra-high-risk criteria. However, to date, no information on the efficacy of interventions in people in the EIPS is available."

The researchers therefore assessed whether an IPI that combined individual cognitive-behavioral therapy, group skills training, cognitive remediation, and multifamily psychoeducation, is effective for prevention of psychosis among patients in an EIPS.

In total, 128 patients in an EIPS were randomly assigned to the IPI (n=63, mean age 26 years) or to supportive counseling (n=65, mean age 27 years) for 12 months.

At the end of the treatment period, the researchers found that 3.2% of patients assigned to the IPI had converted to subthreshold psychosis compared with 16.9% of those assigned to supportive counseling. Indeed, patients assigned to supportive counseling were 6.21 times more likely to have converted to subthreshold psychosis at 12 months than those assigned to the IPI.

The difference between the groups was similar at the 24-month follow up, with patients assigned to supportive counseling being 3.69 times more likely to have converted to subthreshold psychosis than IPI patients at this time, at conversion rates of 20.0% and 6.3%, respectively.

Furthermore, the time to conversion was significantly shorter for the supportive counseling group than for the IPI group, at a mean of 784.32 days compared with 887.1 days, respectively.

Bechdolf and team conclude in the British Journal of Psychiatry: "The data presented indicate that a specifically developed IPI was effective for delaying the onset of subthreshold, first-episode psychosis, and schizophrenia over a 24-month time period.

"Moreover, the very small numbers of converters after termination of treatment raises the likelihood that interventions in the EIPS indeed prevent psychosis."

They add: "IPI has the potential to improve the prognosis of many young people in an EIPS and could reduce the devastating consequences of schizophrenia for the affected individuals, their families and society."

By Mark Cowen

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