A Randomized Controlled Trial of Relapse Prevention Therapy for First-Episode Psychosis Patients: Outcome at 30-Month Follow-Up

Abstract

The effectiveness of a novel 7-month psychosocial treatment designed to prevent the second episode of psychosis was evaluated in a randomized controlled trial at 2 specialist first-episode psychosis (FEP) programs. An individual and family cognitive behavior therapy for relapse prevention was compared with specialist FEP care. Forty-one FEP patients were randomized to the relapse prevention therapy (RPT) and 40 to specialist FEP care. Participants were assessed on an array of measures at baseline, 7- (end of therapy), 12-, 18-, 24-, and 30-month follow-up. At 12-month follow-up, the relapse rate was significantly lower in the therapy condition compared with specialized treatment alone (P = .039), and time to relapse was significantly delayed for those in the relapse therapy condition (P = .038); however, such differences were not maintained. Unexpectedly, psychosocial functioning deteriorated over time in the experimental but not in the control group; these differences were no longer statistically significant when between-group differences in medication adherence were included in the model. Further research is required to ascertain if the initial treatment effect of the RPT can be sustained. Further research is needed to investigate if medication adherence contributes to negative outcomes in functioning in FEP patients who have reached remission, or, alternatively, if a component of RPT is detrimental.

Fear of recurrence: Results of a randomized trial of relapse detection in schizophrenia

“…Furthermore, experience sampling methodology may have an important role in exploring in greater detail the inter‐relationships between the individual's context, Fear of Relapse, affective instability, and coping (Myin‐Germeys et al ., ). Finally the FoRSe measure may help facilitate psychological interventions by helping clinicians and patients identify idiosyncratic experiences that give rise to increased Fear of Recurrence, and thus support clinicians in targeting psychological techniques to prevent or arrest relapse and promote emotional recovery (Braehler et al ., ; Gleeson, Alvarez‐Jimenez, Cotton, Parker, & Hetrick, ; Gleeson et al ., ; Gumley et al ., ; White et al ., ).…”

“…We acknowledge that a longer duration of follow‐up, such as the 30 month follow‐up period adopted by Gleeson et al . (), would be more desirable for generating data on relapse rates and the performance of the FoRSe over time.…”

Can antipsychotic dose reduction lead to better functional recovery in first‐episode psychosis? A randomized controlled‐trial of antipsychotic dose reduction. The reduce trial: Study protocol

“…Remission of negative symptoms will be assessed using the Scale for Assessment of Negative Symptoms (SANS) (Andreasen, 1984). The a priori clinically significant degree of difference on duration of relapse is 7 days, in accordance with published duration criteria (Gleeson et al, 2013). (Table 1).…”

“…CBT for relapse prevention combined with specialist FEP treatment when compared with specialist FEP treatment alone(Gleeson et al, ), led to a significant reduction in relapse rates at 7‐months follow‐up in FEP clients who met remission on positive symptoms. This effect was sustained at 1 year, and relapse rates were kept to historically low levels beyond this time point (30% at 2.5 years) (Gleeson et al, ; Gleeson et al, ). However, these differences were no longer significant at 30‐month follow‐up.…”

Staged treatment and acceptability guidelines in early psychosis study (STAGES): A randomized placebo controlled trial of intensive psychosocial treatment plus or minus antipsychotic medication for first‐episode psychosis with low‐risk of self‐harm or aggression. Study protocol and baseline characteristics of participants

“…Antipsychotic medication is only one of the treatment modalities available, with psychological and psychosocial interventions such as cognitive-behavioural therapy (CBT) and family interventions demonstrating benefits in symptom reduction and relapse prevention (Alvarez-Jimenez, Parker, Hetrick, McGorry, & Gleeson, 2011;Bird et al, 2010;Gleeson et al, 2010;Gleeson et al, 2013). Typically these therapies are provided concurrently with antipsychotic medication.…”