Randomized Controlled Trial of Interventions for Young People at Ultra-High Risk of Psychosis: Study Design and Baseline Characteristics

Phillips, Lisa; Nelson, Barnaby; Yuen, Hok Pan; Francey, Shona; Simmons, Magenta; Stanford, Carrie; Ross, Margaret; Kelly, Daniel P.; Baker, Kathryn; Conus, Philippe; Amminger, G. Paul; Trümpler, François; Yao, Yun; Lim, Michelle H.; McNab, Catharine; Yung, Alison R.; McGorry, Patrick D.

doi:10.1080/00048670903107625

Cited by 75 publications

(64 citation statements)

References 49 publications

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“…Future work needs to provide further empirical validation of the phenomenological model of self-disturbance as a core vulnerability marker of schizophrenia spectrum disorders [see 18 ] and to further develop concepts for types of therapeutic intervention that specifically target psychotic vulnerability factors. The high prevalence of non-psychotic conditions in the UHR population [83,84] introduces the possibility of combining different psychotherapy strategies that target different types of disturbance. These efforts may lead to trialing psychotherapy interventions other than CBT in the UHR population.…”

Section: Discussionmentioning

confidence: 99%

The Phenomenological Model of Psychotic Vulnerability and Its Possible Implications for Psychological Interventions in the Ultra-High Risk (‘Prodromal’) Population

2009

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The early intervention movement for treatment of schizophrenia and other psychotic disorders has extended to include pharmacological and psychological treatment of putatively prodromal (or ‘ultra-high risk’) patients. The psychotherapy that has been trialed to date is cognitive-behaviour therapy (CBT), due to its apparent success with patients with established psychotic disorder and its current popularity as a therapeutic modality. This paper presents phenomenological models of psychotic, particularly schizophrenic, vulnerability, which emphasise a disturbed basic sense of self (ipseity) and intersubjectivity. We argue that these phenomenological models indicate that CBT may not be the most suitable therapy for prodromal patients, and may even be counterproductive. A central element of this argument is that CBT’s emphasis on cognitive reflection and challenging may encourage a core pathological process in these patients (hyper-reflexive awareness). The paper explores alternatives for psychotherapy that emerge from phenomenological accounts of psychosis, while recognising the paradoxical aspects of psychotherapy with these patients. These alternatives include strategies that provide an intersubjective space where patients can evolve a more robust pre-reflective self-awareness (first-person perspective), second-person perspective and experience of trustworthy relationships when encountering others, empathic attunement afforded by the phenomenological approach’s sensitivity to psychotic experience, and strategies that encourage a form of immersion or absorption in present activity, including mindfulness and creative ‘flow’. We also suggest the possible value of combining therapeutic modalities (even ones that may seem contradictory) and of the need to empirically test therapeutic strategies other than CBT in the ultra-high risk population.

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Section: Discussionmentioning

confidence: 99%

The Phenomenological Model of Psychotic Vulnerability and Its Possible Implications for Psychological Interventions in the Ultra-High Risk (‘Prodromal’) Population

2009

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“…These findings therefore may serve to raise awareness of the possible development of psychotic ideation in children with history of psychosocial adversity (Larkin & Read, 2008). Paying attention to (and treatment of) hallucinatory and delusional experiences in the earliest stages may be helpful in preventing possible transition to overt mental illness Phillips et al 2007Phillips et al , 2009). In addition, the effects of TE/SE on AVH persistence may be important, as previous work suggests that particularly persistence of psychotic experiences may result in need for care and formal diagnosis of psychotic disorder (Cougnard et al 2007 ;Dominguez et al 2009 ;Smeets et al 2010 ;Mackie et al 2011).…”

Section: Discussionmentioning

confidence: 99%

Auditory hallucinations in childhood: associations with adversity and delusional ideation

Bartels-Velthuis

Willige

Jenner³

et al. 2011

Psychol. Med.

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Background. Previous work suggests that exposure to childhood adversity is associated with the combination of delusions and hallucinations. In the present study, associations between (severity of) auditory vocal hallucinations (AVH) and (i) social adversity [traumatic experiences (TE) and stressful events (SE)] and (ii) delusional ideation were examined.Method. A baseline case-control sample of children with and without AVH were re-assessed on AVH after 5 years and interviewed about the experience of social adversity and delusions.Results. A total of 337 children (mean age 13.1 years, S.D.=0.5) were assessed : 40 children continued to hear voices that were present at baseline (24 %, persistent group), 15 heard voices only at follow-up (9 %, incident group), 130 children no longer reported AVH that were present at baseline (remitted group) and 152 never heard voices (referent group). Both TE and SE were associated with both incident and persistent AVH, as well as with greater AVH severity and delusional ideation at follow-up. In addition, the combination of AVH and delusions displayed a stronger association with TE and SE compared with either AVH or delusions alone.Conclusions. Early childhood AVH are mostly benign and transitory. However, experience of social adversity is associated with persistence, severity and onset of new AVH closer to puberty, and with delusional ideation.

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“…In a recent, more sophisticated double-blind placebocontrolled RCT, Phillips et al 57 compared the combinations of risperidone and CBT with placebo, and CBT or placebo and supportive therapy, in a group of UHR patients (n = 115). The 6-month transition rates were low in all 3 treatment groups, suggesting that antipsychotics may not be necessary in UHR patients who are detected early, or that recent UHR cohorts are derived from less so-called enriched samples for the true positive rate.…”

Section: Intervention Studies In Uhr Groupsmentioning

confidence: 99%

“…66,67 This generalized effect is appropriate for the UHR group, who have been found to have a wide variety of general psychiatric features, not only attenuated psychotic symptoms, and which are a target in their own right. 57 Applying the clinical staging model to treatment of the UHR population, the evidence reviewed above indicates that so-called gentler therapies such as EPA or psychosocial interventions, including CBT or supportive therapy, may be suitable as a first-line treatment in UHR patients. However, the clinical staging model does not necessarily mean eschewing study of the role of antipsychotic medication in this population.…”

Section: Intervention Studies In Uhr Groupsmentioning

confidence: 99%

Clinical Staging: A Heuristic and Practical Strategy for New Research and Better Health and Social Outcomes for Psychotic and Related Mood Disorders

et al. 2010

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Highlights • A clinical staging model mapping the development, progression, and extension of mental illness over time, may prove to be heuristically and practically useful in clinical practice and basic research. • Clinical staging will aid clinicians to select treatments that are particularly relevant to the earlier stages of illness, when such interventions are likely to be more effective and less harmful than those delivered later in the course of illness. • Clinical staging will allow more precise mapping of the relations between known biological markers and psychosocial risk factors and stage of illness, enabling better integration and representation of knowledge.

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Randomized Controlled Trial of Interventions for Young People at Ultra-High Risk of Psychosis: Study Design and Baseline Characteristics

Cited by 75 publications

References 49 publications

The Phenomenological Model of Psychotic Vulnerability and Its Possible Implications for Psychological Interventions in the Ultra-High Risk (‘Prodromal’) Population

The Phenomenological Model of Psychotic Vulnerability and Its Possible Implications for Psychological Interventions in the Ultra-High Risk (‘Prodromal’) Population

Auditory hallucinations in childhood: associations with adversity and delusional ideation

Clinical Staging: A Heuristic and Practical Strategy for New Research and Better Health and Social Outcomes for Psychotic and Related Mood Disorders

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