Social recovery therapy in combination with early intervention services for enhancement of social recovery in patients with first-episode psychosis (SUPEREDEN3): a single-blind, randomised controlled trial

Fowler, David; Hodgekins, Joanne; French, Paul; Marshall, Max; Freemantle, Nick; McCrone, Paul; Everard, Linda; Lavis, Anna; Jones, Peter; Amos, Tim; Singh, Swaran P.; Sharma, Vimal; Birchwood, Max

doi:10.1016/s2215-0366(17)30476-5

Cited by 75 publications

(96 citation statements)

References 29 publications

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“…The chosen primary outcome of time spent in social activities showed a more than threefold increase in both groups. Levels of time spent in social activities appear to have been lower at baseline and higher at follow-up compared with those reported in a trial with patients in early intervention services, in any group and at any point of time 28 . This might raise questions about the validity of the measurement of this outcome.…”

Section: Discussionmentioning

confidence: 69%

Effectiveness of a volunteer befriending programme for patients with schizophrenia: randomised controlled trial

et al. 2019

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BackgroundBefriending by volunteers has the potential to reduce the frequent social isolation of patients with schizophrenia and thus improve health outcomes. However, trial-based evidence for its effectiveness is limited.AimsTo conduct a randomised controlled trial of befriending for patients with schizophrenia or related disorders.MethodPatients were randomised to a befriending programme for 1 year or to receive information about social activities only (trial registration: ISRCTN14021839). Outcomes were assessed masked to allocation at the end of the programme; at 12 months and at a 6-month follow-up. The primary outcome was daily time spent in activities (using the Time Use Survey (TUS)) with intention-to-treat analysis.ResultsA total of 124 patients were randomised (63 intervention, 61 active control) and 92 (74%) were followed up at 1 year. In the intervention group, 49 (78%) met a volunteer at least once and 31 (49%) had more than 12 meetings. At 1 year, mean TUS scores were more than three times higher in both groups with no significant difference between them (adjusted difference 8.9, 95% CI −40.7 to 58.5, P = 0.72). There were no significant differences in quality of life, symptoms or self-esteem. However, patients in the intervention group had significantly more social contacts than those in the control group at the end of the 12-month period. This difference held true at the follow-up 6 months later.ConclusionsAlthough no difference was found on the primary outcome, the findings suggest that befriending may have a lasting effect on increasing social contacts. It may be used more widely to reduce the social isolation of patients with schizophrenia.Declaration of interestNone.

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Section: Discussionmentioning

confidence: 69%

Effectiveness of a volunteer befriending programme for patients with schizophrenia: randomised controlled trial

et al. 2019

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“…31 Only if a conservative estimate of this margin indicates that clinical reasoning could be enhanced in terms of precision, time, and costs would computeraided decision support in clinical settings be justified. [31][32][33] Fi-nally, validated predictors associated with specific outcomes could provide resource allocation tools for existing psychosocial interventions, [34][35][36] and foster biobehavioral mechanistic research leading to new personalized and preventive treatments for social and occupational disability. 37 To develop such prognostic signatures, the Personalized Prognostic Tools for Early Psychosis Management (PRONIA; https://www.pronia.eu/) study is collecting multimodal data from healthy control participants and young patients who meet criteria for the CHR state, recent-onset psychosis, or recentonset depression (ROD).…”

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confidence: 99%

Prediction Models of Functional Outcomes for Individuals in the Clinical High-Risk State for Psychosis or With Recent-Onset Depression

et al. 2018

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; for the PRONIA Consortium IMPORTANCE Social and occupational impairments contribute to the burden of psychosis and depression. There is a need for risk stratification tools to inform personalized functional-disability preventive strategies for individuals in at-risk and early phases of these illnesses. OBJECTIVE To determine whether predictors associated with social and role functioning can be identified in patients in clinical high-risk (CHR) states for psychosis or with recent-onset depression (ROD) using clinical, imaging-based, and combined machine learning; assess the geographic, transdiagnostic, and prognostic generalizability of machine learning and compare it with human prognostication; and explore sequential prognosis encompassing clinical and combined machine learning. DESIGN, SETTING, AND PARTICIPANTS This multisite naturalistic study followed up patients in CHR states, with ROD, and with recent-onset psychosis, and healthy control participants for 18 months in 7 academic early-recognition services in 5 European countries. Participants were recruited between February 2014 and May 2016, and data were analyzed from April 2017 to January 2018. AIN OUTCOMES AND MEASURES Performance and generalizability of prognostic models. RESULTS A total of 116 individuals in CHR states (mean [SD] age, 24.0 [5.1] years; 58 [50.0%] female) and 120 patients with ROD (mean [SD] age, 26.1 [6.1] years; 65 [54.2%] female) were followed up for a mean (SD) of 329 (142) days. Machine learning predicted the 1-year social-functioning outcomes with a balanced accuracy of 76.9% of patients in CHR states and 66.2% of patients with ROD using clinical baseline data. Balanced accuracy in models using structural neuroimaging was 76.2% in patients in CHR states and 65.0% in patients with ROD, and in combined models, it was 82.7% for CHR states and 70.3% for ROD. Lower functioning before study entry was a transdiagnostic predictor. Medial prefrontal and temporo-parietooccipital gray matter volume (GMV) reductions and cerebellar and dorsolateral prefrontal GMV increments had predictive value in the CHR group; reduced mediotemporal and increased prefrontal-perisylvian GMV had predictive value in patients with ROD. Poor prognoses were associated with increased risk of psychotic, depressive, and anxiety disorders at follow-up in patients in the CHR state but not ones with ROD. Machine learning outperformed expert prognostication. Adding neuroimaging machine learning to clinical machine learning provided a 1.9-fold increase of prognostic certainty in uncertain cases of patients in CHR states, and a 10.5-fold increase of prognostic certainty for patients with ROD. CONCLUSIONS AND RELEVANCE Precision medicine tools could augment effective therapeutic strategies aiming at the prevention of social functioning impairments in patients with CHR states or with ROD.

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“…Our results, even though data‐driven in their nature (Huys, ), might add a step in this regard. Future research, ideally, should merge a psychopathological cluster approach with cognitive impairment (Petruzzelli et al, ) and biological data in order to better define evolutionary trajectories of clinical subtypes and enhance therapeutic algorithms for this populations (Fowler et al, ; Robinson et al, ).…”

Section: Discussionmentioning

confidence: 99%

Dimensional structure of first episode psychosis

Tonna

Ossola

Marchesi

et al. 2019

Early Intervention Psych

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Aim Current diagnostic systems, DSM‐5 and ICD‐10, still adopt a categorical approach to classify psychotic disorders. The present study was aimed at investigating the structure of psychotic symptomatology in both affective and non‐affective psychosis from a dimensional approach. Methods Participants with a first episode psychosis (FEP) were recruited from a cluster‐randomized controlled trial (GET‐UP PIANO TRIAL), offered to all Community Mental Health Centres (CMHCs) located across two northern Italian regions. After clinical stabilization, patients were assessed with a comprehensive set of psychopathological measures including the Positive and Negative Syndrome Scale, the Hamilton Depression Rating Scale and the Bech‐Rafaelsen Mania Rating Scale. A two‐step cluster analysis was performed. Results Overall, 257 FEP patients (male, n = 171, 66.5%; mean age = 24.96 ± 4.56) were included in the study. The cluster analysis revealed a robust four‐cluster solution: delusional‐persecutory (n = 82; 31.9%), depressed (n = 95; 37%), excited (n = 26; 10.1%) and negative‐disorganized (n = 54; 21%), thus suggesting a quadripartite structure with both affective and non‐affective dimensions. Among non‐affective dimensions, negative and disorganization symptoms constituted a unique construct apart from positive symptoms. Conclusions Symptom dimensions may represent a useful tool for dissecting the indistinct and non‐specific psychopathology of FEP in order to better target specific interventions.

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Social recovery therapy in combination with early intervention services for enhancement of social recovery in patients with first-episode psychosis (SUPEREDEN3): a single-blind, randomised controlled trial

Cited by 75 publications

References 29 publications

Effectiveness of a volunteer befriending programme for patients with schizophrenia: randomised controlled trial

Effectiveness of a volunteer befriending programme for patients with schizophrenia: randomised controlled trial

Prediction Models of Functional Outcomes for Individuals in the Clinical High-Risk State for Psychosis or With Recent-Onset Depression

Dimensional structure of first episode psychosis

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