Understanding young peoples’ and family members’ views of treatment for first episode psychosis in a randomised controlled trial (MAPS)

Abstract

Background There is limited evidence to inform treatment decision-making in adolescents experiencing first episode psychosis (FEP). In the MAPS trial (Managing Adolescent first Episode Psychosis: a feasibility Study), adolescents with FEP received either antipsychotic medication (AP), psychological intervention (PI), or both. We investigated treatment views of young people and family members across each treatment arm of MAPS. Methods Thirteen adolescents participating in MAPS and eighteen family members attended in-depth audio-recorded interviews to discuss trial treatments. Interviews were analysed using inductive Thematic Analysis, identifying salient themes across these accounts. Findings Family members in particular reported an urgent need for treatment regardless of type. Both AP and PI were broadly viewed as acceptable treatment approaches, but for differing reasons which participants weighed against a range of concerns. AP were often seen to reduce symptoms of psychosis, though participants expressed concerns about side effects. PI were viewed as interactive treatment approaches that helped improve understanding of psychosis and enhanced coping, although some found PI emotionally and cognitively challenging. Combining treatments was seen to maximise benefits, with a perceived interaction whereby AP facilitated engagement with PI. Interpretation Acceptability of and engagement with treatments for FEP may differ between individual young people and their family/carers. In order to be able to offer fully informed choices, and determine an optimum treatment approach for young people with FEP, definitive trial evidence should be established to determine wanted and unwanted treatment impacts. Funding NIHR HTA programme (project number 15/31/04).

Antipsychotic medication versus psychological intervention versus a combination of both in adolescents with first-episode psychosis (MAPS): a multicentre, three-arm, randomised controlled pilot and feasibility study

“…As MAPS is a feasibility study, our primary outcomes were trial referral and recruitment rates, participant attendance at CBT sessions, medication adherence, acceptability of treatments (determined by assessing discontinuation rates, and by a nested qualitative study of participants being published in parallel 14 ) and completion of follow-up appoint ments including PANSS interviews. To determine the feasibility of progression to a definitive trial, we applied a three-stage progression criteria relating to recruitment, retention to follow-up at the primary endpoint (6 months), and adherence to psychological intervention and to antipsychotics.…”

“Figuring out how to be normal”: Exploring how young people and parents make sense of voice‐hearing in the family context

“…Supporters that were most valued were often parents that they did not live with, siblings, extended family and friends. Health professionals were a containing and private space for exploration that respected young people's autonomy, echoing Byrne et al (2020) on the value young people experiencing FEP place on having someone to talk to.…”

“…Perhaps, with better support, young people would feel they could draw more on family. None of the parents, and only one young person, talked of having had family intervention, which some studies in FEP (Byrne et al, 2020 ) report as being a positive, if difficult, experience for those who did take it up.…”

Clinicians’ views of treatment types for first episode psychosis delivered in a randomised controlled trial (MAPS)

“…It also informative to compare treatment views in this study with those of YP and family members involved in the MAPS trial [25] . There is reasonable agreement that AP is helpful for reducing symptoms of psychosis, alongside common concerns about side effects and some concern about long-term use.…”