Stain Helen J, Bucci Sandra, Baker Amanda L, Carr Vaughan, Emsley Richard, Halpin Sean, Lewin Terry, Schall Ulrich, Clarke Vanessa, Crittenden Kylie, Startup Mike
School of Medicine, Pharmacy and Health, Durham University, UK.
School of Psychological Sciences, University of Manchester, UK.
Schizophr Res. 2016 Oct;176(2-3):212-219. doi: 10.1016/j.schres.2016.08.008. Epub 2016 Aug 20.
Intervention trials for young people at ultra high risk (UHR) for psychosis have shown cognitive behaviour therapy (CBT) to have promising effects on treating psychotic symptoms but have not focused on functional outcomes. We hypothesized that compared to an active control, CBT would: (i) reduce the likelihood of, and/or delay, transition to psychosis; (ii) reduce symptom severity while improving social functioning and quality of life, whether or not transition occurred.
This was a single-blind randomised controlled trial for young people at UHR for psychosis comparing CBT to an active control condition, Non Directive Reflective Listening (NDRL), both in addition to standard care, with a 6month treatment phase and 12months of follow-up. Statistical analysis is based on intention-to-treat and used random effect models to estimate treatment effects common to all time-points.
Fifty-seven young people (mean age=16.5years) were randomised to CBT (n=30) or NDRL (n=27). Rate of transition to psychosis was 5%; the 3 transitions occurred in the CBT condition (baseline, 2months, 5months respectively). The NDRL condition resulted in a significantly greater reduction in distress associated with psychotic symptoms compared to CBT (treatment effect=36.71, standard error=16.84, p=0.029). There were no significant treatment effects on frequency and intensity of psychotic symptoms, global, social or role functioning.
Our sample was higher functioning, younger and experiencing lower levels of psychotic like experiences than other trials. The significantly better treatment effect of NDRL on distress associated with psychotic symptoms supports the recommendations for a stepped-care model of service delivery. This treatment approach would accommodate the younger UHR population and facilitate timely intervention.
ANZCTR 12606000101583.
针对超高风险（UHR）精神病青年的干预试验表明，认知行为疗法（CBT）在治疗精神病症状方面具有显著效果，但尚未关注功能结局。我们假设，与积极对照相比，CBT将：（i）降低发展为精神病的可能性和/或延迟发病；（ii）无论是否发病，均可减轻症状严重程度，同时改善社会功能和生活质量。
这是一项针对UHR精神病青年的单盲随机对照试验，将CBT与积极对照条件下的非指导性反思性倾听（NDRL）进行比较，二者均作为标准护理的补充，治疗阶段为6个月，随访12个月。统计分析基于意向性治疗，并使用随机效应模型估计所有时间点的治疗效果。
57名青年（平均年龄=16.5岁）被随机分为CBT组（n=30）或NDRL组（n=27）。发展为精神病的比例为5%；3例发病均出现在CBT组（分别为基线、2个月和5个月时）。与CBT相比，NDRL组在减轻与精神病症状相关痛苦方面的效果显著更好（治疗效果=36.71，标准误=16.84，p=0.029）。在精神病症状的频率和强度、总体、社会或角色功能方面，未发现显著的治疗效果。
与其他试验相比，我们的样本功能更高、年龄更小，且类似精神病体验的水平更低。NDRL在减轻与精神病症状相关痛苦方面显著更好的治疗效果，支持了分层护理服务模式的建议。这种治疗方法将适用于更年轻的UHR人群，并促进及时干预。
ANZCTR 12606000101583
