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Antidepressant, antipsychotic and psychological interventions in subjects at high clinical risk for psychosis: OASIS 6-year naturalistic study

Published online by Cambridge University Press:  22 October 2014

P. Fusar-Poli ,
M. Frascarelli ,
L. Valmaggia ,
M. Byrne ,
D. Stahl ,
M. Rocchetti ,
L. Codjoe ,
L. Weinberg ,
S. Tognin  and
L. Xenaki
...Show all authors
P. Fusar-Poli*
Affiliation:
King's College London, Institute of Psychiatry, London, UK OASIS team, South London and Maudsley NHS Foundation Trust, London, UK
M. Frascarelli
Affiliation:
King's College London, Institute of Psychiatry, London, UK Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
L. Valmaggia
Affiliation:
King's College London, Institute of Psychiatry, London, UK Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
M. Byrne
Affiliation:
King's College London, Institute of Psychiatry, London, UK Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
D. Stahl
Affiliation:
King's College London, Institute of Psychiatry, London, UK
M. Rocchetti
Affiliation:
King's College London, Institute of Psychiatry, London, UK Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
L. Codjoe
Affiliation:
King's College London, Institute of Psychiatry, London, UK Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
L. Weinberg
Affiliation:
King's College London, Institute of Psychiatry, London, UK Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
S. Tognin
Affiliation:
King's College London, Institute of Psychiatry, London, UK
L. Xenaki
Affiliation:
King's College London, Institute of Psychiatry, London, UK
P. McGuire
Affiliation:
King's College London, Institute of Psychiatry, London, UK
*
*Address for correspondence: P. Fusar-Poli, Department of Psychosis Studies, Institute of Psychiatry PO63, De Crespigny Park, London SE5 8AF, UK. (Email: [email protected])
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Abstract

Background.

Recent randomized controlled trials suggest some efficacy for focused interventions in subjects at high risk (HR) for psychosis. However, treating HR subjects within the real-world setting of prodromal services is hindered by several practical problems that can significantly make an impact on the effect of focused interventions.

Method.

All subjects referred to Outreach and Support in South London (OASIS) and diagnosed with a HR state in the period 2001–2012 were included (n = 258). Exposure to focused interventions was correlated with sociodemographic and clinical characteristics at baseline. Their association with longitudinal clinical and functional outcomes was addressed at follow-up.

Results.

In a mean follow-up time of 6 years (s.d. = 2.5 years) a transition risk of 18% was observed. Of the sample, 33% were treated with cognitive behavioural therapy (CBT) only; 17% of subjects received antipsychotics (APs) in addition to CBT sessions. Another 17% of subjects were prescribed with antidepressants (ADs) in addition to CBT. Of the sample, 20% were exposed to a combination of interventions. Focused interventions had a significant relationship with transition to psychosis. The CBT + AD intervention was associated with a reduced risk of transition to psychosis, as compared with the CBT + AP intervention (hazards ratio = 0.129, 95% confidence interval 0.030–0.565, p = 0.007).

Conclusions.

There were differential associations with transition outcome for AD v. AP interventions in addition to CBT in HR subjects. These effects were not secondary to baseline differences in symptom severity.

Keywords

Antidepressantsfocused interventionshigh risk of psychosisprodromal servicesschizophrenia
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 6 , April 2015 , pp. 1327 - 1339
Copyright
Copyright © Cambridge University Press 2014 

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