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Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2233 (Published 05 April 2012) Cite this as: BMJ 2012;344:e2233

Re: Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial

I follow with interest the responses to the work of Morrison et al (2012): Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial. Despite the range of recruitment and analysis refinements and associated cautions suggested by respondents, the key issue in this paper stands. We need to reconsider whether young people meeting criteria are indeed at “ultra high risk of psychosis” and should be directed towards a treatment intervention.

In this study, as in the range of cited trials with smaller samples (1,2,3,4,5,6), identified symptoms for a large majority group did resolve in the follow up periods. In all studies other than in Amminger et al 2010, the transition to psychosis was not different across control and intervention, by the end of the follow up periods.

This gives us reason also to wonder whether the next research and intervention effort is best directed at refining assessment criteria or interventions with at risk or ultra high risk groups. There is a stronger case for focussing psychosis research on follow up studies, regarding longer term effectiveness and outcomes for young and adult populations, after provision of a range of high quality early interventions. From a population perspective and for the patients and families, there is more to be gained by extending research and intervention efforts beyond the initial two to three years from diagnosis, to minimise impairments and assist with fullest possible recovery.

References:
1. McGorry PD, Yung AR, Phillips LJ, Yuen HP, Francey S, Cosgrave EM, et al. Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Arch Gen Psychiatry 2002;59:921-8.
2. Yung AR, Phillips LJ, Nelson B, Francey SM, PanYuen H, Simmons MB, et al. Randomized controlled trial of interventions for young people at ultra high risk for psychosis: 6-month analysis. J Clin Psychiatry 2011;72:430-40.
3. McGlashan TH, Zipursky RB, Perkins D, Addington J, Miller T, Woods SW, et al. Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. Am J Psychiatry 2006;163:790-9.
4. Addington J, Epstein I, Liu L, French P, Boydell KM, Zipursky RB. A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis. Schizoph Res 2011;125:54-61.
5. Morrison AP, French P, Walford L, Lewis SW, Kilcommons A, Green J, et al. Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. Br J Psychiatry 2004;185:291-7.
6. Amminger GP, Schafer MR, Papageorgiou K, Klier CM, Cotton SM, Harrigan SM, et al. Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry 2010;67:146-54.

Competing interests: No competing interests

18 May 2012
Bridget E Hamilton
Senior Lecturer
University of Melbourne
200 Berkeley St Carlton 3010
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