Antidepressant, antipsychotic and psychological interventions in subjects at high clinical risk for psychosis: OASIS 6-year naturalistic study
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.
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The transitivity assumption was examined by assessing distributions of potential effect modifiers across comparisons in the network.
“The transitivity assumption was examined by assessing the distributions of potential effect modifiers for every comparison in the network, including percentage of males 68 , age 69 , percentage exposed to antipsychotic medications at baseline 70 , type of blinding and publication year 6 .”
From Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis (2018) · cites this paper as [70]
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- Authors
- Fusar-Poli, P., Frascarelli, M., Valmaggia, L., Byrne, M., Stahl, D., Rocchetti, M., Codjoe, L., Weinberg, L., Tognin, S., Xenaki, L., & McGuire, P.
- Affiliations
- King's College London (GB)
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2014-10-22
- Volume
- 45
- Issue
- 6
- Pages
- 1327-1339
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2146755519
- Cited by
- 73
- References
- 45
- Citations by year
- 2026: 1 · 2025: 4 · 2023: 2 · 2022: 4 · 2021: 4 · 2020: 11 · 2019: 11 · 2018: 6 · 2017: 7 · 2016: 15 · 2015: 8
- FWCI
- 7.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- clinical high risk for psychosis, prodromal psychosis, transition to psychosis, cognitive behavioral therapy, antidepressants, antipsychotic drugs, psychological intervention, real-world treatment, functional outcome, OASIS
- MeSH terms
- Adolescent, Adult, Antidepressive Agents, Combined Modality Therapy, Female, Follow-Up Studies, Humans, London, Male, Psychotic Disorders, Risk, Time Factors, Antipsychotic Agents, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult, Prodromal Symptoms
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