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Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial
Open accessAbstract
OBJECTIVE: To determine whether cognitive therapy is effective in preventing the worsening of emerging psychotic symptoms experienced by help seeking young people deemed to be at risk for serious conditions such as schizophrenia. DESIGN: Multisite single blind randomised controlled trial. SETTING: Diverse services at five UK sites. PARTICIPANTS: 288 participants aged 14-35 years (mean 20.74, SD 4.34 years) at high risk of psychosis: 144 were assigned to cognitive therapy plus monitoring of mental state and 144 to monitoring of mental state only. Participants were followed-up for a minimum of 12 months and a maximum of 24 months. INTERVENTION: Cognitive therapy (up to 26 (mean 9.1) sessions over six months) plus monitoring of mental state compared with monitoring of mental state only. MAIN OUTCOME MEASURES: Primary outcome was scores on the comprehensive assessment of at risk mental states (CAARMS), which provides a dichotomous transition to psychosis score and ordinal scores for severity of psychotic symptoms and distress. Secondary outcomes included emotional dysfunction and quality of life. RESULTS: Transition to psychosis based on intention to treat was analysed using discrete time survival models. Overall, the prevalence of transition was lower than expected (23/288; 8%), with no significant difference between the two groups (proportional odds ratio 0.73, 95% confidence interval 0.32 to 1.68). Changes in severity of symptoms and distress, as well as secondary outcomes, were analysed using random effects regression (analysis of covariance) adjusted for site and baseline symptoms. Distress from psychotic symptoms did not differ (estimated difference at 12 months -3.00, 95% confidence interval -6.95 to 0.94) but their severity was significantly reduced in the group assigned to cognitive therapy (estimated between group effect size at 12 months -3.67, -6.71 to -0.64, P=0.018). CONCLUSIONS: Cognitive therapy plus monitoring did not significantly reduce transition to psychosis or symptom related distress but reduced the severity of psychotic symptoms in young people at high risk. Most participants in both groups improved over time. The results have important implications for the at risk mental state concept. TRIAL REGISTRATION: Current Controlled Trials ISRCTN56283883.
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“Only two studies had an overall low risk of bias 33,79 ; five had unclear risk [72][73][74][75][76] , and nine had high risk 30,31,36,37,39,41,77,78,81 .”
From Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis (2018) · cites this paper as [77]
In the citing paper
“the largest CBT-F trial to date provided non-significant results 77”
From Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis (2018) · cites this paper as [77]
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“EDIE-2 was a multi-site randomised controlled trial of a psychological intervention aiming to reduce transition to psychosis (Morrison et al., 2011, Morrison et al., 2012).”
From Sleep duration and psychotic experiences in patients at risk of psychosis: a secondary analysis of the EDIE-2 trial (2019) · cites this paper as Morrison et al., 2012
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“The cognitive therapy based intervention plus monitoring was significantly better than monitoring only in reducing severity of psychotic experiences, but not in reducing distress or transition to psychosis over 12 to 24 months (Morrison et al., 2012).”
From Sleep duration and psychotic experiences in patients at risk of psychosis: a secondary analysis of the EDIE-2 trial (2019) · cites this paper as Morrison et al., 2012
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Rasic, D., Hajek, T., Alda, M., & Uher, R. (2014) · Schizophrenia Bulletin · doi:10.1093/schbul/sbt114 · Cited by 758
The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science
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Self-citationEPA guidance on the early intervention in clinical high risk states of psychoses
Schmidt, S. J., Schultze-Lutter, F., Schimmelmann, B. G., Maric, N. P., Salokangas, R. K. R., Riecher-Rössler, A., van der Gaag, M., Meneghelli, A., Nordentoft, M., Marshall, M., et al. (2015) · European Psychiatry · doi:10.1016/j.eurpsy.2015.01.013 · Cited by 585
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Metadata
- Authors
- Morrison, A. P., French, P., Stewart, S. L. K., Birchwood, M., Fowler, D., Gumley, A. I., Jones, P. B., Bentall, R. P., Lewis, S. W., Murray, G. K., Patterson, P., Brunet, K., Conroy, J., Parker, S., Reilly, T., Byrne, R., Davies, L. M., & Dunn, G.
- Affiliations
- Greater Manchester Mental Health NHS Foundation Trust (GB)
- University of Manchester (GB)
- University of Birmingham (GB)
- University of East Anglia (GB)
- University of Glasgow (GB)
- University of Cambridge (GB)
- University of Liverpool (GB)
- Birmingham and Solihull Mental Health NHS Foundation Trust (GB)
- Cambridgeshire and Peterborough NHS Foundation Trust (GB)
- Corresponding author
- Morrison, A. P.
- ORCID
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2012-04-05
- Volume
- 344
- Issue
- apr05 1
- Pages
- e2233-e2233
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC3320714
- OpenAlex
- W2095692398
- Cited by
- 332
- References
- 89
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 11 · 2023: 15 · 2022: 14 · 2021: 21 · 2020: 23 · 2019: 47 · 2018: 27 · 2017: 25 · 2016: 21 · 2015: 29 · 2014: 19 · 2013: 45 · 2012: 23
- FWCI
- 26.41
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- edoc (University of Basel) (acceptedVersion, other-oa)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- Figshare (submittedVersion, cc-by)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- University of Warwick (cc-by)
- Funders
- National Institute for Health and Care Research
- Medical Research Council (G0500264)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- psychosis prevention, clinical high risk for psychosis, cognitive therapy, transition to psychosis, youth, mental state monitoring, psychotic symptom severity, distress, schizophrenia, early intervention
- MeSH terms
- Adolescent, Adult, Mental Disorders, Humans, Psychotic Disorders, Cognitive Behavioral Therapy, Single-Blind Method, Treatment Outcome, Early Diagnosis, Young Adult
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