Four-Year Follow-up of Cognitive Behavioral Therapy in Persons at Ultra-High Risk for Developing Psychosis: The Dutch Early Detection Intervention Evaluation (EDIE-NL) Trial.

Autor:	Ising HK; Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands; h.ising@parnassia.nl., Kraan TC; Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands;, Rietdijk J; Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands; Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands;, Dragt S; Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands;, Klaassen RM; Child and Adolescent Department, University Medical Center, Utrecht, The Netherlands;, Boonstra N; Department of Research and Education, Friesland Mental Health Services, Leeuwarden, The Netherlands;, Nieman DH; Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands;, Willebrands-Mendrik M; Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands;, van den Berg DP; Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands;, Linszen DH; Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands;, Wunderink L; Department of Research and Education, Friesland Mental Health Services, Leeuwarden, The Netherlands;, Veling W; Department of Psychiatry, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands;, Smit F; Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; Department of Public Mental Health, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands., van der Gaag M; Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands; Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands;
Jazyk:	angličtina
Zdroj:	Schizophrenia bulletin [Schizophr Bull] 2016 Sep; Vol. 42 (5), pp. 1243-52. Date of Electronic Publication: 2016 Mar 18.
DOI:	10.1093/schbul/sbw018
Abstrakt:	Background: Previously, we demonstrated that cognitive behavior therapy for ultra-high risk (called CBTuhr) halved the incidence of psychosis over an 18-month period. Follow-up data from the same study are used to evaluate the longer-term effects at 4 years post-baseline. Method: The Dutch Early Detection and Intervention Evaluation study was a randomized controlled trial of 196 UHR patients comparing CBTuhr with treatment-as-usual (TAU) for comorbid disorders with TAU only. Of the original 196 patients, 113 consented to a 4-year follow-up (57.7%; CBTuhr = 56 vs TAU = 57). Over the study period, psychosis incidence, remission from UHR status, and the effects of transition to psychosis were evaluated. Results: The number of participants in the CBTuhr group making the transition to psychosis increased from 10 at 18-month follow-up to 12 at 4-year follow-up whereas it did not change in the TAU group (n = 22); this still represents a clinically important (incidence rate ratio [IRR] = 12/22 = 0.55) and significant effect (F(1,5) = 8.09, P = .03), favoring CBTuhr. The odds ratio of CBTuhr compared to TAU was 0.44 (95% CI: 0.24-0.82) and the number needed to treat was 8. Moreover, significantly more patients remitted from their UHR status in the CBTuhr group (76.3%) compared with the TAU group (58.7%) [t(120) = 2.08, P = .04]. Importantly, transition to psychosis was associated with more severe psychopathology and social functioning at 4-year follow-up. Conclusions: CBTuhr to prevent a first episode of psychosis in persons at UHR of developing psychosis is still effective at 4-year follow-up. Our data also show that individuals meeting the formal criteria of a psychotic disorder have worse functional and social outcomes compared with non-transitioned cases. Trial Registration: The trial is registered at Current Controlled Trials as trial number ISRCTN21353122 (http://controlled-trials.com/ISRCTN21353122/gaag). (© The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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