Randomized Controlled Trial of Interventions for Young People at Ultra-High Risk of Psychosis: Twelve-Month Outcome
Randomized Controlled Trial of Interventions for Young People at Ultra-High Risk of Psychosis: Twelve-Month Outcome
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DOI：
10.4088/jcp.12m07785
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发表时间：
2013-04-01
影响因子：
5.3
通讯作者：
Yung, Alison R.
中科院分区：
文献类型：
--
作者：
McGorry, Patrick D.;Nelson, Barnaby;Yung, Alison R.
目的：超高风险临床表型与实质性痛苦和功能障碍相关，并赋予转变为全阈值精神病的风险大大增加。一系列旨在缓解当前症状和功能障碍并降低向精神病转变风险的干预措施已显示出可喜的成果，但最佳干预类型和顺序仍有待确定。本研究的目的是确定哪种干预措施在预防向精神病转变方面最有效：认知治疗加低剂量利培酮，认知治疗加安慰剂，或支持治疗加安慰剂。方法：一项双盲、随机、安慰剂对照的12个月低剂量利培酮、认知疗法、在澳大利亚墨尔本的个人评估和危机评估诊所的一组115名客户中进行了支持性治疗或支持性治疗。征聘工作于2000年8月开始，2006年5月结束。主要结局指标是向全阈值精神病的转变，先验定义为至少每天发生一次的明显精神病症状，持续1周或更长时间，并使用风险精神状态综合评估进行评估。次要结果的措施是精神症状，心理社会功能，和quality of life.Results：估计12个月的过渡率如下：认知治疗+利培酮，10.7%;认知治疗+安慰剂，9.6%;和支持治疗+安慰剂，21.8%。而三组之间的转换率无统计学显著差异（对数秩检验P= 0.60），所有3组在试验期间均大幅改善，特别是在阴性症状和整体功能方面。低于预期，所有3组的转换率基本相等，但这并不能为超负荷患者一线使用抗精神病药物提供支持。精神病的高风险，最初的支持性治疗可能是有效的，风险较小。(C)版权所有2012 Physicians Postgraduate Press，Inc.
Objective:The ultra-high risk clinical phenotype is associated with substantial distress and functional impairment and confers a greatly enhanced risk for transition to full-threshold psychosis. A range of interventions aimed at relieving current symptoms and functional impairment and reducing the risk of transition to psychosis has shown promising results, but the optimal type and sequence of intervention remain to be established. The aim of this study was to determine which intervention was most effective at preventing transition to psychosis: cognitive therapy plus low-dose risperidone, cognitive therapy plus placebo, or supportive therapy plus placebo.Method: A double-blind, randomized, placebo-controlled 12-month trial of low-dose risperidone, cognitive therapy, or supportive therapy was conducted in a cohort of 115 clients of the Personal Assessment and Crisis Evaluation Clinic, a specialized service for young people at ultra-high risk of psychosis located in Melbourne, Australia. Recruitment commenced in August 2000 and ended in May 2006. The primary outcome measure was transition to full-threshold psychosis, defined a priori as frank psychotic symptoms occurring at least daily for 1 week or more and assessed using the Comprehensive Assessment of At-Risk Mental States. Secondary outcome measures were psychiatric symptoms, psychosocial functioning, and quality of life.Results: The estimated 12-month transition rates were as follows: cognitive therapy+risperidone, 10.7%; cognitive therapy+placebo, 9.6%; and supportive therapy+placebo, 21.8%. While there were no statistically significant differences between the 3 groups in transition rates (log-rank test P=.60), all 3 groups improved substantially during the trial, particularly in terms of negative symptoms and overall functioning.Conclusions: The lower than expected, essentially equivalent transition rates in all 3 groups fail to provide support for the first-line use of antipsychotic medications in patients at ultra-high risk of psychosis, and an initial approach with supportive therapy is likely to be effective and carries fewer risks. (C) Copyright 2012 Physicians Postgraduate Press, Inc.