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
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
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DOI：
10.1093/schbul/sbw018
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发表时间：
2016-09-01
影响因子：
6.6
通讯作者：
van der Gaag, Mark
中科院分区：
文献类型：
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作者：
Ising, Helga K.;Kraan, Tamar C.;van der Gaag, Mark
背景：之前，我们证明针对超高风险的认知行为疗法（称为 CBTuhr）在 18 个月内将精神病的发病率降低了一半。来自同一研究的后续数据用于评估基线后 4 年的长期影响。方法：荷兰早期检测和干预评估研究是一项对 196 名 UHR 患者进行的随机对照试验，比较 CBTuhr 与常规治疗 (TAU) 治疗仅 TAU 合并症的情况。在最初的 196 名患者中，113 名同意接受 4 年随访（57.7%；CBTuhr = 56 vs TAU = 57）。在研究期间，对精神病的发生率、UHR状态的缓解以及向精神病过渡的影响进行了评估。结果：CBTuhr 组中转变为精神病的参与者人数从 18 个月随访时的 10 人增加到 4 年随访时的 12 人，而 TAU 组中没有变化 (n = 22)；这仍然具有临床重要性（发病率比 [IRR] = 12/22 = 0.55）和显着效果（F(1,5) = 8.09，P = .03），有利于 CBTuhr。 CBTuhr 与 TAU 相比的比值比为 0.44 (95% CI: 0.24-0.82)，需要治疗的人数为 8。此外，与 TAU 组 (58.7%) 相比，CBTuhr 组 (76.3%) 的 UHR 状态缓解的患者明显更多 [t(120) = 2.08, P = .04]。重要的是，在 4 年随访中，向精神病的转变与更严重的精神病理学和社会功能相关。结论：CBTuhr 对于预防患有精神病的 UHR 患者的首次精神病发作在 4 年随访中仍然有效。我们的数据还表明，与非转变病例相比，符合精神障碍正式标准的个体的功能和社会结果更差。试验注册：该试验在当前对照试验中注册，试验号为 ISRCTN21353122 (http://controlled-trials.com/ISRCTN21353122/gaag)。
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).