Randomised controlled trial of early detection and cognitive therapy for preventing transition to psychosis in high-risk individuals. Study design and interim analysis of transition rate and psychological risk factors.
BACKGROUND
There is interest in the possibility of indicated prevention of psychosis. There is a strong case for using psychological approaches to prevent transition to psychosis in high-risk patients.


OBJECTIVE
To identify individuals at high risk of transition to psychosis, and psychological characteristics relevant to the development of psychosis in this group.


METHODS
The design of a randomised controlled trial of cognitive therapy for the prevention of psychosis in people at high risk (meeting operational criteria of brief or attenuated psychotic symptoms, or first-degree family history with functional decline) is outlined. The first patients recruited are compared with non-patient samples on cognitive and personality factors; an interim analysis of transition rate is reported.


RESULTS
Cases (n = 31) were recruited mainly from primary care. Of the 23 high-risk patients monitored for 6-12 months, 5 (22%) made the transition to psychosis. The high-risk group scored significantly higher than non-patients on measures of schizotypy, metacognitive beliefs and dysfunctional self-schemas (sociotropy).


CONCLUSIONS
The findings validate the methods of identifying individuals at high risk of experiencing a psychotic episode. Compared with non-patient controls, the cases showed dysfunctional metacognitive beliefs and self-schemas.
Morrison
A P
AP
Department of Psychology, University of Manchester, Oxford Road, Manchester M13 9PL, UK. tony.morrison@psy.man.ac.uk
Bentall
R P
RP
French
P
P
Walford
L
L
Kilcommons
A
A
Knight
A
A
Kreutz
M
M
Lewis
S W
SW
D000328:Adult; D003071:Cognition; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D012307:Risk Factors; D012649:Self Concept