title: Clinical and functional outcomes after 2 years in the early detection and intervention for the prevention of psychosis multisite effectiveness trial.
abstract: OBJECTIVE
  To test effectiveness of the Early Detection, Intervention, and Prevention of Psychosis Program in preventing the onset of severe psychosis and improving functioning in a national sample of at-risk youth.
  
  
  METHODS
  In a risk-based allocation study design, 337 youth (age 12-25) at risk of psychosis were assigned to treatment groups based on severity of positive symptoms. Those at clinically higher risk (CHR) or having an early first episode of psychosis (EFEP) were assigned to receive Family-aided Assertive Community Treatment (FACT); those at clinically lower risk (CLR) were assigned to receive community care. Between-groups differences on outcome variables were adjusted statistically according to regression-discontinuity procedures and evaluated using the Global Test Procedure that combined all symptom and functional measures.
  
  
  RESULTS
  A total of 337 young people (mean age: 16.6) were assigned to the treatment group (CHR + EFEP, n = 250) or comparison group (CLR, n = 87). On the primary variable, positive symptoms, after 2 years FACT, were superior to community care (2 df, p < .0001) for both CHR (p = .0034) and EFEP (p < .0001) subgroups. Rates of conversion (6.3% CHR vs 2.3% CLR) and first negative event (25% CHR vs 22% CLR) were low but did not differ. FACT was superior in the Global Test (p = .0007; p = .024 for CHR and p = .0002 for EFEP, vs CLR) and in improvement in participation in work and school (p = .025).
  
  
  CONCLUSIONS
  FACT is effective in improving positive, negative, disorganized and general symptoms, Global Assessment of Functioning, work and school participation and global outcome in youth at risk for, or experiencing very early, psychosis.
authors: Tufts University School of Medicine, Boston, MA; Maine Medical Center Research Institute, Portland, ME; mcfarw@mmc.org.
authors: William R
authors: WR
authors: McFarlane
authors: Mailman School of Public Health, Columbia University, New York, NY;
authors: Bruce
authors: B
authors: Levin
authors: Maine Medical Center Research Institute, Portland, ME;
authors: Lori
authors: L
authors: Travis
authors: Maine Medical Center Research Institute, Portland, ME;
authors: F Lee
authors: FL
authors: Lucas
authors: Maine Medical Center Research Institute, Portland, ME;
authors: Sarah
authors: S
authors: Lynch
authors: Maine Medical Center Research Institute, Portland, ME;
authors: Mary
authors: M
authors: Verdi
authors: Maine Medical Center Research Institute, Portland, ME;
authors: Deanna
authors: D
authors: Williams
authors: Department of Psychiatry, Stanford University School Of Medicine, Palo, Alto, CA;
authors: Steven
authors: S
authors: Adelsheim
authors: Marion County Health Department, Salem, OR;
authors: Roderick
authors: R
authors: Calkins
authors: Department of Psychiatry, University of California at Davis, Sacramento, CA;
authors: Cameron S
authors: CS
authors: Carter
authors: Zucker Hillside Hospital, Glen Oaks, NY;
authors: Barbara
authors: B
authors: Cornblatt
authors: Department of Psychiatry, University of Michigan, Ann Arbor, MI; Washtenaw Community Health Organization, Ypsilanti, MI;
authors: Stephan F
authors: SF
authors: Taylor
authors: Zucker Hillside Hospital, Glen Oaks, NY;
authors: Andrea M
authors: AM
authors: Auther
authors: Department of Psychiatry, Oregon Health Sciences University, Portland, OR;
authors: Bentson
authors: B
authors: McFarland
authors: Portland State University, Portland, OR;
authors: Ryan
authors: R
authors: Melton
authors: University of New Mexico, Albuquerque, NM;
authors: Margaret
authors: M
authors: Migliorati
authors: Department of Psychiatry, University of California at Davis, Sacramento, CA;
authors: Tara
authors: T
authors: Niendam
authors: Department of Psychiatry, University of California at Davis, Sacramento, CA;
authors: J Daniel
authors: JD
authors: Ragland
authors: Portland State University, Portland, OR; Mid-Valley Behavioral Care Network, Salem, OR.
authors: Tamara
authors: T
authors: Sale
authors: Department of Psychiatry, Stanford University School Of Medicine, Palo, Alto, CA;
authors: Melina
authors: M
authors: Salvador
authors: Washtenaw Community Health Organization, Ypsilanti, MI;
authors: Elizabeth
authors: E
authors: Spring
mesh_terms: D000293:Adolescent; D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy / Q000523:psychology; D002648:Child; D003156:Community Mental Health Services / Q000379:methods*; D042241:Early Diagnosis; D061345:Early Medical Intervention; D016832:Employment, Supported; D005196:Family Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D019964:Mood Disorders / Q000188:drug therapy / Q000523:psychology; D011618:Psychotic Disorders / Q000517:prevention & control* / Q000523:psychology; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D018692:Antimanic Agents; D014150:Antipsychotic Agents
keywords: assertive community treatment; family psychoeducation; multifamily group; schizophrenia; supported education; supported employment