title: Antidepressant, antipsychotic and psychological interventions in subjects at high clinical risk for psychosis: OASIS 6-year naturalistic study.
abstract: BACKGROUND
  Recent randomized controlled trials suggest some efficacy for focused interventions in subjects at high risk (HR) for psychosis. However, treating HR subjects within the real-world setting of prodromal services is hindered by several practical problems that can significantly make an impact on the effect of focused interventions.
  
  
  METHODS
  All subjects referred to Outreach and Support in South London (OASIS) and diagnosed with a HR state in the period 2001-2012 were included (n = 258). Exposure to focused interventions was correlated with sociodemographic and clinical characteristics at baseline. Their association with longitudinal clinical and functional outcomes was addressed at follow-up.
  
  
  RESULTS
  In a mean follow-up time of 6 years (s.d. = 2.5 years) a transition risk of 18% was observed. Of the sample, 33% were treated with cognitive behavioural therapy (CBT) only; 17% of subjects received antipsychotics (APs) in addition to CBT sessions. Another 17% of subjects were prescribed with antidepressants (ADs) in addition to CBT. Of the sample, 20% were exposed to a combination of interventions. Focused interventions had a significant relationship with transition to psychosis. The CBT + AD intervention was associated with a reduced risk of transition to psychosis, as compared with the CBT + AP intervention (hazards ratio = 0.129, 95% confidence interval 0.030-0.565, p = 0.007).
  
  
  CONCLUSIONS
  There were differential associations with transition outcome for AD v. AP interventions in addition to CBT in HR subjects. These effects were not secondary to baseline differences in symptom severity.
authors.affiliation: King's College London, Institute of Psychiatry,London,UK.
authors.forename: P
authors.initials: P
authors.lastname: Fusar-Poli
authors.affiliation: King's College London, Institute of Psychiatry,London,UK.
authors.forename: M
authors.initials: M
authors.lastname: Frascarelli
authors.affiliation: King's College London, Institute of Psychiatry,London,UK.
authors.forename: L
authors.initials: L
authors.lastname: Valmaggia
authors.affiliation: King's College London, Institute of Psychiatry,London,UK.
authors.forename: M
authors.initials: M
authors.lastname: Byrne
authors.affiliation: King's College London, Institute of Psychiatry,London,UK.
authors.forename: D
authors.initials: D
authors.lastname: Stahl
authors.affiliation: King's College London, Institute of Psychiatry,London,UK.
authors.forename: M
authors.initials: M
authors.lastname: Rocchetti
authors.affiliation: King's College London, Institute of Psychiatry,London,UK.
authors.forename: L
authors.initials: L
authors.lastname: Codjoe
authors.affiliation: King's College London, Institute of Psychiatry,London,UK.
authors.forename: L
authors.initials: L
authors.lastname: Weinberg
authors.affiliation: King's College London, Institute of Psychiatry,London,UK.
authors.forename: S
authors.initials: S
authors.lastname: Tognin
authors.affiliation: King's College London, Institute of Psychiatry,London,UK.
authors.forename: L
authors.initials: L
authors.lastname: Xenaki
authors.affiliation: King's College London, Institute of Psychiatry,London,UK.
authors.forename: P
authors.initials: P
authors.lastname: McGuire
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D062706:Prodromal Symptoms; D011618:Psychotic Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents
keywords: schizophrenia