EPA guidance on the early intervention in clinical high risk states of psychoses.
This guidance paper from the European Psychiatric Association (EPA) aims to provide evidence-based recommendations on early intervention in clinical high risk (CHR) states of psychosis, assessed according to the EPA guidance on early detection. The recommendations were derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. Besides analyses on treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies (n=1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions. However, early intervention failed to achieve significantly greater functional improvements because both early intervention and control conditions produced similar positive effects. With regard to the type of intervention, both psychological and pharmacological interventions produced significant effects on conversion rates, but not on functional outcome relative to the control conditions. Early intervention in youth samples was generally less effective than in predominantly adult samples. Seven evidence-based recommendations for early intervention in CHR samples could have been formulated, although more studies are needed to investigate the specificity of treatment effects and potential age effects in order to tailor interventions to the individual treatment needs and risk status.
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
S J
SJ
Schmidt
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
F
F
Schultze-Lutter
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
B G
BG
Schimmelmann
School of Medicine, University of Belgrade and Clinic of Psychiatry, Clinical Center of Serbia, Belgrade, Serbia.
N P
NP
Maric
Department of Psychiatry, University of Turku, Turku, Finland.
R K R
RK
Salokangas
Center for Gender Research and Early Detection, Psychiatric University Clinics of Basel, Basel, Switzerland.
A
A
Riecher-Rössler
Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; Psychosis Research, Parnassia Psychiatric Institute, Hague, The Netherlands.
M
M
van der Gaag
Dipartimento di Salute Mentale, Centro per l'Individuazione e l'Intervento Precoce nelle Psicosi-Programma 2000, Ospedale Niguarda Ca' Granda, Milan, Italy.
A
A
Meneghelli
Mental Health Center of Copenhagen, University of Copenhagen, Copenhagen, Denmark.
M
M
Nordentoft
School of Medicine, University of Manchester, Manchester, UK; LANTERN Center, Lancashire Care NHS Foundation Trust, Preston, UK.
M
M
Marshall
School of Psychological Sciences, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester West NHS Mental Health Trust, Manchester, UK.
A
A
Morrison
Department of Mental Health, Reggio Emilia Public Health Center, Reggio Emilia, Italy; Regional Working Group on Early Detection of Psychosis, Emilia Romagna Regional Health Service, Bologna, Italy.
A
A
Raballo
Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany. Electronic address: Joachim.klosterkotter@uk-koeln.de.
J
J
Klosterkötter
Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
S
S
Ruhrmann
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D042241:Early Diagnosis; D061345:Early Medical Intervention / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D019964:Mood Disorders / Q000175:diagnosis / Q000628:therapy; D017410:Practice Guidelines as Topic; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000628:therapy*; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
D014150:Antipsychotic Agents
Adolescents; Antipsychotics; Cognitive-behavioral therapy; Early intervention in Europe; Meta-analysis; Neuroprotective; Prevention; Psychosis; Risk; Youth