EPA guidance on the early intervention in clinical high risk states of psychoses

TY - JOUR

T1 - EPA guidance on the early intervention in clinical high risk states of psychoses

AU - Schmidt, S J

AU - Schultze-Lutter, F

AU - Schimmelmann, B G

AU - Maric, N P

AU - Salokangas, R K R

AU - Riecher-Rössler, A

AU - van der Gaag, M

AU - Meneghelli, A

AU - Nordentoft, M

AU - Marshall, M

AU - Morrison, A

AU - Raballo, A

AU - Klosterkötter, J

AU - Ruhrmann, S

N1 - Copyright © 2015 Elsevier Masson SAS. All rights reserved.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - 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.

AB - 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.

KW - Adolescent

KW - Adult

KW - Antipsychotic Agents

KW - Early Diagnosis

KW - Early Medical Intervention

KW - Humans

KW - Male

KW - Mood Disorders

KW - Practice Guidelines as Topic

KW - Psychiatric Status Rating Scales

KW - Psychotic Disorders

KW - Risk Factors

KW - Schizophrenia

KW - Treatment Outcome

U2 - 10.1016/j.eurpsy.2015.01.013

DO - 10.1016/j.eurpsy.2015.01.013

M3 - Journal article

C2 - 25749390

SN - 0924-9338

VL - 30

SP - 388

EP - 404

JO - European Psychiatry

JF - European Psychiatry

IS - 3

ER -