Selection for psychosocial treatment for youth at clinical high risk for psychosis based on the North American Prodrome Longitudinal Study individualized risk calculator

• Type of Material: Article
• Authors: Michelle A. Worthington, Yale University; David J. Miklowitz, University of California Los Angeles; Mary O'Brien, Yale University; Jean Addington, Hotchkiss Brain Institute; Carrie E. Bearden, University of California, Los Angeles; Kristin S. Cadenhead, Department of Psychiatry; Barbara A. Cornblatt, Zucker Hillside Hospital; Daniel H. Mathalon, SFVA Medical Center; Thomas H. McGlashan, Yale University; Diana O. Perkins, The University of North Carolina at Chapel Hill; Larry J. Seidman, Harvard Medical School; Ming T. Tsuang, University of California San Diego; Elaine Walker, Emory University; Scott W. Woods, Yale University; Tyrone D. Cannon, Yale University
• Language: English
• Date: 2021-02-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2021 John Wiley & Sons, Inc. All rights reserved
• Final Published Version (URL): http://dx.doi.org/10.1111/eip.12914
• Title of Journal or Parent Work: Early Intervention in Psychiatry
• Volume: 15
• Issue: 1
• Start Page: 96
• End Page: 103
• Grant/Funding Information: U01 MH081857 to B.A.C., U01 MH82022 to S.W.W., U01 MH066134 to J.A., U01 MH081944 to K.S.C., R01, U01 MH066069 to D.O.P., R01 MH076989 to D.H.M.,; This work was supported by the National Institutes of Health (U01 MH081902 to T.D.C.;; 1RC1 MH088546 to T.D.C. and D.J.M.; R01 MH093676 to D.J.M., MH066286 and BBRF (NARSAD) grants to C.E.B.;; U01 MH081928 to L.J.S., U01 MH081988 to E.F.W.) and a grant from the International Mental Health Research Organization (T.D.C.).
• Keywords: early intervention; Longitudinal Studies; risk; Randomized Controlled Trials as Topic; psychotic disorders; Humans; Adolescent; Family Therapy; Psychotic Disorders; North America; linear models; Prodromal Symptoms; Patient Selection; family therapy
• Research Categories: Psychology, Clinical; Psychology, Behavioral; Psychology, Psychobiology

Abstract

Aim: Recent findings suggest that family-focused therapy (FFT) is effective for individuals at clinical high-risk for psychosis (CHR-P). As outcomes of CHR-P individuals are quite varied, certain psychosocial interventions may be differentially effective in subgroups. The present study examined change in positive symptoms for CHR-P individuals at different levels of predicted risk for conversion to psychosis who received either FFT, a brief form of family education termed enhanced care (EC) or treatment as usual. Methods: Participants were drawn from the North American Prodromal Longitudinal Study (NAPLS2). A subset of NAPLS2 participants completed a randomized study involving FFT or EC. The present study includes participants from the FFT-CHR sub- study and non-randomized NAPLS2 participants. Predicted risk of conversion was calculated using the Individualized Risk Calculator for Psychosis. Robust linear regressions evaluated whether the association between predicted risk of conversion and positive symptom change differed across intervention groups. Results: A total of 94 participants from the FFT-CHR sub-study (FFT-CHR n = 50, EC n = 44) and 401 non-randomized NAPLS2 participants were included in this study. There was a treatment group by predicted risk of conversion interaction that predicted positive symptom improvement: higher risk individuals improved more with FFT-CHR than EC or the non-randomized NAPLS group, whereas lower-risk individuals did not differ in positive symptom improvement across treatment groups (FFT-CHR vs EC: P = .03, β = 20.27; FFT-CHR vs NAPLS2: P < .001, β = 28.40). Conclusions: Intensive treatments such as FFT-CHR may be most appropriate for individuals at the highest levels of clinical risk for psychosis.