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Randomized Controlled Trial
. 2016 Sep;42(5):1243-52.
doi: 10.1093/schbul/sbw018. Epub 2016 Mar 18.

Four-Year Follow-up of Cognitive Behavioral Therapy in Persons at Ultra-High Risk for Developing Psychosis: The Dutch Early Detection Intervention Evaluation (EDIE-NL) Trial

Helga K Ising  1 , Tamar C Kraan  2 , Judith Rietdijk  3 , Sara Dragt  2 , Rianne M C Klaassen  4 , Nynke Boonstra  5 , Dorien H Nieman  2 , Monique Willebrands-Mendrik  2 , David P G van den Berg  6 , Don H Linszen  2 , Lex Wunderink  5 , Wim Veling  7 , Filip Smit  8 , Mark van der Gaag  3
Affiliations
Randomized Controlled Trial

Four-Year Follow-up of Cognitive Behavioral Therapy in Persons at Ultra-High Risk for Developing Psychosis: The Dutch Early Detection Intervention Evaluation (EDIE-NL) Trial

Helga K Ising et al. Schizophr Bull. 2016 Sep.

Abstract

Background: Previously, we demonstrated that cognitive behavior therapy for ultra-high risk (called CBTuhr) halved the incidence of psychosis over an 18-month period. Follow-up data from the same study are used to evaluate the longer-term effects at 4 years post-baseline.

Method: The Dutch Early Detection and Intervention Evaluation study was a randomized controlled trial of 196 UHR patients comparing CBTuhr with treatment-as-usual (TAU) for comorbid disorders with TAU only. Of the original 196 patients, 113 consented to a 4-year follow-up (57.7%; CBTuhr = 56 vs TAU = 57). Over the study period, psychosis incidence, remission from UHR status, and the effects of transition to psychosis were evaluated.

Results: The number of participants in the CBTuhr group making the transition to psychosis increased from 10 at 18-month follow-up to 12 at 4-year follow-up whereas it did not change in the TAU group (n = 22); this still represents a clinically important (incidence rate ratio [IRR] = 12/22 = 0.55) and significant effect (F(1,5) = 8.09, P = .03), favoring CBTuhr. The odds ratio of CBTuhr compared to TAU was 0.44 (95% CI: 0.24-0.82) and the number needed to treat was 8. Moreover, significantly more patients remitted from their UHR status in the CBTuhr group (76.3%) compared with the TAU group (58.7%) [t(120) = 2.08, P = .04]. Importantly, transition to psychosis was associated with more severe psychopathology and social functioning at 4-year follow-up.

Conclusions: CBTuhr to prevent a first episode of psychosis in persons at UHR of developing psychosis is still effective at 4-year follow-up. Our data also show that individuals meeting the formal criteria of a psychotic disorder have worse functional and social outcomes compared with non-transitioned cases.

Trial registration: The trial is registered at Current Controlled Trials as trial number ISRCTN21353122 (http://controlled-trials.com/ISRCTN21353122/gaag).

Keywords: at-risk mental state; cognitive behavior therapy; prevention; schizophrenia; ultra-high risk.

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Figures

Fig. 1.
Fig. 1.
Flowchart of the study participants in the long-term follow-up trial.
See this image and copyright information in PMC

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References

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