{"id":31105,"date":"2012-12-16T23:00:26","date_gmt":"2012-12-17T04:00:26","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=31105"},"modified":"2012-12-16T21:30:41","modified_gmt":"2012-12-17T02:30:41","slug":"worth-pursuing","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/12\/16\/worth-pursuing\/","title":{"rendered":"worth pursuing…"},"content":{"rendered":"
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Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: twelve-month outcome<\/a>.
by McGorry PD, Nelson B, Phillips LJ, Yuen HP, Francey SM, Thampi A, Berger GE, Amminger GP, Simmons MB, Kelly D, Thompson AD, and Yung AR.<\/sup>
Journal of Clinical Psychiatry<\/font><\/strong>. 2012 Nov 27. [Epub ahead of print]<\/div>\n


<\/strong><\/u><\/p>\n

OBJECTIVE<\/font><\/u>: The ultra-high risk clinical phenotype is associated with substantial distress and functional impairment and confers a greatly enhanced risk for transition to full-threshold psychosis. A range of interventions aimed at relieving current symptoms and functional impairment and reducing the risk of transition to psychosis has shown promising results, but the optimal type and sequence of intervention remain to be established. The aim of this study was to determine which intervention was most effective at preventing transition to psychosis: cognitive therapy plus low-dose risperidone, cognitive therapy plus placebo, or supportive therapy plus placebo.<\/strong><\/sup><\/div>\n
METHOD<\/font><\/u>: A double-blind, randomized, placebo-controlled 12-month trial of low-dose risperidone, cognitive therapy, or supportive therapy was conducted in a cohort of 115 clients of the Personal Assessment and Crisis Evaluation Clinic, a specialized service for young people at ultra-high risk of psychosis located in Melbourne, Australia. Recruitment commenced in August 2000 and ended in May 2006. The primary outcome measure was transition to full-threshold psychosis, defined a priori as frank psychotic symptoms occurring at least daily for 1 week or more and assessed using the Comprehensive Assessment of At-Risk Mental States. Secondary outcome measures were psychiatric symptoms, psychosocial functioning, and quality of life.<\/strong><\/sup><\/div>\n
RESULTS<\/font><\/u>: The estimated 12-month transition rates were as follows: cognitive therapy + risperidone, 10.7%; cognitive therapy + placebo, 9.6%; and supportive therapy + placebo, 21.8%. While there were no statistically significant differences between the 3 groups in transition rates (log-rank test P = .60), all 3 groups improved substantially during the trial, particularly in terms of negative symptoms and overall functioning.<\/strong><\/sup><\/div>\n
CONCLUSIONS<\/font><\/u>: The lower than expected, essentially equivalent transition rates in all 3 groups fail to provide support for the first-line use of antipsychotic medications in patients at ultra-high risk of psychosis, and an initial approach with supportive therapy is likely to be effective and carries fewer risks.<\/strong><\/sup><\/div>\n

<\/p>\n

\"reference:<\/div>\n<\/blockquote>\n
[see also Neither Drugs Nor Therapy Prevent Psychosis<\/a>, Neuroskeptic<\/font><\/strong>]<\/div>\n

The evidence is adding up that the idea that one can use a premorbid clinical diagnostic assessment to accurately predict the subsequent development of Schizophrenia hasn’t panned out. One has to wonder why the DSM-5 Task Force thought it was anything more than speculative and stuck with the idea until the Field Trials in spite of a loud outcry, an outcry ultimately joined by the Australian group that was primarily involved in studying the question. Or why Dr. Insel would make it a centerpiece of a speech in Europe a year ago about leading edge discoveries. It looks to me like they were just desperate to have something to add to their manual to make up for having nothing much new to say about the progress in psychiatric diagnosis since 1994. In fact, our core diagnoses haven’t really changed all that much since Kraepelin a century ago. And Eugene Bleuler [who coined the term Schizophrenia] described this premorbid personality around the same time, saying that it was not specific enough for prediction. <\/p>\n

On the other hand, Dr. McGorry’s group is able to define a cohort that has a 10% chance of developing Schizophrenia, a much higher incidence than the general population. Were we not so fixated on treatment or on translational research, we would see this as exciting progress. We’d measure everything we could think of, devise all kinds of sophisticated psychometrics, and follow said group looking for some key that would refine the group further. I hope the Australian group is doing that as we speak. I’d suggest projective tests like the Rorschach and the TAT or something new, looking at the ability to abstract, or for emotional intuition, creative ways to look for subtle signs of the formal thought disorder or the ambivalence so prominent in Schizophrenic thought. This is a research topic, hardly ready for a diagnostic manual, translation, or a treatment plan, but interesting and worth pursuing nonetheless… <\/div>\n","protected":false},"excerpt":{"rendered":"

Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: twelve-month outcome. by McGorry PD, Nelson B, Phillips LJ, Yuen HP, Francey SM, Thampi A, Berger GE, Amminger GP, Simmons MB, Kelly D, Thompson AD, and Yung AR. Journal of Clinical Psychiatry. 2012 Nov 27. [Epub ahead of print] OBJECTIVE: The ultra-high […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-31105","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/31105","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=31105"}],"version-history":[{"count":6,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/31105\/revisions"}],"predecessor-version":[{"id":31111,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/31105\/revisions\/31111"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=31105"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=31105"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=31105"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}