Innovation needed in relapse prevention for those with ultrahigh risk of psychosis

Key Takeaways

• Specialized psychological intervention was not found more efficacious than control conditions in improving remission and recovery.
• Further trials, new treatments and sustained care need development.

Existing treatments for patients with an ultrahigh risk of psychosis offer relatively poor responsiveness, underscoring a need for further innovation in relapse prevention, according to a study published in JAMA Psychiatry.

“Enhancing the intensity of treatment with psychological interventions or medications was challenging to implement with fidelity and adherence in this largely primary care-based sample but nevertheless could not be demonstrated to produce any benefit over and above continuing a simpler form of care,” Patrick D. McGorry, MD, PhD, a professor of youth mental health at the University of Melbourne, and colleagues wrote. “Low remission and high relapse rates confirm the sustained vulnerability and substantial morbidity of the ultrahigh risk population and highlight the need to conduct further adaptive trials, develop new treatments, provide sustained specialist care and identify subgroups for whom treatments can be tailored.”

Participants aged 12 to 25 years at ultrahigh risk of psychosis recruited between April 2016 and January 2019 were randomized into computer-generated treatment allocations. Those who met remission criteria after 6 weeks were randomized to support and problem solving (SPS) or monitoring. Those who did not remit were randomized to cognitive-behavioral case management (CBCM) or SPS.

The participants had a mean age of 17.7 years and 198 of 342 total participants were female.

The researchers found that remission rates were 8.5% at 6 weeks, 10.3% at 20 weeks and 11.4% at 26 weeks. They also found that relapse rates among those who remitted did not significantly differ between SPS and monitoring.

“While some caution is warranted, and needs-based care should continue to be provided to all patients at ultrahigh risk, the findings indicate the need for further sequential randomized trials examining existing treatments with improved adherence and fidelity and for the development of innovative, more effective treatments and enhanced modes of delivery,” McGorry and colleagues wrote.