Abstract
With the emerging global focus on early psychosis, indicated prevention in schizophrenia has increasingly become a focus of psychiatric research interests. It has been argued that CBT may have some advantages compared with antipsychotics regarding this issue. According to MEDLINE, EMBASE and Psycinfo two completed randomised controlled trials (RCTs; PACE, Melbourne, Australia; EDIE, Manchester, United Kingdom) and one ongoing RCT with only preliminary results published so far (FETZ, Cologne/Bonn, Germany) on indicated prevention in schizophrenia including manualised and standardised psychological treatment can be identified. The aims of the present paper are to present and discuss the three approaches with regard to (I) inclusion, exclusion and exit criteria, (II) characteristics of interventions and (III) evaluations. All interventions use intake, exclusion and exit criteria, which have been evaluated in prospective follow-along studies. The approaches are based on the general structure and principles of cognitive behavioural therapy which have been developed, applied and evaluated in a wide range of mental health problems. Despite several methodological limitations, the first evaluations indicate some effects with regard to three possible aims of early intervention: (1) improvement of present possible pre-psychotic symptoms, (2) prevention of social decline/stagnation and (3) prevention or delay of progression to psychosis. Even though the first results are promising, we conclude that several ethical issues have to be taken into consideration and further predictive and therapeutic research is needed to judge whether psychological intervention is a realistic option for the treatment of people at risk of psychosis.
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American Psychiatric Association (1989) Diagnostic and Statistical Manual of Mental Disorders (Third Edition). Washington, DC: American Psychiatric Association
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Washington, DC: American Psychiatric Association
Angermeyer MC, Matschinger H (1996) Public attitude towards psychiatric treatment. Acta Psychiatr Scand 94(5):326–336
APA work group (1997) Practice guidelines for the treatment of patients with schizophrenia. Am J Psychiatry 154(Suppl 4):1–63
APA work group (1998) American Psychiatric Association Practice Guidelines: Practice guideline for the treatment of patients with panic disorder. Am J Psychiatry 155(Suppl 5):1–34
APA work group (2000) American Psychiatric Association Practice Guidelines: Practice guideline for the treatment of patients with major depressive disorder (revision). Am J Psychiatry 157 (Suppl 4):1–45
Bechdolf A, Knost B, Maier S, Schröder C, Hambrecht M, Wagner M (2002) Psychological intervention for persons at risk of psychosis in the early prodromal state. Second revised version. Unpublished Manual, University of Köln/Bonn, Germany
Bechdolf A, Maier S, Knost B, Wagner M, Hambrecht M (2003) Psychological intervention in the early prodromal state. A case report. Nervenarzt 5:436–439
Bechdolf A, Veith V, Stamm E, Janssen B, Berning J, Wagner M, Klosterkötter J (2005) Cognitive-behavioural therapy in the prepsychotic phase: An exploratory study. Psychiatry Res 136(2–3):251–255
Bechdolf A, Ruhrmann S, Wagner M, Kuhn KU, Janssen B, Bottlender R, Wieneke A, Schultze-Lutter F, Maier W, Klosterkötter J (2005) Interventions in the initial prodromal states of psychosis in Germany: Concept and recruitment. Br J Psychiatry Suppl, Aug; S45–S48
Bechdolf A, Pukrop R, Köhn D, Tschinkel S, Schultze-Lutter F, Ruhrmann S, Geyer C, Pohlmann B, Klosterkötter J (2005) Subjective quality of life in subjects at risk for first episode psychosis: A comparison with first episode schizophrenia patients and healthy controls. Schizophr Res 79(1):137–143
Beck AT (1976) Cognitive therapy and the emotional disorders. New York: International Universities Press
Bentall RP, Morrison AP (2002) More harm than good: The case against using antipsychotic drugs to prevent severe mental illness. J Mental Health 11:351–365
Boeker W, Brenner HD, Wuergler S (1989) Vulnerability-linked deficiencies, psychopathology and coping behaviour of schizophrenics and their relatives. Br J Psychiatry 155(Suppl 5):128–135
Bustillo JR, Lauriello J, Horan WP, Keith SJ (2001) The psychosocial treatment of schizophrenia: an update. Am J Psychiatry 158:163–175
Chadwick PDJ, Birchwood M,Trower P (1996) Cognitive therapy for delusions, voices and paranoia. Chichester, England. John Wiley and Sons
Clark DM (1986) A cognitive approach to panic disorder. Behav Res Ther 24:461–470
Clark DM (1999) Anxiety disorders: why they persist and how to treat them. Behav Res Ther 37(Suppl): 5–27
Cohen J (1988) Statistical power analysis for the behavioral sciences (rev ed). Hillsdale, NJ: Erlbaum
Copolov D, Velakoulis D, et al. (2000) Neurobiological findings in early phase schizophrenia. Brain Res Rev 31/2–3:157–165
Cormac I, Jones C, et al. (2003) Cognitive behaviour therapy for schizophrenia (Cochrane Review). The Cochrane Library, Issue 3. Oxford: Update
Cougnard A, Salmi LR, Verdoux H (2003) A decade of debate on early psychosis: a systematic review of screening criteria. Schizophr Res 60(1):91–93
Erlenmeyer-Kimlimg L, Squirres-Wheeler E, Adamo UH, Bassett AS, Cornblatt B, Kestenbaum CJ, Rock D, Roberts SA, Gottesman II (1995) The New York High-Risk Project: Prevalence and comorbidity of Axis I disorders in offspring of schizophrenic parents at 23-year follow-up. Arch Gen Psychiatry 52:857–865
Erlenmeyer-Kimlimg L, Adamo UH, Rock D, Roberts SA, Bassett AS, Squirres-Wheeler E, Cornblatt B, Endicott J, Pape S, Gottesman II (1997) The New York High-Risk Project: Prevalence and comorbidity of Axis I disorders in offspring of schizophrenic parents at 25-year follow-up. Arch Gen Psychiatry 54:1096–1102
Fowler D, Garety P, Kuipers E (1995) Cognitive behaviour therapy for people with psychosis. Chichester, England: John Wiley and Sons
French P, Morrison AP, Walford L, Knight A, Bentall RP (2001) Cognitive therapy for preventing transition to psychosis in high risk individuals: a single case study. In:Morrison AP (ed) A Case Book of Cognitive Therapy for Psychosis. London: Psychology Press, pp 44–67
French P, Morrison AP, Walford L, Knight A, Bentall RP (2003) Cognitive therapy for preventing transition to psychosis in high risk individuals: A case series. Behavioural and Cognitive Psychotherapy 31:53–68
French P, Morrison AP (2004) Early detection and cognitive therapy for people at high risk of developng psychosis. Chichester: John Wiley and Sons
Frith CD (1992) The Cognitive Neuropsychology of Schizophrenia. Hove: Lawrence Erlbaum
Garety PA, Hemsley DR (1994).Delusions: Investigations into the Psychology of Delusional Reasoning. Oxford: Oxford University Press
Garety PA, Kuipers E, Fowler D, Freeman D, Bebbington PE (2001) A cognitive model of the positive symptoms of psychosis. Psychol Med 31:189–195
Goldberg DP, Hillier VF (1979) A scaled version of the general health questionnaire. Psychol Med 9:139–145
Gould RA, Mueser KT, Bolton E, et al. (2002) Cognitive therapy for psychosis in schizophrenia. An effect size analysis. Schizophr Res 48:335–342
Haddock G, Tarrier N, Morrison AP, Hopkins R, Drake R, Lewis S (1999) A pilot study evaluating the effectiveness of individual inpatient cognitive-behavioural therapy in early psychosis. Soc Psychiatry Psychiatr Epidemiol 5:254–258
Hafner H, Riecher-Rössler A, Maurer K, et al. (1992) First onset and early symptomatology of schizophrenia. Eur Arch Psychiatry Clin Neurosci 242:109–118
Häfner H, Nowotny B, et al. (1995) When and how does schizophrenia produce social deficits? Eur Arch Psychiatry Clin Neurosci 246:17–28
Häfner H, Maurer K, Ruhrmann S, Bechdolf A, Klosterkötter J, Wagner M, Maier W, Bottlender R, Möller HJ, Gaebel W, Wölwer W (2004) Are early detection and secondary prevention feasible? Facts and visions. Eur Arch Psychiatry Neurosci 254:117–128
Huber G, Gross G (1989) The concept of basic symptoms in schizophrenic and schizoaffective psychoses. Recent Prog Med 80:646–652
Jackson HJ, McGorry PD, Dudgeon P (1995) Prodromal symptoms of schizophrenia in first-episode psychosis: Prevalence and specifity. Compr Psychiatry 36:241–250
Johnstone EC, Abukmeil SS, Byrne M, Clafferty R, Grant E, Hodges A, Lawrie SM, Owens DGC (2001) Edinburgh high risk study—findings after four years: demographic, attainment and psychopathological issues. Schizophr Res 46:1–15
Kay SR, Opler LA (1987) The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 13:507–518
Kingdon D, Turkington D (1994) Cognitive-behavioural therapy for schizophrenia. Hove, England. Lawrence Erlbaum
Kissling W, Hoffler J, et al. (1999) Direct and indirect costs of schizophrenia Fortschr Neurol Psychiatr 67(1):29–36
Klosterkötter J, Hellmich M, Steinmeyer EM, Schultze-Lutter F (2001) Dia gnosing schizophrenia in the initial prodromal phase. Arch Gen Psychiatry 58:158–164
Klosterkötter J, Ruhrmann S, Schultze-Lutter F, et al. (2005) The European Prediction of Psychosis Study (EPOS): integrating early recognition and intervention in Europe. World Psychiatry (in press)
Kohn D, Niedersteberg A, Wieneke A, Bechdolf A, Pukrop R, Ruhrmann S, Schultze-Lutter F, Maier W, Klosterkötter J (2004) Early course of illness in first episode schizophrenia with long duration of untreated illness—a comparative study. Fortschr Neurol Psychiatr 72(2):88–92
Kuipers E, Garety P, Fowler D, Dunn G, et al. (1997) London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis, I: Effects of the treatment phase. Br J Psychiatry 171:319–327
Kuipers E, Fowler D, Garety P, et al. (1997) London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis, III: Follow up and economic evaluation at 18 months. Br J Psychiatry 173:61–68
Lauber C, Nordt C, et al. (2001) Lay recommendations on how to treat mental disorders. Soc Psychiatry Psychiatr Epidemiol 36 (11):53–56
Larsen TK, Bechdolf A, Birchwood M (2003) The concept of schizophrenia and phase specific treatment.Psychological treatment in pre-psychosis and non-responders. J Am Acad Psychoanal Dyn Psychiatry 31(1):209–228
Liebowitz M (1999) Update on the diagnosis and treatment of social anxiety disorder. J Clin Psychiatry 60(Suppl 18):22–26
Maurer K, Könnecke R, Schultze-Lutter F, Häfner H (2000) Early Recognition Inventory. Unpublished Manual and Instrument. Mannheim, Germany
Maurer K, Horrmann F, Schmidt M, Trendler H, Häfner H (2004) The early recognition inventory: structure, reliability and initial results. Schizophr Res 67(Suppl):34
McGlashan TH, Johannessen JO (1996) Early detection and intervention in schizophrenia. Rationale Schizophr Bull 22:201–222
McGorry PD (1998) “A stich in time”. . . the scope for prevention strategies in early psychosis. Eur Arch Psychiatry Clin Neuroscience 248:22–31
McGorry PD, Yung AR, Phillips LJ, et al. (2002) Can first episode psychosis be delayed or prevented? A randomized controlled trial of interventions during the prepsychotic phase of schizophrenia and related psychosis. Arch Gen Psychiatry 59(10):921–928
Miller TJ, McGlashan TH, Rosen JL, Somjee L, Markovich PJ, Stein K, Woods SW (2002) Prospective diagnosis of the initial prodrome for schizophrenia based on the structured interview for prodromal syndromes: preliminary evidence of interrater reliability and predictive validity. Am J Psychiatry 159:863–865
Miller TJ, McGlashan TH, et al. (2003a) Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophr Bull 29(4):703–715
Miller TJ, Zipursky RB, Perkins D, Addington J, Woods SW, Hawkins KA, Hoffman R, Preda A, Epstein I, Addington D, Lindborg S, Marquez E, Tohen M, Breier A, McGlashan TH (2003b) The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. II.Baseline charactersistics of the “prodromal” sample. Schizophr Res 61(1):19–30
Montgomery S, Asberg M (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134:382–389
Morrison AP (2001) The interpretation of intrusions in psychosis: An integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy 29:257–276
Morrison AP, French P, Walford L, Lewis SW, Kilcommons A, Green J, Parker S, Bentall RP (2004) A randomised controlled trial of early detection and cognitive therapy for the prevention of psychosis in people at ultra-high risk. Br J Psychiatry 185:291–297
Mrazek PJ, Haggerty RJ (eds) (1994) Reducing risks for mental disorders: frontiers for preventive intervention research. National Academy Press, Washington DC
Norman RM, Malla AK (2001) Duration of untreated psychosis: a critical examination of the concept and its importance. Psychol Med 31(3):381–400
Nuechterlein KH, Dawson ME (1984) A heuristic vulnerability/stress model of schizophrenic episodes. Schizophr Bull 10:300–312
Overall JE, Gorham DR (1962) the Prief Psychiatric Rating Scale. Psychol Rep 10:799–812
Pantelis C, Velakoulis D, McGorry PD, Wood SJ, Suckling J, Phillips LJ, Yung AR, Bullmore ET, Brewer W, Soulsby B, Desmond P, McGuire PK (2003) Neuroanatomical abnormalities before and after onset of psychosis: A cross-sectional and longitudinal MRI comparison. Lancet 361(9354):281–288
Phillips LJ, Yung AR, McGorry PD (2000) Identification of young people at risk of psychosis: validation of Personal Assessment and Crisis Evaluation Clinic intake criteria. Aust NZ Psychiatry 34(Suppl):164–169
Phillips LJ, Leicester SB, O’Dwyer LE, Francey SM, Koutsogiannis J, Abdel-Baki A, Kelly D, Jones S, Vay C, Yung AR, McGorry PD (2002) The PACE Clinic: Identification and management of young people at ‘ultra’ high risk of psychosis. Journal of Psychiatric Practice 8(5):255–269
Phillips LJ, Francey SM (2004) Changing PACE: Psychological interventions in the pre-psychotic phase. In: McGorry PD, Gleeson J (eds) Psychological Interventions in Early Psychosis: A Practical Treatment Handbook. Chichester: John Wiley and Sons
Pilling S, Bebbington P, Kuipers E, Garety P, Geddes J, Orbach G, Morgan C (2002) Psychological treatment in schizophrenia: I Meta-analysis of family intervention and cognitive behaviour therapy. Psychol Med 32:763–782
Preda A, Miller TJ, Rosen JL, Somjee L, McGlashan TH, Woods SW (2002) Treatment histories of patients with a syndrome putatively prodromal to schizophrenia. Psychiatr Serv 53(3):342–344
Rector N, Beck AT (2001) Cognitive behavioural therapy for schizophrenia: An empirical review. J Nerv Ment Dis 189(5):278–287
Ruhrmann S, Schultze-Lutter F, Klosterkötter J (2003) Early detection and intervention in the initial prodromal phase of schizophrenia. Pharmacopsychiatry (Suppl 3):162–167
Schultze-Lutter F, Wieneke A, et al. (2004) The Schizophrenia Prediction Instrument, Adult version (SPI-A). Schizophr Res 70(Suppl 1):76–77
Sensky T, Turkington D, Kingdon D, et al. (2000) A randomised controlled trial of cognitive-behavioural therapy for persistent symptoms in schizophrenia resistant to medication. Arch Gen Psychiatry 57:165–172
Süllwold L, Herrlich J (1998) Psychologische Behandlung schizophren Erkrankter. Kohlhammer Verlag, Stuttgart Berlin Köln
Tarrier N, Yusupoff L, Kinney C, et al. (1998) Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia. Br Med J 317:303–307
Verdoux H (2001) Have the time come for early intervention in psychosis? Acta Psychiatr Scand 103:321–322
Wells A, Matthews G (1994) Attention and emotion.London: LEA
World Health Organization (WHO) (2001) The World Health Report 2001, Mental Health: New understanding, new hope: Geneva, WHO
Yung AR, Phillips LJ, McGorry PD, et al. (1998) Prediction of psychosis. Br J Psychiatry 172(Suppl 33):14–20
Yung AR, Phillips LJ, McGorry PD, et al. (1998) Can we predict onset of first episode psychosis in a high risk group? Int Clin Psychopharmacol 13(Suppl 1):S23–S30
Yung AR, Phillips LJ, Yuen HP, Francey SM, McFarlane CA, Hallgren M, McGorry PD (2003) Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group. Schizophr Res 60(1):21–23
Yung AR, Phillips LJ, Yuen HP, McGorry PD (2004a) Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features. Schizophr Res 67:131–142
Yung AR, Phillips LJ, Yuen HP, McGorry PD (2004b) Treating schizophrenia in the pre-psychotic phase. Dunitz, London
Zubin J, Spring B (1977) Vulnerability—a new view of schizophrenia. J Abnorm Psychol 86:103–126
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Bechdolf, A., Phillips, L.J., Francey, S.M. et al. Recent approaches to psychological interventions for people at risk of psychosis. Eur Arch Psychiatry Clin Neurosci 256, 159–173 (2006). https://doi.org/10.1007/s00406-006-0623-0
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DOI: https://doi.org/10.1007/s00406-006-0623-0