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A major trial has prompted calls for a re-appraisal of the antipsychotic “early intervention” model for schizophrenia after it found low transition rates to psychosis and significant benefits from early intervention for psychosis.
While Australian psychiatrists including Professor Patrick McGorry have championed early intervention for people at high risk of psychosis, a study of 288 such patients in the UK found that transition rates were only around 8% and many patients recovered without any active treatment.
The study, in the BMJ (online April 5) found that early intervention with CBT did not reduce the already low rates of transition or symptom-related distress, but it was effective in reducing the severity of psychosis.
The study authors say the lack of any effect of early intervention on transition to psychosis is disappointing, but the low transition rates are reassuring and show that young people can be given “an important and optimistic message” about their prognosis.
“Our observations also suggest that a review of the ultra high risk strategy ... is required,” they say.
The findings show it is highly premature to consider adding a “psychosis risk” category to DSM diagnostic criteria, and also put in question the ethics of using antipsychotics in young people deemed at high risk of psychosis.
“We would suggest that antipsychotics are not delivered as a first line treatment to people meeting the criteria for being in an at-risk mental state,” they conclude.
