A Sequential Adaptive Intervention Strategy Targeting Remission and Functional Recovery in Young People at Ultrahigh Risk of Psychosis

作者：Patrick D. McGorry, Cristina Mei, G. Paul Amminger, Hok Pan Yuen, Melissa Kerr, Jessica Spark, Nicky Wallis, Andrea Polari, Shelley Baird, Kate Buccilli, Sarah-Jane A. Dempsey, Natalie Ferguson, Melanie Formica, Marija Krcmar, Amelia L. Quinn, Yohannes Mebrahtu, Arlan Ruslins, Rebekah Street, Cassandra Wannan, Lisa B. Dixon, Cameron Carter, Rachel Loewy, Tara A. Niendam, Martha Shumway, Barnaby Nelson · 发表于：JAMA Psychiatry · 年份：2023 · DOI：10.1001/jamapsychiatry.2023.1947 · 被引用次数：44 · 研究领域：Schizophrenia research and treatment、Mental Health and Psychiatry、Sleep and related disorders

Importance: Clinical trials have not established the optimal type, sequence, and duration of interventions for people at ultrahigh risk of psychosis. Objective: To determine the effectiveness of a sequential and adaptive intervention strategy for individuals at ultrahigh risk of psychosis. Design, Setting, and Participants: The Staged Treatment in Early Psychosis (STEP) sequential multiple assignment randomized trial took place within the clinical program at Orygen, Melbourne, Australia. Individuals aged 12 to 25 years who were seeking treatment and met criteria for ultrahigh risk of psychosis according to the Comprehensive Assessment of At-Risk Mental States were recruited between April 2016 and January 2019. Of 1343 individuals considered, 342 were recruited. Interventions: Step 1: 6 weeks of support and problem solving (SPS); step 2: 20 weeks of cognitive-behavioral case management (CBCM) vs SPS; and step 3: 26 weeks of CBCM with fluoxetine vs CBCM with placebo with an embedded fast-fail option of ω-3 fatty acids or low-dose antipsychotic medication. Individuals who did not remit progressed through these steps; those who remitted received SPS or monitoring for up to 12 months. Main Outcomes and Measures: Global Functioning: Social and Role scales (primary outcome), Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms, Montgomery-Åsberg Depression Rating Scale, quality of life, transition to psychosis, and remission and relapse rates. Results: The s...