S23. EFFICACY OF COGNITIVE-BEHAVIORAL SOCIAL SKILLS TRAINING IMPROVING SYMPTOMS AND FUNCTIONING IN PATIENTS WITH EARLY-ONSET PSYCHOSIS: A RANDOMIZED CONTROLLED TRAIL

Abstract

BackgroundThe onset of a psychotic disorder before age 18 (early-onset psychosis, EOP) is a marker of greater clinical severity and poor outcome. There is a lack of studies examining the efficacy of psychological treatment in this population. The Cognitive-Behavioral Social Skills Training (CBSST) is an evidence-based psychological intervention for patients with schizophrenia. OBJECTIVE: To analyze the efficacy of the adolescent version of CBSTT (CBSST-Adolt) versus an active psychological intervention, administered during the critical period, to improve symptoms and functioning in patients with EOP.MethodsRandomized controlled trail (RCT) of the adolescent version of the CBSST-Adol compared to an active control intervention. Interventions: The CBSTT-Adol included the 3 original modules (cognitive abilities, social skills, problem-solving skills) but number of sessions was reduced. It was administered in small groups. The active control intervention (PSYCHOED-Adol) included 3 modules (psychoeducation, relapse prevention, healthy life style) with the same format and number of sessions. The language and examples were adapted for adolescents in both interventions. Inclusion criteria: schizophrenia spectrum disorder (schizophrenia, schizoaffective disorder, psychotic disorder not otherwise specified), diagnosed before 18; being in the critical period of the illness (first 5 years after the onset); being clinically stabilized (outpatients). Exclusion criteria: IQ<70; having a substance dependence disorder; having a neurological disorder. Procedure: Patients (n=30) were randomized to both branches of the study after the baseline assessment and were re-assessed after the treatment (CBSST-Adol n=16, PSYCHOED-Adol n=14). The study included a group of healthy controls (HC, n=20) matched for age and sex, who were assessed only at baseline. Pharmacological treatment was supervised by patients’ clinical psychiatrists. Instruments: PANNS, GAF, GF:Role, GF:Social, Life Skills Profile (LSP), Caregivers’ Burden Inventory (CBI). Statistical analyses: T-test was used for comparisons between patients and HC. Lineal generalized models were run for examining group differences after the treatment between CBSST-Adol and PSYCHOED-Adol, controlling for baseline scores. Intention-to-treat analyses.ResultsThere were no significant differences in sex or age, but in socioeconomic status (p<0.001), between HC and EOP subjects. Patients with EOP had lower scores in all areas of functioning (global, role, social, daily living skills, caregivers’ burden, p<0.001). There were no significant differences in any of the baseline characteristic between patients allocated in the CBSST-Adol and the PSYCHOED-Adol groups (sociodemographic variables, symptoms, functioning, pharmacological treatment, duration of the illness, p>0.05). There was a similar rate of dropouts during the trail in both branches of the study (31% and 29%, p>0.05). Improvements in clinical symptoms (PANSS total, p=0.045; PANSS positive symptoms, p=0.009) and functioning (GAF, p=0.002; GF:Social, p=0.025, CBI, p=0.020) were found at post-treatment in all sample. However, there was no a superior effect of CBSST-Adol compared to PSYCHOED-Adol in any variable. There was only a trend to a higher improving of the Communication and social contact subscale of the Life Skills Profile in the CBSST-Adol intervention (p=0.061).DiscussionThe results support the efficacy of psychological intervention improving symptoms and functioning in EOP. We find a similar positive effect after the treatment in both CBSTT-Adol and PSYCHOED-Adol interventions. Main limitations: not having a non-active control group and the sample size.