Abstract
BackgroundAdolescent-onset psychosis is associated with more severe symptoms and poorer outcomes than adult-onset psychosis. The National Institute for Clinical Excellence (NICE) recommend that adolescents with first episode psychosis (FEP) should be offered a combination of antipsychotic medication (APs), cognitive behavioural therapy (CBT) and family intervention (FI). The evidence for APs in treating psychosis is limited in adolescents compared to adults. Nevertheless, it indicates that APs can reduce overall symptoms in adolescents but may cause more severe side effects, including cardiovascular and metabolic effects, than in adults. CBT and FI can improve outcomes in adults, but there are no studies of psychological interventions (PI) in patients under 18 years old. Given this limited evidence base, NICE made a specific research recommendation for determining the clinical and cost effectiveness of APs versus PI versus both treatments for adolescent FEP.Methods/designThe current study aimed to establish the feasibility and acceptability of conducting such a trial by recruiting 14–18-year-olds with a first episode of psychosis into a feasibility prospective randomised open blinded evaluation (PROBE) design, three-arm, randomised controlled trial of APs alone versus PI alone versus a combination of both treatments. We aimed to recruit 90 participants from Early Intervention and Child and Adolescent Mental Health Teams in seven UK sites. APs were prescribed by participants’ usual psychiatrists. PI comprised standardised cognitive behavioural therapy and family intervention sessions.DiscussionThis is the first study to compare APs to PI in an adolescent population with FEP. Recruitment finished on 31 October 2018. The study faced difficulties with recruitment across most sites due to factors including clinician and service-user treatment preferences.Trial registrationCurrent controlled trial with ISRCTN, ISRCTN80567433. Registered on 27 February 2017.
Highlights
Adolescent-onset psychosis is associated with more severe symptoms and poorer outcomes than adult-onset psychosis
Adolescentonset psychosis and schizophrenia is associated with significant societal costs and young people with psychosis and schizophrenia accounted for 25% of adolescent psychiatric inpatient admissions in England and Wales between 1998 and 2004 [7]
Embracing diagnostic uncertainty is essential when working with people with a first episode of psychosis (FEP), as premature diagnosis may lead to pessimism and poorer outcomes [8]; clients may perceive the term “psychosis” as more acceptable than a diagnostic label such as “schizophrenia” [8]
Summary
Adolescent-onset psychosis is associated with more severe symptoms and poorer outcomes than adult-onset psychosis. The National Institute for Clinical Excellence (NICE) recommend that adolescents with first episode psychosis (FEP) should be offered a combination of antipsychotic medication (APs), cognitive behavioural therapy (CBT) and family intervention (FI). The evidence for APs in treating psychosis is limited in adolescents compared to adults. CBT and FI can improve outcomes in adults, but there are no studies of psychological interventions (PI) in patients under 18 years old. Given this limited evidence base, NICE made a specific research recommendation for determining the clinical and cost effectiveness of APs versus PI versus both treatments for adolescent FEP. Embracing diagnostic uncertainty is essential when working with people with a first episode of psychosis (FEP), as premature diagnosis may lead to pessimism and poorer outcomes [8]; clients may perceive the term “psychosis” as more acceptable than a diagnostic label such as “schizophrenia” [8]
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