Family intervention may attenuate early psychosis

An intervention based around family psychoeducation reduces symptoms and improves functioning in patients at clinical high risk (CHR) of psychosis or experiencing early first-episode psychosis, say researchers.

The intervention, called Family-aided Assertive Community Treatment (FACT), incorporates psychoeducational multifamily group therapy, assertive community treatment, supported education and employment and medication where needed, with family therapy being the mainstay of the intervention.

The current study included 337 patients, aged between 12 and 25 years, with positive symptoms, negative symptoms or both on the Scale of Prodromal Symptoms. All 250 patients with a total positive symptom score of at least 7 points received the FACT intervention, while those with lower scores received monthly follow-up phone calls and medication if it became necessary.

Patients in the FACT group were further divided into those at CHR and those experiencing frank psychotic symptoms for the preceding 30 days or less (n=45). The study authors William McFarlane (Maine Medical Center Research Institute, Portland, USA) and co-workers remark that, unexpectedly, they found the FACT intervention to be more effective for the early psychosis group than the CHR group.

At 24 months, positive symptom scores in the CHR and early psychosis groups were significantly less than expected based on the change in untreated patients, but the difference between expected and actual values was markedly larger in the early psychosis group than the CHR group.

The same pattern emerged for negative symptoms and for disorganized and general symptoms, with the effect of treatment being significant in the early psychosis group with a trend towards a beneficial effect in the CHR group.

During follow-up, 20.6% of patients in the FACT group increased their participation in school or work, compared with 7.0% of those in the control group, the researchers write in Schizophrenia Bulletin.

“These results strengthen the evidence that early intervention to prevent onset or progression of psychosis in youth is effective, warrants expansion of practice, and constitutes an advance for public health”, they say.

The rates of conversion to psychosis over 2 years were 2.3% in the control group and 6.3% in the CHR subgroup, which McFarlane et al say “compares favorably to the 29% found in the most recent meta-analysis of untreated naturalistic or standard treatment control samples and the 7.6% 1-year rate in treated subsamples in randomized controlled trials to date.”

They conclude that, “early intervention, particularly prior to onset of frank psychosis, could lead to reduction in total burden of disease.”

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