Family-focused treatment for adolescents and young adults at high risk for psychosis: results of a randomized trial

Abstract

Objective: Longitudinal studies have begun to clarify the phenotypic characteristics of adolescents and young adults at clinical high risk for psychosis. This 8-site randomized trial examined whether a 6-month program of family psychoeducation was effective in reducing the severity of attenuated positive and negative psychotic symptoms and enhancing functioning among individuals at high risk.

Method: Adolescents and young adults (mean age 17.4 ± 4.1 years) with attenuated positive psychotic symptoms, brief and intermittent psychosis, or genetic risk with functional deterioration were randomly assigned to 18 sessions of family-focused therapy for individuals at clinical high risk (FFT-CHR) in 6 months or 3 sessions of family psychoeducation (enhanced care [EC]). FFT-CHR included psychoeducation about early signs of psychosis, stress management, communication training, and problem-solving skills training, whereas EC focused on symptom prevention. Independent evaluators assessed participants at baseline and 6 months on positive and negative symptoms and social-role functioning.

Results: Of 129 participants, 102 (79.1%) were followed up at 6 months. Participants in FFT-CHR showed greater improvements in attenuated positive symptoms over 6 months than participants in EC (F1,97 = 5.49, p = .02). Negative symptoms improved independently of psychosocial treatments. Changes in psychosocial functioning depended on age: participants more than 19 years of age showed more role improvement in FFT-CHR, whereas participants between 16 and 19 years of age showed more role improvement in EC. The results were independent of concurrent pharmacotherapy.

Conclusion: Interventions that focus on improving family relationships may have prophylactic efficacy in individuals at high risk for psychosis. Future studies should examine the specificity of effects of family intervention compared to individual therapy of the same duration and frequency. Clinical trial registration information-Prevention Trial of Family Focused Treatment in Youth at Risk for Psychosis; https://ichgcp.net/clinical-trials-registry/NCT01907282" title="See in ClinicalTrials.gov">NCT01907282.

Keywords: attenuated psychotic symptoms; early warning signs; family therapy; psychoeducation; schizophrenia.

Copyright © 2014 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

CONsolidated Standards of Reporting Trials (CONSORT) Diagram

Figure 2

Effects of family-focused treatment for individuals at clinical high risk (FFT-CHR) and enhanced care (EC) on positive symptoms over 6 months. SOPS = Scale of Prodromal Symptoms. The values are adjusted means and standard errors from intent-to-treat mixed-effect regression models. The treatment by time interaction was significant (F[1, 97] = 5.49, p = .02; n=102).

Figure 3

Effects of family-focused treatment for individuals at clinical high risk (FFT-CHR) and enhanced care (EC) on Global Assessment of Functioning (GAF) scores over 6 months. The values are adjusted means and standard errors from intent-to-treat mixed-effect regression models. The three-way interaction between treatment group, age group, and time was significant (F[2,92]=5.72, p=.005, n=102).