anti-psychotics should be first-line treatment for people at risk
of psychosis, urge researchers
April 6, 2012
by Angela Hussain
should not be used as a first-line treatment for people at risk
of psychosis, including schizophrenia, researchers have claimed.
Instead, “benign” active monitoring or cognitive behavioural
therapy (CBT) should be the favoured first intervention, said researchers.
Their study had found that just 8% of people judged to be “at
high risk” of developing psychosis and who were not prescribed
medication actually went on to be diagnosed with the condition.
This was an “optimisitic” finding, wrote the researchers
yesterday in the British
“This low rate of transition to psychosis…and recovery
from psychosis and affective symptoms is clearly an important and
optimistic message to convey,”
For the research, a total of 288 people aged 14-35 who had sought
psychiatric help and were judged to be at high risk of psychosis
Of these, 144 had 23 weekly cognitive therapy sessions over six
months, and their mental state was monitored. The other 144 only
had their mental state monitored.
Overall, just 8% (23 out of 288) of both groups went on to be diagnosed
with psychosis – a figure that was “lower than expected”.
Although distress from psychotic symptoms did not differ for each
group, symptom severity was significantly reduced for those who
had cognitive therapy.
The researchers concluded that because of the known detrimental
effects, such as brain damage, of anti-psychotics cognitive-behavioural
therapy should instead be considered as a first-line intervention.
“Cognitive therapy reduces the severity of psychotic experiences
without the use of anti-psychotic drugs, which should provide the
benefits of symptom-based improvement without the associated risks
of serious side-effects,” they wrote.
basis of low transition rates, high responsiveness to simple interventions
such as monitoring, a specific effect of cognitive therapy on the
severity of psychotic symptoms, and the toxicity associated with
antipsychotic drugs, we would suggest that anti-psychotics are not
delivered as a first line treatment to people meeting the criteria
for being in an at risk mental state.”
The researchers stated that the low rate of transition to psychosis
should also encourage a “normalising, non-catastrophic”
perspective on psychosis.
They concluded: “Any treatment should largely be needs-driven
on the basis of what problems are presented and prioritised by service
something that cognitive therapy is suited to, given its collaborative,
Reseachers also encouraged the use of “benign” active
monitoring of people at risk of psychosis over a 12-month period,
without therapeutic intervention, as it encouraged active patient
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