Early Intervention & Prevention
Early Intervention & Prevention… Psychotic disorders, such as schizophrenia, affect approximately 1 in 100 people, and can be severely disabling. Psychosis creates a considerable financial, social and personal burden and is amongst the greatest challenges for the NHS. Studies have demonstrated the possibility of finding people who are at high risk of developing psychosis (leading to diagnoses such as schizophrenia), which opens up the prospect of preventing psychosis. There is also evidence that early intervention for psychosis can reduce burden and disability and is associated with better social and clinical outcomes.
Our research at PRU has focused on four areas within early intervention & prevention:
Professor Alison Yung developed the approach to identifying people as being at high risk of developing psychosis and has conducted numerous studies while based in Melbourne, Australia. She moved to Manchester in 2013 and has been a member of The Psychosis Research Unit since her arrival in the UK. She has also developed a structured clinical interview for the assessment of people at high risk of psychosis (the Comprehensive Assessment of At-Risk Mental States: CAARMS).
Tony Morrison and Paul French conducted the world’s first clinical trial using only a psychological intervention (CBT, which should have less severe side effects than antipsychotic medication), which found a sample of people at high-risk, who are distressed and help-seeking because of incipient or attenuated symptoms, and demonstrated that cognitive therapy seems to prevent or delay the development of psychosis, in comparison with regular monitoring (Morrison et al, 2004). This subsequently led to us conducting the world’s largest clinical trial of this kind (Morrison et al.: Early Detection and Intervention Evaluation for people at risk of psychosis EDIE-2: A multisite randomised controlled trial of cognitive therapy for at risk mental states. British Medical Journal 2012; 344:e2233). Six RCTs, including these two, were reviewed by NICE, who concluded that psychosis is preventable, which has enormous implications because of the considerable personal, economic and social costs of this disorder (Stafford et al, BMJ, 2013). The NICE Guidelines For Young People CG155 and Adults CG178 now recommend that people at risk of developing psychosis are offered CBT.
More recently, Sophie Parker and Paul French have applied a similar strategy to the identification and prevention of bipolar disorder in people at high risk of developing bipolar disorder. This approach is currently being evaluated within the BART trial. They are also involved in the current PRODIGY trial, which is evaluating a social recovery orientated CBT for young people who are at risk of a range of emerging psychological difficulties.
There is considerable evidence that early intervention for psychosis is associated with better outcomes for people. The Psychosis Research Unit has strong links with Greater Manchester West NHS Trust’s Early Intervention Service, which was originally established by Tony Morrison and Paul French, who remains Associate Director for Early Intervention for GMW. The NICE guidelines for young people (CG155) and adults (CG178) with psychosis now recommend that all people experiencing a first episode of psychosis should have rapid access to such early intervention services. Our research has focused on evaluating the use of exercise as an intervention to promote well-being in young people with early psychosis (led by Alison Yung) and the development of a recovery-focused CBT for people with early bipolar disorder (led by Steve Jones from the Spectrum Centre, University of Lancaster).
In addition to Alison Yung’s trial of exercise for young people with psychosis, members of the Psychosis Research Unit have been focusing on improving awareness and prevention of physical health problems in this population. Dr David Shiers OBE, who joined our unit in 2014, in collaboration with Paul French, Sophie Parker, SURG members and other service users and carers, as well as colleagues from clinical services, have developed an approach called ‘getting it right from the start.