A Randomized Controlled Trial of Relapse Prevention Therapy for First-Episode Psychosis Patients

Objective: Patients with first-episode psychosis are responsive to acute-phase treatments, but relapse rates are high. This study aimed to evaluate the effectiveness of a psychosocial treatment designed to prevent the second episode of psychosis compared with standardized early psychosis care.

Method: In a randomized controlled trial, conducted at the Early Psychosis Prevention and Intervention Centre and Barwon Health, Australia, a multimodal individual and family cognitive-behavioral therapy for relapse prevention was compared with standardized case management within a specialist early psychosis service. Patients aged 15 to 25 years with a first episode of a DSM-IV psychotic disorder were recruited between November 2003 and May 2005. The main outcome measures were the number of relapses and time to first relapse.

Results: Forty-one first-episode psychosis patients were randomly assigned to the relapse prevention therapy (RPT) and 40 to standardized case management. At the 7-month follow up, the relapse rate was significantly lower in the therapy condition compared to treatment as usual (p = .042) and time to relapse was significantly longer for the RPT condition (p = .03). The number needed to treat was 6 over 7 months.

Conclusion: Interim findings suggest that RPT provided within a specialist early psychosis program was effective in reducing relapse in early psychosis when compared with standardized early psychosis case management.

Trial Registration: www.anzctr.org.au Identifier: ACTRN12605000514606

J Clin Psychiatry 2009;70(4):477-486

https://doi.org/10.4088/JCP.08m04407