Early phase treatment for the prevention of relapse in first episode schizophrenia.

The proposed programme focuses on developing interventions to target known risk factors for relapse and poor health, in young people with early psychosis. The interventions are linked by a common theoretical framework, the Self-regulatory Model of Illness Management and will be designed for optimum delivery by the national network of Early Psychosis Teams. Aims: To develop four phase-specific interventions to prevent relapse of psychosis and/or deterioration in physical health, in people who have experienced a first episode of psychosis. Background:Schizophrenia represents a substantial cost to society because it is: common, begins in adolescence or early adulthood, and often causes life long impairment.The first 3 years are a “critical period” in which the course of the illness is determined. Hence, under the NHS Plan, specialist early psychosis teams now care for people who develop psychosis between 14 and 35 for the first 3 years of their illness. However, in a recent review we have shown that there are no evidence-based treatments specifically designed for the early years. This is important, because emerging evidence shows that in the critical period it is vital to avoid relapse and prevent deterioration in physical health, as both can drastically reduce the chances of full recovery. Our proposed interventions are based on our previous research in this field, and may be understood within a common theoretical framework (the Self-regulatory Model of Disease). They are designed to address key risk factors for relapse and deterioration in health.Research Plans: All the interventions included in the HeLPER programme are complex and will therefore be evaluated in line with The Medical Research Council (MRC) Framework for the development and evaluation of complex interventions. The interventions we propose to evaluate are:(1) Motivational Interviewing and Cognitive Behavioural Therapy.This intervention is directed at substance misuse, a risk factor for relapse and deterioration in health. Motivational Interviewing helps people to recognise the advantages and disadvantages of substance use, whilst Cognitive Behaviour Therapy (CBT) helps the person to understand and manage psychotic experiences. After adapting the intervention for young people with first episode psychosis, we intend to carry out a Phase 2 exploratory trial, involving 80 participants.(2) Cognitive Remediation (CR) targets cognitive deficits that predispose to poor insight and hamper participation with other therapies, such as cognitive therapy. We propose to use CR based on previously successful techniques to target attention, rigid thinking and metacognition. Preliminary qualitative and quantitative work will optimise the CR so that it can be delivered at home over the internet. Then we will carry out an exploratory (MRC Phase II) trial, involving 60 participants to see if initial reciept of CR improves insight and enhances the effectiveness of subsequent cognitive therapy.(3) Guided Self-management Program is designed to address the risk factors of poor adherence and side effects. It has four key elements: (i) good information for patients which contains lay experiences as well as traditional knowledge; (ii) a professional response which fosters partnership working; (iii) negotiation of a self-management; (iv) open access to health professional providing care. We aim to demonstrate the feasibility of providing guided self-management to Early Intervention Service clients using 3g mobile communications technology linking them to a non-medical independent prescriber.(4) The Health Maintenance Intervention is designed to address the risk to physical health of neuroleptic side-effects such as obesity and diabetes. The intervention is based on the Health Education Group approach that we have developed, augmented by the addition of a graded exercise component. After adapting the intervention to meet the needs of people with first episode psychosis we will carry out an ex