The Experience of Sleep Problems and Their Treatment in Young People at Ultra-High Risk of Psychosis: A Thematic Analysis

BackgroundEffective interventions, targeting key contributory causal factors, are needed to prevent the emergence of severe mental health problems in young people. Insomnia is a common clinical issue that is problematic in its own right but that also leads to the development and persistence of psychotic experiences. The implication is that treating sleep problems may prevent the onset of psychosis. We collected initial case series data with 12 young people at ultra-high-risk of psychosis. Post-intervention, there were improvements in sleep, depression and psychotic experiences. Now we test the feasibility of a randomised controlled trial, with a clinical aim to treat sleep problems and hence reduce depression, psychotic experiences, and prevent transition to psychosis.Methods and analysisA randomised controlled feasibility trial will be conducted. Forty patients aged 14 to 25 years who are at ultra-high-risk of psychosis and have sleep disturbance will be recruited from National Health Service (NHS) mental health services. Participants will be randomised to receive either a novel, targeted, youth-focussed sleep intervention in addition to usual care or usual care alone. Assessor-blinded assessments will be conducted at baseline, 3 months (post-intervention) and 9 months (follow-up). The eight-session psychological intervention will target the key mechanisms which disrupt sleep: circadian rhythm irregularities, low sleep pressure, and hyperarousal. To gain an in-depth understanding of participants’ views on the acceptability of the intervention and study procedures, 16 participants (n=10 intervention, n=6 control) will take part in qualitative interviews. Analyses will focus on feasibility outcomes (recruitment, retention, and treatment uptake rates) and provide initial CI estimates of intervention effects. Thematic analysis of the qualitative interviews will assess the acceptability of the intervention and trial procedures.Ethics and disseminationThe trial has received ethical approval from the NHS Health Research Authority. Findings will be disseminated through peer-reviewed publications, conference presentations, and lay networks.Trial registration numberISRCTN85601537.

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Treating sleep problems in young people at ultra-high-risk of psychosis

http://isrctn.com/ ◽

10.1186/isrctn85601537 ◽

2020 ◽

Author(s):

Felicity Waite

Keyword(s):

High Risk ◽

Young People ◽

Sleep Problems ◽

Ultra High Risk

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Treating Sleep Problems in Young People at Ultra-High Risk of Psychosis: A Feasibility Case Series

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465817000601 ◽

2017 ◽

Vol 46 (3) ◽

pp. 276-291 ◽

Cited By ~ 17

Author(s):

Jonathan Bradley ◽

Daniel Freeman ◽

Eleanor Chadwick ◽

Allison G. Harvey ◽

Bradley Mullins ◽

...

Keyword(s):

Mental Health ◽

High Risk ◽

Young People ◽

Sleep Disturbance ◽

Sleep Problems ◽

Psychological Intervention ◽

Case Series ◽

Psychotic Experiences ◽

Time Activity ◽

Ultra High Risk

Background: Our view is that sleep disturbance may be a contributory causal factor in the development and maintenance of psychotic experiences. A recent series of randomized controlled intervention studies has shown that cognitive-behavioural approaches can improve sleep in people with psychotic experiences. However, the effects of psychological intervention for improving sleep have not been evaluated in young people at ultra-high risk of psychosis. Improving sleep might prevent later transition to a mental health disorder. Aims: To assess the feasibility and acceptability of an intervention targeting sleep disturbance in young people at ultra-high risk of psychosis. Method: Patients were sought from NHS mental health services. Twelve young people at ultra-high risk of psychosis with sleep problems were offered an eight-session adapted CBT intervention for sleep problems. The core treatment techniques were stimulus control, circadian realignment, and regulating day-time activity. Participants were assessed before and after treatment and at a one month follow-up. Results: All eligible patients referred to the study agreed to take part. Eleven patients completed the intervention, and one patient withdrew after two sessions. Of those who completed treatment, the attendance rate was 89% and an average of 7.6 sessions (SD = 0.5) were attended. There were large effect size improvements in sleep. Post-treatment, six patients fell below the recommended cut-off for clinical insomnia. There were also improvements in negative affect and psychotic experiences. Conclusion: This uncontrolled feasibility study indicates that treating sleep problems in young people at ultra-high of psychosis is feasible, acceptable, and may be associated with clinical benefits.

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Faculty Opinions recommendation of Young people at ultra high risk for psychosis: a research update.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13854959.15293059 ◽

2012 ◽

Author(s):

Jean Addington

Keyword(s):

High Risk ◽

Young People ◽

Ultra High Risk

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Predictors of treatment response in young people at ultra-high risk for psychosis who received long-chain omega-3 fatty acids

Translational Psychiatry ◽

10.1038/tp.2014.134 ◽

2015 ◽

Vol 5 (1) ◽

pp. e495-e495 ◽

Cited By ~ 27

Author(s):

G P Amminger ◽

A Mechelli ◽

S Rice ◽

S-W Kim ◽

C M Klier ◽

...

Keyword(s):

Fatty Acids ◽

High Risk ◽

Young People ◽

Treatment Response ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

Ultra High Risk ◽

Long Chain

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Randomized Controlled Trial of Interventions for Young People at Ultra High Risk for Psychosis

The Journal of Clinical Psychiatry ◽

10.4088/jcp.08m04979ora ◽

2010 ◽

Vol 72 (04) ◽

pp. 430-440 ◽

Cited By ~ 92

Author(s):

Alison R. Yung ◽

Lisa J. Phillips ◽

Barnaby Nelson ◽

Shona M. Francey ◽

Hok PanYuen ◽

...

Keyword(s):

Randomized Controlled Trial ◽

High Risk ◽

Young People ◽

Controlled Trial ◽

Randomized Controlled ◽

Ultra High Risk

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T34. THE IMPACT OF ANTIDEPRESSANT USE ON THE TRANSITION TO PSYCHOSIS RATE IN THE NEURAPRO TRIAL

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa029.594 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S244-S245

Author(s):

Monika Schlögelhofer ◽

Patrick D McGorry ◽

Barnaby Nelson ◽

Maximus Berger ◽

Connie Markulev ◽

...

Keyword(s):

High Risk ◽

Young People ◽

Rating Scale ◽

Antidepressant Medication ◽

Rank Test ◽

Omega 3 ◽

Ultra High Risk ◽

Antidepressant Use ◽

Randomised Controlled ◽

The Impact

Abstract Background Over the last two decades, several randomised controlled trials (RCTs) have indicated that preventive psychosocial, pharmacologic (Van der Gaag et al. 2013), and nutritional interventions (Amminger et al. 2010) are likely to be beneficial in people at ultra-high risk (UHR) of psychosis, in terms of delaying or preventing a transition to psychosis. Antidepressant medication is commonly prescribed in young people at UHR for psychosis; however, the evidence regarding its efficacy for psychosis prevention is limited (Fusar-Poli et al. 2007; Cornblatt et al. 2007; Fusar-Poli et al. 2015). The main aim of the present study is to investigate the impact of concomitant AD medication on the transition to psychosis rate in young people at ultra-high risk of psychosis who participated in the NEURAPRO trial (McGorry et al. 2017). Methods In this secondary analysis, data from 304 participants of a multicenter, double-blind, placebo-controlled, randomized clinical trial (NEURAPRO) of omega-3 polyunsaturated fatty acids (omega-3 PUFAs) were included. During the trial, concomitant antidepressant medication was permitted for treatment of moderate to severe major depressive disorder (a score of ≥ 21 on the Montgomery-Asberg Depression Rating Scale, MADRS) in all participants. Results Of 304 participants, 189 (62.2%) were treated with ADs. 98 (64.1%) of those were in the omega-3 group and 91 (60.3%) in the placebo group. The transition rate to psychosis was higher in individuals who received AD treatment (13.2%; 25 of 189) as in individuals without ADs (6.1%; 7 of 115). The Kaplan-Meier survival curve estimated a group difference of X2 = 3.237, P = .072 (log rank test). Discussion Antidepressants are widely used in early psychosis. This analysis does not support the view that antidepressants may have reduced the transition to psychosis rate in this cohort. The findings are limited by the fact that antidepressants were prescribed based on clinical discretion. A randomised controlled trial is needed to determine whether antidepressants have a role in prevention of transition to psychosis.

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Randomized Controlled Trial of Interventions for Young People at Ultra-High Risk of Psychosis: Study Design and Baseline Characteristics

Australian & New Zealand Journal of Psychiatry ◽

10.1080/00048670903107625 ◽

2009 ◽

Vol 43 (9) ◽

pp. 818-829 ◽

Cited By ~ 52

Author(s):

Lisa J. Phillips ◽

Barnaby Nelson ◽

Hok Pan Yuen ◽

Shona M. Francey ◽

Magenta Simmons ◽

...

Keyword(s):

High Risk ◽

Young People ◽

Cognitive Therapy ◽

Controlled Trial ◽

Treatment Groups ◽

Mixed Support ◽

Ultra High Risk ◽

Supportive Counselling ◽

Baseline Characteristics ◽

The Impact

Objective: Intervention during the pre-psychotic period of illness holds the potential of delaying or even preventing the onset of a full-threshold disorder, or at least of reducing the impact of such a disorder if it does develop. The first step in realizing this aim was achieved more than 10 years ago with the development and validation of criteria for the identification of young people at ultra-high risk (UHR) of psychosis. Results of three clinical trials have been published that provide mixed support for the effectiveness of psychological and pharmacological interventions in preventing the onset of psychotic disorder. Method: The present paper describes a fourth study that has now been undertaken in which young people who met UHR criteria were randomized to one of three treatment groups: cognitive therapy plus risperidone (CogTher + Risp: n = 43); cognitive therapy plus placebo (CogTher + Placebo: n = 44); and supportive counselling + placebo (Supp + Placebo; n = 28). A fourth group of young people who did not agree to randomization were also followed up (monitoring: n = 78). Baseline characteristics of participants are provided. Results and conclusion: The present study improves on the previous studies because treatment was provided for 12 months and the independent contributions of psychological and pharmacological treatments in preventing transition to psychosis in the UHR cohort and on levels of psychopathology and functioning can be directly compared. Issues associated with recruitment and randomization are discussed.

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