Detection and early intervention to target social recovery in young people with early psychosis and At Risk Mental States who are NEET: the PRODIGY and SUPEREDEN3 trials

Presentation First Author: 
David Fowler

It is now widely recognised that most socially disabling severe mental health problems begin in adolescence. A series of retrospective studies have consistently shown that severe mental illness is often preceded by social decline, that this often becomes stable, and that such pre-morbid social disability is predictive of long-term outcomes. Young people who have symptoms of severe mental illness and are socially withdrawn and Not in Education Employment or Training may be at highest risk. In this paper we describe an ongoing research programme to detect and intervene to improve social recovery amongst this group. The programme includes two large multi-centre trials of social recovery cognitive behaviour therapy. In the SUPEREDEN3 trial we are undertaking a definitive trial of social recovery cognitive behaviour therapy recruiting participant who still show severe social disability despite receiving early intervention for first episode psychosis services. We have recruited 150 cases to this trial. The range of syndromes which contribute to persisting and delayed social recovery in this study include persistent psychosis particularly paranoia and voices, negative symptoms and depression, and social anxiety. The form of cognitive behaviour therapy used in this study incorporates multisystemic and assertive case management techniques as well as CBT. Our work in this multicentre trial in the UK will provide an evidence base for a second step intervention for those in early intervention services who are still showing delayed social recovery problems at one year after inception. We have also observed that social recovery problems typically start early, often many years before the onset of psychosis. An approach targeting social disability therefore also offers a novel strategy for identifying and addressing high risk at an earlier stage. In the PRODIGY trial our approach to identifying high risk cases focusses primarily on adolescents and young people who are Not in Education, Employment and Training and who are showing lifestyle patterns of extreme low activity and at risk mental state or associated severe mental illness symptoms . Our therapy is then addressed at improving social recovery as well as managing symptoms. To date we have recruited over 100 participants to this UK multicentre trial. We describe baseline date and early results from both qualitative and quantitative studies from both trials and reflect on detection and intervention strategies. This paper links to the presentations on this topic by Professors Jan Scott (UK) and Ian Hickie (Australia) on the same topic.

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Date of Presentation: 
9th Oct 2015
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