Opening the Black Box of Cognitive Behavioural Case Management in Young People at Ultra-High Risk for Psychosis

Poster B101, Friday, October 21, 11:30 am - 1:00 pm, Le Baron

Jessica A. Hartmann1,2, Patrick D McGorry1,2, G. Paul Amminger1,2, Hok Pan Yuen1,2, Lieuwe de Haan3, Stefan Smesny4, Connie Markulev1,2, Gregor E. Berger5, Miriam M. Schäfer1,2, Merete Nordentoft6, Anita Riecher-Rössler7, Barnaby Nelson1,2; 1Orygen, the National Centre of Excellence in Youth Mental Health, 2The University of Melbourne, Melbourne, Australia, 3Department of Psychiatry, Academic Medical Centre, University of Amsterdam, The Netherlands, 4Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany, 5University Hospital of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland, 6Research Unit, Mental Health Centre Copenhagen, University of Copenhagen, Denmark, 7University of Basel Psychiatric Clinics, Basel, Switzerland

Cognitive behavioural case management (CBCM) may provide an effective pre-emptive treatment option in people at ultra-high risk (UHR) for psychosis. However, it is not clear which particular CBCM components are most effective and should be routinely incorporated. This study aimed to characterise the progression of a CBCM regimen and to examine the relationship between specific CBCM components and symptomatic/functional outcome. As part of a large trial (Neurapro-E study), participants were provided with a manualised form of CBCM for up to 12 months. CBCM components were registered post-session by the clinician using a checklist. Clinical status and symptomatic/functional outcome was assessed at baseline and re-assessed monthly (month 1-6) or trimonthly (month 6-12). Overall, 269 participants received 12.1 (SD 6.2) CBCM sessions on average. The most prevalent strategies implemented were mental state and symptom monitoring (67%), assessment of symptoms (46%) and stress management (44%). Regression analyses suggest that a greater number of provided sessions predicted increased total depression (MADRS) and general psychopathology scores (BPRS) at 12 months (p<.01). Our preliminary findings indicate that a prominent aspect of cognitive behavioural intervention for UHR patients is stress management, in line with stress-vulnerability models of psychosis onset, as well as monitoring symptom progression. The relationship between more CBCM sessions and worse symptom scores at 12 month follow-up was likely driven by patients with greater clinical need and worse symptom profile. Further analyses to be presented at the conference will address whether particular components of CBCM relate to particular aspects of clinical outcome.

Topic Area: Psychosocial Interventions

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