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Cognitive therapy may reduce psychotic symptom severity but not risk of transition to psychosis in young people at high risk

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Question: Is cognitive therapy effective in preventing transition to psychosis and reducing symptom severity in young people at high risk for schizophrenia and other psychoses?

Patients: 288 participants aged 14–35 years (mean 20.7 years), at high risk of psychosis and seeking help for symptoms. High psychosis risk was defined as experiencing brief limited intermittent psychotic symptoms, attenuated psychotic symptoms or state plus trait factors and assessed using the comprehensive assessment of the at risk mental state (CAARMS). Exclusion criteria included current or previous treatment with antipsychotic medication, moderate-to-severe learning disability, organic impairment or lack of fluency in English. Participants were referred from service organisations.

Setting: Manchester, Birmingham/Worcestershire, Glasgow, Cambridgeshire and Norfolk, UK; 2006–2010.

Intervention: Cognitive therapy in addition to mental state monitoring plus treatment as usual was compared with mental state monitoring plus treatment as usual (control). A maximum of 26 cognitive therapy sessions (1/week) were given over 6 months. Treatment as usual depended on local services and the referring organisation, and varied across study sites. Randomisation was stratified based on study site to address this variability.

Outcomes: Primary outcome: …

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  • Sources of funding The Medical Research Council and the Department of Health.


  • Correspondence to Dr Rick Fraser, Early Intervention in Psychosis, Sussex Partnership NHS Foundation Trust, Horsham, West Sussex RH12 1RJ, UK;

  • Competing interests None.

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