Individual research recommendation details

Recommendation ID

CG155/4

Question

What is the clinical and cost effectiveness of psychological intervention alone, compared with antipsychotic medication and compared with psychological intervention and antipsychotic
medication combined, in young people with first episode psychosis?

Any explanatory notes
(if applicable)

The programme of research would compare the clinical and cost effectiveness of psychological intervention alone, compared with antipsychotic medication, and compared with psychological intervention and antipsychotic medication combined, for young people in the early stages of psychosis using an adequately powered study with a randomised controlled design. The combination of psychological interventions most likely to have an impact is family intervention and individual CBT. The key outcomes should include symptoms, relapse rates, quality of life, treatment acceptability, experience of care, level of psychosocial functioning and the cost effectiveness of the interventions.
Why this is important:- The personal and financial cost of psychosis and schizophrenia to the person, their family and friends, and to society is considerable. The personal cost is reflected in a suicide rate of nearly 15% among people with schizophrenia, a lifelong unemployment rate that varies between 50 and 75%, depending on geographical location, and reduced life expectancy. The additional cost to the healthcare system for one person with schizophrenia is estimated to reach over £50,000 per year, on average, throughout their life. Currently, the mainstay of treatment is antipsychotic medication, but the potential adverse effects are such that there is considerable impetus to develop alternative treatment strategies to allow either lower doses or to remove the need for medication entirely. It has been recognised that psychological interventions as an adjunct to antipsychotic medication have an important part to play in the treatment of schizophrenia. NICE clinical guideline 82 identified family intervention and CBT as adjunct treatments and current evidence suggests that these interventions are cost saving. However, evidence for adjunctive family intervention and CBT is lacking in children and young people with psychosis. Furthermore, there has been one recent positive trial of CBT as a first-line treatment, without antipsychotics, for young people in the early stages of psychosis.

Source guidance details

Comes from guidance

Psychosis and schizophrenia in children and young people: recognition and management

Number

CG155

Date issued

January 2013

Other details