Intervention and treatment in prodromal phase of psychosis

Question 1

What is OASIS?

Answer 1

Outreach And Support In South London

• Clinical service for help-seeking individuals age 15-35, presenting high-risk psychotic symptoms
• 3 core clinical targets:
• > Prevent transition to psychosis (preventative treatments)
• > Improve outcomes if psychosis develops
• > Reduce ‘at-risk’ symptoms and disability (independent from longitudinal outcome)

Question 2

Where is OASIS based?

Answer 2

Part of the South London and Maudsley NHS foundation trust (SLaM)

• Covers London boroughs: Southwark, Lambeth, Lewisham, Croydon
• Clinically-integrated with first-episode services

Question 3

What are the foundations of the work at OASIS?

Answer 3

• Heavily informed by research
• Mostly supported by IoPPN
• > ‘perfect’ integration of clinical and research aspects

Question 4

How are individuals who come to OASIS assessed?

Answer 4

Using CAARMS (semi-structured interview)

Question 5

Who refers individuals to OASIS (Fusar-Poli et al., 2012)?

Answer 5

Mostly:
- GPs (28%)

• Community mental heath teams (CMHT) or community adolescent mental health services (CAMHS) (16%)

Question 6

What is the outcome of high-risk individuals meeting high or ultra high-risk states at OASIS (Rutigliano et al., 2015)?

Answer 6

• Psychosis (18%)
• Non-psychotic co-morbid disorders (32%)
• Persistent high or ultra high-risk state (5%)
• Symptomatic remission (20%)

Question 7

What is the clinical outcome of the majority of individuals not developing psychosis at OASIS?

Answer 7

Ongoing mental health problems for 70% of those not developing psychosis, even at follow-up

Question 8

Why are there no NHS symbols or large obvious signs on the OASIS building?

Answer 8

• Respects individual’s privacy
• Acknowledges stigma they may be subject to
• Keep clinical high-risk services separate from major mental health hospitals
• Improves accessibility and helps to work with more young and distressed adolescents

Question 9

Which treatments for the clinical high-risk for psychosis are being tested in published randomised controlled trials?

Answer 9

Testing the effect of

• Psychological treatments
• Antipsychotics
• Psychological treatments + Antipsychotics
• Experimental therapeutics

Question 10

What do the results of randomised controlled trials testing the effectiveness of preventative treatments for the clinical high-risk for psychosis show (Staffor et al., 2013)?

Answer 10

Systematic review and met-analysis:

• moderate quality evidence for CBT
• lower quality for experimental therapeutics, integrated psychotherapy and antipsychotics

Question 11

What does the evidence form randomised controlled trials on psychosis prevention and social functioning of individuals at clinical high-risk state?

Answer 11

We can delay the onset of psychosis

We can’t prevent psychosis or maintain beneficial effects over longer periods of time (2 years)

No effective treatments for

• Attenuated psychotic symptoms
• Cognitive dysfunction
• Functional impairments
• Negative symptoms

for individuals meeting clinical high-risk state for psychosis