Introduction
psychotic symptoms, Psychosis, First-episode psychosis, psychosis
REMISSION
First-episode psychosis is typically preceded by a prodrome characterized by nonspecific and attenuated psychotic symptoms and functional impairment. Ultrahigh risk criteria were introduced to prospectively identify this prodromal period.Unraveling the heterogeneity in the ultrahigh risk population is paramount to identify subgroups for whom treatments can be tailored.The current study (Staged Treatment in Early Psychosis [STEP]) aimed to evaluate the outcomes of a sequential multiple assignment randomized clinical trial (SMART) comprising support and problem solving (SPS), cognitive-behavioral case management (CBCM), and fluoxetine for individuals at ultrahigh risk for psychosis.Hypothesis 1. Open-label SPS would produce a remission rate of 50% (step 1), based on modeling using previous randomized clinical trial data.Hypothesis 2a. CBCM would result in significantly better functional outcome than SPS (step 2).Hypothesis 2b. In the CBCM group, baseline cognitive biases or vulnerabilities would predict remission and clinical outcome (including functioning) andHypothesis 2c. In the CBCM group, participants with better outcomes and those who remitted would show significantly greater change on these variables than those with worse outcomes and those who did not remit.Hypothesis 3. Antidepressant medication (when added to background CBCM) would result in significantly better clinical outcomes than placebo (step 3).Hypothesis 4. In those who remitted to step 1 and 2 treatments (SPS and CBCM), a maintenance treatment of SPS would result in a significantly lower rate of relapse than monitoring.