Threeyear follow-up of a randomized controlled trial of cognitive therapy for the prevention of psychosis in people at ultrahigh risk

There have been recent advances in the ability to identify people at high risk of developing psychosis. This has led to interest in the possibility of preventing the development of psychosis. A randomized controlled trial compared cog-nitive therapy (CT) over 6 months with monthly monitor-ing in 58 patients meeting criteria for ultrahigh risk of developing a first episode of psychosis. Participants were followed up over a 3-year period. Logistic regression dem-onstrated that CT significantly reduced likelihood of being prescribed antipsychotic medication over a 3-year period, but it did not affect transition to psychosis defined using the Positive and Negative Syndrome Scale (PANSS) or probableDiagnostic and StatisticalManual ofMental Dis-orders, Fourth Edition diagnosis. However, exploratory analyses revealed that CT significantly reduced the likeli-hood of making progression to psychosis as defined on the PANSS over 3 years after controlling for baseline cognitive factors. Follow-up rate at 3 years was 47%. There appear to be enduring benefits of CT over the long term, suggesting that it is an efficacious intervention for people at high risk of developing psychosis. Key words: cognitive therapy/psychosis/prevention/ early interventio