Characterizing transdiagnostic premorbid biotypes can help progress in selective prevention in psychiatry

Abstract

231 ioral problems below the threshold for referral to mental health care. A stage-based screening and stratification approach was set up in non-specialized school-based services, with the dual goal to identify: a) the target group of youths with common emotional and/or behavioral problems; and b) those with emerging/ severe mental illnesses, e.g. psychosis, who were supported to seek specialized care. The common treatment elements were “distilled” from evidence-based single-disorder CBT programs and organized into modules, materials, video-based feedback, supervision and training of the therapists to help them tailor the treatment to the individual subject. The flexible and modular transdiagnostic implementation of CBT outperformed MAU on multiple endpoints, including reduced impact of mental health problems on functioning in daily life at the end of treatment, corresponding to a Cohen’s effect size of 0.60. Harms were low and nondifferential by the end of treatment, but significantly lower with MMM versus MAU at follow-up. All the above-mentioned levels of prevention should be integrated in a common strategy. Interventions at different levels should be regarded not as contradictory, but as synergistic. Therefore, it is sad to witness psychiatrists spending time discussing, for example, the discontinuation of early interventions for high-risk populations in order to prioritize efforts to reduce cannabis use. Instead, we should be inspired by the synergistic approaches implemented in other areas of medicine. Would we see a similar fight in cancer (i.e., scientists attacking each other’s efforts in smoking cessation initiatives or screening programs versus surgical or medical treatment for cancer)? Our approach should be that it is important to intervene at all levels depicted above, and that we need studies, and preferably controlled trials, to identify the most effective interventions. Merete Nordentoft, Pia Jeppesen, Anne Amalie Elgaard Thorup Copenhagen Research Center for Mental Health, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark