Interventions and Transition in Youth at Risk of Psychosis: A Systematic Review and Meta-Analyses

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Objective: The primary objective of this systematic review and meta-analyses was to summarize the impact of all reported treatments on transition to psychosis in high-risk samples.

Data Sources: PsycINFO, Embase, CINAHL, EBM, and MEDLINE online databases were searched from inception to May 2017 using the keywords psychosis, risk, and treatment with no geographical, date, or language restrictions.

Study Selection: A total of 38 independent studies met the inclusion criteria: conducted a treatment study in a sample at high risk for psychosis and reported on transition to psychosis as an outcome.

Data Extraction: The following data were extracted: study characteristics (eg, sample size), participant characteristics (eg, mean age), and clinical outcome data (eg, number and percentage of patients transited for each intervention group at each time-point and transition assessment employed). Data were analyzed using random-effects pairwise meta-analysis (to explore differences between treatment and controls) and multivariate network meta-analyses (NMAs; to explore differences between treatment types on transition) and were reported as risk ratios (RR).

Results: In pairwise meta-analyses, cognitive-behavioral therapy (CBT) studies were associated with a significant reduction in transition compared with controls at 12-month and 18-month follow-up (RR = 0.57; 95% CI, 0.35–0.93; I2 = 7%; P = .02 vs RR = 0.54; 95% CI, 0.32–0.92; I2 = 0%; P = .02). In the NMAs, integrated psychological therapy, CBT, supportive therapy, family therapy, needs-based interventions, omega-3, risperidone plus CBT, ziprasidone, and olanzapine were not significantly more effective at reducing transition at 6 and 12 months relative to each other.

Conclusions: This systematic review and pairwise meta-analyses demonstrated a reduced risk for transition favoring CBT at 12 and 18 months. No interventions were significantly more effective at reducing transition compared with all other interventions in the NMAs. NMA results should be interpreted with caution due to the small sample size.

J Clin Psychiatry 2020;81(3):17r12053

https://doi.org/10.4088/JCP.17r12053