Early interventions to prevent psychosis: systematic review and meta-analysis

Megan R Stafford, Hannah Jackson, Evan Mayo-Wilson, Anthony P Morrison, Tim Kendall, Megan R Stafford, Hannah Jackson, Evan Mayo-Wilson, Anthony P Morrison, Tim Kendall

Abstract

Objective: To determine whether any psychological, pharmacological, or nutritional interventions can prevent or delay transition to psychotic disorders for people at high risk.

Design: Systematic review and meta-analysis.

Data sources: Embase, Medline, PreMedline, PsycINFO, and CENTRAL were searched to November 2011 without restriction to publication status.

Review methods: Randomised trials comparing any psychological, pharmacological, nutritional, or combined intervention with usual services or another treatment. Studies of participants with a formal diagnosis of schizophrenia or bipolar disorder were excluded. Studies were assessed for bias, and relevant limitations were considered in summarising the results.

Results: 11 trials including 1246 participants and eight comparisons were included. Median sample size of included trials was 81 (range 51-288). Meta-analyses were performed for transition to psychosis, symptoms of psychosis, depression, and mania; quality of life; weight; and discontinuation of treatment. Evidence of moderate quality showed an effect for cognitive behavioural therapy on reducing transition to psychosis at 12 months (risk ratio 0.54 (95% confidence interval 0.34 to 0.86); risk difference -0.07 (-0.14 to -0.01). Very low quality evidence for omega-3 fatty acids and low to very low quality evidence for integrated psychotherapy also indicated that these interventions were associated with reductions in transition to psychosis at 12 months.

Conclusions: Although evidence of benefits for any specific intervention is not conclusive, these findings suggest that it might be possible to delay or prevent transition to psychosis. Further research should be undertaken to establish conclusively the potential for benefit of psychological interventions in the treatment of people at high risk of psychosis.

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: support from the National Institute for Health and Clinical Excellence for the submitted work; TK is codirector of the National Collaborating Centre for Mental Health; this work was conducted as part of a guideline about psychosis in children and young people, and the full review protocol is available from the authors; AM was an author of two studies included in this review.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790761/bin/stam008984.f1_default.jpg
Fig 1 PRISMA flowchart. *Number of records screened for eligibility for the guideline in which the current work was a part
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790761/bin/stam008984.f2_default.jpg
Fig 2 Risk of bias
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790761/bin/stam008984.f3_default.jpg
Fig 3 Transition to psychosis for participants receiving CBT versus supportive counselling, (at 6-12 months; includes completers only). M-H=Mantel-Haenszel
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790761/bin/stam008984.f4_default.jpg
Fig 4 Positive symptoms of psychosis for participants receiving CBT versus supportive counselling (at 6-12 months). IV=inverse variance
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790761/bin/stam008984.f5_default.jpg
Fig 5 Transition to psychosis for participants receiving CBT and risperidone versus supportive counselling (at 6-12 months; includes completers only). M-H=Mantel-Haenszel

References

    1. Bebbington P, Brugha T, Meltzer H, Farrell M, Ceresa C, Jenkins R, et al. Psychiatric disorder and dysfunction in the UK National Survey of Psychiatric Morbidity. Soc Psychiatry Psychiatr Epidemiol 2000;35:191-7.
    1. Bebbington P, Brugha T, Coid J, Crawford M, Deverill C, D’Souza J, et al. Adult psychiatric morbidity in England, 2007. Results of a household survey. NHS Information Centre for Health and Social Care, 2011.
    1. Mueser KT, McGurk SR. Schizophrenia. Lancet 2004;363:2063-72.
    1. Bloom DE, Cafiero ET, Jané-Llopis E, Abrahams-Gessel S, Bloom LR, Fathima S, et al. The global economic burden of noncommunicable diseases. World Economic Forum, 2011. .
    1. Mangalore R, Knapp M. Cost of schizophrenia in England. J Ment Health Policy Econ 2007;10:23-41.
    1. McGlashan TH. Commentary: Progress, issues, and implications of prodromal research: an inside view. Schizophr Bull 2003;29:851-8.
    1. Ruhrmann S, Schultze-Lutter F, Salokangas RK, Heinimaa M, Linszen D, Dingemans P, et al. Prediction of psychosis in adolescents and young adults at high risk: results from the prospective European prediction of psychosis study. Arch Gen Psychiatr 2010;67:241-51.
    1. Yung AR, Phillips LJ, Yuen HP, Francey SM, McFarlane CA, Hallgren M, et al. Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group. Schizophr Res 2003;60:21-32.
    1. Miller TJ, McGlashan TH, Rosen JL, Somjee L, Markovich PJ, Stein K, et al. Prospective diagnosis of the initial prodrome for schizophrenia based on the Structured Interview for Prodromal Syndromes: preliminary evidence of interrater reliability and predictive validity. Am J Psychiatr 2002;159:863-5.
    1. Fusar-Poli P, Bonoldi I, Yung AR, Borgwardt S, Kempton MJ, Valmaggia L, et al. Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatr 2012;69:220-9.
    1. National Institute for Health and Clinical Excellence. The NICE guideline on core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. Updated edition. NICE, 2009.
    1. Bird V, Premkumar P, Kendall T, Whittington C, Mitchell J, Kuipers E. Early intervention services, cognitive-behavioural therapy and family intervention in early psychosis: systematic review. Br J Psychiatry 2010;197:350-6.
    1. McCrone P, Craig TK, Power P, Garety PA. Cost-effectiveness of an early intervention service for people with psychosis. Br J Psychiatry 2010;196:377-82.
    1. Marshall M, Rathbone J. Early intervention for psychosis (review). Cochrane Database Syst Rev 2011;6:CD004718.
    1. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version 5.0.1. Cochrane Collaboration, 2008.
    1. Hedges LV. Statistical considerations. In: Cooper HM, Hedges LV, eds. The handbook of research synthesis. Russell Sage Foundation, 1994.
    1. Greenland S, Robins JM. Estimation of a common effect parameter from sparse follow-up data. Biometrics 1985;41:55-68.
    1. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959;22:719-48.
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539-58.
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-60.
    1. Review manager (RevMan) version 5.0. Nordic Cochrane Centre, Cochrane Collaboration, 2008.
    1. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490.
    1. Morrison AP, French P, Walford L, Lewis SW, Kilcommons A, Green J, et al. Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. Br J Psychiatry 2004;185:291-7.
    1. Phillips LJ, Nelson B, Yuen HP, Francey SM, Simmons M, Stanford C, et al. Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: study design and baseline characteristics. Aus N Z J Psychiatry 2009;43:818-29.
    1. Addington J, Epstein I, Liu L, French P, Boydell KM, Zipursky RB. A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis. Schizophr Res 2011;125:54-61.
    1. Amminger GP, Schafer MR, Papageorgiou K, Klier CM, Cotton SM, Harrigan SM, et al. Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatr 2010;67:146-54.
    1. McGlashan TH, Zipursky RB, Perkins D, Addington J, Miller TJ, Woods SW, et al. The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. I. Study rationale and design. Schizophr Res 2003;61:7-18.
    1. Morrison AP, Stewart SL, French P, Bentall RP, Birchwood M, Byrne R, et al. Early detection and intervention evaluation for people at high-risk of psychosis-2 (EDIE-2): trial rationale, design and baseline characteristics. Early Interv Psychiatry 2011;5:24-32.
    1. van der Gaag M, Nieman D, Rietdijk J, Dragt S, Ising-Echergui H, Klaassen R, et al. Cognitive behavioural therapy for subjects at ultra-high risk for developing psychosis: a randomised controlled clinical trial. Schizophr Bull 2012. .
    1. McGorry PD, Yung AR, Phillips LJ, Yuen HP, Francey S, Cosgrave EM, et al. Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Arch Gen Psychiatr 2002;59:921-8.
    1. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987;13:261-76.
    1. Overall JE, Donald RG. The brief psychiatric rating scale. Psychol Rep 1962;10:799-812.
    1. Yung AR. The comprehensive assessment of at-risk mental states (CAARMS). University of Melbourne, 2000.
    1. World Health Organization. The ICD-10 classification of mental and behavioural disorders. Diagnostic criteria for research. WHO, 1993.
    1. Nordentoft M, Petersen L, Jeppesen P, Thorup AA, Abel MB, Ohlenschlaeger J, et al. [OPUS: a randomised multicenter trial of integrated versus standard treatment for patients with a first-episode psychosis—secondary publication]. Ugeskrift Laeger 2006;168:381-4.
    1. Hefner HBA. Early detection and intervention in psychosis. A practice handbook. Schattauer, 2011.
    1. Bechdolf A, Wagner M, Ruhrmann S, Harrigan S, Putzfeld V, Pukrop R, et al. Preventing progression to first-episode psychosis in early initial prodromal states. Br J Psychiatry 2012;200:22-9.
    1. Ruhrmann S, Bechdolf A, Kuhn KU, Wagner M, Schultze-Lutter F, Janssen B, et al. Acute effects of treatment for prodromal symptoms for people putatively in a late initial prodromal state of psychosis. Br J Psychiatry 2007;51(suppl):s88-95.
    1. Bechdolf A, Wagner M, Veith V, Ruhrmann S, Pukrop R, Brockhaus-Dumke A, et al. Randomized controlled multicentre trial of cognitive behaviour therapy in the early initial prodromal state: effects on social adjustment post treatment. Early Interv Psychiatry 2007;1:71-8.
    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edition. American Psychiatric Association, 1994.
    1. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
    1. Sutton AJ, Duval SJ, Tweedie RL, Abrams KR, Jones DR. Empirical assessment of effect of publication bias on meta-analyses. BMJ 2000;320:1574-7.
    1. Whittington CJ, Kendall T, Fonagy P, Cottrell D, Cotgrove A, Boddington E. Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet 2004;363:1341-5.
    1. Abbasi K. Compulsory registration of clinical trials. BMJ 2004;329:637-8.
    1. Zarin DA, Ide NC, Tse T, Harlan WR, West JC, Lindberg DA. Issues in the registration of clinical trials. JAMA 2007;297:2112-20.
    1. Yung AR, Nelson B. Young people at ultra high risk for psychosis: a research update. Early Interv Psychiatry 2011;5(suppl 1):52-7.
    1. Fusar-Poli P, van Os J. Lost in transition: setting the psychosis threshold in prodromal research. Acta Psychiatr Scand 2012, .
    1. Marshall C, Addington J, Epstein I, Lui L, Deighton S, Zipursky RB. Treating young individuals at clinical high risk for psychosis. Early Interv Psychiatry 2012;6:60-8.
    1. Hansen NB, Lambert MJ, Forman EM. The psychotherapy dose-response effect and its implications for treatment delivery services. Clin Psychol Sci Pract 2002;9:329-43.
    1. Lambet M. Presidential address: what we have learned from a decade of research aimed at improving psychotherapy outcome in routine care. Psychother Res 2007;17:1-14.
    1. Freeman MP, Hibbeln JR, Wisner KL, Davis JM, Mischoulon D, Peet M, et al. Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. J Clin Psychiatry 2006;67:1954-67.
    1. Morrison AP, French P, Stewart SLK, Birchwoord M, Fowler D, Gumley AI, et al. Early detection and intervention evaluation for people at risk of psychosis (EDIE-2): a multisite randomised controlled trial of cognitive therapy for at risk mental states. BMJ 2012;344:e2233.
    1. McGorry P. Risk syndromes, clinical staging and DSM V: new diagnostic infrastructure for early intervention in psychiatry. Schizophr Res 2010;120:49-53.
    1. McGlashan TH, Zipursky RB, Perkins D, Addington J, Miller T, Woods SW, et al. Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. Am J Psychiatry 2006;163:790-9.
    1. Miller TJ, Zipursky RB, Perkins D, Addington J, Woods SW, Hawkins KA, et al. The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. II. Baseline characteristics of the “prodromal” sample. Schizophr Res 2003;61:19-30.
    1. Woods SW, Breier A, Zipursky RB, Perkins DO, Addington J, Miller TJ, et al. Randomized trial of olanzapine versus placebo in the symptomatic acute treatment of the schizophrenic prodrome. Biol Psychiatry 2003;54:453-64.
    1. Phillips LJ, McGorry PD, Yuen HP, Ward J, Donovan K, Kelly D, et al. Medium term follow-up of a randomized controlled trial of interventions for young people at ultra high risk of psychosis. Schizophr Res 2007;96:25-33.
    1. Morrison AP, Bentall RP, French P, Walford L, Kilcommons A, Knight A, et al. Randomised controlled trial of early detection and cognitive therapy for preventing transition to psychosis in high-risk individuals. Study design and interim analysis of transition rate and psychological risk factors. Br J Psychiatry 2002;43(suppl):s78-84.
    1. Morrison AP, French P, Parker S, Roberts M, Stevens H, Bentall RP, et al. Three-year follow-up of a randomized controlled trial of cognitive therapy for the prevention of psychosis in people at ultrahigh risk. Schizophr Bull 2007;33:682-7.
    1. Yung AR, Phillips LJ, Nelson B, Francey SM, PanYuen H, Simmons MB, et al. Randomized controlled trial of interventions for young people at ultra high risk for psychosis: 6-month analysis. J Clin Psychiatry 2011;72:430-40.
    1. Rietdijk J, Dragt S, Klaassen R, Ising H, Nieman D, Wunderink L, et al. A single blind randomized controlled trial of cognitive behavioural therapy in a help-seeking population with an At Risk Mental State for psychosis: the Dutch Early Detection and Intervention Evaluation (EDIE-NL) trial. Trials 2010;11:30.
    1. French P, Morrison AP. Early detection and cognitive therapy for people at high risk of developing psychosis. Wiley, 2004.
    1. Beck AT. Cognitive therapy and the emotional disorders. International Universities Press, 1976.
    1. Morrison AP. The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behav Cogn Psychother 2001;29:257-76.
    1. Zubin J, Spring B. Vulnerability: a new view of schizophrenia. J Abnorm Psychol 1977;86:103-26.
    1. Chadwick P, Birchwood M, Trower P. Cognitive therapy for delusions, voices and paranoia. John Wiley and Sons, 1996.
    1. Fowler D, Garety P, Kuipers E. Cognitive behaviour therapy for psychosis: theory and practice. Wiley, 1995.
    1. Haddock G, Tarrier N, Spaulding W, Yusupoff L, Kinney C, McCarthy E. Individual cognitive-behavior therapy in the treatment of hallucinations and delusions: a review. Clin Psychol Rev 1998;18:821-38.
    1. Kingdon DG, Turkington D. Cognitive-behavioural therapy for schizophrenia. Lawrence Erlbaum, 1994.
    1. Larsen TK, Bechdolf A, Birchwood M. The concept of schizophrenia and phase specific treatment. Psychological treatment in pre-psychosis and non-responders. J Am Acad Psychoanal Dyn Psychiatr 2003;31:209-28.
    1. Stein LI, Test MA. Alternative to mental hospital treatment I. Conceptual model, treatment program and clinical evaluation. Arch Gen Psychiatry 1980;31:37-42.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren