Efficacy and safety of pharmacological and psychological interventions for the treatment of psychosis and schizophrenia in children, adolescents and young adults: a systematic review and meta-analysis

Abstract

Background: Studies report contrasting results regarding the efficacy and safety of pharmacological, psychological, and combined interventions in psychosis and schizophrenia in children, adolescents and young adults.

Methods: Systematic review and meta-analysis. Embase, Medline, PreMedline, PsycINFO, and CENTRAL were searched to July 2013 without restriction to publication status. Randomised trials comparing any pharmacological, psychological, or combined intervention for psychosis and schizophrenia in children, adolescents and young adults were included. Studies were assessed for bias, and GRADE criteria were used to describe the quality of the results.

Results: Twenty-seven trials including 3067 participants were identified. Meta-analyses were performed for 12 comparisons: symptoms, relapse, global state, psychosocial functioning, depression, weight and discontinuation. Low quality evidence demonstrated that antipsychotics have small beneficial effects on psychotic symptoms (SMD = -0.42, 95% CI -0.58 to -0.26), and a medium adverse effect on weight gain (WMD = 1.61, 95% CI 0.61 to 2.60) and discontinuation due to side effects (RR = 2.44, 95% CI, 1.12 to 5.31). There were no trials of psychological treatments in under-18 year olds. There was no evidence of an effect of psychological interventions on psychotic symptoms in an acute episode, or relapse rate, but low quality evidence of a large effect for family plus individual CBT on the number of days to relapse (WMD = 32.25, 95% CI -36.52 to -27.98).

Conclusions: For children, adolescents and young adults, the balance of risk and benefit of antipsychotics appears less favourable than in adults. Research is needed to establish the potential for psychological treatments, alone and in combination with antipsychotics, in this population.

Conflict of interest statement

Competing Interests: This work was supported by the National Collaborating Centre for Mental Health and conducted as part of a guideline about psychosis in children, adolescents and young adults. The full review protocol is available from the authors. All authors contributed to the 23 development of the review questions. MRS drafted the review protocol. Sarah Stockton, of the National Collaborating Centre for Mental Health, designed and implemented the searches. MRS, EMW and CEL assessed the eligibility of the studies for inclusion and extracted data. MRS and EMW assessed risk of bias and applied GRADE criteria. The authors would like to acknowledge the support of Hannah Jackson, who worked at the National Collaborating Centre for Mental Health as a research assistant, during guideline development. All authors contributed to the analyses, the writing of the manuscript and agreed on the final draft. All authors had full access to the data (including statistical results and tables) and take responsibility for the integrity of the data and accuracy of the analysis. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. PRISMA flowchart.

Fig 2. Antipsychotic medication compared with placebo at post-treatment—total symptoms.

Fig 3. Antipsychotic medication compared with placebo at post-treatment—weight.

Fig 4. Family plus individual CBT compared with TAU at EPPIC—Time to relapse at post-treatment.