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Meta-Analysis
. 2013 Jan 18:346:f185.
doi: 10.1136/bmj.f185.

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

Megan R Stafford  1 , Hannah Jackson, Evan Mayo-Wilson, Anthony P Morrison, Tim Kendall
Affiliations
Meta-Analysis

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

Megan R Stafford et al. BMJ. .

Erratum in

  • BMJ. 2013;346:f762

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.

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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

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Fig 1 PRISMA flowchart. *Number of records screened for eligibility for the guideline in which the current work was a part
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Fig 2 Risk of bias
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Fig 3 Transition to psychosis for participants receiving CBT versus supportive counselling, (at 6-12 months; includes completers only). M-H=Mantel-Haenszel
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Fig 4 Positive symptoms of psychosis for participants receiving CBT versus supportive counselling (at 6-12 months). IV=inverse variance
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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
See this image and copyright information in PMC

Comment in

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. - PubMed
    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. - PubMed
    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. www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicable....
    1. Mangalore R, Knapp M. Cost of schizophrenia in England. J Ment Health Policy Econ 2007;10:23-41. - PubMed

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