Do Psychological Interventions Work for Psychosis in Adolescents?

Abstract

Background: There is emerging evidence to show that psychological interventions such as cognitive remediation therapy (CRT), psychoeducation, family therapy, and group psychotherapies may be useful for adolescents with psychosis. The current review is on the effects of various psychological interventions for adolescents with psychosis compared with treatment as usual (TAU) or other psychological interventions.

Methods: We undertook a comprehensive search for all randomized controlled trials on the topic as per predefined criteria. For binary data, a standard estimation of risk ratio, and, for continuous data, the mean difference between groups were estimated. GRADE approach was used to assess studies. "Risk of Bias" was calculated, and finally random-effects model was used for analyses.

Results: The review included 7 studies (n = 317). Two studies compared CRT and TAU with TAU alone. CRT showed improvement in short-term memory compared with those in the TAU group (relative risk 0.58, 95% CI 0.37 to 0.89, participants = 31, very low-certainty evidence). When comparing group psychosocial therapy with TAU, global state scores measured using Children's Global Assessment Scale (CGAS) were clearly higher in the intervention arm (mean difference 5.10, 95% CI 1.35 to 8.85, participants = 56, very low-certainty evidence) as compared with the TAU group. None of the other interventions were found to be significantly effective for the treatment of psychosis in adolescents.

Conclusions: Evidence suggests that psychological interventions may have beneficial effects in the treatment of adolescents with psychosis, but the evidence is of low or very low certainty.

Keywords: adolescents; psychological intervention; psychosis; schizophrenia.

Fig 1.

Risk of bias of included studies of psychological interventions for psychosis in adolescents.

Fig 2.

Post-intervention effect on cognitive functioning: Not attaining normal cognitive function for comparison of cognitive remediation therapy plus treatment as usual vs treatment as usual.