Department of Psychiatry, Marques de Valdecilla Public Foundation–Research Institute (FMV-IFIMAV) Av. Valdecilla s/n, 39009, Santander, Spain.
Schizophr Bull. 2011 May;37(3):619-30. doi: 10.1093/schbul/sbp129. Epub 2009 Nov 9.
The majority of first-episode psychosis (FEP) patients reach clinical remission; however, rates of relapse are high. This study sought to undertake a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the effectiveness of pharmacological and non-pharmacological interventions to prevent relapse in FEP patients.
Systematic review and meta-analysis of RCTs.
Of 66 studies retrieved, 18 were eligible for inclusion. Nine studies investigated psychosocial interventions and 9 pharmacological treatments. The analysis of 3 RCTs of psychosocial interventions comparing specialist FEP programs vs treatment as usual involving 679 patients demonstrated the former to be more effective in preventing relapse (odds ratio [OR]=1.80, 95% confidence interval [CI]=1.31-2.48; P<.001; number needed to treat [NNT]=10). While the analysis of 3 different cognitive-behavioral studies not specifically intended at preventing relapse showed no further benefits compared with specialist FEP programs (OR=1.95, 95% CI=0.76-5.00; P=.17), the combination of specific individual and family intervention targeted at relapse prevention may further improve upon these outcomes (OR=4.88, 95% CI=0.97-24.60; P=.06). Only 3 small studies compared first-generation antipsychotics (FGAs) with placebo with no significant differences regarding relapse prevention although all individual estimates favored FGAs (OR=2.82, 95% CI=0.54-14.75; P=.22). Exploratory analysis involving 1055 FEP patients revealed that relapse rates were significantly lower with second-generation antipsychotics (SGAs) compared with FGAs (OR=1.47, 95% CI=1.07-2.01; P<.02; NNT=10).
Specialist FEP programs are effective in preventing relapse. Cognitive-based individual and family interventions may need to specifically target relapse to obtain relapse prevention benefits that extend beyond those provided by specialist FEP programs. Overall, the available data suggest that FGAs and SGAs have the potential to reduce relapse rates. Future trials should examine the effectiveness of placebo vs antipsychotics in combination with intensive psychosocial interventions in preventing relapse in the early course of psychosis. Further studies should identify those patients who may not need antipsychotic medication to be able to recover from psychosis.
大多数首发精神病（FEP）患者达到临床缓解；然而，复发率很高。本研究旨在进行系统评价和荟萃分析，以确定药物和非药物干预措施预防 FEP 患者复发的有效性。
系统评价和随机对照试验的荟萃分析。
在检索到的 66 项研究中，有 18 项符合纳入标准。9 项研究调查了心理社会干预，9 项药理学治疗。对 3 项比较专科 FEP 项目与常规治疗的心理社会干预 RCT 的分析，共涉及 679 例患者，表明前者在预防复发方面更有效（比值比[OR] = 1.80，95%置信区间[CI] = 1.31-2.48；P<.001；需要治疗的人数[NNT] = 10）。虽然 3 项不同的认知行为研究并未专门针对预防复发，但与专科 FEP 项目相比，并未显示出进一步的益处（OR=1.95，95%CI=0.76-5.00；P=.17），但针对复发预防的特定个体和家庭干预的联合可能会进一步改善这些结果（OR=4.88，95%CI=0.97-24.60；P=.06）。只有 3 项小型研究比较了第一代抗精神病药物（FGAs）与安慰剂，关于预防复发没有显著差异，尽管所有个体估计都倾向于 FGAs（OR=2.82，95%CI=0.54-14.75；P=.22）。对 1055 例 FEP 患者进行的探索性分析显示，第二代抗精神病药物（SGAs）的复发率明显低于 FGAs（OR=1.47，95%CI=1.07-2.01；P<.02；NNT=10）。
专科 FEP 项目可有效预防复发。基于认知的个体和家庭干预可能需要专门针对复发，以获得超越专科 FEP 项目提供的预防复发益处。总体而言，现有数据表明，FGAs 和 SGAs 有可能降低复发率。未来的试验应研究安慰剂与抗精神病药物联合强化心理社会干预在预防精神病早期复发中的有效性。进一步的研究应确定那些不需要抗精神病药物治疗就能从精神病中康复的患者。
