Hutton P, Taylor P J
Greater Manchester West Mental Health NHS Foundation Trust, UK.
University of Manchester, UK.
Psychol Med. 2014 Feb;44(3):449-68. doi: 10.1017/S0033291713000354. Epub 2013 Mar 22.
Clinical equipoise regarding preventative treatments for psychosis has encouraged the development and evaluation of psychosocial treatments, such as cognitive behavioural therapy (CBT).
A systematic review and meta-analysis was conducted, examining the evidence for the effectiveness of CBT-informed treatment for preventing psychosis in people who are not taking antipsychotic medication, when compared to usual or non-specific control treatment. Included studies had to meet basic quality criteria, such as concealed and random allocation to treatment groups.
Our search produced 1940 titles, out of which we found seven completed trials (six published). The relative risk (RR) of developing psychosis was reduced by more than 50% for those receiving CBT at every time point [RR at 6 months 0.47, 95% confidence interval (CI) 0.27-0.82, p = 0.008 (fixed-effects only: six randomized controlled trials (RCTs), n = 800); RR at 12 months 0.45, 95% CI 0.28-0.73, p = 0.001 (six RCTs, n = 800); RR at 18-24 months 0.41, 95% CI 0.23-0.72, p = 0.002 (four RCTs, n = 452)]. Heterogeneity was low in every analysis and the results were largely robust to the risk of an unpublished 12-month study having unfavourable results. CBT was also associated with reduced subthreshold symptoms at 12 months, but not at 6 or 18-24 months. No effects on functioning, symptom-related distress or quality of life were observed. CBT was not associated with increased rates of clinical depression or social anxiety (two studies).
CBT-informed treatment is associated with a reduced risk of transition to psychosis at 6, 12 and 18-24 months, and reduced symptoms at 12 months. Methodological limitations and recommendations for trial reporting are discussed.
对于精神病预防性治疗的临床 equipoise 鼓励了心理社会治疗方法的发展与评估，如认知行为疗法（CBT）。
进行了一项系统评价和荟萃分析，考察与常规或非特异性对照治疗相比，接受基于CBT的治疗对未服用抗精神病药物者预防精神病有效性的证据。纳入研究必须符合基本质量标准，如对治疗组进行隐蔽和随机分配。
我们的检索得到1940个标题，从中我们找到了7项完成的试验（6项已发表）。在每个时间点，接受CBT者发生精神病的相对风险（RR）降低了50%以上[6个月时RR为0.47，95%置信区间（CI）0.27 - 0.82，p = 0.008（仅固定效应：6项随机对照试验（RCT），n = 800）；12个月时RR为0.45，95% CI 0.28 - 0.73，p = 0.001（6项RCT，n = 800）；18 - 24个月时RR为0.41，95% CI 0.23 - 0.72，p = 0.002（4项RCT，n = 452）]。每次分析中的异质性都很低，并且结果在很大程度上不受一项未发表的12个月研究结果不利风险的影响。CBT还与12个月时阈下症状的减轻有关，但在6个月或18 - 24个月时没有。未观察到对功能、症状相关痛苦或生活质量的影响。CBT与临床抑郁症或社交焦虑症发生率的增加无关（两项研究）。
基于CBT的治疗与6、12和18 - 24个月时向精神病转变风险的降低以及12个月时症状的减轻有关。讨论了方法学局限性和试验报告的建议。
