Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Alberta, Canada.
Schizophr Bull. 2018 Jun 6;44(4):807-823. doi: 10.1093/schbul/sbx139.
Youth at clinical high risk (CHR) for psychosis often demonstrate significant negative symptoms, which have been reported to be predictive of conversion to psychosis and a reduced quality of life but treatment options for negative symptoms remain inadequate. Therefore, we conducted a systematic review and network meta-analysis of all intervention studies examining negative symptom outcomes in youth at CHR for psychosis.
The authors searched PsycINFO, Medline, Embase, CINAHL, and EBM from inception to December 2016. Studies were selected if they included any intervention that reported follow-up negative symptoms in youth at CHR for psychosis. Treatment comparisons were evaluated using both pairwise and network meta-analyses. Due to the differences in negative symptom scales the effect sizes were reported as the standardized mean difference (SMD).
Of 3027 citations, 32 studies met our inclusion criteria, including a total of 2463 CHR participants. The null hypothesis was not rejected for any of the 11 treatments. N-methyl-D-aspartate-receptor (NMDAR) modulators trended toward a significant reduction in negative symptoms compared to placebo (SMD = -0.54; 95% CI = -1.09 to 0.02; I2 = 0%, P = .06). In respective order of descending effectiveness as per the treatment hierarchy, NMDAR modulators were more effective than family therapy, need-based interventions, risperidone, amisulpride, cognitive behavioral therapy, omega-3, olanzapine, supportive therapy, and integrated psychological interventions.
Efficacy and effectiveness were not confirmed for any negative symptom treatment. Many studies had small samples and the majority were not designed to target negative symptoms.
有精神病临床高危（CHR）表现的年轻人通常有明显的阴性症状，这些症状已被报告与向精神病转变和生活质量下降相关，但针对阴性症状的治疗选择仍然不足。因此，我们对所有检查精神病 CHR 年轻人阴性症状结果的干预研究进行了系统评价和网络荟萃分析。
作者从开始到 2016 年 12 月在 PsycINFO、Medline、Embase、CINAHL 和 EBM 中进行了搜索。如果研究包括报告精神病 CHR 年轻人的阴性症状随访的任何干预，则选择研究。使用成对和网络荟萃分析评估治疗比较。由于阴性症状量表的差异，效应大小以标准化均数差（SMD）报告。
在 3027 条引文中有 32 项研究符合纳入标准，共有 2463 名 CHR 参与者。对于 11 种治疗中的任何一种，都没有拒绝零假设。与安慰剂相比，N-甲基-D-天冬氨酸受体（NMDAR）调节剂治疗呈阴性症状显著减少的趋势（SMD=-0.54；95%CI=-1.09 至 0.02；I2=0%，P=0.06）。按照治疗等级的降序排列，按有效性依次为 NMDAR 调节剂优于家庭治疗、基于需要的干预、利培酮、氨磺必利、认知行为治疗、ω-3、奥氮平、支持性治疗和综合心理干预。
没有任何阴性症状治疗的疗效和有效性得到证实。许多研究样本较小，而且大多数研究不是专门针对阴性症状设计的。
