Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada.
Mathison Centre for Mental Health Research & Education, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6 Canada.
J Clin Psychiatry. 2020 May 19;81(3):17r12053. doi: 10.4088/JCP.17r12053.
The primary objective of this systematic review and meta-analyses was to summarize the impact of all reported treatments on transition to psychosis in high-risk samples.
PsycINFO, Embase, CINAHL, EBM, and MEDLINE online databases were searched from inception to May 2017 using the keywords psychosis, risk, and treatment with no geographical, date, or language restrictions.
A total of 38 independent studies met the inclusion criteria: conducted a treatment study in a sample at high risk for psychosis and reported on transition to psychosis as an outcome.
The following data were extracted: study characteristics (eg, sample size), participant characteristics (eg, mean age), and clinical outcome data (eg, number and percentage of patients transited for each intervention group at each time-point and transition assessment employed). Data were analyzed using random-effects pairwise meta-analysis (to explore differences between treatment and controls) and multivariate network meta-analyses (NMAs; to explore differences between treatment types on transition) and were reported as risk ratios (RR).
In pairwise meta-analyses, cognitive-behavioral therapy (CBT) studies were associated with a significant reduction in transition compared with controls at 12-month and 18-month follow-up (RR = 0.57; 95% CI, 0.35-0.93; I² = 7%; P = .02 vs RR = 0.54; 95% CI, 0.32-0.92; I² = 0%; P = .02). In the NMAs, integrated psychological therapy, CBT, supportive therapy, family therapy, needs-based interventions, omega-3, risperidone plus CBT, ziprasidone, and olanzapine were not significantly more effective at reducing transition at 6 and 12 months relative to each other.
This systematic review and pairwise meta-analyses demonstrated a reduced risk for transition favoring CBT at 12 and 18 months. No interventions were significantly more effective at reducing transition compared with all other interventions in the NMAs. NMA results should be interpreted with caution due to the small sample size.
本系统评价和荟萃分析的主要目的是总结所有报告的治疗方法对高危人群向精神病转变的影响。
从 1970 年至 2017 年 5 月，使用“精神病”、“风险”和“治疗”等关键词，在 PsycINFO、Embase、CINAHL、EBM 和 MEDLINE 在线数据库中进行了检索，无地理、日期或语言限制。
共有 38 项独立研究符合纳入标准：在精神病高危人群中进行了治疗研究，并将精神病转变作为结果进行了报告。
提取了以下数据：研究特征（如样本量）、参与者特征（如平均年龄）和临床结果数据（如每个干预组在每个时间点和采用的过渡评估中转出的患者数量和百分比）。使用随机效应成对荟萃分析（探索治疗与对照组之间的差异）和多变量网络荟萃分析（NMA；探索不同治疗类型对过渡的差异）进行了数据分析，并报告为风险比（RR）。
在成对荟萃分析中，与对照组相比，认知行为疗法（CBT）研究在 12 个月和 18 个月的随访中与过渡显著减少相关（RR=0.57；95%CI，0.35-0.93；I²=7%；P=0.02 与 RR=0.54；95%CI，0.32-0.92；I²=0%；P=0.02）。在 NMA 中，综合心理治疗、CBT、支持性治疗、家庭治疗、基于需求的干预、ω-3、利培酮加 CBT、齐拉西酮和奥氮平在 6 个月和 12 个月时在降低过渡风险方面彼此之间没有显著差异。
本系统评价和成对荟萃分析显示，CBT 在 12 个月和 18 个月时降低了向精神病转变的风险。与 NMA 中的所有其他干预措施相比，没有任何干预措施在降低过渡风险方面更有效。由于样本量小，NMA 结果应谨慎解释。
