Department of Psychiatry, University of Cambridge, Cambridge, UK.
Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Aust N Z J Psychiatry. 2020 Jul;54(7):673-695. doi: 10.1177/0004867420913118. Epub 2020 May 28.
Many people with psychotic experiences do not develop psychotic disorders, yet those who seek help demonstrate high clinical complexity and poor outcomes. In this systematic review and meta-analysis, we evaluated the effectiveness and cost-effectiveness of psychological interventions for people with psychotic experiences.
We searched 13 databases for studies of psychological interventions for adults with psychotic experiences, but psychotic disorders. Our outcomes were the proportion of participants remitting from psychotic experiences (primary); changes in positive and negative psychotic symptoms, depression, anxiety, functioning, distress, and quality of life; and economic outcomes (secondary). We analysed results using multilevel random-effects meta-analysis and narrative synthesis.
A total of 27 reports met inclusion criteria. In general, there was no strong evidence for the superiority of any one intervention. Five studies reported on our primary outcome, though only two reports provided randomised controlled trial evidence that psychological intervention (specifically, cognitive behavioural therapy) promoted remission from psychotic experiences. For secondary outcomes, we could only meta-analyse trials of cognitive behavioural therapy. We found that cognitive behavioural therapy was more effective than treatment as usual for reducing distress (pooled standardised mean difference: -0.24; 95% confidence interval = [-0.37, -0.10]), but no more effective than the control treatment for improving any other outcome. Individual reports indicated that cognitive behavioural therapy, mindfulness-based cognitive therapy, sleep cognitive behavioural therapy, systemic therapy, cognitive remediation therapy, and supportive treatments improved at least one clinical or functional outcome. Four reports included economic evaluations, which suggested cognitive behavioural therapy may be cost-effective compared with treatment as usual.
Our meta-analytic findings were primarily null, with the exception that cognitive behavioural therapy may reduce the distress associated with psychotic experiences. Our analyses were limited by scarcity of studies, small samples and variable study quality. Several intervention frameworks showed preliminary evidence of positive outcomes; however, the paucity of consistent evidence for clinical and functional improvement highlights a need for further research into psychological treatments for psychotic experiences.
CRD42016033869.
许多出现精神病性体验的人并未发展为精神病性障碍，但寻求帮助的患者表现出较高的临床复杂性和较差的结局。在本系统评价和荟萃分析中，我们评估了针对出现精神病性体验的成年人的心理干预措施的有效性和成本效益。
我们对 13 个数据库进行了检索，以查找针对出现精神病性体验但未发展为精神病性障碍的成年人的心理干预措施的研究。我们的结局指标为精神病性体验缓解的参与者比例（主要结局）；阳性和阴性精神病性症状、抑郁、焦虑、功能、痛苦和生活质量的变化；以及经济结局（次要结局）。我们使用多水平随机效应荟萃分析和叙述性综合对结果进行了分析。
共有 27 项报告符合纳入标准。一般来说，没有强有力的证据表明任何一种干预措施具有优越性。五项研究报告了我们的主要结局，但仅有两项报告提供了随机对照试验证据，表明心理干预（具体为认知行为疗法）促进了精神病性体验的缓解。对于次要结局，我们只能对认知行为疗法的试验进行荟萃分析。我们发现，认知行为疗法在减轻痛苦方面比常规治疗更有效（合并标准化均数差：-0.24；95%置信区间：-0.37 至-0.10），但在改善任何其他结局方面与对照治疗无差异。个别报告表明，认知行为疗法、正念认知疗法、睡眠认知行为疗法、系统疗法、认知矫正疗法和支持性治疗至少改善了一种临床或功能结局。四项报告包括了经济评估，结果表明认知行为疗法与常规治疗相比可能具有成本效益。
我们的荟萃分析结果主要为阴性，只有认知行为疗法可能减轻与精神病性体验相关的痛苦。我们的分析受到研究数量少、样本量小和研究质量差异的限制。几种干预框架显示出初步的阳性结果证据；然而，临床和功能改善方面一致性证据的缺乏突出表明需要进一步研究针对精神病性体验的心理治疗方法。
PROSPERO 方案注册编号：CRD42016033869。
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