Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain; Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden.
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Schizophr Res. 2021 Jan;227:20-27. doi: 10.1016/j.schres.2020.05.010. Epub 2020 May 26.
Individuals at Clinical High Risk for Psychosis (CHR-P) may differ considerably in their response to indicated preventive interventions. No studies have tested this.
PRISMA-compliant systematic review of the Web of Science (MEDLINE), PsycInfo, CENTRAL and unpublished/gray literature up to 1 September 2019. RCTs in CHR-P individuals, reporting on attenuated positive psychotic symptoms were included. The primary outcome was the variability ratio between the variance of the severity of attenuated positive psychotic symptoms in the indicated intervention condition vs the control condition (needs-based interventions, NBI) at 6 and 12 months. Random effect models, C statistics, meta-regressions/sensitivity analyses and Cochrane Risk of Bias assessment were performed.
Overall, 1707 individuals from 14 RCTs (57% male, mean age = 20) reporting on the impact of preventive interventions on attenuated positive psychotic symptoms were included. At 6 months, the variability ratio was 1 (95% CI 0.89-1.12). At 12 months, the variability ratio was higher in the indicated intervention compared to the NBI condition but not statistically different: 1.09 (95% CI 0.94-1.25). Between-study heterogeneity was serious (I = 51% and 68%, respectively), but sensitivity analysis suggested it may be related to two outlying studies or larger variability in the response to treatment in small studies.
There is no evidence for individual differences in CHR-P response to preventive treatments. Although the study cannot exclude that subsets of CHR-P individuals may respond differently to preventive treatments, it indicates that the average effect of preventive interventions is a reasonable estimate for the CHR-P individual.
处于精神病前期临床高风险（CHR-P）的个体对有针对性的预防干预的反应可能存在显著差异。目前尚无研究对此进行测试。
系统检索了 Web of Science（MEDLINE）、PsycInfo、CENTRAL 和截止至 2019 年 9 月 1 日的未发表/灰色文献，纳入针对 CHR-P 个体、报告有减轻阳性精神病症状的随机对照试验（RCT）。主要结局指标为有针对性的干预措施与需要为基础的干预措施（NBI）在 6 个月和 12 个月时减轻阳性精神病症状严重程度的变异比。采用随机效应模型、C 统计量、Meta 回归/敏感性分析和 Cochrane 偏倚风险评估。
共有来自 14 项 RCT 的 1707 名个体（57%为男性，平均年龄 20 岁）被纳入研究，评估预防干预对减轻阳性精神病症状的影响。在 6 个月时，变异比为 1（95% CI 0.89-1.12）。在 12 个月时，与 NBI 相比，有针对性的干预措施组的变异比更高，但无统计学差异：1.09（95% CI 0.94-1.25）。研究间异质性严重（分别为 51%和 68%），但敏感性分析表明，这可能与两项离群研究或小研究中对治疗的反应变异性较大有关。
目前尚无证据表明 CHR-P 对预防治疗的反应存在个体差异。尽管该研究不能排除 CHR-P 个体亚组可能对预防治疗有不同的反应，但它表明预防干预的平均效果是 CHR-P 个体的合理估计。
