Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, The Hague, the Netherlands.
Clin Psychol Rev. 2021 Jun;86:102005. doi: 10.1016/j.cpr.2021.102005. Epub 2021 Mar 26.
Intervention at the earliest illness stage, in ultra or clinical high-risk individuals, or indicated prevention, currently represents the most promising strategy to ameliorate, delay or prevent psychosis. We review the current state of evidence and conduct a broad-spectrum meta-analysis of various outcomes: transition to psychosis, attenuated positive and negative psychotic symptoms, mania, depression, anxiety, general psychopathology, symptom-related distress, functioning, quality of life, and treatment acceptability. 26 randomized controlled trials were included. Meta-analytically pooled interventions reduced transition rate (risk ratio [RR] = 0.57, 95%CI 0.41-0.81) and attenuated positive psychotic symptoms at 12-months (standardized mean difference = -0.15, 95%CI = -0.28--0.01). When stratified by intervention type (pharmacological, psychological), only the pooled effect of psychological interventions on transition rate was significant. Cognitive behavioral therapy (CBT) was associated with a reduction in incidence at 12-months (RR = 0.52, 95%CI = 0.33-0.82) and 18-48-months (RR = 0.60, 95%CI = 0.42-0.84), but not 6-months. Findings at 12-months and 18-48-months were robust in sensitivity and subgroup analyses. All other outcomes were non-significant. To date, effects of trialed treatments are specific to transition and, a lesser extent, attenuated positive symptoms, highlighting the future need to target other symptom domains and functional outcomes. Sound evidence supports CBT in reducing transition and the value of intervening at this illness stage. STUDY REGISTRATION: Research Registry ID: reviewregistry907.
早期疾病阶段的干预、超高危或临床高危个体或有指征的预防，目前代表了改善、延缓或预防精神病的最有前途的策略。我们回顾了当前的证据状况，并对各种结果进行了广泛的荟萃分析：向精神病转变、减轻阳性和阴性精神病症状、躁狂、抑郁、焦虑、一般精神病学、症状相关痛苦、功能、生活质量和治疗可接受性。共纳入 26 项随机对照试验。荟萃分析合并干预措施降低了转变率（风险比 [RR] = 0.57，95%CI 0.41-0.81），并在 12 个月时减轻了阳性精神病症状（标准化均数差 [SMD] = -0.15，95%CI = -0.28--0.01）。按干预类型（药物、心理）分层时，只有心理干预对转变率的合并效果有统计学意义。认知行为疗法（CBT）与 12 个月时（RR = 0.52，95%CI = 0.33-0.82）和 18-48 个月时（RR = 0.60，95%CI = 0.42-0.84）的发生率降低相关，但 6 个月时不相关。12 个月和 18-48 个月的结果在敏感性和亚组分析中是稳健的。所有其他结果均无统计学意义。迄今为止，试验治疗的效果仅限于向精神病转变，以及在较小程度上减轻阳性症状，这突出表明未来需要针对其他症状领域和功能结果进行靶向治疗。有可靠的证据支持 CBT 降低向精神病转变的效果，以及在该疾病阶段进行干预的价值。研究注册：研究注册编号：reviewregistry907。
