Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany.
Department of Clinical and Experimental Medicine, Institute of Psychiatry, University of Catania, Catania, Italy.
Lancet Psychiatry. 2021 Nov;8(11):969-980. doi: 10.1016/S2215-0366(21)00243-1. Epub 2021 Oct 12.
Many psychosocial and psychological interventions are used in patients with schizophrenia, but their comparative efficacy in the prevention of relapse is not known. We aimed to evaluate the efficacy, acceptability, and tolerability of psychosocial and psychological interventions for relapse prevention in schizophrenia.
To conduct this systematic review and network meta-analysis we searched for published and unpublished randomised controlled trials that investigated psychosocial or psychological interventions aimed at preventing relapse in patients with schizophrenia. We searched EMBASE, MEDLINE, PsycINFO, BIOSIS, Cochrane Library, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov up to Jan 20, 2020, and searched PubMed up to April 14, 2020. We included open and masked studies done in adults with schizophrenia or related disorders. We excluded studies in which all patients were acutely ill, had a concomitant medical or psychiatric disorder, or were prodromal or "at risk of psychosis". Study selection and data extraction were done by two reviewers independently based on published and unpublished reports, and by contacting study authors. Data were extracted about efficacy, tolerability, and acceptability of the interventions; potential effect moderators; and study quality and characteristics. The primary outcome was relapse measured with operationalised criteria or psychiatric hospital admissions. We did random-effects network meta-analysis to calculate odds ratios (ORs) or standardised mean differences (SMDs) with 95% CIs. The study protocol was registered with PROSPERO, CRD42019147884.
We identified 27 765 studies through the database search and 330 through references of previous reviews and studies. We screened 28 000 records after duplicates were removed. 24 406 records were excluded by title and abstract screening and 3594 full-text articles were assessed for eligibility. 3350 articles were then excluded for a variety of reasons, and 244 full-text articles corresponding to 85 studies were included in the qualitative synthesis. Of these, 72 studies with 10 364 participants (3939 females and 5716 males with sex indicated) were included in the network meta-analysis. The randomised controlled trials included compared 20 psychological interventions given mainly as add-on to antipsychotics. Ethnicity data were not available. Family interventions (OR 0·35, 95% CI 0·24-0·52), relapse prevention programmes (OR 0·33, 0·14-0·79), cognitive behavioural therapy (OR 0·45, 0·27-0·75), family psychoeducation (OR 0·56, 0·39-0·82), integrated interventions (OR 0·62, 0·44-0·87), and patient psychoeducation (OR 0·63, 0·42-0·94) reduced relapse more than treatment as usual at 1 year. The confidence in the estimates ranged from moderate to very low. We found no indication of publication bias.
We found robust benefits in reducing the risk of relapse for family interventions, family psychoeducation, and cognitive behavioral therapy. These treatments should be the first psychosocial interventions to be considered in the long-term treatment for patients with schizophrenia.
German Ministry for Education and Research.
许多心理社会和心理干预措施被用于精神分裂症患者，但它们在预防复发方面的相对疗效尚不清楚。我们旨在评估心理社会和心理干预措施预防精神分裂症复发的疗效、可接受性和耐受性。
为了进行这项系统评价和网络荟萃分析，我们检索了已发表和未发表的随机对照试验，这些试验调查了旨在预防精神分裂症患者复发的心理社会或心理干预措施。我们检索了 EMBASE、MEDLINE、PsycINFO、BIOSIS、 Cochrane 图书馆、世界卫生组织国际临床试验注册平台和 ClinicalTrials.gov，截至 2020 年 1 月 20 日，并检索了 PubMed 截至 2020 年 4 月 14 日。我们纳入了在成年人中进行的开放性和盲法研究，患有精神分裂症或相关障碍。我们排除了所有患者都处于急性发病期、伴有合并医学或精神疾病、或处于前驱期或“有精神病风险”的研究。研究选择和数据提取由两名独立的审阅者根据已发表和未发表的报告以及与研究作者联系进行。数据提取了干预措施的疗效、耐受性和可接受性；潜在的效果调节因素；以及研究质量和特征。主要结局是采用操作性标准或精神科住院治疗来衡量的复发。我们进行了随机效应网络荟萃分析，以计算优势比（OR）或标准化均数差异（SMD）及其 95%置信区间（CI）。研究方案在 PROSPERO、CRD42019147884 中进行了注册。
通过数据库搜索确定了 27765 项研究，通过先前的综述和研究参考文献确定了 330 项研究。我们在去除重复项后筛选了 28000 条记录。通过标题和摘要筛选排除了 24060 条记录，对 3594 篇全文文章进行了资格评估。然后排除了 3350 篇文章，因为有各种原因，244 篇全文文章对应 85 项研究被纳入定性综合分析。其中，72 项研究共纳入 10364 名参与者（3939 名女性和 5716 名男性，其中性别有说明），纳入了网络荟萃分析。这些随机对照试验比较了 20 种主要作为抗精神病药物附加治疗的心理干预措施。没有可用的种族数据。家庭干预（OR 0.35，95%CI 0.24-0.52）、复发预防计划（OR 0.33，0.14-0.79）、认知行为疗法（OR 0.45，0.27-0.75）、家庭心理教育（OR 0.56，0.39-0.82）、综合干预（OR 0.62，0.44-0.87）和患者心理教育（OR 0.63，0.42-0.94）在 1 年内降低复发的效果优于常规治疗。估计的置信度从中等到非常低不等。我们没有发现发表偏倚的迹象。
我们发现家庭干预、家庭心理教育和认知行为疗法在降低复发风险方面具有明显的益处。这些治疗方法应该是精神分裂症患者长期治疗中首先考虑的心理社会干预措施。
德国联邦教育和研究部。
