Department of Psychiatry and Psychotherapy, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Institute of General Practice and Health Services Research, TUM School of Medicine and Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Lancet Psychiatry. 2024 Jul;11(7):545-553. doi: 10.1016/S2215-0366(24)00136-6.
Many patients with schizophrenia have symptoms that do not respond to antipsychotics. This condition is called treatment-resistant schizophrenia and has not received specific attention as opposed to general schizophrenia. Psychological and psychosocial interventions as an add-on treatment to pharmacotherapy could be useful, but their role and comparative efficacy to each other and to standard care in this population are not known. We investigated the efficacy, acceptability, and tolerability of psychological and psychosocial interventions for patients with treatment-resistant schizophrenia.
In this systematic review and network meta-analysis (NMA), we searched for published and unpublished randomised controlled trials (RCTs) through a systematic database search in BIOSIS, CINAHL, Embase, LILACS, MEDLINE, PsychInfo, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform for articles published from inception up to Jan 31, 2020. We also searched the Cochrane Schizophrenia Group registry for studies published from inception up to March 31, 2022, and PubMed and Cochrane CENTRAL for studies published from inception up to July 31, 2023. We included RCTs that included patients with treatment-resistant schizophrenia. The primary outcome was overall symptoms. We did random-effects pairwise meta-analyses and NMAs to calculate standardised mean differences (SMDs) or risk ratios with 95% CIs. No people with lived experience were involved throughout the research process. The study protocol was registered in PROSPERO, CRD42022358696.
We identified 30 326 records, excluding 24 526 by title and abstract screening. 5762 full-text articles were assessed for eligibility, of which 5540 were excluded for not meeting the eligibility criteria, and 222 reports corresponding to 60 studies were included in the qualitative synthesis. Of these, 52 RCTs with 5034 participants (1654 [33·2%] females and 3325 [66·8%] males with sex indicated) comparing 20 psychological and psychosocial interventions provided data for the NMA. Mean age of participants was 38·05 years (range 23·10-48·50). We aimed to collect ethnicity data, but they were scarcely reported. According to the quality of evidence, cognitive behavioural therapy for psychosis (CBTp; SMD -0·22, 95% CI -0·35 to -0·09, 35 trials), virtual reality intervention (SMD -0·41, -0·79 to -0·02, four trials), integrated intervention (SMD -0·70, -1·18 to -0·22, three trials), and music therapy (SMD -1·27, -1·83 to -0·70, one study) were more efficacious than standard care in reducing overall symptoms. No indication of publication bias was identified.
We provide robust findings that CBTp can reduce the overall symptoms of patients with treatment-resistant schizophrenia, and therefore clinicians can prioritise this intervention in their clinical practice. Other psychological and psychosocial interventions showed promising results but need further investigation.
DAAD-ASFE.
许多精神分裂症患者的症状对抗精神病药物没有反应。这种情况被称为治疗抵抗性精神分裂症，与一般精神分裂症相比，它没有得到特别关注。心理和心理社会干预作为药物治疗的附加治疗可能是有用的，但它们在这一人群中的作用和相互比较以及与标准护理的比较效果尚不清楚。我们研究了心理和心理社会干预对治疗抵抗性精神分裂症患者的疗效、可接受性和耐受性。
在这项系统评价和网络荟萃分析（NMA）中，我们通过系统的数据库搜索在 BIOSIS、CINAHL、Embase、LILACS、MEDLINE、PsychInfo、ClinicalTrials.gov 和世界卫生组织国际临床试验注册平台中搜索了从开始到 2020 年 1 月 31 日发表的已发表和未发表的随机对照试验（RCT）。我们还在 Cochrane Schizophrenia 组注册处搜索了从开始到 2022 年 3 月 31 日发表的研究，以及在 PubMed 和 Cochrane CENTRAL 中搜索了从开始到 2023 年 7 月 31 日发表的研究。我们纳入了包括治疗抵抗性精神分裂症患者的 RCT。主要结局是总体症状。我们进行了随机效应的成对荟萃分析和 NMA，以计算标准化均数差异（SMD）或风险比及其 95%置信区间。整个研究过程中没有涉及任何具有亲身体验的人。研究方案已在 PROSPERO 中注册，CRD42022358696。
我们确定了 30326 条记录，通过标题和摘要筛选排除了 24526 条。对 5762 篇全文文章进行了资格评估，其中 5540 篇因不符合资格标准而被排除，222 篇报告对应 60 项研究被纳入定性综合分析。其中，52 项 RCT 共有 5034 名参与者（1654 名[33.2%]女性和 3325 名[66.8%]男性有性别说明），比较了 20 种心理和心理社会干预措施，为 NMA 提供了数据。参与者的平均年龄为 38.05 岁（范围 23.10-48.50）。我们旨在收集种族数据，但很少有报道。根据证据质量，认知行为治疗精神病（CBTp；SMD-0.22，95%CI-0.35 至-0.09，35 项试验）、虚拟现实干预（SMD-0.41，-0.79 至-0.02，四项试验）、综合干预（SMD-0.70，-1.18 至-0.22，三项试验）和音乐治疗（SMD-1.27，-1.83 至-0.70，一项研究）在降低总体症状方面比标准护理更有效。没有发现发表偏倚的迹象。
我们提供了有力的证据表明 CBTp 可以减轻治疗抵抗性精神分裂症患者的总体症状，因此临床医生可以在临床实践中优先考虑这种干预措施。其他心理和心理社会干预措施显示出有希望的结果，但需要进一步研究。
DAAD-ASFE。
