Frearson Grace, de Otazu Olivares Javier, Catalan Ana, Aymerich Claudia, Salazar de Pablo Gonzalo
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
School of Medicine, Universidad Nacional Pedro Henríquez Ureña, Santo Domingo, Dominican Republic.
Child Adolesc Ment Health. 2025 Feb;30(1):66-82. doi: 10.1111/camh.12755. Epub 2024 Dec 17.
Despite evidence suggesting that age moderates the response to preventative treatment for those at clinical high risk of psychosis (CHR-P), no meta-analysis has assessed the effectiveness of preventative interventions for CHR-P children and adolescents. Our aim was to synthesise evidence assessing preventative interventions on a wide range of mental health outcomes for CHR-P children and adolescents.
A systematic search was conducted on Ovid MEDLINE, Pubmed, APA PsycInfo and Web of Science until June 2024 (PROSPERO: CRD42023406696). Intervention studies that had a mean participant age of under 18 years old that reported on mental health outcomes for CHR-P participants were selected. A meta-analysis was conducted for independent studies reporting the effectiveness of interventions on different outcomes (transition to psychosis, attenuated positive, negative and total prodromal psychotic symptoms, depressive symptoms and global functioning) compared to control conditions of no intervention or placebo. Evidence from other studies was also reported narratively.
Twenty-four studies and 1319 CHR-P children and adolescents were included. Compared to no intervention or placebo, preventative interventions were effective for positive symptoms (SMD = 0.379, p = .022, 95% CI 0.055, 0.703), negative symptoms (SMD = 0.583, p = .004, 95% CI 0.187, 0.980), total symptoms (SMD = 0.677, p = .002, 95% CI 0.249, 1.105) and functioning (SMD = 0.944, p = .038, 95% CI 0.052, 1.836) but not reducing transition to psychosis or depressive symptoms.
There are disparities in the effectiveness of preventative interventions for different outcomes, with transition to psychosis not being the only relevant outcome. Differences in the efficacy of preventative interventions emerged between CHR-P children and adolescents versus adults.
尽管有证据表明年龄会影响临床高危精神病患者（CHR-P）对预防性治疗的反应，但尚无荟萃分析评估针对CHR-P儿童和青少年的预防性干预措施的有效性。我们的目的是综合评估针对CHR-P儿童和青少年的各种心理健康结局的预防性干预措施的证据。
在Ovid MEDLINE、Pubmed、APA PsycInfo和Web of Science上进行了系统检索，直至2024年6月（PROSPERO：CRD42023406696）。选择平均参与者年龄在18岁以下、报告了CHR-P参与者心理健康结局的干预研究。对独立研究进行荟萃分析，比较与无干预或安慰剂对照条件相比，干预措施对不同结局（向精神病的转变、减轻的阳性、阴性和总前驱精神病症状、抑郁症状和整体功能）的有效性。其他研究的证据也进行了叙述性报告。
纳入了24项研究和1319名CHR-P儿童和青少年。与无干预或安慰剂相比，预防性干预措施对阳性症状（标准化均数差[SMD]=0.379，p=0.022，95%置信区间[CI]0.055，0.703）、阴性症状（SMD=0.583，p=0.004，95%CI 0.187，0.980）、总症状（SMD=0.677，p=0.002，95%CI 0.249，1.105）和功能（SMD=0.944，p=0.038，95%CI 0.052，1.836）有效，但不能减少向精神病的转变或抑郁症状。
预防性干预措施对不同结局的有效性存在差异，向精神病的转变并非唯一相关结局。CHR-P儿童和青少年与成年人之间预防性干预措施的疗效存在差异。
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