Efficacy and Acceptability of Interventions for Attenuated Positive Psychotic Symptoms in Individuals at Clinical High Risk of Psychosis: A Network Meta-Analysis

Davies, Cathy; Raduà, Joaquim; Cipriani, Andrea; Ståhl, Daniel; Provenzani, Umberto; McGuire, Philip; Fusar‐Poli, Paolo

doi:10.3389/fpsyt.2018.00187

Cited by 95 publications

(100 citation statements)

References 89 publications

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“…Two independent aggregate-data network meta-analyses published in 2018 found lack of evidence to favor specific preventive treatments compared to each (and every) other for improving attenuated positive psychotic symptoms (58,61).…”

Section: Symptomsmentioning

confidence: 99%

“…Importantly, although the meta-analyses presented in Table 2 were conducted by different and independent research teams, their results converge. For example, two independent meta-analyses both concluded that there is no evidence to favor specific treatments over each other for improving attenuated positive psychotic symptoms in CHR-P individuals (58,61). Unfortunately, there is no robust evidence that current treatments can improve functional levels in these patients.…”

Section: Evidence-based Efficacy Of Preventive Treatments For Chr-p Imentioning

confidence: 99%

“…A second issue, as detailed in the introduction (32), is the possibility that if the two recent network meta-analyses (30,61) had pooled together psychosocial and pharmacological trials, statistically significant findings could have emerged (32). On a statistical and conceptual level, if the randomized controlled trials are all pooled together, there could be no "network" metaanalysis comparing specific nodes against each other but just a simple meta-analysis of the average efficacy of all treatments.…”

Section: Apples Oranges and The Production Of Clinically Meaninglesmentioning

confidence: 99%

“…As indicated in our latest network meta-analyses (30,61) and in Table 3, innovative experimental therapeutics in CHR-P individuals are under development. These compounds, if used along with the above strategies, are expected to advance knowledge in this field.…”

Section: New Experimental Therapeuticsmentioning

confidence: 99%

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Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence)

et al. 2019

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Background: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned. Methods: Umbrella review. A multi-step independent literature search of Web of Science until January 11, 2019, identified interventional meta-analyses in CHR-P individuals. The individual randomised controlled trials that were analysed by the meta-analyses were extracted. A review of ongoing trials and a simulation of living meta-analysis complemented the analysis. Results: Seven meta-analyses investigating preventive treatments in CHR-P individuals were included. None of them produced pooled effect sizes across psychological, pharmacological, or other types of interventions. The outcomes analysed encompassed risk of psychosis onset, the acceptability of treatments, the severity of attenuated positive/negative psychotic symptoms, depression, symptom-related distress, social functioning, general functioning, and quality of life. These meta-analyses were based on 20 randomised controlled trials: the vast majority defined the prevention of psychosis onset as their primary outcome of interest and only powered to large effect sizes. There was no evidence to favour any preventive intervention over any other (or control condition) for improving any of these clinical outcomes. Caution is required when making clinical recommendations for the prevention of psychosis in individuals at risk. Discussion: Prevention of psychosis from a CHR-P state has been, and should remain, the primary outcome of interventional research, refined and complemented by other clinically meaningful outcomes. Stagnation of knowledge should promote innovative and collaborative research efforts, in line with the progressive and incremental nature of medical knowledge. Advancements will most likely be associated with the development of new experimental therapeutics that are ongoing along with the ability to deconstruct the high heterogeneity within CHR-P populations. This would require the estimation of treatment-specific effect sizes through living individual participant data meta-analyses,

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Section: Symptomsmentioning

confidence: 99%

Section: Evidence-based Efficacy Of Preventive Treatments For Chr-p Imentioning

confidence: 99%

Section: Apples Oranges and The Production Of Clinically Meaninglesmentioning

confidence: 99%

Section: New Experimental Therapeuticsmentioning

confidence: 99%

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Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence)

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“…Prevention of psychosis in patients at CHR-P and amelioration of symptoms are clinical priorities. However, there are currently no licensed pharmacological treatments for this patient group, which remains an unmet clinical need (Davies et al, 2018a(Davies et al, , 2018b. One potential novel treatment is the neuropeptide oxytocin, which is currently under investigation in relation to a number of neuropsychiatric disorders characterised by social dysfunction, such as autism spectrum disorder and schizophrenia.…”

Section: <Figure 1>mentioning

confidence: 99%

Neurochemical effects of oxytocin in people at clinical high risk for psychosis

Davies

Rutigliano

Micheli

et al. 2019

European Neuropsychopharmacology

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Prevention of Psychosis

et al. 2020

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IMPORTANCE Detection, prognosis, and indicated interventions in individuals at clinical high risk for psychosis (CHR-P) are key components of preventive psychiatry. OBJECTIVE To provide a comprehensive, evidence-based systematic appraisal of the advancements and limitations of detection, prognosis, and interventions for CHR-P individuals and to formulate updated recommendations. EVIDENCE REVIEW Web of Science, Cochrane Central Register of Reviews, and Ovid/PsychINFO were searched for articles published from January 1, 2013, to June 30, 2019, to identify meta-analyses conducted in CHR-P individuals. MEDLINE was used to search the reference lists of retrieved articles. Data obtained from each article included first author, year of publication, topic investigated, type of publication, study design and number, sample size of CHR-P population and comparison group, type of comparison group, age and sex of CHR-P individuals, type of prognostic assessment, interventions, quality assessment (using AMSTAR [Assessing the Methodological Quality of Systematic Reviews]), and key findings with their effect sizes.FINDINGS In total, 42 meta-analyses published in the past 6 years and encompassing 81 outcomes were included. For the detection component, CHR-P individuals were young (mean [SD] age, 20.6 [3.2] years), were more frequently male (58%), and predominantly presented with attenuated psychotic symptoms lasting for more than 1 year before their presentation at specialized services. CHR-P individuals accumulated several sociodemographic risk factors compared with control participants. Substance use (33% tobacco use and 27% cannabis use), comorbid mental disorders (41% with depressive disorders and 15% with anxiety disorders), suicidal ideation (66%), and self-harm (49%) were also frequently seen in CHR-P individuals. CHR-P individuals showed impairments in work (Cohen d = 0.57) or educational functioning (Cohen d = 0.21), social functioning (Cohen d = 1.25), and quality of life (Cohen d = 1.75). Several neurobiological and neurocognitive alterations were confirmed in this study. For the prognosis component, the prognostic accuracy of CHR-P instruments was good, provided they were used in clinical samples. Overall, risk of psychosis was 22% at 3 years, and the risk was the highest in the brief and limited intermittent psychotic symptoms subgroup (38%). Baseline severity of attenuated psychotic (Cohen d = 0.35) and negative symptoms (Cohen d = 0.39) as well as low functioning (Cohen d = 0.29) were associated with an increased risk of psychosis. Controlling risk enrichment and implementing sequential risk assessments can optimize prognostic accuracy. For the intervention component, no robust evidence yet exists to favor any indicated intervention over another (including needs-based interventions and control conditions) for preventing psychosis or ameliorating any other outcome in CHR-P individuals. However, because the uncertainty of this evidence is high, needs-based and psychological interventions should still be offered. CONCL...

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Efficacy and Acceptability of Interventions for Attenuated Positive Psychotic Symptoms in Individuals at Clinical High Risk of Psychosis: A Network Meta-Analysis

Cited by 95 publications

References 89 publications

Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence)

Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence)

Neurochemical effects of oxytocin in people at clinical high risk for psychosis

Prevention of Psychosis

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