Interventions for prodromal stage of psychosis

Kuharić, Dina Bošnjak; Kekin, Ivana; Hew, J.T.; Kuzman, Martina Rojnić; Puljak, Livia

doi:10.1002/14651858.cd012236.pub2

Cited by 61 publications

(74 citation statements)

References 258 publications

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“…In the period after these reviews were published, a Cochrane Review 76 was added to the literature which concluded that "the evidence available suggests that omega-3 fatty acids may prevent transition to psychosis" and that "more research is needed to confirm this finding". However, this Cochrane Review had some methodological flaws as the last search they conducted was in August 2017 and subsequently published the review 2 years later.…”

Section: Systematic Reviews Of Treatmentmentioning

confidence: 99%

Progression from being at-risk to psychosis: next steps

et al. 2020

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Over the past 20 years there has been a great deal of research into those considered to be at risk for developing psychosis. Much has been learned and studies have been encouraging. The aim of this paper is to offer an update of the current status of research on risk for psychosis, and what the next steps might be in examining the progression from CHR to psychosis. Advances have been made in accurate prediction, yet there are some methodological issues in ascertainment, diagnosis, the use of data-driven selection methods and lack of external validation. Although there have been several high-quality treatment trials the heterogeneity of this clinical high-risk population has to be addressed so that their treatment needs can be properly met. Recommendations for the future include more collaborative research programmes, and ensuring they are accessible and harmonized with respect to criteria and outcomes so that the field can continue to move forward with the development of large collaborative consortiums as well as increased funding for multisite projects.

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Section: Systematic Reviews Of Treatmentmentioning

confidence: 99%

Progression from being at-risk to psychosis: next steps

et al. 2020

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“…An independent pairwise meta-analysis published by the Cochrane group after completion of the current study has confirmed these findings. The study concluded that "there was no convincing, unbiased, high-quality evidence to suggest that any type of intervention is of value" for CHR-P people (108).…”

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

confidence: 99%

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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“…Preventive interventions in individuals at clinical high risk for psychosis (CHR-P) are the mainstream approach to improve outcomes of the most severe mental disorder ( 1 ). Recent independent network ( 2 , 3 ) or pairwise meta-analyses ( 4 ) converged indicating that there is no evidence to favour the recommended first-line treatment—Cognitive Behavioural Therapy, CBT—over other interventions (including needs-based-interventions) for the prevention of psychosis in CHR-P populations. Since the meta-analytical confidence interval of these estimates is large, there is high uncertainty ( 5 ) and future randomised controlled trials (RCT) are thus expected to have a major impact on the level of the evidence.…”

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confidence: 99%