Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis

Abstract

Preventing psychosis in patients at clinical high risk may be a promising avenue for pre-emptively ameliorating outcomes of the most severe psychiatric disorder. However, information on how each preventive intervention fares against other currently available treatment options remains unavailable. The aim of the current study was to quantify the consistency and magnitude of effects of specific preventive interventions for psychosis, comparing different treatments in a network meta-analysis. PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials, and unpublished/grey literature were searched up to July 18, 2017, to identify randomized controlled trials conducted in individuals at clinical high risk for psychosis, comparing different types of intervention and reporting transition to psychosis. Two reviewers independently extracted data. Data were synthesized using network meta-analyses. The primary outcome was transition to psychosis at different time points and the secondary outcome was treatment acceptability (dropout due to any cause). Effect sizes were reported as odds ratios and 95% confidence intervals (CIs). Sixteen studies (2,035 patients, 57% male, mean age 20.1 years) reported on risk of transition. The treatments tested were needs-based interventions (NBI); omega-3 + NBI; ziprasidone + NBI; olanzapine + NBI; aripiprazole + NBI; integrated psychological interventions; family therapy + NBI; D-serine + NBI; cognitive behavioural therapy, French & Morrison protocol (CBT-F) + NBI; CBT-F + risperidone + NBI; and cognitive behavioural therapy, van der Gaag protocol (CBT-V) + CBT-F + NBI. The network meta-analysis showed no evidence of significantly superior efficacy of any one intervention over the others at 6 and 12 months (insufficient data were available after 12 months). Similarly, there was no evidence for intervention differences in acceptability at either time point. Tests for inconsistency were non-significant and sensitivity analyses controlling for different clustering of interventions and biases did not materially affect the interpretation of the results. In summary, this study indicates that, to date, there is no evidence that any specific intervention is particularly effective over the others in preventing transition to psychosis. Further experimental research is needed.

The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials

“…No meta‐analyses directly compared nutrient supplementation to psychotropic medications. All studies were placebo‐controlled.…”

“…Specific psychiatric conditions (and reported outcomes) considered in this meta‐review included: schizophrenia (examining total symptoms along with positive, negative, general and depressive symptoms, and tardive dyskinesia); states at risk for psychosis (examining attenuated psychosis symptoms, negative symptoms, transition to psychosis, and functioning); depressive disorders (including any clinical depression, diagnosed major depressive disorder (MDD), depression in pregnancy, in old age, or as a comorbidity to chronic health conditions); anxiety and stress‐related conditions (including generalized anxiety disorder, obsessive‐compulsive disorder (OCD) and trichotillomania); bipolar disorder type I and II (examining overall symptoms, bipolar mania, bipolar depression, functional impairments, and quality of life); and ADHD (including composite symptoms, hyperactivity‐impulsivity, inattention, behavioural comorbidities such as aggression, and cognitive functioning).…”

“…Three trials (N=512) examining the impact of omega‐3 (1,200‐1,400 mg/day) as a monotherapy to prevent transition to psychosis in young people meeting “at risk” criteria showed no indication of benefit (all p>0.1) compared to placebo over 26 weeks (OR=0.64, 95% CI: 0.15‐2.68) or 52 weeks (OR=0.64, 95% CI: 0.18‐2.26).…”

Need for evidence-based early intervention programmes: a public health perspective

“…The UHR/CHR programme, although an indicated prevention strategy, arguably meets some of these principles to a degree; yet it fails to meet the most essential criterion: availability of effective treatment for disease prevention. The most recent network meta-analysis of all randomised controlled trials of pharmacological and non-pharmacological interventions for UHR/CHR showed no evidence for specific effect of any intervention, including needs-based treatment (also placebo), in preventing ‘transition’ to psychosis 13. The authors discussed that these recent findings, contradicting the early meta-analyses that reported a positive effect, are mainly driven by the non-significant findings from more recent trials.…”

Early intervention in psychosis in low‐ and middle‐income countries: a WPA initiative

“…The most consistent evidence is from trials of specialist EIP care versus treatment as usual, which shows better short‐to‐medium clinical and functional outcomes for those receiving EIP care, as well as cost‐effectiveness of EIP, while the evidence of specific effective CHR/UHR interventions to prevent the emergence of psychosis remains unclear.…”