Methodological Biases in CBT Trial—Commentary: Modular Cognitive-Behavioral Therapy for Affective Symptoms in Young Individuals at Ultra-High Risk of First Episode of Psychosis: Randomized Controlled Trial

Fusar‐Poli, Paolo; Raduà, Joaquim; McKenna, Peter; Laws, Keith R.; Davies, Cathy; Jauhar, Sameer

doi:10.3389/fpsyt.2020.00394

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…These were considered the most accurate data on transition rates and were used in the metaanalysis. For the Pozza and Dèttore ( 2020) study, we confirmed with the first author, given the recent uncertainty (Fusar-Poli, Radua, et al, 2020), that transitioned cases experienced frank psychotic symptoms for at least eight consecutive days according to the CAARMS criteria (as opposed to a DSM brief psychotic disorder).…”

Section: Data Extractionsupporting

confidence: 72%

Preventive interventions for individuals at ultra high risk for psychosis: An updated and extended meta-analysis

Mei

Gaag

Nelson

et al. 2021

Clinical Psychology Review

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Section: Data Extractionsupporting

confidence: 72%

Preventive interventions for individuals at ultra high risk for psychosis: An updated and extended meta-analysis

Mei

Gaag

Nelson

et al. 2021

Clinical Psychology Review

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“…For instance, a decrease from 6 to 3 in one of the CHR-P symptoms may be more clinically relevant than a decrease from 3 to 0. Nevertheless, these findings confirm that transition to psychosis is not a trivial event of little clinical meaning, as argued by some authors, but related to real-world morbidity and mortality (Fusar-Poli et al, 2020b). Sixth, as transition to psychosis is defined by the worsening of attenuated psychotic symptoms, differences in secondary outcome were somewhat tautologically expected.…”

Section: Discussionsupporting

confidence: 80%

“…The large effect size improvements in attenuated psychotic symptoms compared to other outcomes may be explained by a better therapeutic response for positive symptoms, which tends to respond better to antipsychotic medication or cognitive-behavioural therapy, compared to other outcomes such as negative symptoms (Woodward et al ., 2014 ). However, there is no convincing evidence suggesting that specific preventive interventions can specifically improve attenuated (as opposed to established) psychotic symptoms better than others, including needs-based interventions (Davies et al ., 2018 ; Fusar-Poli et al ., 2019 a , 2020 c ). A specific concern relates to the impact of antipsychotics in CHR-P individuals, which appears to be largely secondary to the high comorbidities accumulated and their transdiagnostic impact on the clinical presentation (Salazar de Pablo et al ., 2020 b ; Fusar-Poli and Salazar de Pablo, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes in individuals at clinical high risk of psychosis who do not transition to psychosis: a meta-analysis

Pablo

Soardo

Cabras

et al. 2022

Epidemiol Psychiatr Sci

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Aims The clinical outcomes of individuals at clinical high risk of psychosis (CHR-P) who do not transition to psychosis are heterogeneous and inconsistently reported. We aimed to comprehensively evaluate longitudinally a wide range of outcomes in CHR-P individuals not developing psychosis. Methods “Preferred Reporting Items for Systematic reviews and Meta-Analyses” and “Meta-analysis Of Observational Studies in Epidemiology”-compliant meta-analysis (PROSPERO: CRD42021229212) searching original CHR-P longitudinal studies in PubMed and Web of Science databases up to 01/11/2021. As primary analysis, we evaluated the following outcomes within CHR-P non-transitioning individuals: (a) change in the severity of attenuated psychotic symptoms (Hedge's g); (b) change in the severity of negative psychotic symptoms (Hedge's g); (c) change in the severity of depressive symptoms (Hedge's g); (d) change in the level of functioning (Hedge's g); (e) frequency of remission (at follow-up). As a secondary analysis, we compared these outcomes in those CHR-P individuals who did not transition vs. those who did transition to psychosis at follow-up. We conducted random-effects model meta-analyses, sensitivity analyses, heterogeneity analyses, meta-regressions and publication bias assessment. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS). Results Twenty-eight studies were included (2756 CHR-P individuals, mean age = 20.4, 45.5% females). The mean duration of follow-up of the included studies was of 30.7 months. Primary analysis: attenuated psychotic symptoms [Hedges’ g = 1.410, 95% confidence interval (CI) 1.002–1.818]; negative psychotic symptoms (Hedges’ g = 0.683, 95% CI 0.371–0.995); depressive symptoms (Hedges’ g = 0.844, 95% CI 0.371–1.317); and functioning (Hedges’ g = 0.776, 95% CI 0.463–1.089) improved in CHR-P non-transitioning individuals; 48.7% remitted at follow-up (95% CI 39.3–58.2%). Secondary analysis: attenuated psychotic symptoms (Hedges’ g = 0.706, 95% CI 0.091–1.322) and functioning (Hedges’ g = 0.623, 95% CI 0.375–0.871) improved in CHR-P individuals not-transitioning compared to those transitioning to psychosis, but there were no differences in negative or depressive symptoms or frequency of remission (p > 0.05). Older age was associated with higher improvements of attenuated psychotic symptoms (β = 0.225, p = 0.012); publication years were associated with a higher improvement of functioning (β = −0.124, p = 0.0026); a lower proportion of Brief Limited Intermittent Psychotic Symptoms was associated with higher frequencies of remission (β = −0.054, p = 0.0085). There was no metaregression impact for study continent, the psychometric instrument used, the quality of the study or proportion of females. The NOS scores were 4.4 ± 0.9, ranging from 3 to 6, revealing the moderate quality of the included studies. Conclusions Clinical outcomes improve in CHR-P individuals not transitioning to psychosis but only less than half remit over time. Sustained clinical attention should be provided in the longer term to monitor these outcomes.

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“…There are still questions on the effectiveness of CBT which is probably the intervention most often provided to people deemed to be at high risk of psychosis (36). Large trials have failed to show significant effects in reducing transition (35,37,38) and the methodological rigour of some of the more recent trials in this area, which showed promising effects, has been thoroughly questioned (39).…”

Section: Interventions For People At Risk Of Psychosismentioning

confidence: 99%

Psychosocial interventions for people with a first episode psychosis: between tradition and innovation

Singh

Mohan

Giacco

2021

Current Opinion in Psychiatry

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Methodological Biases in CBT Trial—Commentary: Modular Cognitive-Behavioral Therapy for Affective Symptoms in Young Individuals at Ultra-High Risk of First Episode of Psychosis: Randomized Controlled Trial

Cited by 6 publications

References 18 publications

Preventive interventions for individuals at ultra high risk for psychosis: An updated and extended meta-analysis

Preventive interventions for individuals at ultra high risk for psychosis: An updated and extended meta-analysis

Clinical outcomes in individuals at clinical high risk of psychosis who do not transition to psychosis: a meta-analysis

Psychosocial interventions for people with a first episode psychosis: between tradition and innovation

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