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Cited by 531Schizophrenia research and treatmentPsychiatric care and mental health servicesMaternal Mental Health During Pregnancy and Postpartum

Early intervention for psychosis

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Marshall, Max, Rathbone, John·2011·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd004718.pub3PMC PMC4163966
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Abstract

BACKGROUND: Proponents of early intervention have argued that outcomes might be improved if more therapeutic efforts were focused on the early stages of schizophrenia or on people with prodromal symptoms. Early intervention in schizophrenia has two elements that are distinct from standard care: early detection, and phase-specific treatment (phase-specific treatment is a psychological, social or physical treatment developed, or modified, specifically for use with people at an early stage of the illness).Early detection and phase-specific treatment may both be offered as supplements to standard care, or may be provided through a specialised early intervention team. Early intervention is now well established as a therapeutic approach in America, Europe and Australasia. OBJECTIVES: To evaluate the effects of: (a) early detection; (b) phase-specific treatments; and (c) specialised early intervention teams in the treatment of people with prodromal symptoms or first-episode psychosis. SEARCH STRATEGY: We searched the Cochrane Schizophrenia Group Trials Register (March 2009), inspected reference lists of all identified trials and reviews and contacted experts in the field. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) designed to prevent progression to psychosis in people showing prodromal symptoms, or to improve outcome for people with first-episode psychosis. Eligible interventions, alone and in combination, included: early detection, phase-specific treatments, and care from specialised early intervention teams. We accepted cluster-randomised trials but excluded non-randomised trials. DATA COLLECTION AND ANALYSIS: We reliably selected studies, quality rated them and extracted data. For dichotomous data, we estimated relative risks (RR), with the 95% confidence intervals (CI). Where possible, we calculated the number needed to treat/harm statistic (NNT/H) and used intention-to-treat analysis (ITT). MAIN RESULTS: Studies were diverse, mostly small, undertaken by pioneering researchers and with many methodological limitations (18 RCTs, total n=1808). Mostly, meta-analyses were inappropriate. For the six studies addressing prevention of psychosis for people with prodromal symptoms, olanzapine seemed of little benefit (n=60, 1 RCT, RR conversion to psychosis 0.58 CI 0.3 to 1.2), and cognitive behavioural therapy (CBT) equally so (n=60, 1 RCT, RR conversion to psychosis 0.50 CI 0.2 to 1.7). A risperidone plus CBT plus specialised team did have benefit over specialist team alone at six months (n=59, 1 RCT, RR conversion to psychosis 0.27 CI 0.1 to 0.9, NNT 4 CI 2 to 20), but this was not seen by 12 months (n=59, 1 RCT, RR 0.54 CI 0.2 to 1.3). Omega 3 fatty acids (EPA) had advantage over placebo (n=76, 1 RCT, RR transition to psychosis 0.13 CI 0.02 to 1.0, NNT 6 CI 5 to 96). We know of no replications of this finding.The remaining trials aimed to improve outcome in first-episode psychosis. Phase-specific CBT for suicidality seemed to have little effect, but the single study was small (n=56, 1 RCT, RR suicide 0.81 CI 0.05 to 12.26). Family therapy plus a specialised team in the Netherlands did not clearly affect relapse (n=76, RR 1.05 CI 0.4 to 3.0), but without the specialised team in China it may (n=83, 1 RCT, RR admitted to hospital 0.28 CI 0.1 to 0.6, NNT 3 CI 2 to 6). The largest and highest quality study compared specialised team with standard care. Leaving the study early was reduced (n=547, 1 RCT, RR 0.59 CI 0.4 to 0.8, NNT 9 CI 6 to 18) and compliance with treatment improved (n=507, RR stopped treatment 0.20 CI 0.1 to 0.4, NNT 9 CI 8 to 12). The mean number of days spent in hospital at one year were not significantly different (n=507, WMD, -1.39 CI -2.8 to 0.1), neither were data for 'Not hospitalised' by five years (n=547, RR 1.05 CI 0.90 to 1.2). There were no significant differences in numbers 'not living independently' by one year (n=507, RR 0.55 CI 0.3 to 1.2). At five years significantly fewer participants in the treatment group were 'not living independently' (n=547, RR 0.42 CI 0.21 to 0.8, NNT 19 CI 14 to 62). When phase-specific treatment (CBT) was compared with befriending no significant differences emerged in the number of participants being hospitalised over the 12 months (n=62, 1 RCT, RR 1.08 CI 0.59 to 1.99).Phase-specific treatment E-EPA oils suggested no benefit (n=80, 1 RCT, RR no response 0.90 CI 0.6 to 1.4) as did phase-specific treatment brief intervention (n=106, 1 RCT, RR admission 0.86 CI 0.4 to 1.7). Phase-specific ACE found no benefit but participants given vocational intervention were more likely to be employed (n=41, 1 RCT, RR 0.39 CI 0.21 to 0.7, NNT 2 CI 2 to 4). Phase-specific cannabis and psychosis therapy did not show benefit (n=47, RR cannabis use 1.30 CI 0.8 to 2.2) and crisis assessment did not reduce hospitalisation (n=98, RR 0.85 CI 0.6 to 1.3). Weight was unaffected by early behavioural intervention. AUTHORS' CONCLUSIONS: There is emerging, but as ye

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  1. Davidson M Reducing the risk of early transition to psychosis: using long-acting atypical antipsychotics in young patients 2004 Proceedings of the Thematic Conference of the World Psychiatric Association on ‘Treatments in Psychiatry: An Update’ Florence, Italy 2004 Nov 10-13
  2. Grawe R Widen JH Result of two years optimal out-patient treatment of first episode schizophrenia: a controlled study Nordic Journal of Psychiatry Supplement 1998 52 76
  3. Hartmann W Muller P The therapy of first time hospitalized schizophrenics [Zur stationaren behandlung erstmals hospitalisierter schizophrener] Fortschritte der Neurologie Neurologie und Medizinische Psychologie 1974 42 601 14 4498818
  4. Keefe RSE Treatment of neurocognitive deficits with olanzapine or haloperidol in first episode psychosis 2000 Proceedings of the Second International Conference on Early Psychosis New York, USA 2000 31st March - 2nd April
  5. Mottaghipour Y Woodland L Sara G Efficacy and effectiveness in early psychosis family education group program 2000 Proceedings of the Second International Conference on Early Psychosis New York, USA 2000 31st March - 2nd April
  6. Nuechterlein KH Subotnik KL Ventura J Gitlin MJ Green MF Wallace CJ Becker DR Liberman RP Drake RE Mintz J Advances in improving and predicting work outcome in recent - onset schizophrenia Schizophrenia Bulletin 2005 31 31
  7. Wang L Wang Z Risperidone versus clozapine treatment in first-episode psychosis 2000 Proceedings of the Second International Conference on Early Psychosis New York, USA 2000 31st March - 2nd April
  8. Deng Q-Y Huang Z-L Xie Z-Y Research the effect of early intervention of first episode schizophrenia Medical Journal of Chinese Civil Administration 2006 18 9 794 6
  9. Lee H Protective and risk factors in adolescents with schizophrenia Dissertation Abstracts International: Section B: The Sciences and Engineering
  10. Li G Zong L Tian S Effect of early psychotherapy on post-schizophrenia depression Chinese Journal of Health Psychology 2007 15 1 24 5
  11. Tao YL Yong YL Tian CW Wei YY Yu HC Yuan A Chang YL Hong LZ Cai XJ Effect of early intervention on quality of life in patients with first episode schizophrenia Chinese Journal of Clinical Rehabilitation 2004 8 18 3464 65
  12. Deeks J Issues in the selection for meta-analyses of binary data 2000 Proceedings of the 8th International Cochrane Colloquium Cape Town 2000 Oct 25-28th
  13. Edwards J McGorry PD Pennell K Birchwood M Fowler D Jackson C Models of early intervention in psychosis: an analysis of service approaches Early Intervention in Psychosis 2000 281 314 Wiley Chichester
  14. Falloon IRH Boyd JL McGill CW Family Care of Schizophrenia 1984 Guildford Press New York
  15. Higgins JPT Green S Cochrane Handbook for Systematic Reviews of Interventions 2008 John Wiley & Sons Chicester
  16. The Nordic Cochrane Centre, The Cochrane Collaboration Review Manager (RevMan) 2008 The Nordic Cochrane Centre, The Cochrane Collaboration Copenhagen 5.0
  17. Wing Jk Barbo T Brugha T Burke J Cooper J Giel R Jablenski A Regier D Sartorius N Schedules for clinical assessment in neuropsychiatry Archives of General Psychiatry 1990 47 589 93 2190539

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Authors
Marshall, M., & Rathbone, J.
Affiliations
  • University of Manchester (GB)
  • University of Sheffield (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2011-06-15
Volume
2011
Issue
6
Pages
1111-4
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd004718.pub3
PMC
PMC4163966
OpenAlex
W2125959313
Cited by
531
References
261
Citations by year
2026: 5 · 2025: 14 · 2024: 10 · 2023: 6 · 2022: 22 · 2021: 17 · 2020: 25 · 2019: 35 · 2018: 19 · 2017: 21 · 2016: 42 · 2015: 45 · 2014: 48 · 2013: 40 · 2012: 51
FWCI
6.98
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Keywords
early intervention, psychosis, schizophrenia, prodromal symptoms, first-episode psychosis, early detection, olanzapine, risperidone, cognitive behavioral therapy, antipsychotic drugs, treatment outcomes, adverse effects, hospitalization, social functioning, quality of life
MeSH terms
Humans, Psychotic Disorders, Schizophrenia, Time Factors, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Early Diagnosis, Suicidal Ideation

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