Early interventions to prevent psychosis: systematic review and meta-analysis
Open accessAbstract
OBJECTIVE: To determine whether any psychological, pharmacological, or nutritional interventions can prevent or delay transition to psychotic disorders for people at high risk. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Embase, Medline, PreMedline, PsycINFO, and CENTRAL were searched to November 2011 without restriction to publication status. REVIEW METHODS: Randomised trials comparing any psychological, pharmacological, nutritional, or combined intervention with usual services or another treatment. Studies of participants with a formal diagnosis of schizophrenia or bipolar disorder were excluded. Studies were assessed for bias, and relevant limitations were considered in summarising the results. RESULTS: 11 trials including 1246 participants and eight comparisons were included. Median sample size of included trials was 81 (range 51-288). Meta-analyses were performed for transition to psychosis, symptoms of psychosis, depression, and mania; quality of life; weight; and discontinuation of treatment. Evidence of moderate quality showed an effect for cognitive behavioural therapy on reducing transition to psychosis at 12 months (risk ratio 0.54 (95% confidence interval 0.34 to 0.86); risk difference -0.07 (-0.14 to -0.01). Very low quality evidence for omega-3 fatty acids and low to very low quality evidence for integrated psychotherapy also indicated that these interventions were associated with reductions in transition to psychosis at 12 months. CONCLUSIONS: Although evidence of benefits for any specific intervention is not conclusive, these findings suggest that it might be possible to delay or prevent transition to psychosis. Further research should be undertaken to establish conclusively the potential for benefit of psychological interventions in the treatment of people at high risk of psychosis.
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During lifespan, there are sensitive periods where risk and protective factors have greater impact and long-lasting consequences.
“During a lifespan, there are sensitive periods where risk and protective factors may have greater impact and long-lasting consequences.16,40”
From Preventive strategies for mental health (2018) · cites this paper as [40]
Previous pairwise meta-analyses in this field had methodological limitations, including heterogeneous interventions, non-standard clinical high risk samples, non-randomized trials, pooling of time-dependent outcomes, and poor meta-analytical approaches.
“The other meta-analyses were affected by mistakes 19 or methodological limitations”
From Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis (2018) · cites this paper as [15]
Previous pairwise meta-analyses in this field had methodological limitations, including heterogeneous interventions, non-standard clinical high risk samples, non-randomized trials, pooling of time-dependent outcomes, and poor meta-analytical approaches.
“The other meta-analyses were affected by mistakes 19 or methodological limitations”
From Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis (2018) · cites this paper as [19]
Evidence converges on a lack of significant benefit for clinical outcomes other than transition to psychosis, including attenuated symptom severity, functioning, depressive comorbidities, distress and quality of life.
“There is also converging lack of significant benefits on other clinical outcomes besides transition to psychosis, such as attenuated symptom severity 14,15,96 , functioning 10,14,18 , depressive comorbidities 15 , distress 14 , and quality of life 14,15 .”
From Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis (2018) · cites this paper as [15]
The Stafford et al meta-analysis analyzed 11 studies, but one was open-label and another did not use standard clinical high risk for psychosis criteria, leaving nine studies with 1,043 patients in common with the current study.
“For example, the metaanalysis by Stafford et al 15 -on which current clinical guidelines are based -analyzed 11 studies, but one of them included an open-label trial (N5124) 94 and another did not assess participants against standard CHR-P criteria (N579) 20 , leaving nine studies (N51,043) that are in common with the current”
From Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis (2018) · cites this paper as [15]
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- Authors
- Stafford, M. R., Jackson, H., Mayo-Wilson, E., Morrison, A. P., & Kendall, T.
- Affiliations
- Royal College of Psychiatrists (GB)
- University of Manchester (GB)
- Sheffield Health and Social Care NHS Foundation Trust (GB)
- Corresponding author
- Kendall, T.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2013-01-18
- Volume
- 346
- Issue
- jan18 1
- Pages
- f185-f185
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC3548617
- OpenAlex
- W2024581069
- Cited by
- 456
- References
- 80
- Citations by year
- 2026: 12 · 2025: 10 · 2024: 13 · 2023: 17 · 2022: 9 · 2021: 33 · 2020: 40 · 2019: 45 · 2018: 35 · 2017: 47 · 2016: 54 · 2015: 64 · 2014: 52 · 2013: 25
- FWCI
- 8.87
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- psychosis prevention, early intervention, high-risk groups, transition to psychosis, cognitive behavioral therapy, omega-3 fatty acids, integrative psychotherapy, dietary intervention, schizophrenia, bipolar disorder, depression, mania, quality of life, treatment discontinuation
- MeSH terms
- Clinical Trials as Topic, Combined Modality Therapy, Humans, Psychotic Disorders, Risk Factors, Antipsychotic Agents, Fatty Acids, Omega-3, Cognitive Behavioral Therapy, Dietary Supplements, Early Diagnosis
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