Comparing interventions for early psychosis: a systematic review and component network meta-analysis

Area of Science:

• Psychiatry
• Clinical Psychology
• Evidence-Based Medicine

Background:

• Early Intervention in Psychosis (EIP) services aim to improve outcomes for individuals experiencing early psychosis.
• However, the heterogeneity of EIP services and their varying treatment components pose challenges in understanding sustained treatment effects.
• The impact of specific EIP service components on long-term outcomes remains unclear.

Purpose of the Study:

• To systematically review and analyze the effectiveness of different components within specialized early psychosis intervention services.
• To identify which treatment components are most effective in improving outcomes for early psychosis patients.
• To provide evidence-based recommendations for optimizing EIP service delivery.

Main Methods:

• A systematic review and component network meta-analysis (cNMA) of randomized controlled trials (RCTs) were conducted.
• Searches were performed across multiple databases (CENTRAL, EMBASE, MEDLINE, CINAHL, PsycINFO, Web of Science) up to February 2023.
• Primary outcomes included positive and negative psychotic symptoms at 3-month and 1-year follow-up, and treatment dropouts.

Main Results:

• 37 RCTs with 4599 participants were included. Psychological interventions showed benefits in reducing negative symptoms at 3 months and improving social functioning at 1 year.
• The addition of case management significantly reduced both negative and positive psychotic symptoms at 1-year follow-up.
• Pharmacotherapy was a component in all included trial arms, precluding analysis of its specific effect.

Conclusions:

• Psychological interventions and case management, in conjunction with pharmacotherapy, appear to be crucial components for achieving sustained clinical benefits in early psychosis services.
• These findings underscore the importance of integrated treatment approaches within EIP.
• Limitations include the small number of studies and sparsely connected networks, necessitating cautious interpretation.