Psychological Interventions to Reduce Positive Symptoms in Schizophrenia: Systematic Review and Network Meta-Analysis

Area of Science:

• Psychiatry and Mental Health
• Clinical Psychology
• Evidence-Based Medicine

Background:

• Psychological interventions are increasingly recognized for schizophrenia management.
• Evidence for the efficacy of psychological treatments, particularly for positive symptoms, remains debated.
• A comprehensive evaluation of existing evidence is needed.

Purpose of the Study:

• To evaluate the efficacy, acceptability, and tolerability of psychological treatments for positive symptoms in schizophrenia.
• To synthesize evidence using a network meta-analysis approach, integrating direct and indirect comparisons.
• To assess psychological interventions as add-on therapy to antipsychotics.

Main Methods:

• Systematic search of multiple databases (EMBASE, MEDLINE, PsycINFO, PubMed, etc.) for randomized controlled trials (RCTs) up to January 2018.
• Inclusion of 53 RCTs involving 4,068 adult participants with schizophrenia and positive symptoms.
• Network meta-analysis comparing seven psychological interventions against control conditions, with change in positive symptoms as the primary outcome.

Main Results:

• Cognitive behavioural therapy (CBT) demonstrated a significant reduction in positive symptoms compared to inactive control, treatment as usual, and supportive therapy (SMD ranging from -0.29 to -0.47).
• CBT was associated with a higher dropout rate compared to treatment as usual (RR=0.74).
• Effect sizes for CBT were in the lower to medium range, depending on the control group; confidence in estimates varied from moderate to very low.

Conclusions:

• Cognitive behavioural therapy appears effective in reducing positive symptoms in moderately ill schizophrenia patients when used as an add-on to antipsychotic medication.
• While effective, CBT's association with increased dropout rates warrants consideration.
• Further research with higher confidence estimates is needed to fully elucidate the role of various psychological interventions.