Abstract
Background: Attenuated positive psychotic symptoms represent the defining features of the clinical high-risk for psychosis (CHR-P) criteria. The effectiveness of each available treatment for reducing attenuated positive psychotic symptoms remains undetermined. This network meta-analysis (NMA) investigates the consistency and magnitude of the effects of treatments on attenuated positive psychotic symptoms in CHR-P individuals, weighting the findings for acceptability.
Methods: Web of Science (MEDLINE), PsycInfo, CENTRAL and unpublished/grey literature were searched up to July 18, 2017. Randomized controlled trials in CHR-P individuals, comparing at least two interventions and reporting on attenuated positive psychotic symptoms at follow-up were included, following PRISMA guidelines. The primary outcome (efficacy) was level of attenuated positive psychotic symptoms at 6 and 12 months; effect sizes reported as standardized mean difference (SMD) and 95% CIs in mean follow-up scores between two compared interventions. The secondary outcome was treatment acceptability (reported as odds ratio (OR)). NMAs were conducted for both primary and secondary outcomes. Treatments were cluster-ranked by surface under the cumulative ranking curve values for efficacy and acceptability. Assessments of biases, assumptions, sensitivity analyses and complementary pairwise meta-analyses for the primary outcome were also conducted.
Results: Overall, 1707 patients from 14 studies (57% male, mean age= 20) were included. In the NMA for efficacy, ziprasidone + Needs-Based Intervention (NBI) was found to be superior to NBI (SMD= -1.10, 95% CI -2.04 to -0.15), Cognitive Behavioural Therapy-French & Morrison protocol (CBT-F) + NBI (SMD= -1.03, 95% CI -2.05 to -0.01), and risperidone + CBT-F + NBI (SMD= -1.18, 95% CI -2.29 to -0.07) at 6 months. However, these findings did not survive sensitivity analyses. For acceptability, aripiprazole + NBI was significantly more acceptable than olanzapine + NBI (OR= 3.73; 95% CI 1.01 to 13.81) at 12 months only. No further significant NMA effects were observed at 6 or 12 months. The results were not affected by inconsistency or evident small-study effects, but only two studies had an overall low risk of bias.
Conclusion: On the basis of the current literature, there is no robust evidence to favour any specific intervention for improving attenuated positive psychotic symptoms in CHR-P individuals.
Methods: Web of Science (MEDLINE), PsycInfo, CENTRAL and unpublished/grey literature were searched up to July 18, 2017. Randomized controlled trials in CHR-P individuals, comparing at least two interventions and reporting on attenuated positive psychotic symptoms at follow-up were included, following PRISMA guidelines. The primary outcome (efficacy) was level of attenuated positive psychotic symptoms at 6 and 12 months; effect sizes reported as standardized mean difference (SMD) and 95% CIs in mean follow-up scores between two compared interventions. The secondary outcome was treatment acceptability (reported as odds ratio (OR)). NMAs were conducted for both primary and secondary outcomes. Treatments were cluster-ranked by surface under the cumulative ranking curve values for efficacy and acceptability. Assessments of biases, assumptions, sensitivity analyses and complementary pairwise meta-analyses for the primary outcome were also conducted.
Results: Overall, 1707 patients from 14 studies (57% male, mean age= 20) were included. In the NMA for efficacy, ziprasidone + Needs-Based Intervention (NBI) was found to be superior to NBI (SMD= -1.10, 95% CI -2.04 to -0.15), Cognitive Behavioural Therapy-French & Morrison protocol (CBT-F) + NBI (SMD= -1.03, 95% CI -2.05 to -0.01), and risperidone + CBT-F + NBI (SMD= -1.18, 95% CI -2.29 to -0.07) at 6 months. However, these findings did not survive sensitivity analyses. For acceptability, aripiprazole + NBI was significantly more acceptable than olanzapine + NBI (OR= 3.73; 95% CI 1.01 to 13.81) at 12 months only. No further significant NMA effects were observed at 6 or 12 months. The results were not affected by inconsistency or evident small-study effects, but only two studies had an overall low risk of bias.
Conclusion: On the basis of the current literature, there is no robust evidence to favour any specific intervention for improving attenuated positive psychotic symptoms in CHR-P individuals.
| Original language | English |
|---|---|
| Article number | 187 |
| Journal | Frontiers in Psychiatry |
| Volume | 9 |
| Early online date | 12 Jun 2018 |
| DOIs | |
| Publication status | Published - 2018 |
Keywords
- Psychosis risk
- interventions
- symptoms
- network meta-analysis
- treatments
- clinical high risk