Efficacy of psychological interventions in young individuals at ultra-high risk for psychosis: A naturalistic study

Review: Efficacy of preventative interventions for children and adolescents at clinical high risk of psychosis - a systematic review and meta-analysis of intervention studies

BACKGROUND

Despite evidence suggesting that age moderates the response to preventative treatment for those at clinical high risk of psychosis (CHR-P), no meta-analysis has assessed the effectiveness of preventative interventions for CHR-P children and adolescents. Our aim was to synthesise evidence assessing preventative interventions on a wide range of mental health outcomes for CHR-P children and adolescents.

METHOD

A systematic search was conducted on Ovid MEDLINE, Pubmed, APA PsycInfo and Web of Science until June 2024 (PROSPERO: CRD42023406696). Intervention studies that had a mean participant age of under 18 years old that reported on mental health outcomes for CHR-P participants were selected. A meta-analysis was conducted for independent studies reporting the effectiveness of interventions on different outcomes (transition to psychosis, attenuated positive, negative and total prodromal psychotic symptoms, depressive symptoms and global functioning) compared to control conditions of no intervention or placebo. Evidence from other studies was also reported narratively.

RESULTS

Twenty-four studies and 1319 CHR-P children and adolescents were included. Compared to no intervention or placebo, preventative interventions were effective for positive symptoms (SMD = 0.379, p = .022, 95% CI 0.055, 0.703), negative symptoms (SMD = 0.583, p = .004, 95% CI 0.187, 0.980), total symptoms (SMD = 0.677, p = .002, 95% CI 0.249, 1.105) and functioning (SMD = 0.944, p = .038, 95% CI 0.052, 1.836) but not reducing transition to psychosis or depressive symptoms.

CONCLUSIONS

There are disparities in the effectiveness of preventative interventions for different outcomes, with transition to psychosis not being the only relevant outcome. Differences in the efficacy of preventative interventions emerged between CHR-P children and adolescents versus adults.

Schizophrenia: One Name, Many Different Manifestations

Schizophrenia is a disabling condition impacting approximately 1% of the worldwide population. Symptoms include positive symptoms (eg, hallucinations, delusions), negative symptoms (eg, avolition, anhedonia), and cognitive impairment. There are likely many different environmental and pathophysiologic etiologies involving distinct neurotransmitters and neurocircuits. Pharmacologic treatment at present consists of dopamine receptor antagonists, which are reasonably effective at treating positive symptoms, but less effective at treating cognitive and negative symptoms. Nondopaminergic medications targeting alternative receptors are under investigation. Supportive psychosocial treatments can work in tandem with antipsychotic medications and optimize patient care.

Public health primary prevention implemented by clinical high-risk services for psychosis

Clinical High Risk for Psychosis (CHR-P) services have been primarily developed to support young people with attenuated symptoms (indicated prevention). No evidence-based appraisal has systematically investigated to what extent these clinics may implement other preventive approaches. PRISMA 2020-compliant systematic review of Web of Science, Cochrane Central Register of Reviews, and Ovid/PsychINFO, from inception until 14th June 2021, identifying original studies describing public health strategies: (a) service characteristics (configuration of mental health service, outreach, pathways to care); (b) universal interventions (general population); (c) selective interventions targeting CHR-P service-users or family/carers. Public health preventive initiatives were systematically stratified according to core social determinants of mental disorders associated with the 2030 Sustainable Development Goals promoted by the United Nations Member States (UN 2030 SDG) and good mental health outcomes. A total of 66 publications were included, providing data on 13 standalone, 40 integrated, three networks, and six regional or international surveys of CHR-P services across Europe, Asia, Oceania, Africa, North and South America, providing care to >28 M people. CHR-P services implement numerous public health initiatives targeting social and cultural (16 initiatives), economic (seven initiatives), demographic (six initiatives), environmental events (four initiatives) and neighbourhood (three initiatives) UN 2030 SGD determinants of mental disorders. There is additional evidence for CHR-P services promoting good mental health. The main barriers were the lack of resources for expanding public health prevention at a large scale. CHR-P services implement numerous public health prevention initiatives and promotion of good mental health beyond indicated prevention of psychosis.