Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence)
Background: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned.Methods: Umbrella review. A multi-step independent literat...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2019-12-01
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| Series: | Frontiers in Psychiatry |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/article/10.3389/fpsyt.2019.00764/full |
| _version_ | 1818066987207622656 |
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| author | Paolo Fusar-Poli Paolo Fusar-Poli Paolo Fusar-Poli Paolo Fusar-Poli Cathy Davies Marco Solmi Marco Solmi Natascia Brondino Andrea De Micheli Magdalena Kotlicka-Antczak Jae Il Shin Joaquim Radua Joaquim Radua Joaquim Radua |
| author_facet | Paolo Fusar-Poli Paolo Fusar-Poli Paolo Fusar-Poli Paolo Fusar-Poli Cathy Davies Marco Solmi Marco Solmi Natascia Brondino Andrea De Micheli Magdalena Kotlicka-Antczak Jae Il Shin Joaquim Radua Joaquim Radua Joaquim Radua |
| author_sort | Paolo Fusar-Poli |
| collection | DOAJ |
| description | Background: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned.Methods: Umbrella review. A multi-step independent literature search of Web of Science until January 11, 2019, identified interventional meta-analyses in CHR-P individuals. The individual randomised controlled trials that were analysed by the meta-analyses were extracted. A review of ongoing trials and a simulation of living meta-analysis complemented the analysis.Results: Seven meta-analyses investigating preventive treatments in CHR-P individuals were included. None of them produced pooled effect sizes across psychological, pharmacological, or other types of interventions. The outcomes analysed encompassed risk of psychosis onset, the acceptability of treatments, the severity of attenuated positive/negative psychotic symptoms, depression, symptom-related distress, social functioning, general functioning, and quality of life. These meta-analyses were based on 20 randomised controlled trials: the vast majority defined the prevention of psychosis onset as their primary outcome of interest and only powered to large effect sizes. There was no evidence to favour any preventive intervention over any other (or control condition) for improving any of these clinical outcomes. Caution is required when making clinical recommendations for the prevention of psychosis in individuals at risk.Discussion: Prevention of psychosis from a CHR-P state has been, and should remain, the primary outcome of interventional research, refined and complemented by other clinically meaningful outcomes. Stagnation of knowledge should promote innovative and collaborative research efforts, in line with the progressive and incremental nature of medical knowledge. Advancements will most likely be associated with the development of new experimental therapeutics that are ongoing along with the ability to deconstruct the high heterogeneity within CHR-P populations. This would require the estimation of treatment-specific effect sizes through living individual participant data meta-analyses, controlling risk enrichment during recruitment, statistical power, and embedding precision medicine within youth mental health services that can accommodate sequential prognosis and advanced trial designs.Conclusions: The evidence-based challenges and proposed solutions addressed by this umbrella review can inform the next generation of research into preventive treatments for psychosis. |
| first_indexed | 2024-12-10T15:16:31Z |
| format | Article |
| id | doaj.art-6ec5468f5f774a4391f07818c3c17eac |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-12-10T15:16:31Z |
| publishDate | 2019-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-6ec5468f5f774a4391f07818c3c17eac2022-12-22T01:43:47ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402019-12-011010.3389/fpsyt.2019.00764460288Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence)Paolo Fusar-Poli0Paolo Fusar-Poli1Paolo Fusar-Poli2Paolo Fusar-Poli3Cathy Davies4Marco Solmi5Marco Solmi6Natascia Brondino7Andrea De Micheli8Magdalena Kotlicka-Antczak9Jae Il Shin10Joaquim Radua11Joaquim Radua12Joaquim Radua13Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United KingdomOASIS Service, South London and Maudsley NHS Foundation Trust, London, United KingdomDepartment of Brain and Behavioral Sciences, University of Pavia, Pavia, ItalyNational Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United KingdomEarly Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United KingdomEarly Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United KingdomNeuroscience Department, Psychiatry Unit, Padua Neuroscience Center, University of Padua, Padua, ItalyDepartment of Brain and Behavioral Sciences, University of Pavia, Pavia, ItalyEarly Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United KingdomDepartment of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, PolandDepartment of Pediatrics, Yonsei University College of Medicine, Seoul, South KoreaEarly Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United KingdomInstitut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, SpainDepartment of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, SwedenBackground: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned.Methods: Umbrella review. A multi-step independent literature search of Web of Science until January 11, 2019, identified interventional meta-analyses in CHR-P individuals. The individual randomised controlled trials that were analysed by the meta-analyses were extracted. A review of ongoing trials and a simulation of living meta-analysis complemented the analysis.Results: Seven meta-analyses investigating preventive treatments in CHR-P individuals were included. None of them produced pooled effect sizes across psychological, pharmacological, or other types of interventions. The outcomes analysed encompassed risk of psychosis onset, the acceptability of treatments, the severity of attenuated positive/negative psychotic symptoms, depression, symptom-related distress, social functioning, general functioning, and quality of life. These meta-analyses were based on 20 randomised controlled trials: the vast majority defined the prevention of psychosis onset as their primary outcome of interest and only powered to large effect sizes. There was no evidence to favour any preventive intervention over any other (or control condition) for improving any of these clinical outcomes. Caution is required when making clinical recommendations for the prevention of psychosis in individuals at risk.Discussion: Prevention of psychosis from a CHR-P state has been, and should remain, the primary outcome of interventional research, refined and complemented by other clinically meaningful outcomes. Stagnation of knowledge should promote innovative and collaborative research efforts, in line with the progressive and incremental nature of medical knowledge. Advancements will most likely be associated with the development of new experimental therapeutics that are ongoing along with the ability to deconstruct the high heterogeneity within CHR-P populations. This would require the estimation of treatment-specific effect sizes through living individual participant data meta-analyses, controlling risk enrichment during recruitment, statistical power, and embedding precision medicine within youth mental health services that can accommodate sequential prognosis and advanced trial designs.Conclusions: The evidence-based challenges and proposed solutions addressed by this umbrella review can inform the next generation of research into preventive treatments for psychosis.https://www.frontiersin.org/article/10.3389/fpsyt.2019.00764/fullpsychosisschizophreniapreventiontreatmentsmeta-analysisevidence |
| spellingShingle | Paolo Fusar-Poli Paolo Fusar-Poli Paolo Fusar-Poli Paolo Fusar-Poli Cathy Davies Marco Solmi Marco Solmi Natascia Brondino Andrea De Micheli Magdalena Kotlicka-Antczak Jae Il Shin Joaquim Radua Joaquim Radua Joaquim Radua Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence) Frontiers in Psychiatry psychosis schizophrenia prevention treatments meta-analysis evidence |
| title | Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence) |
| title_full | Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence) |
| title_fullStr | Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence) |
| title_full_unstemmed | Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence) |
| title_short | Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence) |
| title_sort | preventive treatments for psychosis umbrella review just the evidence |
| topic | psychosis schizophrenia prevention treatments meta-analysis evidence |
| url | https://www.frontiersin.org/article/10.3389/fpsyt.2019.00764/full |
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