Cognitive behavioral therapy may reduce risk for first episode of psychosis

Cognitive behavioral therapy may reduce the risk for first psychosis episode among individuals at clinical high risk for psychosis, according to results of a systematic review and meta-analyses published in Journal of Clinical Psychiatry.

“The morbidity associated with frank psychotic illnesses is well-recognized, with general consensus that effective interventions are necessary to prevent the onset of psychosis,” Daniel J. Devoe, MSc, of the department of psychiatry at University of Calgary’s Hotchkiss Brain Institute, and colleagues wrote. “Accordingly, transition to a psychotic disorder has been the primary outcome in the majority of randomized and observational intervention studies in those at CHR [clinical high risk] for psychosis. A variety of interventions (eg, antipsychotics, CBT, omega-3) have been tested, but most of these interventions have not been efficacious over control treatment or treatment as usual at reducing transition rates.”

Thus, the researchers noted the existing need for more data on the impact of interventions on transition to psychosis, which would inform future trials and clinical practice. In the current study, they aimed to assess the impact of all reported treatments on transition to psychosis among high-risk samples. They searched five databases from inception to May 2017 using the keywords psychosis, risk and treatment with no language, geographical or date restrictions. They included 38 independent studies that examined treatment among a sample of individuals at high risk for psychosis and reported on transition to psychosis as an outcome. Further, they extracted data on study and participant characteristics, as well as clinical outcome data. The researchers analyzed data using multivariate network meta-analyses and random-effects pairwise meta-analysis.

According to results of pairwise meta-analyses, CBT studies were linked to a significant reduction in transition compared with controls at 12-month and 18-month follow-up (risk ratio [RR] = 0.57; 95% CI, 0.35-0.93 vs. RR = 0.54; 95% CI, 0.32-0.92). Network meta-analyses revealed no significantly greater effectiveness when comparing the following interventions with each another at 6 months and 12 months:

• integrated psychological therapy;

• CBT;

• supportive therapy;

• family therapy;

• needs-based interventions;

• omega-3;

• risperidone plus CBT;

• ziprasidone; and

• olanzapine.

“This systematic review and meta-analyses demonstrated a reduced risk for transition favoring CBT at 12 and 18 months,” Devoe and colleagues wrote. “However, no interventions were significantly more effective at reducing transition compared with each other in the network meta-analysis. [Integrated psychological therapy] and family therapy, although promising, require more clinical trials to determine a more precise and generalizable effect [among youth at clinical high risk].”