Preventing a first episode of psychosis: Meta-analysis of randomized controlled prevention trials of 12 month and longer-term follow-ups.

M. van der Gaag, H.F.E. Smit, A. Bechdolf, P. French, D.H. Linszen, A.R. Yung, P. McCorry, P. Cuijpers

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Over the last decade many studies were conducted to assess the feasibility of early detection of people at risk of developing psychosis and intervention to prevent or delay a first psychotic episode. Most of these studies were small and underpowered. A meta-analysis can demonstrate the effectiveness of the efforts to prevent or postpone a first episode of psychosis.A search conducted according the PRISMA guideline identified 10 studies reporting 12-month follow-up data on transition to psychosis, and 5 studies with follow-ups varying from 24 to 48. months. Both random and fixed effects meta-analyses were conducted.The quality of the studies varied from poor to excellent. Overall the risk reduction at 12. months was 54% (RR. = 0.463; 95% CI. = 0.33-0.64) with a Number Needed to Treat (NNT) of 9 (95% CI. = 6-15). Although the interventions differed, there was only mild heterogeneity and publication bias was small. All sub-analyses demonstrated effectiveness. Also 24 to 48-month follow-ups were associated with a risk reduction of 37% (RR. = .635; 95% CI. = 0.44-0.92) and a NNT of 12 (95% CI. = 7-59). Sensitivity analysis excluding the methodologically weakest study showed that the findings were robust.Early detection and intervention in people at ultra-high risk of developing psychosis can be successful to prevent or delay a first psychosis. Antipsychotic medication showed efficacy, but more trials are needed. Omega-3 fatty acid needs replication. Integrated psychological interventions need replication with more methodologically sound studies. The findings regarding CBT appear robust, but the 95% confidence interval is still wide. © 2013 Elsevier B.V.
Original languageEnglish
Pages (from-to)56-62
Number of pages7
JournalSchizophrenia Research
Volume149
Issue number1-3
DOIs
Publication statusPublished - 2013

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