A meta-analysis, published in The Lancet, Psychiatry, investigated various psychosocial and psychological treatments for schizophrenia and compared their efficacy, acceptability, and tolerability in relapse prevention. The study, led by Irene Bighelli, PhD, and colleagues, found that family interventions, family psychoeducation, and cognitive behavioral therapy offer benefits in reducing risk of schizophrenia relapse versus standard care.
According to the authors, this is the first meta-analysis to investigate associated relapse prevention of schizophrenia treatments. They suggested that the three treatments they identified “should be the first psychosocial interventions to be considered in the long-term treatment for patients with schizophrenia.”
Studies were collected from the EMBASE, MEDLINE, PsycINFO, BIOSIS, Cochrane Library, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov (up to Jan 20, 2020), and PubMed (up to April 14, 2020). The meta-analysis considered the recorded results of the interventions, as well as potential effect moderators and study quality and characteristics. The primary outcome was relapse, as measured with operationalized criteria, or psychiatric hospital admissions. Odds ratios (ORs), and standardized mean differences (SMDs) were calculated with random-effects network meta-analysis with 95% CIs.
A total of 244 full-text articles were included in the qualitative analysis. Of those, 72 studies with 10,364 participants were included in the network meta-analysis. The included trials compared 20 psychological interventions. Family interventions (OR=0·35, 95% CI, 0·24-0·52), relapse prevention programs (OR= 0·33, 0·14-0·79), cognitive behavioral therapy (OR=0·45, 0·27-0·75), family psychoeducation (OR=0·56, 0·39-0·82), integrated interventions (OR= 0·62, 0·44-0·87), and patient psychoeducation (O= 0·63, 0·42-0·94) reduced relapse more than standard care at one year.
The study’s authors acknowledged limitations, including that many comparisons were based on a relatively low number of studies, resulting in low statistical power. Risk of bias was also identified in the included studies. Additionally, authors planned to compare different definitions of relapse, but relapse was often too poorly defined in the studies to analyze (except for readmission to hospital).
The researchers ultimately concluded that family interventions, family psychoeducation, and cognitive behavioral therapy interventions were superior to standard care alone in schizophrenia relapse prevention at one year. They suggested that further trials that more strictly define relapse, record concurrent drug treatments, and explore the specific mechanisms by which various treatments reduce risk of relapse are necessary.
Source: The Lancet, Psychiatry
