Efficacy and acceptability of psychosocial interventions in schizophrenia: systematic overview and quality appraisal of the meta-analytic evidence

Abstract

Psychosocial interventions are recommended in schizophrenia and first-episode psychosis/early psychosis (EP).Nevertheless, literature is heterogeneous and often contradictory. We conducted an umbrella review of (network) meta-analyses of randomized controlled trials (RCTs) comparing psychosocial interventions vs treatment as usual (TAU)/active interventions(ACTIVE)/MIXED controls. Primary outcome was total symptoms (TS); secondary outcomes were positive/negative/depressive symptoms (PS/NS/DS), cognition, functioning, relapse, hospitalization, quality of life (QoL), treatment discontinuation. Standardized mean difference (SMD)/odds ratio (OR)/risk ratio (RR) vs TAU/ACTIVE/MIXED were summarized at end-of-treatment (EoT)/follow-up (FU). Quality was rated as high/medium/low (AMSTAR-PLUS). Eighty-three meta-analyses were included (RCTs=1 246; n=84 925). Against TAU, regarding TS, Early Intervention Services (EIS) were superior EoT/FU in EP (SMD=-0.32/-0.21), cognitive behavioral therapy (CBT) in schizophrenia EoT/FU (SMD=-0.38/-0.19). Regarding secondary outcomes, in EP, EIS were superior for all outcomes EoT except cognition, and at FU for PS/NS/QoL, specific family interventions (FI-s) prevented relapse EoT; in schizophrenia, superiority emerged EoT for CBT for PS/NS/relapse/functioning/QoL; psychoeducation (EDU)/any FI for relapse; cognitive remediation therapy (CRT) for cognition/functioning; and hallucination-focused integrative treatment for PS. Against ACTIVE, in EP, mixed family interventions (FI-m) were superior at FU regarding TS (SMD=-0.61) and for functioning/relapse among secondary outcomes. In schizophrenia, regarding TS, mindfulness and social skills training (SST) were superior EoT, CBT at FU; regarding secondary outcomes superiority emerged at EoT for computerized cognitive drill-and-practice training for PS/DS, CRT for cognition/functioning, EDU for relapse, individual placement and support for employment; and at FU CBT for PS/NS. Against MIXED, in schizophrenia, CRT/EDU were superior for TS EoT (d=-0.14/SMD=-0.33), CRT regarding secondary outcomes EoT for DS/social functioning, both EoT/FU for NS/cognition/global functioning; compensatory cognitive interventions for PS/functioning EoT/FU and NS EoT; CBT for PS at FU, and EDU/SST for relapse EoT.In conclusion, mental health services should consider prioritizing EIS/any FI in EP and CBT/CRT/any FI/IPS for schizophrenia, but other interventions may be helpful for specific outcomes.

Life engagement in people living with schizophrenia: predictors and correlates of patient life engagement in a large sample of people living in the community

“…Several psychosocial interventions have been shown to provide significant improvements in real-world outcomes of people living with schizophrenia (Bighelli et al, 2021; Solmi et al, 2023; Vita et al, 2022 b ): cognitive remediation (Lejeune, Northrop, & Kurtz, 2021; Vita et al, 2021), social skills training (Turner et al, 2018), physical exercise (Stubbs et al, 2018), cognitive behavioral therapy for psychosis (Bighelli et al, 2018) and meta-cognitive training (Penney et al, 2022) all have solid meta-analytic evidence of effectiveness, not only in their main treatment targets but also in improving psychosocial functioning and real-world outcomes.…”

Self-Regulatory Neuronal Mechanisms and Long-Term Challenges in Schizophrenia Treatment

“…Although there is already encouraging experience for psychosocial interventions during the period of immediate exacerbation of schizophrenia symptoms—rather heterogeneous and sometimes contradictory—here we refer only to long-term cognitive remediation programs [ 120 ]. Simple social-cognitive trainings may have a positive effect on emotion recognition, mental state attribution, or social perception, but not generally on psychotic symptoms or overall level of social functioning [ 121 ].…”

State of the art in psychological therapies for psychosis: Family interventions for psychosis

“…Subsequent global meta‐analyses confirm these effects (Bighelli et al, 2021; Morillo et al, 2022), with a suggestion that psychoeducation is key (Rodolico et al, 2022). Effects are clearer in established compared with early psychosis (Camacho‐Gomez & Castellvi, 2020; Claxton et al, 2017; Solmi et al, 2023), and translation of outcomes to children with psychosis and at risk groups remains mixed (Catalan et al, 2021; Daruvala et al, 2021; de Haan et al, 2022).…”