Efficacy and Safety of Pharmacological and Psychological Interventions for the Treatment of Psychosis and Schizophrenia in Children, Adolescents and Young Adults: A Systematic Review and Meta-Analysis

Abstract

BackgroundStudies report contrasting results regarding the efficacy and safety of pharmacological, psychological, and combined interventions in psychosis and schizophrenia in children, adolescents and young adults.MethodsSystematic review and meta-analysis. Embase, Medline, PreMedline, PsycINFO, and CENTRAL were searched to July 2013 without restriction to publication status. Randomised trials comparing any pharmacological, psychological, or combined intervention for psychosis and schizophrenia in children, adolescents and young adults were included. Studies were assessed for bias, and GRADE criteria were used to describe the quality of the results.ResultsTwenty-seven trials including 3067 participants were identified. Meta-analyses were performed for 12 comparisons: symptoms, relapse, global state, psychosocial functioning, depression, weight and discontinuation. Low quality evidence demonstrated that antipsychotics have small beneficial effects on psychotic symptoms (SMD = -0.42, 95% CI -0.58 to -0.26), and a medium adverse effect on weight gain (WMD = 1.61, 95% CI 0.61 to 2.60) and discontinuation due to side effects (RR = 2.44, 95% CI, 1.12 to 5.31). There were no trials of psychological treatments in under-18 year olds. There was no evidence of an effect of psychological interventions on psychotic symptoms in an acute episode, or relapse rate, but low quality evidence of a large effect for family plus individual CBT on the number of days to relapse (WMD = 32.25, 95% CI -36.52 to -27.98).ConclusionsFor children, adolescents and young adults, the balance of risk and benefit of antipsychotics appears less favourable than in adults. Research is needed to establish the potential for psychological treatments, alone and in combination with antipsychotics, in this population.

A multi-national comparison of antipsychotic drug use in children and adolescents, 2005–2012

“…AP can be divided in two groups: first generation (typical) antipsychotics (FGA) and second-generation (atypical) antipsychotics (SGA) [2, 3]. Efficacy of AP in youth has been demonstrated for psychotic symptoms [4], bipolar disorder [5], irritability in autistic children [6], tics [7], and some forms of (severe) aggressive behaviour [8, 9]. Ample use of AP drugs has been described in children with a mental handicap and behavioral symptoms [10].…”

Cognitive-behavioral therapy for schizophrenia: an overview on efficacy, recent trends and neurobiological findings

“…There is also evidence that the combination of family interventions with individual CBT can be strongly effective in extending the time-to-relapse in young people with psychosis. 56 It has also been argued that CBT may be effective in the treatment of schizophrenia but that it may not outperform other therapy alternatives when addressing several outcomes such as adverse effects, relapse, rehospitalization, global mental state and social functioning. 57 Orfanos et al 58 found no specific effects of CBT group interventions on the negative symptoms and social functioning of patients with schizophrenia.…”

Open‐label study of cognitive behavioural therapy for individuals with at‐risk mental state: Feasibility in the Japanese clinical setting

“…Minimizing the use of antipsychotics for individuals with ARMS is preferable because the use of antipsychotics may induce health problems and brain volume reduction (Ho et al, 2011). Further, the risk-benefit ratio of antipsychotics for the young population may be relatively low compared to the adult population (Stafford et al, 2015). Excessive use of antipsychotics for ARMS and overdiagnosis of schizophrenia is matter of great concern in Japan, and probably also in many other areas, with the exception of a limited number of Western regions (Katsura et al, 2014;Mizuno, Nemoto, Tsujino, Funatogawa, & Takeshi, 2012).…”