Psychological interventions to reduce positive symptoms in schizophrenia: systematic review and network meta‐analysis

Bighelli, Irene; Salanti, Georgia; Huhn, Maximilian; Schneider‐Thoma, Johannes; Krause, Marc; Reitmeir, Cornelia; Wallis, Sofia; Schwermann, Felicitas; Pitschel-Walz, Gabriele; Barbui, Corrado; Furukawa, Toshi A; Leucht, Stefan

doi:10.1002/wps.20577

Cited by 146 publications

(123 citation statements)

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“…Where the two meta‐analyses diverged, however, was in relation to the findings in blind trials. Bighelli et al continued to find a significant effect against treatment as usual (−0.27; 95% CI: –0.41 to −0.13) in 15 blind trials, but not against inactive control (−0.14; 95% CI: –0.37 to 0.09), although the number of studies here was smaller (n=5). In contrast, Jauhar et al found that the pooled effect size for positive symptoms against all controls dropped to very low levels in their sub‐analysis of 20 blind trials (–0.08; 95% CI: –0.18 to 0.03).…”

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confidence: 66%

“…Of clear relevance here is a network meta‐analysis of psychological interventions in schizophrenia published in this journal which found pooled evidence that CBT is effective against positive symptoms. On the contrary, a 2014 meta‐analysis by Jauhar et al failed to find clear evidence of effectiveness against this class of symptoms.…”

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confidence: 99%

“…Bighelli et al’s examination of CBT for positive symptoms was based on 27 trials out of a total dataset of 40 that met their inclusion criteria (the remaining studies contained data relevant to one or more of the other outcomes they examined, e.g., overall symptoms, negative symptoms, relapse/rehospitalization, depression, quality of life, functioning and mortality). In these 27 studies, the pooled effect size was at the upper end of the small range, against both treatment as usual (–0.30; 95% CI: –0.45 to −0.14, 18 trials) and inactive control interventions (−0.29; 95% CI: –0.55 to −0.03, 7 trials).…”

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confidence: 99%

“…The most important difference between the two meta‐analyses was found to concern the inclusion criteria used. While Jauhar et al employed a broad strategy similar to those used by NICE and the Cochrane Collaboration, the focus in Bighelli et al’s meta‐analysis was planned from the outset to be on the efficacy of psychological interventions for treating positive symptoms (the indication CBT was initially developed for). Consequently, trials carried out in patients with predominantly negative symptoms and those enrolling stable patients (i.e., relapse prevention studies) were excluded.…”

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confidence: 99%

“…This methodological difference turned out to be consequential. Although the number of studies of CBT included were not greatly different in the two meta‐analyses (27 vs. 33), only 14 of the studies in Bighelli et al were also included by Jauhar et al. This means that Bighelli et al had more studies with positive symptoms as explicit inclusion criteria (14 in Jauhar et al vs. 27 in Bighelli et al).…”

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confidence: 99%

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Effect of a Nurse-Led Preventive Psychological Intervention on Symptoms of Posttraumatic Stress Disorder Among Critically Ill Patients

Wade

Mouncey

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et al. 2019

JAMA

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for the POPPI Trial Investigators IMPORTANCE A meta-analysis of outcomes during the 6 months after intensive care unit (ICU) discharge indicate a prevalence for clinically important posttraumatic stress disorder (PTSD) symptoms of 25%.OBJECTIVE To determine whether a nurse-led preventive, complex psychological intervention, initiated in the ICU, reduces patient-reported PTSD symptom severity at 6 months. DESIGN, SETTING, AND PARTICIPANTSA multicenter, parallel-group, cluster-randomized clinical trial with integrated economic and process evaluations conducted in 24 ICUs in the United Kingdom. Participants were critically ill patients who regained mental capacity following receipt of level 3 (intensive) care. A total of 2961 eligible patients were identified from September 2015 to January 2017. A total of 2048 were approached for participation in the ICU, of which 1458 provided informed consent. Follow-up was completed December 2017.INTERVENTIONS Twenty four ICUs were randomized 1:1 to the intervention or control group. Intervention ICUs (n = 12; 669 participants) delivered usual care during a baseline period followed by an intervention period. The preventive, complex psychological intervention comprised promotion of a therapeutic ICU environment plus 3 stress support sessions and a relaxation and recovery program delivered by trained ICU nurses to high-risk (acutely stressed) patients. Control ICUs (n = 12; 789 participants) delivered usual care in both baseline and intervention periods. MAIN OUTCOMES AND MEASURESThe primary clinical outcome was PTSD symptom severity among survivors at 6 months measured using the PTSD Symptom Scale-Self-Report questionnaire (score range, 0-51, with higher scores indicating greater symptom severity; the minimal clinically important difference was considered to be 4.2 points). RESULTSAmong 1458 enrolled patients (mean [SD] age, 58 [16] years; 599 women [41%]), 1353 (93%) completed the study and were included in the final analysis. At 6 months, the mean PTSD Symptom Scale-Self-Report questionnaire score in intervention ICUs was 11.8 (baseline period) compared with 11.5 (intervention period) (difference, −0.40 [95% CI, −2.46 to 1.67]) and in control ICUs, 10.1 (baseline period) compared with 10.2 (intervention period) (difference, 0.06 [95% CI, −1.74 to 1.85]) between periods. There was no significant difference in PTSD symptom severity at 6 months (treatment effect estimate [difference in differences] of −0.03 [95% CI, −2.58 to 2.52]; P = .98).CONCLUSIONS AND RELEVANCE Among critically ill patients in the ICU, a nurse-led preventive, complex psychological intervention did not significantly reduce patient-reported PTSD symptom severity at 6 months. These findings do not support the use of this psychological intervention.

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Treatment of First-Episode Schizophrenia in a Young Woman

2020

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A 20-year-old woman was referred by her family physician to a community mental health team in London, United Kingdom. Her mental state had deteriorated progressively over the previous 12 months, following the death of her father. After a period living alone, she had returned to the family home 4 months prior to her presentation and had beennotedtobesociallywithdrawn,preoccupied,anddistractible.Herfamilyphysician,suspectingadepressiveepisode, had prescribed citalopram up to a dosage of 40 mg once daily, to no effect. Her family subsequently sought advice from the family physician when the patient was noted to be speaking to herself, expressing concerns about people meaning her harm, and professing the belief that she could hear other peoples' thoughts.The patient had been born in Sierra Leone after a complicated delivery and had traveled to the United Kingdom as a child with her family, who were fleeing from a civil war. On arrival in the UnitedKingdom,herfamilyclaimedasylumandmovedintoasmallapartmentinahigh-risebuilding in central London. Although there was no reported developmental delay, she had struggled academically at school and was bullied for having overweight. She left school without qualifications at age 16 years and worked as a shop assistant. She left this job about a year prior to her referral to psychiatry after a period of sick leave following the death of her father. She was a nonsmoker, did not drink alcohol, and denied illicit drug use. A paternal relative was reported to have a diagnosis of schizophrenia. There was no comorbid physical illness.On review, the patient was kempt and had overweight. Eye contact was fleeting, and she presented as anxious, with a degree of psychomotor agitation. Her speech was normal in rate, volume, and tone, although tangential. There was no other evidence of thought disorder. She denied feeling low in mood or suicidal and was objectively euthymic. There was some sleep disturbance, with the patient reporting being fearful to go to sleep owing to persecutory beliefs regarding her neighbors. She reflected that over the preceding few months, she had experienced a sensation of detachment from her immediate environment, as though it was not real, making her world similar to that of a video game. She reported that in the apartment where she had previously been living, she had realized that something was amiss and had become convinced that the door number of her neighbor's flat, number 6, signified that they meant her harm. She explained this was because 6 was associated with the number of the devil. She reported hearing her neighbors commenting negatively about her appearance. These distressing experiences prompted her to return to her family home, but she continued to hear her neighbors' voices making derogatory comments about her appearance and began to hear them commentingonheractionsandthoughtsinthethirdpersonaswell.Onreturninghome,herparanoia regarding her previous neighbors worsened, resulting in her rarely leaving the house. The volumeandfrequencyofderogatoryaudito...

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Psychological interventions to reduce positive symptoms in schizophrenia: systematic review and network meta‐analysis

Cited by 146 publications

References 83 publications

The controversy about cognitive behavioural therapy for schizophrenia

The controversy about cognitive behavioural therapy for schizophrenia

Effect of a Nurse-Led Preventive Psychological Intervention on Symptoms of Posttraumatic Stress Disorder Among Critically Ill Patients

Treatment of First-Episode Schizophrenia in a Young Woman

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