Psychosocial treatments for relapse prevention in schizophrenia: study protocol for a systematic review and network meta-analysis of randomised evidence

Abstract

IntroductionThere is evidence that different psychosocial interventions could reduce the risk of relapse in schizophrenia, but a comprehensive evidence based on their relative efficacy is lacking. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs) to rank psychosocial treatments for relapse prevention in schizophrenia according to their efficacy, acceptability and tolerability.Methods and analysisWe will include all RCTs comparing a psychosocial treatment aimed at preventing relapse in patients with schizophrenia with another psychosocial intervention or with a no treatment condition (waiting list, treatment as usual). We will include studies on adult patients with schizophrenia, excluding specific subpopulations (eg, acutely ill patients). Primary outcome will be the number of patients experiencing a relapse. Secondary outcomes will be acceptability (dropout), change in overall, positive, negative and depressive symptoms, quality of life, adherence, functioning and adverse events. Published and unpublished studies will be sought through database searches, trial registries and websites. Study selection and data extraction will be conducted by at least two independent reviewers. We will conduct random-effects NMA to synthesise all evidence for each outcome and obtain a comprehensive ranking of all treatments. NMA will be conducted in R within a frequentist framework. The risk of bias in studies will be evaluated using the Cochrane Risk of Bias tool and the credibility of the evidence will be evaluated using Confidence in Network Meta-Analysis (CINeMA). Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings.Ethics and disseminationNo ethical issues are foreseen. Results from this study will be published in peer-reviewed journals and presented at relevant conferences.PROSPERO registration numberCRD42019147884.

Psychosocial and psychological interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis

“…We characterised the amount of heterogeneity as low, moderate, or high using the first and third quantiles of their empirical distributions. 15,16 To explore potential sources of heterogeneity or inconsistency, we did a priori planned subgroup analyses for the primary outcome on the following potential effect modifiers: 17 firstepisode patients, setting (individual vs nonindividual), inpatient status, number of sessions, and baseline severity.…”

“…To identify eligible studies, we searched EMBASE, MEDLINE, PsycINFO, PubMed, BIOSIS, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform for randomised controlled trials published up to Jan 20, 2020, and in PubMed up to April 14, 2020, that compared psychosocial interventions for relapse prevention with each other or with a control condition in people with schizophrenia. The search terms included terms related to schizophrenia and schizophrenialike disorders, randomisation, and a great variety of terms related to psychosocial interventions (appendix pp [8][9][10][11][12][13][14][15][16][17].…”

Clinical and demographic factors associated with early relapse in patients with schizophrenia: a naturalistic observation study

“…Therefore, patients meeting the remission criteria were classified as ‘early relapse’ for patients experiencing relapse in a year after the remission, and as ‘no early relapse’ for patients experiencing relapse after a year. The duration of 1 year was determined for early relapse as it was in line with the literature (Robinson et al ., 2005; Uçok et al ., 2006; Ascher-Svanum et al ., 2010; Liu et al ., 2019; Bighelli et al ., 2020). Furthermore, the 1 year after the remission is a period where the rate of relapse is the highest, patients try to adapt to normal life after an attack, and where professional and social functionality is regulated; thus, 1 year was selected (Robinson et al ., 2005; Uçok et al ., 2006; Ascher-Svanum et al ., 2010; Liu et al ., 2019; Bighelli et al ., 2020).…”

Evaluation of Everyday Living Areas for Deinstitutionalized Community-Living People with Mental Illness

“…Therefore, it is assumed that ELAs contain the social resources to provide these services and that patients have free access to them [15]. It has been reported previously that community-based psychosocial and psychological interventions for psychiatric patients may reduce readmissions more than standard inpatient care [21][22][23]. The Japanese government established the ELA as an area within which people with mental illness can receive support for living in the community following deinstitutionalization.…”