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Review: more research needed on early intervention for psychosis

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Question

Question

What are the effects of early detection, phase-specific treatments and specialised early intervention teams for people with prodromal symptoms or first-episode psychosis?

Outcomes

Primary outcomes: progression to psychosis in people with prodromal symptoms; prevention of relapse or re-admission during follow-up in people with first-episode psychosis. Outcomes were as defined by the individual studies. Secondary outcomes: general outcomes such as overall functioning; mental state outcomes; behaviour outcomes; adverse effects; economic outcomes and quality of life.

Methods

Design

Systematic review and meta-analysis.

Data sources

The Cochrane Schizophrenia Group Trials Register was searched in March 2009; additional studies were identified by hand searches of reference lists of all identified trials and reviews, and contact with experts in the field.

Study selection and analysis

Randomised controlled trials (RCTs) comparing early interventions designed to prevent progression to psychosis in people showing prodromal symptoms or to improve outcome for people with first-episode psychosis against a control treatment were included. Cluster-randomised trials were included. Outcome data were converted to dichotomous data by identifying cut-off points on rating scales where possible. RR and number needed to treat (NNT) were calculated.

Main results

Eighteen RCTs were included with 1808 participants in total. Six trials addressed the prevention of psychosis for people with prodromal symptoms and 12 trials were concerned with improving outcome …

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