Individuals in early-phase psychosis experience better outcomes with early intervention services than they do with treatment as usual, supporting the need to fund and use early intervention services for these individuals, according to a meta-analysis published in JAMA Psychiatry.
The systematic literature review was conducted according to PRISMA guidelines by 3 independent investigators that extracted data from PubMed, PsycINFO, EMBASE, and ClinicalTrials.gov for a random-effects meta-analysis and pre-specified subgroup and meta-regression analyses. Ten randomized clinical trials were analyzed to compare early intervention services with treatment as usual in 2176 individuals with first-episode psychosis or early-phase schizophrenia spectrum disorders.
The clinical trials ranged in duration from 9 to 24 months, with a mean trial duration of 16.2 (standard deviation 7.4) months. Thirteen meta-analyzable outcomes were reviewed, including: all-cause treatment discontinuation (risk ratio [RR] 0.70; 95% CI, 0.61-0.80; P < .001), at least 1 psychiatric hospitalization (RR 0.74; 95% CI, 0.61-0.90;P =.003), involvement in school or work (RR 1.13; 95% CI, 1.03-1.24; P =.01), negative symptom severity (standardized mean difference [SMD] −0.28; 95% CI, −0.42 to −0.14; P <.001), positive symptom severity (SMD −0.22; 95% CI, −0.32 to −0.11; P <.001), and total symptom severity (SMD −0.32; 95% CI, −0.47 to −0.17; P <.001).
Each study included early intervention services of psychopharmacological treatment and family psychoeducation and counseling. Some studies included other components, eg, cognitive behavior therapy, vocational and educational counseling, social skills training, and crisis management.
This systematic literature review explored the question of whether early intervention services are superior to treatment as usual regarding both symptom-related and illness-related treatment outcomes. At the end of treatment for all of these outcomes, early intervention services were associated with superior outcomes compared with treatment as usual. The results support the allocation of public resources to and use of early intervention services in individuals with early-phase psychosis, which has already begun throughout the world.
Correll CU, Galling B, Pawar A, et al. Comparison of early intervention services vs treatment as usual for early-phase psychosis: a systematic review, meta-analysis, and meta-regression [published online May 2, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.0623