An evidence map of interventions across premorbid, ultra-high risk and first episode phases of psychosis

Abstract

The onset of psychotic disorders peaks in adolescence and young adulthood. Early interventions during the ultra-high risk and first episode stages of illness are increasingly emphasised given the greater opportunities for clinical and functional recovery during these early phases. As a large volume of such research now exists, there is a need to summarise the extent and distribution of research to ascertain what is, and is not yet known about the evidence-base for preventing and treating early psychotic disorders.

Methods: An 'evidence mapping' methodology was used to systematically search for intervention studies published post-1980 in English (participant mean age: 6-30 years). Studies were restricted to systematic reviews, meta-analyses and controlled trials. The Cochrane Central Register of Controlled Trials, PSYCHINFO, MEDLINE and EMBASE were searched. Studies were screened according to these criteria and mapped on pre-defined study characteristics, including intervention types, stage of illness and type of study.

Results: Fifty-eight controlled trials and 8 systematic reviews were identified. The majority pertained to the first episode stage of illness (n=37), indicated prevention (n=9) and relapse prevention (n=9). Most studies involved biological (n=32) or psychological (n=17) interventions. Antipsychotic medication (n=27) and cognitive behavioural therapy (CBT; n=10) were the most common intervention modalities.

Conclusions: The extant research is dominated by trials examining intervention for first episode psychosis with antipsychotic medication. Biological interventions other than antipsychotics are sparse for patients with established psychotic disorders. For at-risk populations, there is a need for high-quality prevention studies of pharmaceutical treatments (e.g. neuroprotective agents) and a broad range of psychosocial interventions, including, but not limited to, CBT.