title: Preventing a first episode of psychosis: meta-analysis of randomized controlled prevention trials of 12 month and longer-term follow-ups.
abstract: Over the last decade many studies were conducted to assess the feasibility of early detection of people at risk of developing psychosis and intervention to prevent or delay a first psychotic episode. Most of these studies were small and underpowered. A meta-analysis can demonstrate the effectiveness of the efforts to prevent or postpone a first episode of psychosis. A search conducted according the PRISMA guideline identified 10 studies reporting 12-month follow-up data on transition to psychosis, and 5 studies with follow-ups varying from 24 to 48 months. Both random and fixed effects meta-analyses were conducted. The quality of the studies varied from poor to excellent. Overall the risk reduction at 12 months was 54% (RR=0.463; 95% CI=0.33-0.64) with a Number Needed to Treat (NNT) of 9 (95% CI=6-15). Although the interventions differed, there was only mild heterogeneity and publication bias was small. All sub-analyses demonstrated effectiveness. Also 24 to 48-month follow-ups were associated with a risk reduction of 37% (RR=.635; 95% CI=0.44-0.92) and a NNT of 12 (95% CI=7-59). Sensitivity analysis excluding the methodologically weakest study showed that the findings were robust. Early detection and intervention in people at ultra-high risk of developing psychosis can be successful to prevent or delay a first psychosis. Antipsychotic medication showed efficacy, but more trials are needed. Omega-3 fatty acid needs replication. Integrated psychological interventions need replication with more methodologically sound studies. The findings regarding CBT appear robust, but the 95% confidence interval is still wide.
authors.affiliation: VU University and EMGO Institute of Health and Care Research, Amsterdam, The Netherlands. m.vander.gaag@vu.nl
authors.forename: Mark
authors.initials: M
authors.lastname: van der Gaag
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
authors.forename: Andreas
authors.initials: A
authors.lastname: Bechdolf
authors.forename: Paul
authors.initials: P
authors.lastname: French
authors.forename: Don H
authors.initials: DH
authors.lastname: Linszen
authors.forename: Alison R
authors.initials: AR
authors.lastname: Yung
authors.forename: Patrick
authors.initials: P
authors.lastname: McGorry
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care; D011618:Psychotic Disorders / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
chemical_list: D014150:Antipsychotic Agents
keywords: Meta-analysis; Prevention; Psychosis; Transition to psychosis; Ultra-high risk