Social and occupational recovery in early psychosis: a systematic review and meta-analysis of psychosocial interventions

2021 ◽  
pp. 1-12
Author(s):  
E. Frawley ◽  
M. Cowman ◽  
M. Lepage ◽  
G. Donohoe
Keyword(s):  
Supported Employment ◽  
Early Stage ◽  
Meta Analysis ◽  
Cognitive Remediation ◽  
Psychosocial Interventions ◽  
Behavioural Therapy ◽  
Early Psychosis ◽  
Duration Of Treatment ◽  
Early Intervention Services ◽  
Improved Function

Abstract Background Psychosis, even in its early stages, ranks highly among the causes of disability worldwide, resulting in an increased focus on improved recovery of social and occupational functioning. This study aimed to provide an estimate of the effectiveness of psychosocial interventions for improving functioning in early psychosis. We also sought evidence of superiority between intervention approaches. Methods An electronic search was conducted using PubMed and PsycINFO to identify original articles reporting on trials of psychosocial interventions in early-stage psychosis, published up to December 2020 and is reported following PRISMA guidelines. Data were extracted on validated measures of functioning from included studies and pooled standardised mean difference (SMD) was estimated. Results In total, 31 studies involving 2811 participants were included, focusing on: cognitive behavioural therapy for psychosis (CBTp), family-based therapy, supported employment, cognitive remediation training (CRT) and multi-component psychosocial interventions. Across interventions, improved function was observed (SMD = 0.239; 95% confidence interval 0.115–0.364, p < 0.001). Effect sizes varied by intervention type, stage of illness, length and duration of treatment and outcome measure used. In particular, interventions based on CRT significantly outperformed symptom-focused CBT interventions, while multi-component interventions were associated with largest gains. Conclusions Psychosocial interventions, particularly when provided as part of a multi-component intervention model and delivered in community-based settings are associated with significant improvements in social and occupational function. This review underscores the value of sensitively tracking and targeting psychosocial function as part of the standard provided by early intervention services.

scholarly journals Psychological and psychosocial interventions for negative symptoms in psychosis: Systematic review and meta-analysis

2017 ◽  
Vol 210 (5) ◽  
pp. 324-332 ◽  
Author(s):  
Danyael Lutgens ◽  
Genevieve Gariepy ◽  
Ashok Malla
Keyword(s):  
Systematic Review ◽  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Meta Analysis ◽  
Psychosocial Interventions ◽  
Detailed Examination ◽  
Behavioural Therapy ◽  
Integrated Treatment ◽  
Treatment As Usual

BackgroundNegative symptoms observed in patients with psychotic disorders undermine quality of life and functioning. Antipsychotic medications have a limited impact. Psychological and psychosocial interventions, with medication, are recommended. However, evidence for the effectiveness of specific non-biological interventions warrants detailed examination.AimsTo conduct a meta-analytic and systematic review of the literature on the effectiveness of non-biological treatments for negative symptoms in psychotic disorders.MethodWe searched for randomised controlled studies of psychological and psychosocial interventions in psychotic disorders that reported outcome on negative symptoms. Standardised mean differences (SMDs) in values of negative symptoms at the end of treatment were calculated across study domains as the main outcome measure.ResultsA total of 95 studies met our criteria and 72 had complete quantitative data. Compared with treatment as usual cognitive–behavioural therapy (pooled SMD −0.34, 95% CI −0.55 to −0.12), skills-based training (pooled SMD −0.44, 95% CI −0.77 to −0.10), exercise (pooled SMD −0.36, 95% CI −0.71 to −0.01), and music treatments (pooled SMD −0.58, 95% CI −0.82 to −0.33) provide significant benefit. Integrated treatment models are effective for early psychosis (SMD −0.38, 95% CI −0.53 to −0.22) as long as the patients remain in treatment. Overall quality of evidence was moderate with a high level of heterogeneity.ConclusionsSpecific psychological and psychosocial interventions have utility in ameliorating negative symptoms in psychosis and should be included in the treatment of negative symptoms. However, more effective treatments for negative symptoms need to be developed.

scholarly journals Developing early intervention services in the NHS: a survey to guide workforce and training needs

2003 ◽  
Vol 27 (07) ◽  
pp. 254-258 ◽  
Author(s):  
Swaran Singh ◽  
Christine Wright ◽  
Eileen Joyce ◽  
Tom Barnes ◽  
Thomas Burns
Keyword(s):  
Early Intervention ◽  
Psychosocial Interventions ◽  
Behavioural Therapy ◽  
First Episode Psychosis ◽  
First Episode ◽  
Care Programme ◽  
Early Intervention Services ◽  
Episode Psychosis ◽  
Trained Staff ◽  
Intervention Services

Aims and Method We conducted a questionnaire study to establish the incidence, specialist staff availability, treatment provision and socio-demographic profile of patients with first-episode psychosis referred to all adult and child and adolescent community mental health teams in south and west London. Results All 39 teams completed the questionnaire, identifying 295 cases of first-episode psychosis (annual incidence 21/100 000/year) referred in the year 2000. Teams manage to engage most patients with first-episode psychosis. A total of 73% of cases of first-episode psychosis were on some form of Care Programme Approach. However, many teams did not have adequately trained staff to provide psychosocial interventions. Even where such staff were available, care was focused mainly on monitoring medication and risk assessment, with only half the teams providing psycho-educational programmes and only a quarter offering individual cognitive–behavioural therapy to those with first-episode psychosis. Clinical Implications Establishing early intervention services nationwide will require significant new resources, including specialist trained staff, which could prove difficult to provide in inner-city areas. Rather than a single, uniform service model, several models of early intervention services based on locally determined need might be more realistic and appropriate, and also allow research into their relative efficacy.

scholarly journals Psychosocial therapies for the adjunctive treatment of bipolar disorder in adults: Network meta-analysis

2017 ◽  
Vol 210 (5) ◽  
pp. 333-341 ◽  
Author(s):  
Mary Lou Chatterton ◽  
Emily Stockings ◽  
Michael Berk ◽  
Jan J. Barendregt ◽  
Rob Carter ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Meta Analysis ◽  
Bipolar Affective Disorder ◽  
Psychosocial Interventions ◽  
Behavioural Therapy ◽  
Adjunctive Treatment ◽  
Depression Symptom ◽  
Pool Data ◽  
Symptom Scale ◽  
Meta Analyses

BackgroundFew trials have compared psychosocial therapies for people with bipolar affective disorder, and conventional meta-analyses provided limited comparisons between therapies.AimsTo combine evidence for the efficacy of psychosocial interventions used as adjunctive treatment of bipolar disorder in adults, using network meta-analysis (NMA).MethodSystematic review identified studies and NMA was used to pool data on relapse to mania or depression, medication adherence, and symptom scales for mania, depression and Global Assessment of Functioning (GAF).ResultsCarer-focused interventions significantly reduced the risk of depressive or manic relapse. Psychoeducation alone and in combination with cognitive–behavioural therapy (CBT) significantly reduced medication non-adherence. Psychoeducation plus CBT significantly reduced manic symptoms and increased GAF. No intervention was associated with a significant reduction in depression symptom scale scores.ConclusionsOnly interventions for family members affected relapse rates. Psychoeducation plus CBT reduced medication non-adherence, improved mania symptoms and GAF. Novel methods for addressing depressive symptoms are required.

Research assessments more important than duration of treatment? A systematic review and meta-analysis of the duration of psychosocial treatments for alcohol use disorders

2016 ◽  
Vol 33 (S1) ◽  
pp. S118-S118
Author(s):  
L. Schmidt ◽  
A.S. Nielsen ◽  
A.B. Bojesen ◽  
K. Andersen
Keyword(s):  
Systematic Review ◽  
Alcohol Use ◽  
Meta Analysis ◽  
Linear Regression Analysis ◽  
Alcohol Use Disorders ◽  
Heavy Drinking ◽  
Psychosocial Interventions ◽  
Multiple Linear Regression Analysis ◽  
Research Assessment ◽  
Duration Of Treatment

Background and aimsThe recommendations of duration of treatment for alcohol use disorders (AUD) in clinical guidelines are based on consensus decisions. There is a risk that patients will receive too little or too much therapy. We hypothesize that there is an association between duration and effect up until a point where the effects of treatment diminish.MethodsA systematic review and meta-analysis of randomized controlled trials of psychosocial interventions in the alcohol outpatient treatment centers. Population: adults (> 17 years) suffering from AUD treated with at least two sessions of therapy.StatisticsMultiple linear regression analysis with outcome measured in percentage of days abstinent (PDA), percentage of heavy days drinking (PHD), drinks per drinking day (DDD) and/or proportion of participants abstinent (ABS) as a function of duration of treatment.ResultsForty-four studies with 8485 participants were included. Mean duration: 18 (8–82) weeks and 15 (2–36) sessions. Mean follow-up time: 43 (8–104) weeks with a mean of 5 (2–18) research assessments. Only ABS was significantly associated with duration of treatment; ABS increased with 1.6%-point (P < 0.01) with each additional week in treatment. Surprisingly the analysis showed that each research assessment increased PDA with 11%-point (P < 0.001), decreased PHD with 4%-point (P < 0.05) and decreased DDD with 8%-point (P < 0.001).ConclusionDuration of treatment was associated positively with proportion of participants abstinent but not percentage of days abstinent drinks per drinking day or percentage of heavy drinking days. The three latter outcomes were affected positively by number of research assessments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals From Clozapine to Cognitive Remediation

2016 ◽  
Vol 62 (2) ◽  
pp. 94-101 ◽  
Author(s):  
Jason Quinn ◽  
Nathan J. Kolla
Keyword(s):  
Cognitive Remediation ◽  
Psychosocial Interventions ◽  
Evidence Base ◽  
Behavioural Therapy ◽  
Psychosocial Studies ◽  
Literature Searches ◽  
Cognitive Behavioural ◽  
Evidence Based Treatments ◽  
Forensic Psychiatric ◽  
Persons With Schizophrenia

Objective: Although a minority of persons with schizophrenia (SCZ) commits violent acts, SCZ remains a risk factor for violence. Here, we present a broad overview of evidence-based treatments for violence in SCZ, including biological and psychosocial interventions. Method: We conducted MEDLINE and PsychINFO literature searches to retrieve articles relating to treatments for violent, hostile, or aggressive behaviours in SCZ. Results: Clozapine shows the strongest evidence for treating the acute violence of SCZ. Other atypical antipsychotics also possess antiaggressive effects, although the evidence is not as robust as that for clozapine. Psychosocial treatments can be useful adjuncts to pharmacotherapy once patients’ positive symptoms have stabilized. Cognitive behavioural therapy for psychosis and cognitive remediation are 2 psychosocial interventions that have demonstrated positive outcomes for violence in SCZ. Most psychosocial studies that examined violence as an outcome were conducted in forensic psychiatric settings. Conclusions: Effective treatments exist for persons with SCZ who pose a risk for violent and aggressive behaviour, although the overall evidence base remains relatively weak. More randomized controlled trials of programs showing evidence for reduction of violence in SCZ are required. Further research should delineate which patients could benefit from multimodal treatment and where and when such treatments are optimally delivered.

scholarly journals Employment and educational outcomes in early intervention programmes for early psychosis: a systematic review

2014 ◽  
Vol 24 (5) ◽  
pp. 446-457 ◽  
Author(s):  
G. R. Bond ◽  
R. E. Drake ◽  
A. Luciano
Keyword(s):  
Systematic Review ◽  
Early Intervention ◽  
Educational Outcomes ◽  
Supported Employment ◽  
Meta Analysis ◽  
Early Psychosis ◽  
Empirical Literature ◽  
Employment Rate ◽  
Education Outcomes ◽  
Vocational Services

Aims.Young adults with early psychosis want to pursue normal roles – education and employment. This paper summarises the empirical literature on the effectiveness of early intervention programmes for employment and education outcomes.Methods.We conducted a systematic review of employment/education outcomes for early intervention programmes, distinguishing three programme types: (1) those providing supported employment, (2) those providing unspecified vocational services and (3) those without vocational services. We summarised findings for 28 studies.Results.Eleven studies evaluated early intervention programmes providing supported employment. In eight studies that reported employment outcomes separately from education outcomes, the employment rate during follow-up for supported employment patients was 49%, compared with 29% for patients receiving usual services. The two groups did not differ on enrolment in education. In four controlled studies, meta-analysis showed that the employment rate for supported employment participants was significantly higher than for control participants, odds ratio = 3.66 [1.93–6.93],p < 0.0001. Five studies (four descriptive and one quasi-experimental) of early intervention programmes evaluating unspecified vocational services were inconclusive. Twelve studies of early intervention programmes without vocational services were methodologically heterogeneous, using diverse methods for evaluating vocational/educational outcomes and precluding a satisfactory meta-analytic synthesis. Among studies with comparison groups, 7 of 11 (64%) reported significant vocational/education outcomes favouring early intervention over usual services.Conclusions.In early intervention programmes, supported employment moderately increases employment rates but not rates of enrolment in education. These improvements are in addition to the modest effects early programmes alone have on vocational/educational outcomes compared with usual services.

scholarly journals Web-Based Cognitive Remediation Improves Supported Employment Outcomes in Severe Mental Illness: Randomized Controlled Trial

2017 ◽  
Vol 4 (3) ◽  
pp. e30 ◽  
Author(s):  
Anthony WF Harris ◽  
Tanya Kosic ◽  
Jean Xu ◽  
Chris Walker ◽  
William Gye ◽  
...  
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Cognitive Deficits ◽  
Supported Employment ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Cognitive Remediation ◽  
Psychosocial Interventions ◽  
Web Based ◽  
Clinical Trials Registry

Background Finding work is a top priority for most people; however, this goal remains out of reach for the majority of individuals with a severe mental illness (SMI) who remain on benefits or are unemployed. Supported employment (SE) programs aimed at returning people with a severe mental illness to work are successful; however, they still leave a significant number of people with severe mental illness unemployed. Cognitive deficits are commonly found in SMI and are a powerful predictor of poor outcome. Fortunately, these deficits are amenable to treatment with cognitive remediation therapy (CRT) that significantly improves cognition in SMI. CRT combined with SE significantly increases the likelihood of individuals with severe mental illness obtaining and staying in work. However, the availability of CRT is limited in many settings. Objective The aim of this study was to examine whether Web-based CRT combined with a SE program can improve the rate return to work of people with severe mental illness. Methods A total of 86 people with severe mental illness (mean age 39.6 years; male: n=55) who were unemployed and who had joined a SE program were randomized to either a Web-based CRT program (CogRem) or an Internet-based control condition (WebInfo). Primary outcome measured was hours worked over 6 months post treatment. Results At 6 months, those participants randomized to CogRem had worked significantly more hours (P=.01) and had earned significantly more money (P=.03) than those participants randomized to the WebInfo control condition. No change was observed in cognition. Conclusions This study corroborates other work that has found a synergistic effect of combining CRT with a SE program and extends this to the use of Web-based CRT. The lack of any improvement in cognition obscures the mechanism by which an improved wage outcome for participants randomized to the active treatment was achieved. However, the study substantially lowers the barrier to the deployment of CRT with other psychosocial interventions for severe mental illness. Trial Registration Australian and New Zealand Clinical Trials Registry (ANZCTR) 12611000849998; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=12611000849998&isBasic=True (Archived by WebCite at http://www.webcitation.org/6sMKwpeos)

scholarly journals Developing early intervention services in the NHS: a survey to guide workforce and training needs

2003 ◽  
Vol 27 (7) ◽  
pp. 254-258 ◽  
Author(s):  
Swaran Singh ◽  
Christine Wright ◽  
Eileen Joyce ◽  
Tom Barnes ◽  
Thomas Burns
Keyword(s):  
Early Intervention ◽  
Psychosocial Interventions ◽  
Behavioural Therapy ◽  
First Episode Psychosis ◽  
First Episode ◽  
Care Programme ◽  
Early Intervention Services ◽  
Episode Psychosis ◽  
Trained Staff ◽  
Intervention Services

Aims and MethodWe conducted a questionnaire study to establish the incidence, specialist staff availability, treatment provision and socio-demographic profile of patients with first-episode psychosis referred to all adult and child and adolescent community mental health teams in south and west London.ResultsAll 39 teams completed the questionnaire, identifying 295 cases of first-episode psychosis (annual incidence 21/100 000/year) referred in the year 2000. Teams manage to engage most patients with first-episode psychosis. A total of 73% of cases of first-episode psychosis were on some form of Care Programme Approach. However, many teams did not have adequately trained staff to provide psychosocial interventions. Even where such staff were available, care was focused mainly on monitoring medication and risk assessment, with only half the teams providing psycho-educational programmes and only a quarter offering individual cognitive–behavioural therapy to those with first-episode psychosis.Clinical ImplicationsEstablishing early intervention services nationwide will require significant new resources, including specialist trained staff, which could prove difficult to provide in inner-city areas. Rather than a single, uniform service model, several models of early intervention services based on locally determined need might be more realistic and appropriate, and also allow research into their relative efficacy.

scholarly journals Early intervention services, cognitive–behavioural therapy and family intervention in early psychosis: systematic review

2010 ◽  
Vol 197 (5) ◽  
pp. 350-356 ◽  
Author(s):  
Victoria Bird ◽  
Preethi Premkumar ◽  
Tim Kendall ◽  
Craig Whittington ◽  
Jonathan Mitchell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Early Intervention ◽  
Hospital Admission ◽  
Cognitive Behavioural Therapy ◽  
Family Intervention ◽  
Behavioural Therapy ◽  
Early Psychosis ◽  
Early Intervention Services ◽  
Cognitive Behavioural ◽  
Intervention Services

BackgroundEarly intervention services for psychosis aim to detect emergent symptoms, reduce the duration of untreated psychosis, and improve access to effective treatments.AimsTo evaluate the effectiveness of early intervention services, cognitive–behavioural therapy (CBT) and family intervention in early psychosis.MethodSystematic review and meta-analysis of randomised controlled trials of early intervention services, CBT and family intervention for people with early psychosis.ResultsEarly intervention services reduced hospital admission, relapse rates and symptom severity, and improved access to and engagement with treatment. Used alone, family intervention reduced relapse and hospital admission rates, whereas CBT reduced the severity of symptoms with little impact on relapse or hospital admission.ConclusionsFor people with early psychosis, early intervention services appear to have clinically important benefits over standard care. Including CBT and family intervention within the service may contribute to improved outcomes in this critical period. The longer-term benefits of this approach and its component treatments for people with early and established psychosis need further research.

scholarly journals Effectiveness of psychosocial interventions for hypertensive disorders in pregnancy: A systematic review and meta-analysis

2022 ◽  
Author(s):  
Daniel A. Nnate ◽  
Kobi Vannessa Ajayi ◽  
Md Mahbub Hossain ◽  
Paul Guerby
Keyword(s):  
Spiritual Care ◽  
Meta Analysis ◽  
Psychosocial Interventions ◽  
Behavioural Therapy ◽  
Care Education ◽  
Hypertensive Disorders ◽  
Cognitive Behavioural ◽  
Hypertensive Disorders In Pregnancy ◽  
Gestational Stress ◽  
In Pregnancy

Objective: Studies on psychosocial interventions for perinatal mental health and wellbeing are mostly limited to the postpartum period. However, the physiological changes associated with hypertensive disorders in pregnancy predisposes women to severe psychological distress and adverse birth outcomes. This review investigated the effectiveness of psychosocial interventions for hypertensive disorders during pregnancy. Methods: Cochrane CENTRAL, Embase, MEDLINE, MIDIRS, CINAHL, PsycINFO, PsycArticles, and Web of Science were searched up to 22nd August 2021. Effect sizes on relevant health outcomes were pooled in a meta‐analysis using STATA software. Results: Eight randomised trials involving 460 participants met the inclusion criteria. Included studies adopted several interventions ranging from music, exercise, cognitive behavioural therapy (CBT), spiritual care education and psychoeducation. The pooled effect showed a significant reduction in anxiety (d= −0.35 [−0.58, −0.11], p=0.004) and depression (d= −0.37 [−0.57, −0.17], p=0.0003). Spiritual care education significantly reduced postpartum stress disorder (d= −62.00 [−93.10, −30.90], p= 0.0001). However, CBT showed no effect on gestational stress (d= −2.20 [-4.89, 0.48], p= 0.11). Conclusion: This study provides satisfactory evidence that psychosocial interventions may likely reduce anxiety and depression associated with hypertensive disorders in pregnancy. However, the evidence is very uncertain about its effect on neonatal outcomes.

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