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No Conclusive Evidence for Use of Psychosis Interventions

Early psychosis may benefit from specialized early interventions and phase-specific treatment

MONDAY, June 20 (HealthDay News) -- There is emerging but inconclusive evidence that individuals with prodromal symptoms or first-episode psychosis may benefit from specialized early intervention services and phase-specific treatment, according to a review published in the June issue of the Cochrane Database of Systematic Reviews.

Max Marshall, M.D., from the University of Manchester, and John Rathbone, from the University of Sheffield -- both in the United Kingdom, evaluated the effects of early detection, phase-specific treatments, and specialized early intervention teams in the treatment of people with prodromal symptoms or first-episode psychosis. They searched the Cochrane Schizophrenia Group Trials Register (March 2009) and identified 18 randomized controlled trials that included 1,808 participants.

The investigators found that the studies were diverse, usually small, undertaken by pioneering researchers with many limitations, and that meta-analysis was mostly inappropriate. For six studies addressing the prevention of psychosis for individuals with prodromal symptoms, olanzapine and cognitive behavioral therapy (CBT) had little benefit. Risperidone, CBT, and specialized teams had more benefit over specialist teams alone at six months, but not at 12 months. Omega 3 fatty acids (eicosapentaenoic acid) had some advantage over placebo. In trials that looked at the outcome in first-episode psychosis, phase-specific CBT had little effect on suicidality. Family therapy with a specialized team did not affect relapse, but without the team it may. The largest and highest quality study comparing specialized team with standard care showed no difference in average days spent in hospital, those not living independently by one year, and those not hospitalized by five years.

"There is emerging, but as yet inconclusive evidence to suggest that people in the prodrome of psychosis can be helped by some interventions," the authors write.

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