Effectiveness of Psychosocial Intervention for Persons in Prodromal State of Schizophrenia: A Systematic Review
Keywords:
psychosocial Intervention, prodromal state of schizophrenia, transition to the first episode of psychosis, systematic reviewAbstract
Schizophrenia is a chronic and severe mental illness. Finding an effective intervention in preventing the progression to the first episode of schizophrenia for persons in a prodromal state is very important. The objective of this review is to evaluate the effectiveness of psychosocial intervention in preventing the progression to first episode schizophrenia for persons in a prodromal state. The systematic review of quantitative evidence has been adopted using the eight steps of the Joanna Briggs Institute (JBI, 2014). Studies published in Thai or English language during 2006-2016 were considered for inclusion in this review. The results found 13 studies that met inclusion criteria and critical appraising of the study quality, to include in this systematic review. The meta-analysis was performed to evaluate the effectiveness by using SUMARI software developed by Joanna Briggs Institute (JBI, 2017) and a narrative summary was used when the meta-analysis was not possible.
The results found that the psychosocial interventions that were found to be effective in preventing the progression to first episode schizophrenia for persons in a prodromal state included cognitive behavioral therapy combined with a low dose antipsychotic at a six month period (Odds Ratio 0.28; 95% confidence interval (CI) 0.09, 0.86; p<0.05) and cognitive behavioral therapy at a 12-month period (Odds Ratio 0.58; 95% confidence interval (CI) 0.36, 0.95; p<0.05).
Based on the results of systematic review, clinical practice guidelines in preventing the progression to first episode schizophrenia for persons in prodromal state should be developed. Cognitive behavioral therapy combined with a low dose antipsychotic should be implemented in a six-month period and cognitive behavioral therapy should be applied in a twelve-month period. Primary research should be further investigated on the effectiveness of a combination of psychosocial interventions due to the existing evidence that showed a small number of studies and very low quality levels which resulted in the inability to perform meta-analysis to synthesis the overall effect size of this kind of intervention.
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