Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence)

Background: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned.Methods: Umbrella review. A multi-step independent literature search of Web of Science until January 11, 2019, identified interventional meta-analyses in CHR-P individuals. The individual randomised controlled trials that were analysed by the meta-analyses were extracted. A review of ongoing trials and a simulation of living meta-analysis complemented the analysis.Results: Seven meta-analyses investigating preventive treatments in CHR-P individuals were included. None of them produced pooled effect sizes across psychological, pharmacological, or other types of interventions. The outcomes analysed encompassed risk of psychosis onset, the acceptability of treatments, the severity of attenuated positive/negative psychotic symptoms, depression, symptom-related distress, social functioning, general functioning, and quality of life. These meta-analyses were based on 20 randomised controlled trials: the vast majority defined the prevention of psychosis onset as their primary outcome of interest and only powered to large effect sizes. There was no evidence to favour any preventive intervention over any other (or control condition) for improving any of these clinical outcomes. Caution is required when making clinical recommendations for the prevention of psychosis in individuals at risk.Discussion: Prevention of psychosis from a CHR-P state has been, and should remain, the primary outcome of interventional research, refined and complemented by other clinically meaningful outcomes. Stagnation of knowledge should promote innovative and collaborative research efforts, in line with the progressive and incremental nature of medical knowledge. Advancements will most likely be associated with the development of new experimental therapeutics that are ongoing along with the ability to deconstruct the high heterogeneity within CHR-P populations. This would require the estimation of treatment-specific effect sizes through living individual participant data meta-analyses, controlling risk enrichment during recruitment, statistical power, and embedding precision medicine within youth mental health services that can accommodate sequential prognosis and advanced trial designs.Conclusions: The evidence-based challenges and proposed solutions addressed by this umbrella review can inform the next generation of research into preventive treatments for psychosis. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Paolo Fusar-Poli [verfasserIn] Cathy Davies [verfasserIn] Marco Solmi [verfasserIn] Natascia Brondino [verfasserIn] Andrea De Micheli [verfasserIn] Magdalena Kotlicka-Antczak [verfasserIn] Jae Il Shin [verfasserIn] Joaquim Radua [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2019

Schlagwörter:	psychosis schizophrenia prevention treatments meta-analysis evidence

Übergeordnetes Werk:	In: Frontiers in Psychiatry - Frontiers Media S.A., 2010, 10(2019)
Übergeordnetes Werk:	volume:10 ; year:2019

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.3389/fpsyt.2019.00764

Katalog-ID:	DOAJ034365842

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allfields	10.3389/fpsyt.2019.00764 doi (DE-627)DOAJ034365842 (DE-599)DOAJ6ec5468f5f774a4391f07818c3c17eac DE-627 ger DE-627 rakwb eng RC435-571 Paolo Fusar-Poli verfasserin aut Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence) 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned.Methods: Umbrella review. A multi-step independent literature search of Web of Science until January 11, 2019, identified interventional meta-analyses in CHR-P individuals. The individual randomised controlled trials that were analysed by the meta-analyses were extracted. A review of ongoing trials and a simulation of living meta-analysis complemented the analysis.Results: Seven meta-analyses investigating preventive treatments in CHR-P individuals were included. None of them produced pooled effect sizes across psychological, pharmacological, or other types of interventions. The outcomes analysed encompassed risk of psychosis onset, the acceptability of treatments, the severity of attenuated positive/negative psychotic symptoms, depression, symptom-related distress, social functioning, general functioning, and quality of life. These meta-analyses were based on 20 randomised controlled trials: the vast majority defined the prevention of psychosis onset as their primary outcome of interest and only powered to large effect sizes. There was no evidence to favour any preventive intervention over any other (or control condition) for improving any of these clinical outcomes. Caution is required when making clinical recommendations for the prevention of psychosis in individuals at risk.Discussion: Prevention of psychosis from a CHR-P state has been, and should remain, the primary outcome of interventional research, refined and complemented by other clinically meaningful outcomes. Stagnation of knowledge should promote innovative and collaborative research efforts, in line with the progressive and incremental nature of medical knowledge. Advancements will most likely be associated with the development of new experimental therapeutics that are ongoing along with the ability to deconstruct the high heterogeneity within CHR-P populations. This would require the estimation of treatment-specific effect sizes through living individual participant data meta-analyses, controlling risk enrichment during recruitment, statistical power, and embedding precision medicine within youth mental health services that can accommodate sequential prognosis and advanced trial designs.Conclusions: The evidence-based challenges and proposed solutions addressed by this umbrella review can inform the next generation of research into preventive treatments for psychosis. psychosis schizophrenia prevention treatments meta-analysis evidence Psychiatry Paolo Fusar-Poli verfasserin aut Paolo Fusar-Poli verfasserin aut Paolo Fusar-Poli verfasserin aut Cathy Davies verfasserin aut Marco Solmi verfasserin aut Marco Solmi verfasserin aut Natascia Brondino verfasserin aut Andrea De Micheli verfasserin aut Magdalena Kotlicka-Antczak verfasserin aut Jae Il Shin verfasserin aut Joaquim Radua verfasserin aut Joaquim Radua verfasserin aut Joaquim Radua verfasserin aut In Frontiers in Psychiatry Frontiers Media S.A., 2010 10(2019) (DE-627)631498796 (DE-600)2564218-2 16640640 nnns volume:10 year:2019 https://doi.org/10.3389/fpsyt.2019.00764 kostenfrei https://doaj.org/article/6ec5468f5f774a4391f07818c3c17eac kostenfrei https://www.frontiersin.org/article/10.3389/fpsyt.2019.00764/full kostenfrei https://doaj.org/toc/1664-0640 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 10 2019
spelling	10.3389/fpsyt.2019.00764 doi (DE-627)DOAJ034365842 (DE-599)DOAJ6ec5468f5f774a4391f07818c3c17eac DE-627 ger DE-627 rakwb eng RC435-571 Paolo Fusar-Poli verfasserin aut Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence) 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned.Methods: Umbrella review. A multi-step independent literature search of Web of Science until January 11, 2019, identified interventional meta-analyses in CHR-P individuals. The individual randomised controlled trials that were analysed by the meta-analyses were extracted. A review of ongoing trials and a simulation of living meta-analysis complemented the analysis.Results: Seven meta-analyses investigating preventive treatments in CHR-P individuals were included. None of them produced pooled effect sizes across psychological, pharmacological, or other types of interventions. The outcomes analysed encompassed risk of psychosis onset, the acceptability of treatments, the severity of attenuated positive/negative psychotic symptoms, depression, symptom-related distress, social functioning, general functioning, and quality of life. These meta-analyses were based on 20 randomised controlled trials: the vast majority defined the prevention of psychosis onset as their primary outcome of interest and only powered to large effect sizes. There was no evidence to favour any preventive intervention over any other (or control condition) for improving any of these clinical outcomes. Caution is required when making clinical recommendations for the prevention of psychosis in individuals at risk.Discussion: Prevention of psychosis from a CHR-P state has been, and should remain, the primary outcome of interventional research, refined and complemented by other clinically meaningful outcomes. Stagnation of knowledge should promote innovative and collaborative research efforts, in line with the progressive and incremental nature of medical knowledge. Advancements will most likely be associated with the development of new experimental therapeutics that are ongoing along with the ability to deconstruct the high heterogeneity within CHR-P populations. This would require the estimation of treatment-specific effect sizes through living individual participant data meta-analyses, controlling risk enrichment during recruitment, statistical power, and embedding precision medicine within youth mental health services that can accommodate sequential prognosis and advanced trial designs.Conclusions: The evidence-based challenges and proposed solutions addressed by this umbrella review can inform the next generation of research into preventive treatments for psychosis. psychosis schizophrenia prevention treatments meta-analysis evidence Psychiatry Paolo Fusar-Poli verfasserin aut Paolo Fusar-Poli verfasserin aut Paolo Fusar-Poli verfasserin aut Cathy Davies verfasserin aut Marco Solmi verfasserin aut Marco Solmi verfasserin aut Natascia Brondino verfasserin aut Andrea De Micheli verfasserin aut Magdalena Kotlicka-Antczak verfasserin aut Jae Il Shin verfasserin aut Joaquim Radua verfasserin aut Joaquim Radua verfasserin aut Joaquim Radua verfasserin aut In Frontiers in Psychiatry Frontiers Media S.A., 2010 10(2019) (DE-627)631498796 (DE-600)2564218-2 16640640 nnns volume:10 year:2019 https://doi.org/10.3389/fpsyt.2019.00764 kostenfrei https://doaj.org/article/6ec5468f5f774a4391f07818c3c17eac kostenfrei https://www.frontiersin.org/article/10.3389/fpsyt.2019.00764/full kostenfrei https://doaj.org/toc/1664-0640 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 10 2019
allfields_unstemmed	10.3389/fpsyt.2019.00764 doi (DE-627)DOAJ034365842 (DE-599)DOAJ6ec5468f5f774a4391f07818c3c17eac DE-627 ger DE-627 rakwb eng RC435-571 Paolo Fusar-Poli verfasserin aut Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence) 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned.Methods: Umbrella review. A multi-step independent literature search of Web of Science until January 11, 2019, identified interventional meta-analyses in CHR-P individuals. The individual randomised controlled trials that were analysed by the meta-analyses were extracted. A review of ongoing trials and a simulation of living meta-analysis complemented the analysis.Results: Seven meta-analyses investigating preventive treatments in CHR-P individuals were included. None of them produced pooled effect sizes across psychological, pharmacological, or other types of interventions. The outcomes analysed encompassed risk of psychosis onset, the acceptability of treatments, the severity of attenuated positive/negative psychotic symptoms, depression, symptom-related distress, social functioning, general functioning, and quality of life. These meta-analyses were based on 20 randomised controlled trials: the vast majority defined the prevention of psychosis onset as their primary outcome of interest and only powered to large effect sizes. There was no evidence to favour any preventive intervention over any other (or control condition) for improving any of these clinical outcomes. Caution is required when making clinical recommendations for the prevention of psychosis in individuals at risk.Discussion: Prevention of psychosis from a CHR-P state has been, and should remain, the primary outcome of interventional research, refined and complemented by other clinically meaningful outcomes. Stagnation of knowledge should promote innovative and collaborative research efforts, in line with the progressive and incremental nature of medical knowledge. Advancements will most likely be associated with the development of new experimental therapeutics that are ongoing along with the ability to deconstruct the high heterogeneity within CHR-P populations. This would require the estimation of treatment-specific effect sizes through living individual participant data meta-analyses, controlling risk enrichment during recruitment, statistical power, and embedding precision medicine within youth mental health services that can accommodate sequential prognosis and advanced trial designs.Conclusions: The evidence-based challenges and proposed solutions addressed by this umbrella review can inform the next generation of research into preventive treatments for psychosis. psychosis schizophrenia prevention treatments meta-analysis evidence Psychiatry Paolo Fusar-Poli verfasserin aut Paolo Fusar-Poli verfasserin aut Paolo Fusar-Poli verfasserin aut Cathy Davies verfasserin aut Marco Solmi verfasserin aut Marco Solmi verfasserin aut Natascia Brondino verfasserin aut Andrea De Micheli verfasserin aut Magdalena Kotlicka-Antczak verfasserin aut Jae Il Shin verfasserin aut Joaquim Radua verfasserin aut Joaquim Radua verfasserin aut Joaquim Radua verfasserin aut In Frontiers in Psychiatry Frontiers Media S.A., 2010 10(2019) (DE-627)631498796 (DE-600)2564218-2 16640640 nnns volume:10 year:2019 https://doi.org/10.3389/fpsyt.2019.00764 kostenfrei https://doaj.org/article/6ec5468f5f774a4391f07818c3c17eac kostenfrei https://www.frontiersin.org/article/10.3389/fpsyt.2019.00764/full kostenfrei https://doaj.org/toc/1664-0640 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 10 2019
allfieldsGer	10.3389/fpsyt.2019.00764 doi (DE-627)DOAJ034365842 (DE-599)DOAJ6ec5468f5f774a4391f07818c3c17eac DE-627 ger DE-627 rakwb eng RC435-571 Paolo Fusar-Poli verfasserin aut Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence) 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned.Methods: Umbrella review. A multi-step independent literature search of Web of Science until January 11, 2019, identified interventional meta-analyses in CHR-P individuals. The individual randomised controlled trials that were analysed by the meta-analyses were extracted. A review of ongoing trials and a simulation of living meta-analysis complemented the analysis.Results: Seven meta-analyses investigating preventive treatments in CHR-P individuals were included. None of them produced pooled effect sizes across psychological, pharmacological, or other types of interventions. The outcomes analysed encompassed risk of psychosis onset, the acceptability of treatments, the severity of attenuated positive/negative psychotic symptoms, depression, symptom-related distress, social functioning, general functioning, and quality of life. These meta-analyses were based on 20 randomised controlled trials: the vast majority defined the prevention of psychosis onset as their primary outcome of interest and only powered to large effect sizes. There was no evidence to favour any preventive intervention over any other (or control condition) for improving any of these clinical outcomes. Caution is required when making clinical recommendations for the prevention of psychosis in individuals at risk.Discussion: Prevention of psychosis from a CHR-P state has been, and should remain, the primary outcome of interventional research, refined and complemented by other clinically meaningful outcomes. Stagnation of knowledge should promote innovative and collaborative research efforts, in line with the progressive and incremental nature of medical knowledge. Advancements will most likely be associated with the development of new experimental therapeutics that are ongoing along with the ability to deconstruct the high heterogeneity within CHR-P populations. This would require the estimation of treatment-specific effect sizes through living individual participant data meta-analyses, controlling risk enrichment during recruitment, statistical power, and embedding precision medicine within youth mental health services that can accommodate sequential prognosis and advanced trial designs.Conclusions: The evidence-based challenges and proposed solutions addressed by this umbrella review can inform the next generation of research into preventive treatments for psychosis. psychosis schizophrenia prevention treatments meta-analysis evidence Psychiatry Paolo Fusar-Poli verfasserin aut Paolo Fusar-Poli verfasserin aut Paolo Fusar-Poli verfasserin aut Cathy Davies verfasserin aut Marco Solmi verfasserin aut Marco Solmi verfasserin aut Natascia Brondino verfasserin aut Andrea De Micheli verfasserin aut Magdalena Kotlicka-Antczak verfasserin aut Jae Il Shin verfasserin aut Joaquim Radua verfasserin aut Joaquim Radua verfasserin aut Joaquim Radua verfasserin aut In Frontiers in Psychiatry Frontiers Media S.A., 2010 10(2019) (DE-627)631498796 (DE-600)2564218-2 16640640 nnns volume:10 year:2019 https://doi.org/10.3389/fpsyt.2019.00764 kostenfrei https://doaj.org/article/6ec5468f5f774a4391f07818c3c17eac kostenfrei https://www.frontiersin.org/article/10.3389/fpsyt.2019.00764/full kostenfrei https://doaj.org/toc/1664-0640 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 10 2019
allfieldsSound	10.3389/fpsyt.2019.00764 doi (DE-627)DOAJ034365842 (DE-599)DOAJ6ec5468f5f774a4391f07818c3c17eac DE-627 ger DE-627 rakwb eng RC435-571 Paolo Fusar-Poli verfasserin aut Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence) 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned.Methods: Umbrella review. A multi-step independent literature search of Web of Science until January 11, 2019, identified interventional meta-analyses in CHR-P individuals. The individual randomised controlled trials that were analysed by the meta-analyses were extracted. A review of ongoing trials and a simulation of living meta-analysis complemented the analysis.Results: Seven meta-analyses investigating preventive treatments in CHR-P individuals were included. None of them produced pooled effect sizes across psychological, pharmacological, or other types of interventions. The outcomes analysed encompassed risk of psychosis onset, the acceptability of treatments, the severity of attenuated positive/negative psychotic symptoms, depression, symptom-related distress, social functioning, general functioning, and quality of life. These meta-analyses were based on 20 randomised controlled trials: the vast majority defined the prevention of psychosis onset as their primary outcome of interest and only powered to large effect sizes. There was no evidence to favour any preventive intervention over any other (or control condition) for improving any of these clinical outcomes. Caution is required when making clinical recommendations for the prevention of psychosis in individuals at risk.Discussion: Prevention of psychosis from a CHR-P state has been, and should remain, the primary outcome of interventional research, refined and complemented by other clinically meaningful outcomes. Stagnation of knowledge should promote innovative and collaborative research efforts, in line with the progressive and incremental nature of medical knowledge. Advancements will most likely be associated with the development of new experimental therapeutics that are ongoing along with the ability to deconstruct the high heterogeneity within CHR-P populations. This would require the estimation of treatment-specific effect sizes through living individual participant data meta-analyses, controlling risk enrichment during recruitment, statistical power, and embedding precision medicine within youth mental health services that can accommodate sequential prognosis and advanced trial designs.Conclusions: The evidence-based challenges and proposed solutions addressed by this umbrella review can inform the next generation of research into preventive treatments for psychosis. psychosis schizophrenia prevention treatments meta-analysis evidence Psychiatry Paolo Fusar-Poli verfasserin aut Paolo Fusar-Poli verfasserin aut Paolo Fusar-Poli verfasserin aut Cathy Davies verfasserin aut Marco Solmi verfasserin aut Marco Solmi verfasserin aut Natascia Brondino verfasserin aut Andrea De Micheli verfasserin aut Magdalena Kotlicka-Antczak verfasserin aut Jae Il Shin verfasserin aut Joaquim Radua verfasserin aut Joaquim Radua verfasserin aut Joaquim Radua verfasserin aut In Frontiers in Psychiatry Frontiers Media S.A., 2010 10(2019) (DE-627)631498796 (DE-600)2564218-2 16640640 nnns volume:10 year:2019 https://doi.org/10.3389/fpsyt.2019.00764 kostenfrei https://doaj.org/article/6ec5468f5f774a4391f07818c3c17eac kostenfrei https://www.frontiersin.org/article/10.3389/fpsyt.2019.00764/full kostenfrei https://doaj.org/toc/1664-0640 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 10 2019
language	English
source	In Frontiers in Psychiatry 10(2019) volume:10 year:2019
sourceStr	In Frontiers in Psychiatry 10(2019) volume:10 year:2019
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	psychosis schizophrenia prevention treatments meta-analysis evidence Psychiatry
isfreeaccess_bool	true
container_title	Frontiers in Psychiatry
authorswithroles_txt_mv	Paolo Fusar-Poli @@aut@@ Cathy Davies @@aut@@ Marco Solmi @@aut@@ Natascia Brondino @@aut@@ Andrea De Micheli @@aut@@ Magdalena Kotlicka-Antczak @@aut@@ Jae Il Shin @@aut@@ Joaquim Radua @@aut@@
publishDateDaySort_date	2019-01-01T00:00:00Z
hierarchy_top_id	631498796
id	DOAJ034365842
language_de	englisch
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callnumber-first	R - Medicine
author	Paolo Fusar-Poli
spellingShingle	Paolo Fusar-Poli misc RC435-571 misc psychosis misc schizophrenia misc prevention misc treatments misc meta-analysis misc evidence misc Psychiatry Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence)
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topic_title	RC435-571 Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence) psychosis schizophrenia prevention treatments meta-analysis evidence
topic	misc RC435-571 misc psychosis misc schizophrenia misc prevention misc treatments misc meta-analysis misc evidence misc Psychiatry
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title	Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence)
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title_full	Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence)
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author_browse	Paolo Fusar-Poli Cathy Davies Marco Solmi Natascia Brondino Andrea De Micheli Magdalena Kotlicka-Antczak Jae Il Shin Joaquim Radua
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title_sort	preventive treatments for psychosis: umbrella review (just the evidence)
callnumber	RC435-571
title_auth	Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence)
abstract	Background: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned.Methods: Umbrella review. A multi-step independent literature search of Web of Science until January 11, 2019, identified interventional meta-analyses in CHR-P individuals. The individual randomised controlled trials that were analysed by the meta-analyses were extracted. A review of ongoing trials and a simulation of living meta-analysis complemented the analysis.Results: Seven meta-analyses investigating preventive treatments in CHR-P individuals were included. None of them produced pooled effect sizes across psychological, pharmacological, or other types of interventions. The outcomes analysed encompassed risk of psychosis onset, the acceptability of treatments, the severity of attenuated positive/negative psychotic symptoms, depression, symptom-related distress, social functioning, general functioning, and quality of life. These meta-analyses were based on 20 randomised controlled trials: the vast majority defined the prevention of psychosis onset as their primary outcome of interest and only powered to large effect sizes. There was no evidence to favour any preventive intervention over any other (or control condition) for improving any of these clinical outcomes. Caution is required when making clinical recommendations for the prevention of psychosis in individuals at risk.Discussion: Prevention of psychosis from a CHR-P state has been, and should remain, the primary outcome of interventional research, refined and complemented by other clinically meaningful outcomes. Stagnation of knowledge should promote innovative and collaborative research efforts, in line with the progressive and incremental nature of medical knowledge. Advancements will most likely be associated with the development of new experimental therapeutics that are ongoing along with the ability to deconstruct the high heterogeneity within CHR-P populations. This would require the estimation of treatment-specific effect sizes through living individual participant data meta-analyses, controlling risk enrichment during recruitment, statistical power, and embedding precision medicine within youth mental health services that can accommodate sequential prognosis and advanced trial designs.Conclusions: The evidence-based challenges and proposed solutions addressed by this umbrella review can inform the next generation of research into preventive treatments for psychosis.
abstractGer	Background: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned.Methods: Umbrella review. A multi-step independent literature search of Web of Science until January 11, 2019, identified interventional meta-analyses in CHR-P individuals. The individual randomised controlled trials that were analysed by the meta-analyses were extracted. A review of ongoing trials and a simulation of living meta-analysis complemented the analysis.Results: Seven meta-analyses investigating preventive treatments in CHR-P individuals were included. None of them produced pooled effect sizes across psychological, pharmacological, or other types of interventions. The outcomes analysed encompassed risk of psychosis onset, the acceptability of treatments, the severity of attenuated positive/negative psychotic symptoms, depression, symptom-related distress, social functioning, general functioning, and quality of life. These meta-analyses were based on 20 randomised controlled trials: the vast majority defined the prevention of psychosis onset as their primary outcome of interest and only powered to large effect sizes. There was no evidence to favour any preventive intervention over any other (or control condition) for improving any of these clinical outcomes. Caution is required when making clinical recommendations for the prevention of psychosis in individuals at risk.Discussion: Prevention of psychosis from a CHR-P state has been, and should remain, the primary outcome of interventional research, refined and complemented by other clinically meaningful outcomes. Stagnation of knowledge should promote innovative and collaborative research efforts, in line with the progressive and incremental nature of medical knowledge. Advancements will most likely be associated with the development of new experimental therapeutics that are ongoing along with the ability to deconstruct the high heterogeneity within CHR-P populations. This would require the estimation of treatment-specific effect sizes through living individual participant data meta-analyses, controlling risk enrichment during recruitment, statistical power, and embedding precision medicine within youth mental health services that can accommodate sequential prognosis and advanced trial designs.Conclusions: The evidence-based challenges and proposed solutions addressed by this umbrella review can inform the next generation of research into preventive treatments for psychosis.
abstract_unstemmed	Background: Indicated primary prevention in young people at Clinical High Risk for Psychosis (CHR-P) is a promising avenue for improving outcomes of one of the most severe mental disorders but their effectiveness has recently been questioned.Methods: Umbrella review. A multi-step independent literature search of Web of Science until January 11, 2019, identified interventional meta-analyses in CHR-P individuals. The individual randomised controlled trials that were analysed by the meta-analyses were extracted. A review of ongoing trials and a simulation of living meta-analysis complemented the analysis.Results: Seven meta-analyses investigating preventive treatments in CHR-P individuals were included. None of them produced pooled effect sizes across psychological, pharmacological, or other types of interventions. The outcomes analysed encompassed risk of psychosis onset, the acceptability of treatments, the severity of attenuated positive/negative psychotic symptoms, depression, symptom-related distress, social functioning, general functioning, and quality of life. These meta-analyses were based on 20 randomised controlled trials: the vast majority defined the prevention of psychosis onset as their primary outcome of interest and only powered to large effect sizes. There was no evidence to favour any preventive intervention over any other (or control condition) for improving any of these clinical outcomes. Caution is required when making clinical recommendations for the prevention of psychosis in individuals at risk.Discussion: Prevention of psychosis from a CHR-P state has been, and should remain, the primary outcome of interventional research, refined and complemented by other clinically meaningful outcomes. Stagnation of knowledge should promote innovative and collaborative research efforts, in line with the progressive and incremental nature of medical knowledge. Advancements will most likely be associated with the development of new experimental therapeutics that are ongoing along with the ability to deconstruct the high heterogeneity within CHR-P populations. This would require the estimation of treatment-specific effect sizes through living individual participant data meta-analyses, controlling risk enrichment during recruitment, statistical power, and embedding precision medicine within youth mental health services that can accommodate sequential prognosis and advanced trial designs.Conclusions: The evidence-based challenges and proposed solutions addressed by this umbrella review can inform the next generation of research into preventive treatments for psychosis.
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title_short	Preventive Treatments for Psychosis: Umbrella Review (Just the Evidence)
url	https://doi.org/10.3389/fpsyt.2019.00764 https://doaj.org/article/6ec5468f5f774a4391f07818c3c17eac https://www.frontiersin.org/article/10.3389/fpsyt.2019.00764/full https://doaj.org/toc/1664-0640
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author2	Paolo Fusar-Poli Cathy Davies Marco Solmi Natascia Brondino Andrea De Micheli Magdalena Kotlicka-Antczak Jae Il Shin Joaquim Radua
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up_date	2024-07-03T22:50:00.652Z
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