Do Psychological Interventions Work for Psychosis in Adolescents?

Rhea Daruvala; Ajit Kumar; Soumitra Shankar Datta

Disclosures

Schizophr Bull. 2021;47(3):692-694. 

In This Article

Main Results

The review included 7 studies wherein the total number of participants was 319. The studies assessed a heterogeneous group of psychological interventions with variable risk bias (figure 1). No adverse events were reported in any of the studies. None of the studies were sponsored by the industry. The review made 6 main comparisons but included mostly small trials.

Figure 1.

Risk of bias of included studies of psychological interventions for psychosis in adolescents.

Two studies compared CRT and TAU (CRT + TAU) with TAU alone and found no clear difference in global state score as measured by Children's Global Assessment Scale (CGAS) between the CRT + TAU and TAU groups (MD −4.90, 95% CI −11.05 to 1.25; participants = 50, very low-certainty evidence). Mental state scores measured using the Positive and Negative Syndrome Scale (PANSS) were lower in the TAU group (MD 8.30, 95% CI 0.46 to 16.14, participants = 50, very low-certainty evidence), which is likely due to the baseline characteristics in the PANSS score of the 2 groups being different from the start. It was clear that the participants in the CRT group showed improvement in short-term memory, measured using digit span test, which is a cognitive function, compared with those in the TAU group (RR 0.58, 95% CI 0.37 to 0.89, participants= 31, very low-certainty evidence) (figure 2).

Figure 2.

Post-intervention effect on cognitive functioning: Not attaining normal cognitive function for comparison of cognitive remediation therapy plus treatment as usual vs treatment as usual.

One study assessed the effectiveness of adding group psychosocial therapy to TAU and reported that global state scores measured using CGAS were higher in the intervention arm (MD 5.10, 95% CI 1.35 to 8.85, participants = 56, very low-certainty evidence) as compared with the TAU arm but there was no difference in mental state scores measured using PANSS.

One study evaluated the effects of combining 2 types of psychological interventions namely cognitive remediation program and psychoeducational treatment program (CRP + PTP) and compared this with PTP alone. This study showed that in either of the arms, following the interventions, the global state scores (CGAS, high = good) were not clearly different (MD 1.60, 95% CI −6.48 to 9.68; participants = 25; studies = 1; very low certainty), as were mental state scores (brief psychiatric rating scale [BPRS] total score, high = poor, MD −5.40, 95% CI −16.42 to 5.62; participants = 24; studies = 1; very low certainty) and cognitive functioning scores (span of apprehension task-12 [SPAN-12] score, high = good, MD 2.40, 95% CI −2.67 to 7.47; participants = 25; studies = 1; very low certainty).

Another study compared psychoeducation combined with multifamily treatment (PTP + MFT) to MFT alone and found no difference in global state scores (CGAS, high = good, MD 3.38, 95% CI −4.87 to 11.63; participants = 49; studies = 1; very low certainty) and mental state scores (PANSS total, high = poor, MD −8.23, 95% CI −17.51 to 1.05; participants = 49; studies = 1; very low certainty) for psychosis in adolescents.

Other interventions that were used in the various studies included structured group therapy and computer-assisted cognitive remediation programs. However, none of the above-mentioned interventions were found to be significantly effective when compared with control interventions for the treatment of psychosis in adolescents.

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