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Efficacy and acceptability of psychosocial interventions in schizophrenia: systematic overview and quality appraisal of the meta-analytic evidence

Molecular Psychiatry volume 28, pages 354–368 (2023)Cite this article

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Abstract

Psychosocial interventions are recommended in schizophrenia and first-episode psychosis/early psychosis (EP). Nevertheless, literature is heterogeneous and often contradictory. We conducted an umbrella review of (network) meta-analyses of randomized controlled trials (RCTs) comparing psychosocial interventions vs treatment as usual (TAU)/active interventions(ACTIVE)/MIXED controls. Primary outcome was total symptoms (TS); secondary outcomes were positive/negative/depressive symptoms (PS/NS/DS), cognition, functioning, relapse, hospitalization, quality of life (QoL), treatment discontinuation. Standardized mean difference (SMD)/odds ratio (OR)/risk ratio (RR) vs TAU/ACTIVE/MIXED were summarized at end-of-treatment (EoT)/follow-up (FU). Quality was rated as high/medium/low (AMSTAR-PLUS). Eighty-three meta-analyses were included (RCTs = 1246; n = 84,925). Against TAU, regarding TS, Early Intervention Services (EIS) were superior EoT/FU in EP (SMD = −0.32/−0.21), cognitive behavioral therapy (CBT) in schizophrenia EoT/FU (SMD = −0.38/−0.19). Regarding secondary outcomes, in EP, EIS were superior for all outcomes EoT except cognition, and at FU for PS/NS/QoL, specific family interventions (FI-s) prevented relapse EoT; in schizophrenia, superiority emerged EoT for CBT for PS/NS/relapse/functioning/QoL; psychoeducation (EDU)/any FI for relapse; cognitive remediation therapy (CRT) for cognition/functioning; and hallucination-focused integrative treatment for PS. Against ACTIVE, in EP, mixed family interventions (FI-m) were superior at FU regarding TS (SMD = −0.61) and for functioning/relapse among secondary outcomes. In schizophrenia, regarding TS, mindfulness and social skills training (SST) were superior EoT, CBT at FU; regarding secondary outcomes superiority emerged at EoT for computerized cognitive drill-and-practice training for PS/DS, CRT for cognition/functioning, EDU for relapse, individual placement and support (IPS) for employment; and at FU CBT for PS/NS. Against MIXED, in schizophrenia, CRT/EDU were superior for TS EoT (d = −0.14/SMD = −0.33), CRT regarding secondary outcomes EoT for DS/social functioning, both EoT/FU for NS/cognition/global functioning; compensatory cognitive interventions for PS/functioning EoT/FU and NS EoT; CBT for PS at FU, and EDU/SST for relapse EoT. In conclusion, mental health services should consider prioritizing EIS/any FI in EP and CBT/CRT/any FI/IPS for schizophrenia, but other interventions may be helpful for specific outcomes.

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Fig. 1: Efficacy of psychosocial interventions on total symptoms in patients with early psychosis and schizophrenia.
Fig. 2: Heat map indicating efficacy profile of psychosocial interventions.

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Funding

No funding directly supported the present work. CA has received funding support from the Spanish Ministry of Science and Innovation. Instituto de Salud Carlos III, co-financed by ERDF Funds from the European Commission, “A way of making Europe”, CIBERSAM. Madrid Regional Government (B2017/BMD-3740 AGES-CM-2), Fundación Familia Alonso and Fundación Alicia Koplowitz.

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Author notes

  1. Marco Solmi

    Present address: Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany

  2. These authors contributed equally: Marco Solmi, Giovanni Croatto.

Authors and Affiliations

  1. Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada

    Marco Solmi

  2. Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada

    Marco Solmi

  3. Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada

    Marco Solmi

  4. School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Marco Solmi

  5. Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

    Marco Solmi & Paolo Fusar-Poli

  6. Department of Mental Health, AULSS 3 Serenissima, Veneto, Italy

    Giovanni Croatto, Giada Piva & Stella Rosson

  7. Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy

    Paolo Fusar-Poli

  8. OASIS service, South London and Maudsley NHS Foundation Trust, London, UK

    Paolo Fusar-Poli

  9. National Institute for Health Research, Maudsley Biomedical Research Centre, London, UK

    Paolo Fusar-Poli

  10. Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA

    Jose M. Rubio & Christoph U. Correll

  11. IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment), Deakin University, Geelong, Victoria, Australia

    Andre F. Carvalho

  12. Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain

    Eduard Vieta

  13. Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, CIBERSAM, Madrid, Spain

    Celso Arango

  14. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Nicole R. DeTore

  15. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    Nicole R. DeTore

  16. Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA

    Elizabeth S. Eberlin & Kim T. Mueser

  17. Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA

    Kim T. Mueser

  18. Department of Occupational Therapy, Boston University, Boston, MA, USA

    Kim T. Mueser

  19. Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

    Christoph U. Correll

  20. Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA

    Christoph U. Correll

  21. Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany

    Christoph U. Correll

Authors
  1. Marco Solmi
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  2. Giovanni Croatto
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Contributions

CUC, GC, JR, MS conceived the study. EE, GC, GP, MS, NDT, SR, conducted literature screening and data extraction including quality assessment. CUC, GC, KTM, MS, drafted the first version of the manuscript. All authors critically revised and finally approved the submitted version of the present work.

Corresponding author

Correspondence to Christoph U. Correll.

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Competing interests

GC, SR, GP, NDT, EE, KTM have nothing to disclose. MS has been a consultant and/or advisor to or have received honoraria from Angelini, Lundbeck, Otsuka. EV has received grants and served as consultant, advisor or CME speaker for the following entities: Abbott, Allergan, Angelini, Dainippon Sumitomo Pharma, Janssen, Lundbeck, Novartis, Otsuka, Raffo, Richter, Sage, Sanofi-Aventis, and Takeda, unrelated to the present work. CA has been a consultant to or has received honoraria or grants from Acadia, Angelini, Gedeon Richter, Janssen Cilag, Lundbeck, Minerva, Otsuka, Roche, Sage, Servier, Shire, Schering Plough, Sumitomo Dainippon Pharma, Sunovion and Takeda. PFP has received advisory consultancy fees from Lundbeck outside of this work. RS has received research support from Roche, Janssen, GSK and Takeda outside of this work. CUC has been a consultant and/or advisor to or has received honoraria from: AbbVie, Acadia, Alkermes, Allergan, Angelini, Aristo, Axsome, Boehringer-Ingelheim, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Damitsa, Gedeon Richter, Hikma, Holmusk, IntraCellular Therapies, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedAvante-ProPhase, MedInCell, Medscape, Merck, Mindpax, Mitsubishi Tanabe Pharma, Mylan, Neurocrine, Noven, Otsuka, Pfizer, Pharmabrain, PPD Biotech, Recordati, Relmada, Reviva, Rovi, Seqirus, Servier, SK Life Science, Sumitomo Dainippon, Sunovion, Sun Pharma, Supernus, Takeda, Teva, and Viatris. He provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck, Relmada, Reviva, Rovi, and Teva. He has received grant support from Janssen and Takeda. He received royalties from UpToDate and is also a stock option holder of Cardio Diagnostics, Mindpax, and LB Pharma.

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Solmi, M., Croatto, G., Piva, G. et al. Efficacy and acceptability of psychosocial interventions in schizophrenia: systematic overview and quality appraisal of the meta-analytic evidence. Mol Psychiatry 28, 354–368 (2023). https://doi.org/10.1038/s41380-022-01727-z

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