Featured Review: Psychological interventions for psychosis in adolescents

Are psychological interventions effective and safe for adolescents with psychosis? Are there any differences in effect between different psychological interventions? New Cochrane systematic review looks at the available evidence. 

 

 

Psychosis is a mental illnesses characterised by alterations in thoughts and perceptions as delusions (false beliefs), hallucinations (seeing or hearing things that others do not see or hear) and can happen during adolescence. When this happens, the young person needs to see a mental health professional who will often prescribe medications. However, along with medications, adolescents with psychosis are likely to benefit from age‐appropriate psychological treatments (talking treatments) such as cognitive remediation therapy, psychoeducation, family therapy and group psychotherapy. These interventions can address social and psychological needs such as integration with peers and deal with the stigma and exclusion. We have reviewed the effects of these interventions for young people with psychosis using data from randomised controlled trials.

The Information Specialist of Cochrane Schizophrenia searched their trials register in May 2016 and March 2019 for trials that randomly allocated adolescents with psychosis to various treatment groups. The treatment groups could include either psychological interventions (with or without their usual treatment), medications alone, treatment‐as‐usual or other psychological interventions (with or without usual treatment).

This review includes only seven trials conducted in various parts of the world. The trials compared a variety of different psychological interventions with treatment‐as‐usual or with other types of psychological interventions, and they reported different outcome measures, making it difficult for us to compare one study with another. We were interested in the effect these treatments have on seven main outcomes: global state, mental state, adverse effects, cognitive functioning, global functioning, service use, and leaving the study early. None of the included studies reported adverse effect data.

Results

Absolute effect of psychological interventions (PIs, comparing PIs with treatment‐as‐usual (TAU))

Our analyses of reported data suggests that cognitive remediation therapy may help improve short term memory (a cognitive function) but treatment‐as‐usual may be better than CRT for improving mental state. Group therapy may be also be useful for improving global state. All other analyses for the main outcomes showed PIs had little or no effect compared to TAU.

Relative effects of PIs (comparing one type of PI with another type of PI)

Our analyses showed no real differences between the different types of PIs.

 

Conclusions

Some psychological interventions may have beneficial effects for selected outcomes but, overall, most results suggest little or no effect. However, all our results were based on data from a very small number of studies with small numbers of participants. We also have concerns with the methods used in these studies. Thus, there is considerable uncertainty about the reliability of these findings. We cannot make firm conclusions based on this evidence. Relevant well‐conducted randomised controlled trials are needed.