Compensatory Interventions for Cognitive Impairments in Psychosis: A Systematic Review and Meta-Analysis.
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ABSTRACT: Objective
Cognitive compensatory interventions aim to alleviate psychosocial disability by targeting functioning directly using aids and strategies, thereby minimizing the impact of cognitive impairment. The aim was to conduct a systematic review and meta-analysis of cognitive compensatory interventions for psychosis by examining the effects on functioning and symptoms, and exploring whether intervention factors, study design, and age influenced effect sizes.Methods
Electronic databases (Ovid Medline, PsychINFO) were searched up to October 2018. Records obtained through electronic and manual searches were screened independently by two reviewers according to selection criteria. Data were extracted to calculate estimated effects (Hedge's g) of treatment on functioning and symptoms at post-intervention and follow-up. Study quality was assessed using Cochrane Collaboration's risk of bias tool.Results
Twenty-six studies, from 25 independent randomized controlled trials (RCTs) were included in the meta-analysis (1654 participants, mean age = 38.9 years, 64% male). Meta-analysis revealed a medium effect of compensatory interventions on functioning compared to control conditions (Hedge's g = 0.46, 95% CI = 0.33, 0.60, P < .001), with evidence of relative durability at follow-up (Hedge's g = 0.36, 95% CI = 0.19, 0.54, P < .001). Analysis also revealed small significant effects of cognitive compensatory treatment on negative, positive, and general psychiatric symptoms, but not depressive symptoms. Estimated effects did not significantly vary according to treatment factors (ie, compensatory approach, dosage), delivery method (ie, individual/group), age, or risk of bias. Longer treatment length was associated with larger effect sizes for functioning outcomes. No evidence of publication bias was identified.Conclusion
Cognitive compensatory interventions are associated with robust, durable improvements in functioning in people with psychotic illnesses.
SUBMITTER: Allott K
PROVIDER: S-EPMC7345816 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundSubjective cognitive decline (SCD) is considered a risk factor for Alzheimer's disease (AD), highlighting the need for identifying and ranking effective interventions. This was addressed in a systematic review and network meta-analysis (NMA) of pharmacological and non-pharmacological interventions for SCD.MethodsMEDLINE, Web of Science Core Collection, CENTRAL, and PsycINFO were searched for randomized controlled trials (RCTs) investigating effects on memory, global cognition, and quality of life. Random-effect model NMAs were conducted. The Cochrane Risk-of-Bias-2 tool assessed methodological quality. Prospero-Registration: CRD42020180457.ResultsThe systematic review included 56 RCTs. Education programs were most effective for improving memory, second most effective for improving global cognition. Quality of life and adverse events could not be included due to insufficient data. Overall methodological quality of studies was low.ConclusionEducation programs were most effective for improving memory and cognition, warranting further research into effective elements of this intervention. There is urgent need to address identified methodological shortcomings in SCD intervention research.
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Project description:AIM:Attenuated psychotic symptoms (APSs) have been the primary emphasis in youth at clinical high risk (CHR) for psychosis for assessing symptomology and determining subsequent transition to a psychotic disorder. Previous reviews primarily focused on the efficacy of cognitive behavioural therapy (CBT) on APS; however, a comprehensive assessment of other interventions to date is lacking. Therefore, we conducted a systematic review and meta-analysis of all intervention studies examining APS in CHR youth. METHOD:The authors searched Embase, CINAHL, PsycINFO, Medline and EBM from inception to May 2017. Studies were selected if they included any intervention that reported follow-up APS in youth at CHR. Interventions were evaluated and stratified by time using both pairwise and network meta-analyses (NMAs). Due to the differences in APS scales, effect sizes were calculated as Hedges g and reported as the standardized mean difference (SMD). RESULTS:Forty-one studies met our inclusion criteria. In pairwise meta-analyses, CBT was associated with a trend towards reduction in APS compared to controls at 12-months. In the NMA, integrated psychological therapy, CBT, supportive therapy, family therapy, needs-based interventions, omega-3, risperidone plus CBT and olanzapine were not significantly more effective at reducing APS at 6 and 12 months relative to any other intervention. CONCLUSIONS:CBT demonstrated a slight trend at reducing APS at long-term follow-up compared to controls. No interventions were significantly more effective at reducing APS compared to all other interventions in the NMA. [Correction added on 4 June 2018, after first online publication: Some parts of the Abstract section particularly 'Results' and 'Conclusions' have been corrected.].
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Project description:ObjectiveYouth at clinical high risk (CHR) for psychosis often demonstrate significant negative symptoms, which have been reported to be predictive of conversion to psychosis and a reduced quality of life but treatment options for negative symptoms remain inadequate. Therefore, we conducted a systematic review and network meta-analysis of all intervention studies examining negative symptom outcomes in youth at CHR for psychosis.MethodThe authors searched PsycINFO, Medline, Embase, CINAHL, and EBM from inception to December 2016. Studies were selected if they included any intervention that reported follow-up negative symptoms in youth at CHR for psychosis. Treatment comparisons were evaluated using both pairwise and network meta-analyses. Due to the differences in negative symptom scales the effect sizes were reported as the standardized mean difference (SMD).ResultsOf 3027 citations, 32 studies met our inclusion criteria, including a total of 2463 CHR participants. The null hypothesis was not rejected for any of the 11 treatments. N-methyl-D-aspartate-receptor (NMDAR) modulators trended toward a significant reduction in negative symptoms compared to placebo (SMD = -0.54; 95% CI = -1.09 to 0.02; I2 = 0%, P = .06). In respective order of descending effectiveness as per the treatment hierarchy, NMDAR modulators were more effective than family therapy, need-based interventions, risperidone, amisulpride, cognitive behavioral therapy, omega-3, olanzapine, supportive therapy, and integrated psychological interventions.ConclusionsEfficacy and effectiveness were not confirmed for any negative symptom treatment. Many studies had small samples and the majority were not designed to target negative symptoms.
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