Abstract：
BACKGROUND: Current clinical guidelines recommend that patients with co-occurring psychosis and alcohol or substance use disorders (A/SUD) receive evidenced-based treatment for both disorders, including psychological intervention for psychosis. However, the efficacy of such treatments for individuals with co-occurring psychosis and A/SUD is unclear.
METHODS: Randomized controlled trials (RCTs) of psychological interventions for psychosis were systematically reviewed, to investigate how alcohol and substance use has been accounted for across sample inclusion and secondary measures. Findings from trials including individuals with co-occurring alcohol or substance use issues were then narratively summarized using the Synthesis Without Meta-Analysis guidelines, to indicate the overall efficacy of psychological interventions for psychosis, for this comorbid population.
RESULTS: Across the 131 trials identified, 60.3% of trials excluded individuals with alcohol or substance use issues. Additionally, only 6.1% measured alcohol or substance use at baseline, while only 2.3% measured alcohol or substance use as a secondary outcome. Across trials explicitly including individuals with alcohol or substance use issues, insufficient evidence was available to conclude the efficacy of any individual psychological intervention. However, preliminary findings suggest that psychoeducation (PE) and metacognitive therapy (MCT) may be proposed for further investigation.
CONCLUSIONS: Overall, co-occurring alcohol and substance use issues have been largely neglected across the recent RCTs of psychological interventions for psychosis; highlighting the challenges of making treatment decisions for these individuals using the current evidence base.
METHODS: Randomized controlled trials (RCTs) of psychological interventions for psychosis were systematically reviewed, to investigate how alcohol and substance use has been accounted for across sample inclusion and secondary measures. Findings from trials including individuals with co-occurring alcohol or substance use issues were then narratively summarized using the Synthesis Without Meta-Analysis guidelines, to indicate the overall efficacy of psychological interventions for psychosis, for this comorbid population.
RESULTS: Across the 131 trials identified, 60.3% of trials excluded individuals with alcohol or substance use issues. Additionally, only 6.1% measured alcohol or substance use at baseline, while only 2.3% measured alcohol or substance use as a secondary outcome. Across trials explicitly including individuals with alcohol or substance use issues, insufficient evidence was available to conclude the efficacy of any individual psychological intervention. However, preliminary findings suggest that psychoeducation (PE) and metacognitive therapy (MCT) may be proposed for further investigation.
CONCLUSIONS: Overall, co-occurring alcohol and substance use issues have been largely neglected across the recent RCTs of psychological interventions for psychosis; highlighting the challenges of making treatment decisions for these individuals using the current evidence base.
摘要：
背景：当前的临床指南建议同时患有精神病和酒精或物质使用障碍（A/SUD）的患者接受两种疾病的循证治疗，包括精神病的心理干预。然而,此类治疗对合并精神病和A/SUD患者的疗效尚不清楚.
方法：对精神病心理干预的随机对照试验（RCTs）进行系统评价，调查酒精和物质使用如何在样本纳入和次要措施中得到解释。然后使用“无荟萃分析”指南对包括同时存在酒精或物质使用问题的个体在内的试验结果进行了叙述性总结。为了表明心理干预对精神病的总体疗效，对于这个合并症的人口。
结果：在确定的131项试验中，60.3%的试验排除了有酒精或物质使用问题的个体。此外,基线时只有6.1%的酒精或物质使用量，而只有2.3%的人将酒精或物质的使用作为次要结果。在明确包括酒精或物质使用问题的个体的试验中，没有足够的证据来推断任何个体心理干预的疗效.然而,初步研究结果表明，心理教育（PE）和元认知治疗（MCT）可能被建议进一步研究。
结论：总体而言，在最近的精神病心理干预RCT中,同时发生的酒精和药物使用问题在很大程度上被忽视;突出了使用当前证据基础为这些个体做出治疗决策的挑战.
方法：对精神病心理干预的随机对照试验（RCTs）进行系统评价，调查酒精和物质使用如何在样本纳入和次要措施中得到解释。然后使用“无荟萃分析”指南对包括同时存在酒精或物质使用问题的个体在内的试验结果进行了叙述性总结。为了表明心理干预对精神病的总体疗效，对于这个合并症的人口。
结果：在确定的131项试验中，60.3%的试验排除了有酒精或物质使用问题的个体。此外,基线时只有6.1%的酒精或物质使用量，而只有2.3%的人将酒精或物质的使用作为次要结果。在明确包括酒精或物质使用问题的个体的试验中，没有足够的证据来推断任何个体心理干预的疗效.然而,初步研究结果表明，心理教育（PE）和元认知治疗（MCT）可能被建议进一步研究。
结论：总体而言，在最近的精神病心理干预RCT中,同时发生的酒精和药物使用问题在很大程度上被忽视;突出了使用当前证据基础为这些个体做出治疗决策的挑战.
