背景:未治疗的精神病持续时间(DUP)作为早期发现和干预目标以改善首发精神病患者的预后的作用尚不清楚。
方法:符合PRISMA/MOOSE的系统评价,以确定直到2023年2月1日的研究,包括干预组和对照组,报告两组的DUP。随机效应荟萃分析评估(1)DUP在早期检测/干预服务与对照组的差异,(2)早期检测策略在基线(服务输入)时对八个真实世界结果的有效性,(3)早期干预策略对随访时10项真实世界结局的疗效。我们进行了质量评估,异质性,出版偏见,和荟萃回归分析(PROSPERO:CRD42020163640)。
结果:来自6229次引用,检索到33项干预研究。与对照组相比,干预组实现了较小的DUP降低(Hedges\'g=0.168,95%CI=0.055-0.283)。早期检测组在基线时具有更好的功能水平(g=0.281,95%CI=0.073-0.488)。两组在总精神病理学方面没有差异,录取率,生活质量,阳性/阴性/抑郁症状,和就业率(P>0.05)。早期干预改善了生活质量(g=0.600,95%CI=0.408-0.791),就业率(g=0.427,95%CI=0.135-0.718),阴性症状(g=0.417,95%CI=0.153-0.682),复发率(g=0.364,95%CI=0.117-0.612),入院率(g=0.335,95%CI=0.198-0.468),总精神病理学(g=0.298,95%CI=0.014-0.582),抑郁症状(g=0.268,95%CI=0.008-0.528),和功能(g=0.180,95%CI=0.065-0.295)在随访,但不是阳性症状或缓解(P>0.05)。
结论:比较针对DUP组和对照组的干预措施,早期检测策略对DUP和其他相关因素的影响有限.然而,早期干预对相关结局的影响显著,强调支持全球早期干预服务的重要性。
BACKGROUND: The role of duration of untreated psychosis (DUP) as an early detection and intervention target to improve outcomes for individuals with first-episode psychosis is unknown.
METHODS: PRISMA/MOOSE-compliant systematic review to identify studies until February 1, 2023, with an intervention and a control group, reporting DUP in both groups. Random effects meta-analysis to evaluate (1) differences in DUP in early detection/intervention services vs the control group, (2) the efficacy of early detection strategies regarding eight real-world outcomes at baseline (service entry), and (3) the efficacy of early intervention strategies on ten real-world outcomes at follow-up. We conducted quality assessment, heterogeneity, publication bias, and meta-regression analyses (PROSPERO: CRD42020163640).
RESULTS: From 6229 citations, 33 intervention studies were retrieved. The intervention group achieved a small DUP reduction (Hedges\' g = 0.168, 95% CI = 0.055-0.283) vs the control group. The early detection group had better functioning levels (g = 0.281, 95% CI = 0.073-0.488) at baseline. Both groups did not differ regarding total psychopathology, admission rates, quality of life, positive/negative/depressive symptoms, and employment rates (P > .05). Early interventions improved quality of life (g = 0.600, 95% CI = 0.408-0.791), employment rates (g = 0.427, 95% CI = 0.135-0.718), negative symptoms (g = 0.417, 95% CI = 0.153-0.682), relapse rates (g = 0.364, 95% CI = 0.117-0.612), admissions rates (g = 0.335, 95% CI = 0.198-0.468), total psychopathology (g = 0.298, 95% CI = 0.014-0.582), depressive symptoms (g = 0.268, 95% CI = 0.008-0.528), and functioning (g = 0.180, 95% CI = 0.065-0.295) at follow-up but not positive symptoms or remission (P > .05).
CONCLUSIONS: Comparing interventions targeting DUP and control groups, the impact of early detection strategies on DUP and other correlates is limited. However, the impact of early intervention was significant regarding relevant outcomes, underscoring the importance of supporting early intervention services worldwide.