Attenuated psychotic symptom interventions in youth at risk of psychosis: A systematic review and meta-analysis

Early Interv Psychiatry. 2019 Feb;13(1):3-17. doi: 10.1111/eip.12677. Epub 2018 May 11.


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.].

Keywords: clinical high risk; meta-analysis; schizophrenia; systematic review.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Antipsychotic Agents / therapeutic use*
  • Fatty Acids, Omega-3 / therapeutic use*
  • Humans
  • Psychotherapy*
  • Psychotic Disorders / diet therapy
  • Psychotic Disorders / drug therapy
  • Psychotic Disorders / therapy*


  • Antipsychotic Agents
  • Fatty Acids, Omega-3