Disorders - Psychosis Disorders
Allott, K., McGorry, P., Pan-Yuen, H., ODonnell, C.
Background: Vitamin B12, vitamin B6 and folic acid are homocysteinereducing agents. People with schizophrenia have been found to have increased homocysteine levels. Elevated homocysteine has been associated with impaired cognition. Previous research in chronic schizophrenia has shown that supplementation with folate plus vitamin B12 can improve cognition and clinical symptoms. Whether homocysteine lowering agents are effective in first-episode psychosis is unknown. The aim of this study was to investigate if adjunctive vitamin B12, B6 and folic acid can lower homocysteine and improve symptomatology and cognition in people with first-episode psychosis. Methods: This was a randomised, double-blind, placebo-controlled trial conducted at the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia. One hundred and twenty patients aged 15-26 years with first-episode psychosis consented and were randomised to receive folic acid 5mg, vitamin B12 0.4mg, and vitamin B6 50mg or placebo, each taken once-daily for 12 weeks as an adjunct to antipsychotic medication. Co-primary measures were change in cognition as measured by a composite score from a battery of 11 tests and total symptomatology (PANSS) over 12 weeks. Secondary outcomes included additional cognitive, symptom, functioning, tolerability and safety measures. Results: Of the 120 participants randomised in the study, 20 dropped out with no follow-up assessments and were excluded from analysis. Of the remaining 100 participants, 52 were in the vitamins group and 48 the placebo group. At baseline, the two treatment groups had lower levels of folate and vitamin B12 intake than healthy controls, but did not differ from each other. Vitamin B12, B6 and folic acid reduced homocysteine levels in the vitamin group over 12 weeks. The homocysteine lowering effects of the vitamins did not confer a major advantage over placebo therapy in improving the co-primary PANSS (p=.75) or composite cognition (p=0.79) outcomes over 12 weeks. There was a significant difference between groups among females in the cognitive domain of speed of processing (p=.049) and attention/vigilance (p=0.002), in which the mean performance of the placebo group declined over 12 weeks, whereas performance in the vitamin group remained showed improvement. Discussion: Folic acid, B12 and B6 supplementation appears well tolerated and safe in first-episode psychosis and lowers homocysteine levels in this population. However, supplementation may not offer extra benefits to all patients with first-episode psychosis, with the possible exception of speed of processing and attention/vigilance. Although previous research suggests that males preferentially benefit, our findings suggest that there may be a specific beneficial effect on cognition for females with first-episode psychosis.
Schizophrenia Bulletin, 44 (Supplement 1) : S130
- Year: 2018
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Vitamins and supplements
Anagnostopoulou, N., Kyriakopoulos, M., Alba, A.
BACKGROUND: Early onset psychosis (EOP), referring to psychosis with onset before the age of 18 years, is a more severe form of psychosis associated with worse prognosis. While medication is the treatment of choice, psychological interventions are also considered to have an important role in the management of symptoms and disability associated with this condition. The present review aimed to explore the effectiveness of such interventions.
METHOD: An electronic search was conducted on the Embase, Medline, and PsychInfo databases for papers of randomized controlled trials (RCTs) referring to psychological interventions in EOP. References of identified papers were hand searched for additional studies. Identified studies were quality assessed.
RESULTS: Eight studies were included in the present review evaluating cognitive remediation therapy (CRT), cognitive behavioural therapy (CBT), a family intervention and psychoeducation. CRT was associated with improvement in cognitive function and CBT and CRT seem to also have a positive effect in psychosocial functioning. Symptom reduction appears to not be significantly affected by the proposed treatments.
CONCLUSIONS: There is some evidence supporting the effectiveness of psychological interventions in EOP. However, most research on adolescents is focused on CRT and its effects on cognitive deficits. More studies on the effects of psychological interventions in EOP are needed.
European Child & Adolescent Psychiatry, : 04
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
Correll, C. U., Galling, B., Pawar, A., Krivko, A., Bonetto, C., Ruggeri, M., Craig, T. J., Nordentoft, M., Srihari, V. H., Guloksuz, S., Hui, C. L. M., Chen, E. Y. H., Valencia, M., Juarez, F., Robinson, D. G., Schooler, N. R., Brunette, M. F., Mueser, K. T., Rosenheck, R. A., Marcy, P., Addington, J., Estroff, S. E., Robinson, J., Penn, D., Severe, J. B., Kane, J. M.
Importance: The value of early intervention in psychosis and allocation of public resources has long been debated because outcomes in people with schizophrenia spectrum disorders have remained suboptimal.
Objective: To compare early intervention services (EIS) with treatment as usual (TAU) for early-phase psychosis.
Data Sources: Systematic literature search of PubMed, PsycINFO, EMBASE, and ClinicalTrials.gov without language restrictions through June 6, 2017.
Study Selection: Randomized trials comparing EIS vs TAU in first-episode psychosis or early-phase schizophrenia spectrum disorders.
Data Extraction and Synthesis: This systematic review was conducted according to PRISMA guidelines. Three independent investigators extracted data for a random-effects meta-analysis and prespecified subgroup and meta-regression analyses.
Main Outcomes and Measures: The coprimary outcomes were all-cause treatment discontinuation and at least 1 psychiatric hospitalization during the treatment period.
Results: Across 10 randomized clinical trials (mean [SD] trial duration, 16.2 [7.4] months; range, 9-24 months) among 2176 patients (mean [SD] age, 27.5 [4.6] years; 1355 [62.3%] male), EIS was associated with better outcomes than TAU at the end of treatment for all 13 meta-analyzable outcomes. These outcomes included the following: all-cause treatment discontinuation (risk ratio [RR], 0.70; 95% CI, 0.61-0.80; P < .001), at least 1 psychiatric hospitalization (RR, 0.74; 95% CI, 0.61-0.90; P = .003), involvement in school or work (RR, 1.13; 95% CI, 1.03-1.24; P = .01), total symptom severity (standardized mean difference [SMD], -0.32; 95% CI, -0.47 to -0.17; P < .001), positive symptom severity (SMD, -0.22; 95% CI, -0.32 to -0.11; P < .001), and negative symptom severity (SMD, -0.28; 95% CI, -0.42 to -0.14; P < .001). Superiority of EIS regarding all outcomes was evident at 6, 9 to 12, and 18 to 24 months of treatment (except for general symptom severity and depressive symptom severity at 18-24 months).
Conclusions and Relevance: In early-phase psychosis, EIS are superior to TAU across all meta-analyzable outcomes. These results support the need for funding and use of EIS in patients with early-phase psychosis.
JAMA Psychiatry, 75(6) : 555-565
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Davies, C., Cipriani, A., Ioannidis, J. P. A., Radua, J., Stahl, D., Provenzani, U., McGuire, P., Fusar-Poli, P.
Preventing psychosis in patients at clinical high risk may be a promising avenue for pre-emptively ameliorating outcomes of the most severe psychiatric disorder. However, information on how each preventive intervention fares against other currently available treatment options remains unavailable. The aim of the current study was to quantify the consistency and magnitude of effects of specific preventive interventions for psychosis, comparing different treatments in a network meta-analysis. PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials, and unpublished/grey literature were searched up to July 18, 2017, to identify randomized controlled trials conducted in individuals at clinical high risk for psychosis, comparing different types of intervention and reporting transition to psychosis. Two reviewers independently extracted data. Data were synthesized using network meta-analyses. The primary outcome was transition to psychosis at different time points and the secondary outcome was treatment acceptability (dropout due to any cause). Effect sizes were reported as odds ratios and 95% confidence intervals (CIs). Sixteen studies (2,035 patients, 57% male, mean age 20.1 years) reported on risk of transition. The treatments tested were needs-based interventions (NBI); omega-3 + NBI; ziprasidone + NBI; olanzapine + NBI; aripiprazole + NBI; integrated psychological interventions; family therapy + NBI; D-serine + NBI; cognitive behavioural therapy, French & Morrison protocol (CBT-F) + NBI; CBT-F + risperidone + NBI; and cognitive behavioural therapy, van der Gaag protocol (CBT-V) + CBT-F + NBI. The network meta-analysis showed no evidence of significantly superior efficacy of any one intervention over the others at 6 and 12 months (insufficient data were available after 12 months). Similarly, there was no evidence for intervention differences in acceptability at either time point. Tests for inconsistency were non-significant and sensitivity analyses controlling for different clustering of interventions and biases did not materially affect the interpretation of the results. In summary, this study indicates that, to date, there is no evidence that any specific intervention is particularly effective over the others in preventing transition to psychosis. Further experimental research is needed. Copyright © 2018 World Psychiatric Association
World Psychiatry, 17(2) : 196-209
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Davies, C., Radua, J., Cipriani, A., Stahl, D., Provenzani, U., McGuire, P., Fusar-Poli, P.
Background: Attenuated positive psychotic symptoms represent the defining features of the clinical high-risk for psychosis (CHR-P) criteria. The effectiveness of each available treatment for reducing attenuated positive psychotic symptoms remains undetermined. This network meta-analysis (NMA) investigates the consistency and magnitude of the effects of treatments on attenuated positive psychotic symptoms in CHR-P individuals, weighting the findings for acceptability. Methods: Web of Science (MEDLINE), PsycInfo, CENTRAL and unpublished/gray literature were searched up to July 18, 2017. Randomized controlled trials in CHR-P individuals, comparing at least two interventions and reporting on attenuated positive psychotic symptoms at follow-up were included, following PRISMA guidelines. The primary outcome (efficacy) was level of attenuated positive psychotic symptoms at 6 and 12 months; effect sizes reported as standardized mean difference (SMD) and 95% CIs in mean follow-up scores between two compared interventions. The secondary outcome was treatment acceptability [reported as odds ratio (OR)]. NMAs were conducted for both primary and secondary outcomes. Treatments were cluster-ranked by surface under the cumulative ranking curve values for efficacy and acceptability. Assessments of biases, assumptions, sensitivity analyses and complementary pairwise meta-analyses for the primary outcome were also conducted. Results: Overall, 1,707 patients from 14 studies (57% male, mean age = 20) were included, representing the largest evidence synthesis of the effect of preventive treatments on attenuated positive psychotic symptoms to date. In the NMA for efficacy, ziprasidone + Needs-Based Intervention (NBI) was found to be superior to NBI (SMD = -1.10, 95% CI -2.04 to -0.15), Cognitive Behavioral Therapy-French and Morrison protocol (CBT-F) + NBI (SMD = -1.03, 95% CI -2.05 to -0.01), and risperidone + CBT-F + NBI (SMD = -1.18, 95% CI -2.29 to -0.07) at 6 months. However, these findings did not survive sensitivity analyses. For acceptability, aripiprazole + NBI was significantly more acceptable than olanzapine + NBI (OR = 3.73; 95% CI 1.01 to 13.81) at 12 months only. No further significant NMA effects were observed at 6 or 12 months. The results were not affected by inconsistency or evident small-study effects, but only two studies had an overall low risk of bias. Conclusion: On the basis of the current literature, there is no robust evidence to favor any specific intervention for improving attenuated positive psychotic symptoms in CHR-P individuals. Copyright © 2018 Davies, Radua, Cipriani, Stahl, Provenzani, McGuire and Fusar-Poli.
Frontiers in Psychiatry, 9 (JUN) (no pagination)(187) :
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
Galling, B., Correll, C.
Background: The value of early intervention in psychosis and allocation of public resources has long been debated since outcomes in people with schizophrenia-spectrum disorders have remained suboptimal. Several research programs for early psychosis yielded promising results for teambased, multi-element coordinated specialty care (CSC). Methods: Systematic literature search of PubMed/PsycInfo/Embase/clinicaltrials. gov without language restrictions until 06/06/2017. Random effects meta-analysis of randomized trials comparing CSC versus Treatment as Usual (TAU) in in first episode psychosis or early-phase schizophreniaspectrum disorders (schizophrenia, psychotic disorder not otherwise specified, schizoaffective disorder, schizophreniform disorder, delusional disorder), calculating standardized mean differences (SMDs) and risk ratios (RRs) for continuous and categorical outcomes as well as prespecified subgroup and meta-regression analyses. Co-primary outcomes were all-cause treatment discontinuation and >=1 psychiatric hospitalization during the treatment period. Key secondary outcomes were total symptom improvement, functioning, and work or school involvement. Results: Across 10 trials (n=2,176; age=27.5 +/- 4.6 years; male=62.3%; trial duration=16.2 +/- 7.4 (range=9-24) months), CSC outperformed TAU at the end of treatment regarding all meta-analyzable outcomes. This included all-cause discontinuation (studies=10, n=2,173, RR=0.70, 95% confidence interval (CI)=0.61-0.80, p<0.001; number-needed-to-treat (NNT)=12.4), >=1 hospitalization (studies=10, n=2,105, RR=0.74, 95%CI=0.61-0.90, p=0.003; NNT=10.1), total symptom severity (studies=8, n=1,179, SMD=- 0.32, 95%CI=-0.47, -0.17, p<0.001), positive symptoms (studies=10, n=1,532, SMD=-0.22, 95%CI=-0.32, -0.13, p<0.001), negative symptoms (studies=10, n=1,432, SMD=-0.28, 95%CI=-0.42, -0.14, p<0.001), general symptoms (studies=8, n=1,118, SMD=-0.30, 95%CI=-0.47, -0.13, p=0.001), depressive symptoms (studies=5, n=874, SMD=-0.19, 95%CI=- 0.35, -0.03, p=0.017), functioning (studies=7, n=1,005, SMD=0.21, 95%CI=0.09-0.34, p=0.001), involvement in school/work (studies=6, n=1,743, RR=1.13, 95%CI=1.03-1.24, p=0.012; NNT=17.8), and quality of life (studies=4, n=505, SMD=0.23, 95%CI=0.004-0.456, p=0.046). Superiority of CSC regarding all outcomes was also evident at 6, 9-12, and 18-24 months of treatment (except general symptoms and depression at 18-24 months). Discussion: In early psychosis, CSC is superior to TAU across all meta-analyzable, highly relevant outcomes with small-to-medium effect sizes. These results support the need for funding and utilization of CSC in patients with early-phase psychosis.
Schizophrenia Bulletin, 44 (Supplement 1) : S108
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Case management
, Other service delivery and improvement interventions
Oliver, D., Davies, C., Crossland, G., Lim, S., Gifford, G., McGuire, P., Fusar-Poli, P.
Background: Reduction of duration of untreated psychosis (DUP) is the key strategy of early interventions for improving the outcomes of first episode psychosis. Although several controlled interventional studies have been conducted with the aim of reducing DUP, the results are highly inconsistent and conflicting. Methods: The current study systematically searched Web of Science and Ovid for English original articles investigating interventions adopted to reduce DUP, compared to a control intervention, up to 6th April 2017. 16 controlled interventional studies were retrieved, including 1964 patients in the intervention arm and 1358 in the control arm. The controlled interventions studies were characterised by: standalone first episode psychosis services, standalone clinical high risk services, community interventions, healthcare professional training and multifocus interventions. Random effects meta-analyses were conducted. Results: There was no summary evidence that available interventions are successful in reducing DUP during the first episode of psychosis (Hedges' g = -0.12, 95%CIs -0.25 to 0.01). Subgroup analyses showed no differences within each subgroup, with the exception of clinical high risk services (Hedges' g = -0.386, 95%CI -0.726 to -0.045). . There was substantial heterogeneity (I2 = 66.4%), most of which was accounted by different definitions of DUP onset (R2=0.88). Discussion: These negative findings may reflect a parcelled research base in the area, lack of prospective randomized controlled trials (only two randomised cluster designed studies were present) and small sample sizes. Psychometric standardisation of DUP definition, improvement of study design and implementation of preventative strategies seem the most promising avenues for reducing DUP and improving outcomes of first-episode psychosis.
Schizophrenia Bulletin, 44 (6) : 1362-1372
- Year: 2018
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Vijverberg, R., Ferdinand, R., Beekman, A., van-Meijel, B.
Background: During the past decades deinstitutionalisation policies have led to a transition from inpatient towards community mental health care. Many European countries implement Assertive Community Treatment (ACT) as an alternative for inpatient care for "difficult to reach" children and adolescents with severe mental illness. ACT is a well-organized low-threshold treatment modality; patients are actively approached in their own environment, and efforts are undertaken to strengthen the patient's motivation for treatment. The assumption is that ACT may help to avoid psychiatric hospital admissions, enhance cost-effectiveness, stimulate social participation and support, and reduce stigma. ACT has been extensively investigated in adults with severe mental illness and various reviews support its effectiveness in this patient group. However, to date there is no review available regarding the effectiveness of youth-ACT. It is unknown whether youth-ACT is as effective as it is in adults. This review aims to assess the effects of youth-ACT on severity of psychiatric symptoms, general functioning, and psychiatric hospital admissions. Method: A systematic literature search was conducted in PubMed, Cochrane Library, PsychINFO and CINAHL published up to March 2017. To assess methodological quality of the included studies, the Oxford Centre of Evidence-Based Medicine grading system was used. Results: Thirteen studies were included in this review. There are indications that youth-ACT is effective in reducing severity of psychiatric symptoms, improving general functioning, and reducing duration and frequency of psychiatric hospital admissions. Conclusions: The current literature on youth-ACT is limited but promising. There are indications that youth-ACT is effective in reducing severity of psychiatric symptoms, improving general functioning, and reducing duration and frequency of psychiatric hospital admissions. The effect of youth-ACT may be comparable with the effect of ACT in adults. Similar as in adult ACT, the studies on youth-ACT found effects that vary from small to large. Randomized experimental research designs are needed to further corroborate effectiveness. Copyright © 2017 The Author(s).
BMC Psychiatry, 17 (1) (no pagination)(284) :
- Year: 2017
- Problem: Psychosis Disorders, Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
, First episode (psychosis only)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Case management
, Other service delivery and improvement interventions
Breitborde, N. J. K., Woolverton, C., Dawson, S. C., Bismark, A., Bell, E. K., Bathgate, C. J., Norman, K.
Aim: Meta-cognitive skills training (MST) is a frequent component of cognitive remediation programmes for individuals with psychosis. However, no study has investigated whether incorporating such activities produces increased clinical benefits compared with computerized cognitive remediation alone. Methods: Individuals with first-episode psychosis who completed computerized cognitive remediation with concurrent meta-cognitive skills training (CCR + MST) were compared with a historical control group who received computerized cognitive remediation alone (CCR) and did not differ from the CCR + MST group with regard to pre-intervention cognition, diagnosis, age, duration of psychotic illness or sex. Participants completed assessments of cognition and real-world functioning before and after 6 months of treatment. Results: Individual receiving CCR + MST experience greater gains in cognition and real-world functioning than individuals who received CCR. Conclusions: MST may be an important component within cognitive remediation programmes for first-episode psychosis. Copyright © 2015 Wiley Publishing Asia Pty Ltd
Early Intervention in Psychiatry, 11(3) : 244-249
- Year: 2017
- Problem: Psychosis Disorders
- Type: Controlled clinical trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive remediation therapy, Other Psychological Interventions
Gomis, O., Palma, C., Farriols, N.
BACKGROUND: This theoretical study reviews the main findings and research on home-based treatment for psychosis. The principal purpose was to analyze the various types of home-based service and make recommendations for a service that would meet the needs of both first-episode and resistant patients. We compare the Early Intervention Service, which aims to reduce the range of untreated psychosis (DUP) with other types of home-care and similar interventions that have already been implemented: crisis resolution home teams (CRHTs), Open Dialogue Approach (ODA), social skills training (SST) and foster homes.
METHOD: We searched electronic bibliographic databases including PubMed, PsycINFO, and Discovery for relevant publications appearing between 2005 and 2015. Ninetythree publications were deemed eligible for inclusion; 9 of these were systematic reviews and the rest were scientific papers or books.
DISCUSSION: We describe in this review the most widely used home-based interventions, including individual and family therapy. Multidisciplinary teams carry out all the interventions discussed. There does not appear to be a form of psychotherapy, which is effective in treating resistant patients.
CONCLUSIONS: Home-based interventions improve adherence to treatment, everyday living and social skills and also have a beneficial impact on family conflicts and other social conflicts. As a whole result, the number of incomes is reduced, patients' quality of life and autonomy are increased and inclusion and community living are improved.
Actas Espanolas De Psiquiatria, 45(6) : 290-302
- Year: 2017
- Problem: Psychosis Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Barbato, M., Buchy, L., Bray, S., MacMaster, F., Deighton, S., Addington, J.
Schizophrenia Research, 190 : 180-181
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Robinson, D. G.
Objectives: The RAISE-ETP (Recovery After an Initial Schizophrenia Episode Early Treatment Program) study compared NAVIGATE, a comprehensive, multidisciplinary, team-based treatment approach for first-episode psychosis (FEP) to clinician-choice community care (CC). The primary outcome was quality of life; secondary outcomes included symptoms and work and school participation. Methods: Thirty-four community treatment clinics in 21 states were randomly assigned to provide either NAVIGATE or CC care. NAVIGATE treatment included four core interventions: 1) personalized medication management (assisted by COMPASS, a web-based decision support system developed for RAISE-ETP); 2) family psychoeducation; 3) resilience-focused individual therapy; and 4) supported employment and education. Diagnosis, duration of untreated psychosis (DUP), and clinical outcomes were assessed live and remotely by two-way video of centralized raters masked to treatment allocation. Participants (N = 404; mean age 23 years, 13.6% 18 years or younger; 37.4% 20 years or younger), with schizophrenia spectrum disorders and lifetime treatment for antipsychosis (<6 months), were enrolled and followed for at least two years. The primary outcome measure was the total score of the Heinrichs-Carpenter Quality of Life Scale (QLS). Results: Over the first two years, the 223 participants at NAVIGATE sites remained in treatment longer (P < 0.004); experienced greater improvement in quality of life (P < 0.02 for QLS total score) and psychopathology (P < 0.02 for PANSS total scores; P < 0.04 for Calgary Depression Scale for Schizophrenia scores); and more involvement in work or school (P < 0.05) compared with the 181 participants at CC sites. The sample median DUP was 74 weeks. NAVIGATE participants with DUP of 74 weeks or less had greater improvement on quality of life and psychopathology compared with those with DUP greater than 74 weeks. Subgroup analysis of outcomes for younger participants in the trial will be presented at the meeting. Conclusions: Comprehensive care for FEP can be implemented at community mental health clinics, with associated improvement in functional and clinical outcomes. Effects are more pronounced for those with shorter DUP. Attention to strategies to reduce DUP could improve outcomes for patients early in the course of illness.
Journal of the American Academy of Child and Adolescent Psychiatry, 56 (10) : S340
- Year: 2017
- Problem: Psychosis Disorders
- Type: Randomised controlled trials
-
Stage: First episode (psychosis only)
-
Treatment and intervention: Biological Interventions (any)
, Service Delivery & Improvement, Psychological Interventions (any)
, Psychoeducation, Individual placement and support (IPS), vocational interventions