Objective:

Many people with psychotic experiences do not develop psychotic disorders, yet those who seek help demonstrate high clinical complexity and poor outcomes. In this systematic review and meta-analysis, we evaluated the effectiveness and cost-effectiveness of psychological interventions for people with psychotic experiences.

Method:

We searched 13 databases for studies of psychological interventions for adults with psychotic experiences, but not psychotic disorders. Our outcomes were the proportion of participants remitting from psychotic experiences (primary); changes in positive and negative psychotic symptoms, depression, anxiety, functioning, distress, and quality of life; and economic outcomes (secondary). We analysed results using multilevel random-effects meta-analysis and narrative synthesis.

Results:

A total of 27 reports met inclusion criteria. In general, there was no strong evidence for the superiority of any one intervention. Five studies reported on our primary outcome, though only two reports provided randomised controlled trial evidence that psychological intervention (specifically, cognitive behavioural therapy) promoted remission from psychotic experiences. For secondary outcomes, we could only meta-analyse trials of cognitive behavioural therapy. We found that cognitive behavioural therapy was more effective than treatment as usual for reducing distress (pooled standardised mean difference: −0.24; 95% confidence interval = [−0.37, −0.10]), but no more effective than the control treatment for improving any other outcome. Individual reports indicated that cognitive behavioural therapy, mindfulness-based cognitive therapy, sleep cognitive behavioural therapy, systemic therapy, cognitive remediation therapy, and supportive treatments improved at least one clinical or functional outcome. Four reports included economic evaluations, which suggested cognitive behavioural therapy may be cost-effective compared with treatment as usual.

Conclusion:

Our meta-analytic findings were primarily null, with the exception that cognitive behavioural therapy may reduce the distress associated with psychotic experiences. Our analyses were limited by scarcity of studies, small samples and variable study quality. Several intervention frameworks showed preliminary evidence of positive outcomes; however, the paucity of consistent evidence for clinical and functional improvement highlights a need for further research into psychological treatments for psychotic experiences.

PROSPERO protocol registration number:

CRD42016033869

中文翻译：

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对有精神病经历的人的心理干预：对受控和不受控有效性和经济研究的系统回顾和荟萃分析。

 客观的：

许多有精神病经历的人不会发展为精神病，但寻求帮助的人却表现出高度的临床复杂性和不良的结果。在这项系统评价和荟萃分析中，我们评估了对有精神病经历的人进行心理干预的有效性和成本效益。

 方法：

我们检索了 13 个数据库，寻找对有精神病经历的成年人进行心理干预的研究，但没有搜索精神障碍。我们的结果是从精神病经历中缓解的参与者比例（主要）；积极和消极精神病症状、抑郁、焦虑、功能、痛苦和生活质量的变化；和经济成果（次要）。我们使用多级随机效应荟萃分析和叙述综合来分析结果。

 结果：

共有 27 份报告符合纳入标准。总的来说，没有强有力的证据表明任何一种干预措施的优越性。五项研究报告了我们的主要结果，尽管只有两项报告提供了随机对照试验证据，表明心理干预（特别是认知行为疗法）促进了精神病经历的缓解。对于次要结果，我们只能对认知行为疗法的试验进行荟萃分析。我们发现认知行为疗法在减轻痛苦方面比常规治疗更有效（汇总标准化平均差：-0.24；95%置信区间=[-0.37，-0.10]），但在改善任何痛苦方面并不比对照治疗更有效。其他结果。个别报告表明，认知行为疗法、基于正念的认知疗法、睡眠认知行为疗法、全身疗法、认知矫正疗法和支持性治疗改善了至少一项临床或功能结果。四份报告包括经济评估，表明认知行为疗法与常规治疗相比可能具有成本效益。

 结论：

我们的荟萃分析结果基本上是无效的，但认知行为疗法可能会减少与精神病经历相关的痛苦。我们的分析受到研究稀缺、样本量小和研究质量参差不齐的限制。一些干预框架显示出积极成果的初步证据；然而，缺乏临床和功能改善的一致证据突出表明需要进一步研究精神病经历的心理治疗。

PROSPERO协议注册号：

CRD42016033869