Background

Acute inpatient psychiatric wards are important yet challenging environments in which to implement psychological interventions for people with schizophrenia-spectrum disorders. No meta-analysis to date has evaluated whether psychological interventions are effective in this context.

Methods

We systematically searched Embase, Medline and PsycInfo databases for randomised controlled trials (RCTs) of psychological interventions implemented in acute inpatient psychiatric settings with individuals with schizophrenia-spectrum disorders. We conducted random effects meta-analyses of between-groups outcomes at post-intervention and relapse/re-hospitalisation rates by follow-up.

Results

Twenty-nine trials were suitable for meta-analysis. Psychological interventions improved post-intervention positive symptoms, social functioning and treatment compliance and reduced the risk of relapse/ re-hospitalisation, relative to control conditions. Analyses of specific intervention effects found positive effects of psychoeducation on several key outcomes (power > 80%) and preliminary evidence for positive effects of acceptance and commitment therapy (ACT), cognitive behaviour therapy (CBT) and metacognitive training (MCT) on some outcomes (power < 80%).

Conclusion

Psychological interventions can be helpful for acute inpatients with schizophrenia-spectrum disorders. However, risk of bias was often high or unclear, and some analyses were underpowered. Further research should use more rigorous RCT designs and publish meta-analysable data on positive symptoms, general psychopathology, relapse/ re-hospitalisation, social functioning and treatment compliance.

中文翻译：

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精神分裂症谱系障碍急性精神病住院患者的心理干预：系统评价和荟萃分析

背景

急性住院精神科病房是对精神分裂症谱系障碍患者实施心理干预的重要但具有挑战性的环境。迄今为止，还没有荟萃分析评估心理干预在这种情况下是否有效。

方法

我们系统地搜索了 Embase、Medline 和 PsycInfo 数据库，以获取在精神分裂症谱系障碍患者的急性住院精神病环境中实施的心理干预的随机对照试验 (RCT)。我们对干预后的组间结果和随访的复发/再住院率进行了随机效应荟萃分析。

结果

29 项试验适合进行荟萃分析。相对于对照条件，心理干预改善了干预后的阳性症状、社会功能和治疗依从性，并降低了复发/再住院的风险。对特定干预效果的分析发现心理教育对几个关键结果（能力 > 80%）的积极影响以及接受和承诺疗法 (ACT)、认知行为疗法 (CBT) 和元认知训练 (MCT) 对某些结果的积极影响的初步证据（功率 < 80%）。

结论

心理干预可能有助于精神分裂症谱系障碍的急性住院患者。然而，偏倚风险通常很高或不明确，一些分析的效力不足。进一步的研究应该使用更严格的 RCT 设计，并发布关于阳性症状、一般精神病理学、复发/再住院、社会功能和治疗依从性的元分析数据。