Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis A Systematic Review, Meta-analysis, and Meta-regression

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 reviewwas 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 outcomeswere 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.