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@ARTICLE{Salahuddin:270302,
author = {Salahuddin, Nurul Husna and Schütz, Alexandra and
Pitschel-Walz, Gabi and Mayer, Susanna Franziska and
Chaimani, Anna and Siafis, Spyridon and Priller, Josef and
Leucht, Stefan and Bighelli, Irene},
title = {{P}sychological and psychosocial interventions for
treatment-resistant schizophrenia: a systematic review and
network meta-analysis},
journal = {The lancet / Psychiatry},
volume = {11},
number = {7},
issn = {2215-0366},
address = {Philadelphia, Pa.},
publisher = {Elsevier},
reportid = {DZNE-2024-00774},
pages = {545 - 553},
year = {2024},
abstract = {Many patients with schizophrenia have symptoms that do not
respond to antipsychotics. This condition is called
treatment-resistant schizophrenia and has not received
specific attention as opposed to general schizophrenia.
Psychological and psychosocial interventions as an add-on
treatment to pharmacotherapy could be useful, but their role
and comparative efficacy to each other and to standard care
in this population are not known. We investigated the
efficacy, acceptability, and tolerability of psychological
and psychosocial interventions for patients with
treatment-resistant schizophrenia.In this systematic review
and network meta-analysis (NMA), we searched for published
and unpublished randomised controlled trials (RCTs) through
a systematic database search in BIOSIS, CINAHL, Embase,
LILACS, MEDLINE, PsychInfo, ClinicalTrials.gov, and the WHO
International Clinical Trials Registry Platform for articles
published from inception up to Jan 31, 2020. We also
searched the Cochrane Schizophrenia Group registry for
studies published from inception up to March 31, 2022, and
PubMed and Cochrane CENTRAL for studies published from
inception up to July 31, 2023. We included RCTs that
included patients with treatment-resistant schizophrenia.
The primary outcome was overall symptoms. We did
random-effects pairwise meta-analyses and NMAs to calculate
standardised mean differences (SMDs) or risk ratios with
$95\%$ CIs. No people with lived experience were involved
throughout the research process. The study protocol was
registered in PROSPERO, CRD42022358696.We identified 30 326
records, excluding 24 526 by title and abstract screening.
5762 full-text articles were assessed for eligibility, of
which 5540 were excluded for not meeting the eligibility
criteria, and 222 reports corresponding to 60 studies were
included in the qualitative synthesis. Of these, 52 RCTs
with 5034 participants (1654 $[33·2\%]$ females and 3325
$[66·8\%]$ males with sex indicated) comparing 20
psychological and psychosocial interventions provided data
for the NMA. Mean age of participants was 38·05 years
(range 23·10-48·50). We aimed to collect ethnicity data,
but they were scarcely reported. According to the quality of
evidence, cognitive behavioural therapy for psychosis (CBTp;
SMD -0·22, $95\%$ CI -0·35 to -0·09, 35 trials), virtual
reality intervention (SMD -0·41, -0·79 to -0·02, four
trials), integrated intervention (SMD -0·70, -1·18 to
-0·22, three trials), and music therapy (SMD -1·27, -1·83
to -0·70, one study) were more efficacious than standard
care in reducing overall symptoms. No indication of
publication bias was identified.We provide robust findings
that CBTp can reduce the overall symptoms of patients with
treatment-resistant schizophrenia, and therefore clinicians
can prioritise this intervention in their clinical practice.
Other psychological and psychosocial interventions showed
promising results but need further investigation.DAAD-ASFE.},
keywords = {Humans / Network Meta-Analysis / Psychosocial Intervention:
methods / Schizophrenia, Treatment-Resistant: therapy /
Randomized Controlled Trials as Topic / Psychotherapy:
methods / Antipsychotic Agents: therapeutic use / Treatment
Outcome / Schizophrenia: therapy / Antipsychotic Agents (NLM
Chemicals)},
cin = {AG Priller},
ddc = {610},
cid = {I:(DE-2719)5000007},
pnm = {353 - Clinical and Health Care Research (POF4-353)},
pid = {G:(DE-HGF)POF4-353},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:38879276},
doi = {10.1016/S2215-0366(24)00136-6},
url = {https://pub.dzne.de/record/270302},
}