Family interventions, family psychoeducation, and cognitive behavioral therapy provide clear, robust benefits for relapse prevention in people with schizophrenia, according to findings from a systematic review and network meta-analysis published in The Lancet Psychiatry.

“These treatments should be the first psychosocial interventions to be considered in the long-term treatment for patients with schizophrenia,” researchers advised.

The network meta-analysis investigated 20 psychosocial and psychological interventions for relapse prevention. Data stemmed from 72 randomized clinical trials involving 10,364 participants. Most of the psychological interventions in the trials were provided as an add-on to antipsychotic treatment.

In Stable Schizophrenia, Lower Antipsychotic Doses Offer Efficacy for Relapse Prevention

Compared with standard care alone, family interventions, family psychoeducation, cognitive behavioral therapy, patient psychoeducation, integrated interventions, and relapse prevention programs were superior in preventing relapses at 12 months, analysis revealed. Odds ratios for relapse compared with treatment as usual were 0.35 for family interventions, 0.56 for family psychoeducation, 0.45 for cognitive behavioral therapy, 0.63 for patient psychoeducation, 0.62 for integrated interventions, and 0.33 for relapse prevention programs.

While patient psychoeducation, integrated interventions, and relapse prevention programs appeared effective, researchers found considerable variability in different subgroup and sensitivity analyses involving them — in contrast to more robust results found for family interventions, family psychoeducation, and cognitive behavioral therapy.

“For this reason,” they wrote, “although our results demonstrate that many psychological interventions can play a role in the prevention of relapse in patients with schizophrenia, policymakers and clinicians should consider giving priority to family interventions, family psychoeducation, and cognitive behavioural therapy when allocating resources and planning maintenance treatment for patients with schizophrenia.”

Reference

Bighelli I, Rodolico A, García-Mieres H, et al. Psychosocial and psychological interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis. The Lancet Psychiatry. Published online October 12, 2021. doi: https://doi.org/10.1016/S2215-0366(21)00243-1