Psychological and Needs-Based Interventions in CHR-P

What the evidence says

The one meta-analytic claim on this page finds no measured difference between interventions. Fusar-Poli (2020) states that "no robust evidence yet exists to favor any indicated intervention over another (including needs-based interventions and control conditions) for preventing psychosis or ameliorating any other outcome in CHR-P individuals." The claim carries high direction confidence but low magnitude confidence, and the source notes high uncertainty in the evidence base.

A comparison study points the same way on functioning. Niendam (2009) reports that needs-based interventions and combined low-dose risperidone plus cognitive behavioral therapy did not differ on Global Assessment of Functioning (GAF) scores at the 12-month follow-up (McGorry et al. 2002). The source notes that the study design is not fully specified and that replication studies of CHR functional outcome are lacking.

Sleep-focused psychological treatment is the one lever where the claims report improvement. A cognitive behavioral therapy (CBT) intervention for insomnia in young CHR-P patients improved sleep variables, psychiatric symptoms, and social functioning. A second claim cites Waite et al. (2018) for a positive effect of psychological insomnia treatment on sleep, mood, and functioning in CHR-P and early psychosis groups. A third, hedged claim cites Poe et al. (2017): treating sleep problems "appears to be" useful for ameliorating CHR-P symptoms. The claims give no effect sizes, and they flag uncertainty about sample size, generalizability to CHR-P patients without insomnia, and how long the gains last.

Two adjacent levers have thin evidence. Available data "do not provide a rationale" for antipsychotics to prevent conversion to first-episode psychosis. For omega-3 fatty acids, intake reduces insomnia and improves sleep quality, but a meta-analysis found no statistically significant effect on conversion in CHR-P. Social cognition training programs (SCIT and TAR) show benefits in schizophrenia, but the source says they have not yet been applied to at-risk populations. For that population, the absence is the result.

Where the evidence splits

The meta-analytic claim finds no robust evidence that any intervention improves "any other outcome" in CHR-P. The insomnia claims report improved sleep, mood, symptoms, and functioning after psychological treatment. The sources on this page do not explain the difference. The meta-analytic claim describes comparisons against other interventions and control conditions, and the insomnia claims describe improvements without stating a comparator. The insomnia studies are also described as single interventions in small or specific samples. Whether the improvements would persist against a control condition is not established here.

Omega-3 results are internally mixed. Some studies found positive effects in CHR-P, but the meta-analysis found no statistically significant effect on conversion. The source cites contradictory results and low statistical power, but it does not say which design differences produce the split.

Thresholds and dose-response

No threshold established in the current sources.

Open empirical questions

• Do CBT-based insomnia treatments improve sleep, symptoms, and functioning in CHR-P against a control condition, and do the gains last past follow-up?
• Do the insomnia findings extend to CHR-P patients who do not have insomnia?
• Do social cognition training programs such as SCIT and TAR change outcomes in CHR-P populations?
• Do needs-based interventions differ from other interventions on conversion to psychosis, as opposed to GAF scores at 12 months?