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 In this systematic review and network meta-analysis (NMA), we searched for published and unpublished randomised controlled trials (RCTs) through a systematic database search in BIOSIS, CINAHL, Embase, LILACS, MEDLINE, PsychInfo, , and the WHO International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.

中文翻译：

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难治性精神分裂症的心理和社会心理干预：系统评价和网络荟萃分析


许多精神分裂症患者的症状对抗精神病药物没有反应。这种情况被称为难治性精神分裂症，与一般精神分裂症不同，它没有得到特别的关注。心理和社会心理干预作为药物治疗的附加治疗可能是有用的，但它们的作用和相互之间以及与该人群标准护理的比较疗效尚不清楚。我们调查了心理和社会心理干预对难治性精神分裂症患者的疗效、可接受性和耐受性。在本系统综述和网络荟萃分析（network meta-analysis， NMA）中，我们通过在BIOSIS、CINAHL、Embase、LILACS、MEDLINE、PsychInfo和WHO国际临床试验注册平台中检索已发表和未发表的随机对照试验（randomised controlled trials， RCTs），检索从建库到2020年1月31日发表的文章。我们还检索了 Cochrane 精神分裂症组注册库，以查找从建库到 2022 年 3 月 31 日发表的研究，以及 PubMed 和 Cochrane CENTRAL 检索从建库到 2023 年 7 月 31 日发表的研究。我们纳入了纳入难治性精神分裂症患者的 RCT。主要结局是总体症状。我们进行了随机效应成对meta分析和NMAs，以计算标准化均数差（standardised mean differences， SMDs）或具有95%CIs的风险比。在整个研究过程中没有涉及任何有生活经验的人。该研究方案在 CRD42022358696 年的 PROSPERO 注册。我们确定了 30 326 条记录，通过标题和摘要筛选排除了 24 526 条。 对 5762 篇全文文章进行了合格性评估，其中 5540 篇因不符合资格标准而被排除在外，定性综合纳入了对应于 60 项研究的 222 份报告。其中，52 项随机对照试验，涉及 5034 名参与者 （1654 [33·2%] 女性和 3325 名 [66·8%] 有性别指征的男性），比较了 20 项心理和社会心理干预措施，为 NMA 提供了数据。参与者的平均年龄为 38·05 岁（范围 23·10–48·50）。我们旨在收集种族数据，但几乎没有报告。根据证据质量，精神病的认知行为疗法 （CBTp;SMD –0·22,95% CI –0·35 至 -0·09,35 项试验）、虚拟现实干预（SMD –0·41，–0·79 至 –0·02，四项试验）、综合干预（SMD –0·70，–1·18 至 -0·22，三项试验）和音乐疗法（SMD –1·27，–1·83 至 -0·70，一项研究）在减轻总体症状方面比标准护理更有效。未发现发表偏倚的迹象。我们提供了强有力的发现，即 CBTp 可以减轻难治性精神分裂症患者的整体症状，因此临床医生可以在他们的临床实践中优先考虑这种干预。其他心理和社会心理干预措施显示出有希望的结果，但需要进一步研究。DAAD-ASFE 的。