Summary of findings for the main comparison. Adjunct cognitive behavioural therapy versus adjunct supportive psychotherapy.
| Adjunct cognitive behavioural therapy compared to adjunct supportive psychotherapy (both with standard medication for most patients) for delusional disorder | ||||||
| Patient or population: patients with delusional disorder Settings: community Intervention: cognitive behavioural therapy Comparison: attention (both with standard medication) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Attention (mainly with standard medication) | Cognitive behavioural therapy(mainly with standard medication) | |||||
| Global state: Clinically significant improvement | See comment | No study reported this outcome | ||||
| Mental state: Delusions ‐ clinically significant improvement | See comment | MADS reported in the single relevant small study, but not a clinical scale and no report of symptomatic improvement on delusions | ||||
| Mental state: Depression BDI Follow‐up: 6 months | CBT ‐ average score 12.0 (SD 14.4, N = 11) Attention 'placebo' ‐ average score 18.3 (SD 7.8, N = 6) |
Not estimable | 17 (1 study) | ⊕⊕⊝⊝ low1,3 | Data skewed | |
|
Mental state:
Anxiety BAI Follow‐up: 6 months |
CBT ‐ average score 16.1 (SD 14.6, N = 11) Attention 'placebo' ‐ average score 14.0 (SD 14.2, N = 6) |
Not estimable | 17 (1 study) | ⊕⊕⊝⊝ low1,3 | Data skewed | |
| Service use: Admission | See comment | No study reported this outcome | ||||
| Social function: Self worth ‐ average score Social Self‐Esteem Inventory Follow‐up: 6 months | The mean social functioning: self worth average score in the intervention groups was 30.5 higher (7.51 to 53.49 higher) | 17 (1 study) | ⊕⊝⊝⊝ very low1,2,3 | |||
| Adverse event: Leaving the study early Follow‐up: 6 months | Low | RR 0.17 (0.02 to 1.18) | 24 (1 study) | ⊕⊕⊕⊝ moderate4 | ||
| 100 per 1000 | 17 per 1000 (2 to 118) | |||||
| Moderate | ||||||
| 300 per 1000 | 51 per 1000 (6 to 354) | |||||
| High | ||||||
| 500 per 1000 | 85 per 1000 (10 to 590) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). BAI: Beck Anxiety Inventory; BDI: Beck Depression Inventory;CBT: cognitive behavioural therapy; CI: confidence interval; MADS: Maudsley Assessment of Delusions Schedule; RR: risk ratio; SD: standard deviation | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1Risk of bias: rated 'serious' ‐ unblinded for subjective outcome, poor reporting for those who left early. 2Indirectness: rated 'very serious' ‐ measure reported self worth rather than social functioning. 3Imprecision: rated 'serious' ‐ small trial, wide confidence intervals. 4Indirectness: rated 'very serious' ‐ leaving study may not be adverse effect or event. Reasons for attrition not reported.