Table 5.

Clinical interpretation of the current evidence for selecting a preventive intervention for CHR-P individuals.

Currently, no reliable recommendation can be made regarding whether specific interventions (e.g. psychological interventions, medications, dietary interventions, needs-based interventions) are more effective compared to each other for the prevention of psychosis in CHR-P individuals.

Consequently, the safest approach is recommended, that is needs-based interventions and psychological interventions over antipsychotics, because the latter are not more efficacious than other options and have known side effects.

The selection of these two interventions should be based on factors such as the characteristics of each individual. These can include patients’ preferences (e.g., some patients may prefer psychological interventions over needs-based interventions), social circumstances (e.g. needs based interventions which include housing/vocational support may be suited for patients for whom these issues represent the presenting complaint), nature of symptoms (e.g. psychological interventions may be indicated for those presenting with cognitive biases in addition to attenuated psychotic symptoms), predicted risk (e.g. those presenting with brief and limited intermittent psychotic symptoms may need psychological treatments beyond needs-based interventions) or the local availability of each intervention.

Some suggestions can be made on the basis of differences that, even if non-statistically significant, had at least a moderate effect size (Odds Ratio > 2.5 for preventing the onset of psychosis, or Cohen’s d > 0.5 for reducing symptoms).

• The most efficacious intervention for preventing psychosis onset could be Integrated Psychological Interventions (IPI), and the second most efficacious could be Cognitive Behavioral Therapy (van der Gaag protocol) combined with needs-based interventions.

• Omega-3 and CBT could be more efficacious than IPI for improving attenuated positive psychotic symptoms.

• N-methyl-d-aspartate receptor modulators could be more efficacious than needs-based interventions alone, CBT and family therapy for improving attenuated negative symptoms.

• Importantly, none of these differences reached statistical significance.

Finally, it will be essential to consult the results of new and forthcoming studies as they emerge. In this regard, living meta-analyses could provide new evidence earlier than updating a conventional meta-analysis.