Review Paper Benefits of Enriched Intervention Compared With Standard Care for Patients With Recent-Onset Psychosis: A Metaanalytic Approach

Objective: To assess the effectiveness of enriched intervention (EI) on symptomatic and functional outcomes, compared with standard care (SC). Method: Studies were retrieved from search engines and, using a metaanalytic approach, we compared EI trials with SC trials. Eleven EI sample trials (1053 patients) and 6 SC sample trials (500 patients), totalling data from 1553 patients (69 % male), were examined. We calculated the effect sizes (ESs) of both symptomatic and functional improvement over a follow-up period of about 1 year. Results: Significant differences between EI and SC were observed at follow-up for the improvement of both positive and negative symptoms, respectively: positive, EI = –1.54 (95%CI, –1.63 to –1.45) and SC = –1.07 (95%CI, –1.19 to –0.94) (Qbetween = 40.3, df 1, P < 0.001); negative, EI = –0.44 (95%CI, –0.53 to –0.35) and SC = –0.18 (95%CI, –0.31 to –0.05) (Qbetween = 10.6, df 1, P < 0.01). We also observed a significant difference between the EI and the SC groups for functional improvement over the follow-up period with mean EI = 1.11 (95%CI, 0.99 to 1.23) and SC = 0.63 (95%CI, 0.49 to 0.77) (Qbetween = 24.5, df 1, P < 0.001). Conclusions: There is now quantitative evidence across multiple studies and sites to indicate that EIs for patients with recent-onset psychosis are significantly more effective than SC for symptomatic and functional improvement over a period of about 1 year. (Can J Psychiatry 2007;52:464–472) Information on funding and support and author affiliations appears at the end of the article