T29. TREATMENT AND GLOBAL FUNCTIONING IN YOUTH AT CLINICAL HIGH RISK FOR PSYCHOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
Poor global functioning in youth at clinical high risk (CHR) for psychosis has been associated with sleep disturbances, neurocognitive impairments, and transition to psychosis. A recent meta-analysis demonstrated that the CHR state is characterized by large functional impairments similar to those with psychotic disorders and thus require treatment. However, the impact of different treatment types on global functioning remains unknown. Thus, the goal of this systematic review and meta-analysis was to determine the impact of interventions on global functioning in those at CHR for psychosis. We systematically searched the electronic databases PsycINFO, Embase, CINAHL, EBM, and MEDLINE with no date, geographical, or language restrictions. Studies were selected if they conducted a randomized control trial (RCT) in CHR for psychosis samples and reported changes in global functioning using either the Global Assessment of Functioning (GAF) or Social and Occupational Functioning Assessment Scale (SOFAS). Data were evaluated using random effects pairwise meta‐analyses, separated by treatment type, and stratified by time. Effect sizes were reported as the standardized mean difference (SMD) and 95% CIs for the comparison between control and experimental conditions. Heterogeneity was assessed using Tau2 and the I2 index. Fourteen studies met our inclusion criteria. Interventions included antipsychotics (k=2), cognitive behavioural therapy (CBT, k=6), cognitive remediation (k=1), family therapy (k=1), integrative psychosocial therapy (k=1), and omega‐3 (k=3). Meta-analyses could only be performed for CBT and omega‐3 trials. CBT did not significantly improve global functioning at 6-months (SMD = -0.08; 95% CI = −0.35, 0.19, I2= 48%;P=.58, 5 studies, N= 506), 12-months (SMD = 0.07; 95% CI = −0.10, 0.25, I2= 0%;P=.43, 6 studies, N= 501), 18-months (SMD = 0.09; 95% CI = −0.21, 0.39, I2= 0%;P=.56, 2 studies, N= 168), and long-term (24–48 months) follow-up (SMD = 0.01; 95% CI = −0.28, 0.29, I2= 0%;P=.96, 3 studies, N= 190). Omega‐3 did not significantly improve global functioning at 6-months (SMD = 0.35; 95% CI = −0.40, 1.09, I2= 91%; P=.36, 3 studies, N= 390) and 12-months (SMD = 0.52; 95% CI = −0.53, 1.56, I2= 94%; P=.33, 3 studies, N= 330). This systematic review and meta‐analysis established that neither CBT nor omega-3 significantly impacted global functioning versus controls in those at CHR for psychosis. The majority of trials utilized the GAF which is greatly influenced by impairment in psychiatric symptoms. Additionally, RCTs using the Comprehensive Assessment of At-Risk Mental States (CAARMS) criteria for CHR included functioning on the SOFAS as a diagnostic criterion. Future treatment studies may wish to use scales that specifically address social and role functioning to further elucidate the impact of treatment on functioning.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.026 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.021 | 0.051 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".