The quality of evidence is downgraded by study limitations (unclear allocation concealment and selective reporting).
Patients with schizophrenia should be trained to recognize early signs of recurrence.
The recommendation attaches a relatively high value on avoiding relapses and an improvement in general mental state.
A Cochrane review [Abstract] 1 included 34 studies with a total of 3554 subjects. The patients had diagnosis of schizophrenia or a non-affective, non-organic serious or chronic mental illness. They received an intervention, lasting minimum one hour, designed to systematically train patients to recognize early warning signs of relapses and act to prevent the recurrence of schizophrenic episodes. The interventions included diary keeping, completion of questionnaires and card sorting techniques, and a plan of action based on the early warning signs. The interventions could be individually or group-based and could involve family. In the included studies, the early warning signs interventions were used alongside with other psychological interventions.
Early warning signs interventions reduced the relapses and hospitalizations to almost a half compared to usual care, whereas no significant differences were found in the length of time taken to relapse or to be re-hospitalized. There was only little and inconsistent evidence of participants' satisfaction with care. Nine studies reported an improvement in general mental state suggesting that early warning signs intervention is not associated with an increase in depressive symptoms.
| Outcome | Number of participants (trials) | Control:Usual care | Intervention:Early warning signs interventions | Effect size (95% CI) |
| Proportion of people who experienced relapse | 1502(15) | 43% | 23% | RR 0.53(0.36 to 0.79) |
| Time to relapse | 550(6) | - | - | HR 0.53(0.27 to 1.06) |
| Hospitalisation rate | 1457(15) | 39% | 19% | RR 0.48(0.35 to 0.66) |
Date of latest search: 2012-09-24
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