Early Intervention in Psychosis and Management of First Episode Psychosis in Low- and Lower-Middle-Income Countries: A Systematic Review

Farooq, Saeed; Fonseka, Nishani; Wajid Ali, Malik; Milner, Abbie; Hamid, Shumaila; Sheikh, Saima; Firaz Khan, Muhammad; Mukhtar-Ul-Haq Azeemi, Mian; Ariyadasa, Gayan; Jalil Khan, Abdul; Ayub, Muhammad

Abstract

Background and Hypothesis People with first-episode psychosis (FEP) in low- and lower-middle-income countries (LMIC) experience delays in receiving treatment, resulting in poorer outcomes and higher mortality. There is robust evidence for effective and cost-effective early intervention in psychosis (EIP) services for FEP, but the evidence for EIP in LMIC has not been reviewed. We aim to review the evidence on early intervention for the management of FEP in LMIC. Study Design We searched 4 electronic databases (Medline, Embase, PsycINFO, and CINAHL) to identify studies describing EIP services and interventions to treat FEP in LMIC published from 1980 onward. The bibliography of relevant articles was hand-searched. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Study Results The search strategy produced 5074 records; we included 18 studies with 2294 participants from 6 LMIC countries. Thirteen studies (1553 participants) described different approaches for EIP. Pharmacological intervention studies (n = 4; 433 participants) found a high prevalence of metabolic syndrome among FEP receiving antipsychotics (P ≤ .005). One study found a better quality of life in patients using injectables compared to oral antipsychotics (P = .023). Among the non-pharmacological interventions (n = 3; 308 participants), SMS reminders improved treatment engagement (OR = 1.80, CI = 1.02–3.19). The methodological quality of studies evidence was relatively low. Conclusions The limited evidence showed that EIP can be provided in LMIC with adaptations for cultural factors and limited resources. Adaptations included collaboration with traditional healers, involving nonspecialist healthcare professionals, using mobile technology, considering the optimum use of long-acting antipsychotics, and monitoring antipsychotic side effects.

Citation

Farooq, S., Fonseka, N., Wajid Ali, M., Milner, A., Hamid, S., Sheikh, S., …Ayub, M. (2024). Early Intervention in Psychosis and Management of First Episode Psychosis in Low- and Lower-Middle-Income Countries: A Systematic Review. Schizophrenia Bulletin, Article sbae025. https://doi.org/10.1093/schbul/sbae025

• Journal Article Type: Article
• Acceptance Date: Feb 21, 2024
• Online Publication Date: Mar 25, 2024
• Publication Date: Mar 25, 2024
• Deposit Date: Mar 25, 2024
• Publicly Available Date: Apr 3, 2024
• Journal: Schizophrenia Bulletin
• Print ISSN: 0586-7614
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Article Number: sbae025
• DOI: https://doi.org/10.1093/schbul/sbae025
• Keywords: psychiatry, first-episode psychosis, early intervention in psychosis services, pharmacological intervention, non-pharmacological interventions