European Child & Adolescent Psychiatry

, Volume 28, Issue 6, pp 735–746 | Cite as

Psychological interventions in psychosis in children and adolescents: a systematic review

  • Nefeli AnagnostopoulouEmail author
  • Marinos Kyriakopoulos
  • Anca Alba



Early onset psychosis (EOP), referring to psychosis with onset before the age of 18 years, is a more severe form of psychosis associated with worse prognosis. While medication is the treatment of choice, psychological interventions are also considered to have an important role in the management of symptoms and disability associated with this condition. The present review aimed to explore the effectiveness of such interventions.


An electronic search was conducted on the Embase, Medline, and PsychInfo databases for papers of randomized controlled trials (RCTs) referring to psychological interventions in EOP. References of identified papers were hand searched for additional studies. Identified studies were quality assessed.


Eight studies were included in the present review evaluating cognitive remediation therapy (CRT), cognitive behavioural therapy (CBT), a family intervention and psychoeducation. CRT was associated with improvement in cognitive function and CBT and CRT seem to also have a positive effect in psychosocial functioning. Symptom reduction appears to not be significantly affected by the proposed treatments.


There is some evidence supporting the effectiveness of psychological interventions in EOP. However, most research on adolescents is focused on CRT and its effects on cognitive deficits. More studies on the effects of psychological interventions in EOP are needed.


Early onset psychosis Cognitive remediation Cognitive behavioural therapy Psychoeducation Adolescent Family intervention 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical declaration

The manuscript does not contain clinical studies or patient data.


  1. 1.
    Giannitelli M, Consoli A, Raffin M, Jardri R, Levinson DF, Cohen D, Laurent-Levinson C (2017) An overview of medical risk factors for childhood psychosis: Implications for research and treatment. Schizophr ResGoogle Scholar
  2. 2.
    WHO (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines, vol 1. World Health OrganizationGoogle Scholar
  3. 3.
    APA (2013) Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric PubGoogle Scholar
  4. 4.
    Reininghaus U, Böhnke JR, Hosang G, Farmer A, Burns T, McGuffin P, Bentall RP (2016) Evaluation of the validity and utility of a transdiagnostic psychosis dimension encompassing schizophrenia and bipolar disorder. Br J Psychiatry. 115.167882Google Scholar
  5. 5.
    Bora E, Murray RM (2013) Meta-analysis of cognitive deficits in ultra-high risk to psychosis and first-episode psychosis: do the cognitive deficits progress over, or after, the onset of psychosis? Schizophr Bull 40(4):744–755Google Scholar
  6. 6.
    Jin H, Mosweu I (2017) The societal cost of schizophrenia: a systematic review. PharmacoEconomics 35(1):25–42Google Scholar
  7. 7.
    Kirkbride JB, Errazuriz A, Croudace TJ, Morgan C, Jackson D, Boydell J, Murray RM, Jones PB (2012) Incidence of schizophrenia and other psychoses in England, 1950–2009: a systematic review and meta-analyses. PloS One 7(3):e31660Google Scholar
  8. 8.
    Fraguas D, Díaz-Caneja CM, Pina-Camacho L, Janssen J, Arango C (2016) Progressive brain changes in children and adolescents with early-onset psychosis: a meta-analysis of longitudinal MRI studies. Schizophr Res 173(3):132–139Google Scholar
  9. 9.
    NICE (2013) Psychosis and Schizophrenia in children and young people: management and treatment. LondonGoogle Scholar
  10. 10.
    NICE (2013) Psychosis and schizophrenia in adults: treatment and managementGoogle Scholar
  11. 11.
    Organization WH (2015) Update of the Mental Health Gap Action Programme (mhGAP) guidelines for mental, neurological and substance use disorders, 2015. World Health OrganizationGoogle Scholar
  12. 12.
    Schmidt SJ, Schultze-Lutter F, Schimmelmann B, Maric N, Salokangas R, Riecher-Rössler A, van der Gaag M, Meneghelli A, Nordentoft M, Marshall M (2015) EPA guidance on the early intervention in clinical high risk states of psychoses. Eur Psychiatry 30(3):388–404Google Scholar
  13. 13.
    Breitborde NJ, Moe AM, Ered A, Ellman LM, Bell EK (2017) Optimizing psychosocial interventions in first-episode psychosis: current perspectives and future directions. Psychol Res Behav Manag 10:119Google Scholar
  14. 14.
    Armando M, Pontillo M, Vicari S (2015) Psychosocial interventions for very early and earlyonset schizophrenia: a review of treatment efficacy. Curr Opin Psychiatry 28(4):312–323Google Scholar
  15. 15.
    Bird V, Premkumar P, Kendall T, Whittington C, Mitchell J, Kuipers E (2010) Early intervention services, cognitive–behavioural therapy and family intervention in early psychosis: systematic review. Br J Psychiatry 197(5):350–356Google Scholar
  16. 16.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269Google Scholar
  17. 17.
    Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12Google Scholar
  18. 18.
    Rund BR, Moe L, Sollien T, Fjell A, Borchgrevink T, Hallert M, Naess P (1994) The Psychosis Project: outcome and cost-effectiveness of a psychoeducational treatment programme for schizophrenic adolescents. Acta Psychiatr Scand 89(3):211–218Google Scholar
  19. 19.
    Puig O, Penades R, Baeza I, De La Serna E, Sanchez-Gistau V, Bernardo M, Castro-Fornieles J (2013) Treatment of cognitive deficits in adolescents with early-onset schizophrenia: a randomised controlled trial of cognitive remediation. Eur Neuropsychopharmacol 23:S611Google Scholar
  20. 20.
    Puig O, Penades R, Baeza I, Sanchez-Gistau V, De La Serna E, Fonrodona L, Bernardo M, Castro-Fornieles J (2010) Real-world outcome improvements after cognitive remediation therapy in adolescents with early-onset schizophrenia. Early Interv Psychiatry 4:153Google Scholar
  21. 21.
    Wykes T, Newton E, Landau S, Rice C, Thompson N, Frangou S (2007) Cognitive remediation therapy (CRT) for young early onset patients with schizophrenia: an exploratory randomized controlled trial. Schizophr Res 94(1):221–230Google Scholar
  22. 22.
    Landa Y, Mueser K, Reyna VF, Walkup J, Shreck E, Silbersweig DA (2012) Family and group based cognitive behavioral therapy prevention program for adolescents prone to paranoia. Early Interv Psychiatry 6:97Google Scholar
  23. 23.
    Ueland T, Rund B (2004) A controlled randomized treatment study: The effects of a cognitive remediation program on adolescents with early onset psychosis. Acta Psychiatr Scand 109(1):70–74Google Scholar
  24. 24.
    Puig O, Penades R, Baeza I, De La Serna E, Sanchez-Gistau V, Bernardo M, Castro-Fornieles J (2014) Cognitive remediation therapy in adolescents with early-onset schizophrenia: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 53(8):879–887Google Scholar
  25. 25.
    Ueland T, Rund B (2005) Cognitive remediation for adolescents with early onset psychosis: A 1-year follow-up study. Acta Psychiatr Scand 111(3):193–201Google Scholar
  26. 26.
    Holzer L, Urben S, Passini CM, Jaugey L, Herzog MH, Halfon O, Pihet S (2014) A randomized controlled trial of the effectiveness of computer-assisted cognitive remediation (CACR) in adolescents with psychosis or at high risk of psychosis. Behav Cognit Psychother 42(04):421–434Google Scholar
  27. 27.
    Urben S, Pihet S, Jaugey L, Halfon O, Holzer L (2012) Computer-assisted cognitive remediation in adolescents with psychosis or at risk for psychosis: a 6-month follow-up. Acta Neuropsychiatr 24(6):328–335Google Scholar
  28. 28.
    Calvo A, Moreno M, Ruiz-Sancho A, Rapado-Castro M, Moreno C, Sanchez-Gutierrez T, Arango C, Mayoral M (2014) Intervention for adolescents with early-onset psychosis and their families: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 53(6):688–696Google Scholar
  29. 29.
    Calvo A, Moreno M, Ruiz-Sancho A, Rapado-Castro M, Moreno C, Sanchez-Gutierrez T, Arango C, Mayoral M (2015) Psychoeducational group intervention for adolescents with psychosis and their families: A two-year follow-up. J Am Acad Child Adolesc Psychiatry 54(12):984–990Google Scholar
  30. 30.
    Browning S, Corrigall R, Garety P, Emsley R, Jolley S (2013) Psychological interventions for adolescent psychosis: a pilot controlled trial in routine care. Eur Psychiatry 28(7):423–426Google Scholar
  31. 31.
    Juckel G, Morosini PL (2008) The new approach: psychosocial functioning as a necessary outcome criterion for therapeutic success in schizophrenia. Curr Opin Psychiatry 21(6):630–639Google Scholar
  32. 32.
    Peters E, Ward T, Jackson M, Morgan C, Charalambides M, McGuire P, Woodruff P, Jacobsen P, Chadwick P, Garety PA (2016) Clinical, socio-demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a “need for care”. World Psychiatry 15(1):41–52Google Scholar
  33. 33.
    Waller H, Garety P, Jolley S, Fornells-Ambrojo M, Kuipers E, Onwumere J, Woodall A, Craig T (2015) Training frontline mental health staff to deliver “low intensity” psychological therapy for psychosis: a qualitative analysis of therapist and service user views on the therapy and its future implementation. Behav Cognit Psychother 43(03):298–313Google Scholar
  34. 34.
    Johns L, Jolley S, Keen N, Peters E (2014) CBT with people with psychosis. How to become a more effective CBT therapist. 191–207Google Scholar
  35. 35.
    Gin K, Banerjea P, Abbott C, Browning S, Bracegirdle K, Corrigall R, Jolley S (2017) Childhood unusual experiences in community Child and Adolescent Mental Health Services in South. Prevalence and impact. Schizophrenia Research, East LondonGoogle Scholar
  36. 36.
    Wykes T, van der Gaag M (2001) Is it time to develop a new cognitive therapy for psychosis—cognitive remediation therapy (CRT)? Clin Psychol Rev 21(8):1227–1256Google Scholar
  37. 37.
    Penadés R, Catalán R, Puig O, Masana G, Pujol N, Navarro V, Guarch J, Gastó C (2010) Executive function needs to be targeted to improve social functioning with Cognitive Remediation Therapy (CRT) in schizophrenia. Psychiatry research 177(1):41–45Google Scholar
  38. 38.
    Lecomte T, Leclerc C, Corbiere M, Wykes T, Wallace CJ, Spidel A (2008) Group cognitive behavior therapy or social skills training for individuals with a recent onset of psychosis? Results of a randomized controlled trial. J Nerv Mental Dis 196(12):866–875Google Scholar
  39. 39.
    Lewis S, Tarrier N, Haddock G, Bentall R, Kinderman P, Kingdon D, Siddle R, Drake R, Everitt J, Leadley K (2002) Randomised controlled trial of cognitive—behavioural therapy in early schizophrenia: acute-phase outcomes. Br J Psychiatry 181(43):s91-s97Google Scholar
  40. 40.
    Shawyer F, Farhall J, Mackinnon A, Trauer T, Sims E, Ratcliff K, Larner C, Thomas N, Castle D, Mullen P (2012) A randomised controlled trial of acceptance-based cognitive behavioural therapy for command hallucinations in psychotic disorders. Behav Res Therapy 50(2):110–121Google Scholar
  41. 41.
    Birchwood M, Michail M, Meaden A, Tarrier N, Lewis S, Wykes T, Davies L, Dunn G, Peters E (2014) Cognitive behaviour therapy to prevent harmful compliance with command hallucinations (COMMAND): a randomised controlled trial. Lancet Psychiatry 1(1):23–33Google Scholar
  42. 42.
    Harter S (1999) The construction of the self: a developmental perspective. Guilford PressGoogle Scholar
  43. 43.
    Maddox L, Jolley S, Laurens KR, Hirsch C, Hodgins S, Browning S, Bravery L, Bracegirdle K, Smith P, Kuipers E (2013) Cognitive behavioural therapy for unusual experiences in children: a case series. Behav Cognit Psychother 41(3):344–358Google Scholar
  44. 44.
    Miklowitz DJ, O’Brien MP, Schlosser DA, Addington J, Candan KA, Marshall C, Domingues I, Walsh BC, Zinberg JL, De Silva SD (2014) Family-focused treatment for adolescents and young adults at high risk for psychosis: results of a randomized trial. J Am Acad Child Adolesc Psychiatry 53(8):848–858Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Nefeli Anagnostopoulou
    • 1
    Email author
  • Marinos Kyriakopoulos
    • 2
    • 3
  • Anca Alba
    • 3
  1. 1.National and Specialist Bethlem Adolescent UnitSouth London and Maudsley NHS Foundation TrustLondonUK
  2. 2.Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
  3. 3.National and Specialist Acorn Lodge Inpatient Children’s UnitSouth London and Maudsley NHS Foundation TrustLondonUK

Personalised recommendations