Authors’ conclusions
This review indicates that early warning signs interventions may have a positive effect on the proportions of people re-hospitalised
and on rates of relapse, but not on time to recurrence. However, the overall quality of the evidence was very low, indicating that we
do not know if early warning signs interventions will have similar effects outside trials and that it is very likely that further research
will alter these estimates. Moreover, the early warning signs interventions were used along side other psychological interventions, and
we do not know if they would be effective on their own. They may be cost-effective due to reduced hospitalisation and relapse rates,
but before mental health services consider routinely providing psychological interventions involving the early recognition and prompt
management of early warning signs to adults with schizophrenia, further research is required to provide evidence of high or moderate
quality regarding the efficacy of early warning signs interventions added to usual care without additional psychological interventions,
or to clarify the kinds of additional psychological interventions that might aid its efficacy. Future RCTs should be adequately-powered,
and designed to minimise the risk of bias and be transparently reported. They should also systematically evaluate resource costs and
resource use, alongside efficacy outcomes and other outcomes that are important to people with serious mental illness and their carers.
Authors’ conclusionsThis review indicates that early warning signs interventions may have a positive effect on the proportions of people re-hospitalisedand on rates of relapse, but not on time to recurrence. However, the overall quality of the evidence was very low, indicating that wedo not know if early warning signs interventions will have similar effects outside trials and that it is very likely that further researchwill alter these estimates. Moreover, the early warning signs interventions were used along side other psychological interventions, andwe do not know if they would be effective on their own. They may be cost-effective due to reduced hospitalisation and relapse rates,but before mental health services consider routinely providing psychological interventions involving the early recognition and promptmanagement of early warning signs to adults with schizophrenia, further research is required to provide evidence of high or moderatequality regarding the efficacy of early warning signs interventions added to usual care without additional psychological interventions,or to clarify the kinds of additional psychological interventions that might aid its efficacy. Future RCTs should be adequately-powered,and designed to minimise the risk of bias and be transparently reported. They should also systematically evaluate resource costs andresource use, alongside efficacy outcomes and other outcomes that are important to people with serious mental illness and their carers.
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