Paolo Fusar-Poli1, Marco Cappucciati2, Stefan Borgwardt3, Scott W Woods4, Jean Addington5, Barnaby Nelson6, Dorien H Nieman7, Daniel R Stahl8, Grazia Rutigliano8, Anita Riecher-Rössler3, Andor E Simon9, Masafumi Mizuno10, Tae Young Lee11, Jun Soo Kwon11, May M L Lam12, Jesus Perez13, Szabolcs Keri14, Paul Amminger6, Sibylle Metzler15, Wolfram Kawohl15, Wulf Rössler15, Jimmy Lee16, Javier Labad17, Tim Ziermans18, Suk Kyoon An19, Chen-Chung Liu20, Kristen A Woodberry21, Amel Braham22, Cheryl Corcoran23, Patrick McGorry6, Alison R Yung24, Philip K McGuire8. 1. Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom2OASIS Clinic, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom. 2. Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom3Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. 3. University of Basel Psychiatric Clinics, Basel, Switzerland. 4. Department of Psychiatry, Yale University, New Haven, Connecticut. 5. Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. 6. Orygen, the National Centre of Excellence in Youth Mental Health, and Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia. 7. Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 8. Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. 9. University of Basel Psychiatric Clinics, Basel, Switzerland9Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, Bruderholz, Switzerland. 10. Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan. 11. Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea. 12. Kwai Chung Hospital, New Territories, Hong Kong, People's Republic of China. 13. Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom. 14. Nyiro Gyula Hospital, National Institute of Psychiatry and Addictions, Budapest, Hungary. 15. Centre for Social Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland. 16. Department of General Psychiatry, Institute of Mental Health, Singapore, Singapore. 17. Department of Psychiatry, Corporacio Sanitaria Parc Tauli Sabadell, Barcelona, Spain. 18. Department of Clinical Child and Adolescent Studies, Leiden University, Leiden, the Netherlands. 19. Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea. 20. Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan. 21. Center for Psychiatric Research, Maine Medical Center, Portland, Maine22Departments of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. 22. Psychiatry Department, University Hospital Farhat Hached, Sousse, Tunisia. 23. Department of Psychiatry, Columbia University, New York, New York. 24. Institute of Brain, Behaviour and Mental Health, University of Manchester, and Greater Manchester West National Health Service Mental Health Foundation Trust, Manchester, United Kingdom.
Abstract
IMPORTANCE: Individuals can be classified as being at clinical high risk (CHR) for psychosis if they meet at least one of the ultra-high-risk (UHR) inclusion criteria (brief limited intermittent psychotic symptoms [BLIPS] and/or attenuated psychotic symptoms [APS] and/or genetic risk and deterioration syndrome [GRD]) and/or basic symptoms [BS]. The meta-analytical risk of psychosis of these different subgroups is still unknown. OBJECTIVE: To compare the risk of psychosis in CHR individuals who met at least one of the major inclusion criteria and in individuals not at CHR for psychosis (CHR-). DATA SOURCES: Electronic databases (Web of Science, MEDLINE, Scopus) were searched until June 18, 2015, along with investigation of citations of previous publications and a manual search of the reference lists of retrieved articles. STUDY SELECTION: We included original follow-up studies of CHR individuals who reported the risk of psychosis classified according to the presence of any BLIPS, APS and GRD, APS alone, GRD alone, BS, and CHR-. DATA EXTRACTION AND SYNTHESIS: Independent extraction by multiple observers and random-effects meta-analysis of proportions. Moderators were tested with meta-regression analyses (Bonferroni corrected). Heterogeneity was assessed with the I2 index. Sensitivity analyses tested robustness of results. Publication biases were assessed with funnel plots and the Egger test. MAIN OUTCOMES AND MEASURES: The proportion of each subgroup with any psychotic disorder at 6, 12, 24, 36, and 48 or more months of follow-up. RESULTS: Thirty-three independent studies comprising up to 4227 individuals were included. The meta-analytical proportion of individuals meeting each UHR subgroup at intake was: 0.85 APS (95%CI, 0.79-0.90), 0.1 BLIPS (95%CI, 0.06-0.14), and 0.05 GRD (95%CI, 0.03-0.07). There were no significant differences in psychosis risk at any time point between the APS and GRD and the APS-alone subgroups. There was a higher risk of psychosis in the any BLIPS greater than APS greater than GRD-alone subgroups at 24, 36, and 48 or more months of follow-up. There was no evidence that the GRD subgroup has a higher risk of psychosis than the CHR- subgroup. There were too few BS or BS and UHR studies to allow robust conclusions. CONCLUSIONS AND RELEVANCE: There is meta-analytical evidence that BLIPS represents separate risk subgroup compared with the APS. The GRD subgroup is infrequent and not associated with an increased risk of psychosis. Future studies are advised to stratify their findings across these different subgroups. The CHR guidelines should be updated to reflect these differences.
IMPORTANCE: Individuals can be classified as being at clinical high risk (CHR) for psychosis if they meet at least one of the ultra-high-risk (UHR) inclusion criteria (brief limited intermittent psychotic symptoms [BLIPS] and/or attenuated psychotic symptoms [APS] and/or genetic risk and deterioration syndrome [GRD]) and/or basic symptoms [BS]. The meta-analytical risk of psychosis of these different subgroups is still unknown. OBJECTIVE: To compare the risk of psychosis in CHR individuals who met at least one of the major inclusion criteria and in individuals not at CHR for psychosis (CHR-). DATA SOURCES: Electronic databases (Web of Science, MEDLINE, Scopus) were searched until June 18, 2015, along with investigation of citations of previous publications and a manual search of the reference lists of retrieved articles. STUDY SELECTION: We included original follow-up studies of CHR individuals who reported the risk of psychosis classified according to the presence of any BLIPS, APS and GRD, APS alone, GRD alone, BS, and CHR-. DATA EXTRACTION AND SYNTHESIS: Independent extraction by multiple observers and random-effects meta-analysis of proportions. Moderators were tested with meta-regression analyses (Bonferroni corrected). Heterogeneity was assessed with the I2 index. Sensitivity analyses tested robustness of results. Publication biases were assessed with funnel plots and the Egger test. MAIN OUTCOMES AND MEASURES: The proportion of each subgroup with any psychotic disorder at 6, 12, 24, 36, and 48 or more months of follow-up. RESULTS: Thirty-three independent studies comprising up to 4227 individuals were included. The meta-analytical proportion of individuals meeting each UHR subgroup at intake was: 0.85 APS (95%CI, 0.79-0.90), 0.1 BLIPS (95%CI, 0.06-0.14), and 0.05 GRD (95%CI, 0.03-0.07). There were no significant differences in psychosis risk at any time point between the APS and GRD and the APS-alone subgroups. There was a higher risk of psychosis in the any BLIPS greater than APS greater than GRD-alone subgroups at 24, 36, and 48 or more months of follow-up. There was no evidence that the GRD subgroup has a higher risk of psychosis than the CHR- subgroup. There were too few BS or BS and UHR studies to allow robust conclusions. CONCLUSIONS AND RELEVANCE: There is meta-analytical evidence that BLIPS represents separate risk subgroup compared with the APS. The GRD subgroup is infrequent and not associated with an increased risk of psychosis. Future studies are advised to stratify their findings across these different subgroups. The CHR guidelines should be updated to reflect these differences.
Authors: Cathy Davies; Andrea Cipriani; John P A Ioannidis; Joaquim Radua; Daniel Stahl; Umberto Provenzani; Philip McGuire; Paolo Fusar-Poli Journal: World Psychiatry Date: 2018-06 Impact factor: 49.548
Authors: Jordina Tor; Montserrat Dolz; Anna Sintes; Daniel Muñoz; Marta Pardo; Elena de la Serna; Olga Puig; Gisela Sugranyes; Inmaculada Baeza Journal: Eur Child Adolesc Psychiatry Date: 2017-09-15 Impact factor: 4.785
Authors: Joseph S DeLuca; Nicole D Andorko; Doha Chibani; Samantha Y Jay; Pamela J Rakhshan Rouhakhtar; Emily Petti; Mallory J Klaunig; Elizabeth C Thompson; Zachary B Millman; Kathleen M Connors; LeeAnn Akouri-Shan; John Fitzgerald; Samantha L Redman; Caroline Roemer; Miranda A Bridgwater; Jordan E DeVylder; Cheryl A King; Steven C Pitts; Shauna P Reinblatt; Heidi J Wehring; Kristin L Bussell; Natalee Solomon; Sarah M Edwards; Gloria M Reeves; Robert W Buchanan; Jason Schiffman Journal: J Psychother Integr Date: 2020-06