Year: 2024
Type: review
Abstract: OBJECTIVE: Early-onset psychosis (EOP) refers to the development of psychosis before the age of 18 years. We aimed to summarize, for the first time, the meta-analytical evidence in the field of this vulnerable population and to provide evidence-based recommendations. METHOD: We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant, pre-registered (PROSPERO: CRD42022350868) systematic review of several databases and registers to identify meta-analyses of studies conducted in EOP individuals to conduct an umbrella review. Literature search, screening, data extraction, and quality assessment were carried out independently. Results were narratively reported, clustered across core domains. Quality assessment was performed with the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool. RESULTS: A total of 30 meta-analyses were included (373 individual studies, 25,983 participants, mean age 15.1 years, 38.3% female). Individuals with EOP showed more cognitive impairments compared with controls and individuals with adult/late-onset psychosis. Abnormalities were observed meta-analytically in neuroimaging markers but not in oxidative stress and inflammatory response markers. In all, 60.1% of EOP individuals had a poor prognosis. Clozapine was the antipsychotic with the highest efficacy for overall, positive, and negative symptoms. Tolerance to medication varied among the evaluated antipsychotics. The risk of discontinuation of antipsychotics for any reason or side effects was low or equal compared to placebo. CONCLUSION: EOP is associated with cognitive impairment, involuntary admissions, and poor prognosis. Antipsychotics can be efficacious in EOP, but tolerability and safety need to be taken into consideration. Clozapine should be considered in EOP individuals who are resistant to 2 non-clozapine antipsychotics. Further meta-analytical research is needed on response to psychological interventions and other prognostic factors. PLAIN LANGUAGE SUMMARY: This umbrella review summarized the meta-analytical knowledge from 30 meta-analyses on early-onset psychosis. Early-onset psychosis refers to the development of psychosis before the age of 18 years and is associated with cognitive impairment, hospitalization, and poor prognosis. Individuals with early-onset psychosis show more cognitive impairments and abnormalities compared with controls. Clozapine was the antipsychotic with the highest efficacy for positive, negative, and overall symptoms and should be considered in individuals with early-onset psychosis. STUDY PREREGISTRATION INFORMATION: Early Onset Psychosis: Umbrella Review on Diagnosis, Prognosis and Treatment factors; https://www.crd.york.ac.uk/PROSPERO/; CRD42022350868.
Institutions: King's College London, South London and Maudsley NHS Foundation Trust, University of Pavia, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, Donostiako Unibertsitate Ospitalea, University of the Basque Country, Hospital de Basurto, The Francis Crick Institute, National and Kapodistrian University of Athens, National Health Service, National Institute for Health and Care Research, NIHR Maudsley Biomedical Research Centre, Ludwig-Maximilians-Universität München, Northwell Health, Feinstein Institute for Medical Research, Hofstra University, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital, Deutsches Zentrum für Psychische Gesundheit, Charité – Universitätsmedizin Berlin
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,000
Funders: South London and Maudsley NHS Foundation Trust, Francis Crick Institute, Northwell Health, National Institute for Health and Care Research, Academy of Medical Sciences, King's College London, Euskal Herriko Unibertsitatea, Università degli Studi di Pavia, National and Kapodistrian University of Athens, Ludwig-Maximilians-Universität München, Centro de Investigación Biomédica en Red de Salud Mental, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Feinstein Institutes for Medical Research, NIHR Maudsley Biomedical Research Centre
Award: G3407259032
OpenAlex ID: W4391189014