Year: 2020
Type: review
Abstract: Importance: Detection, prognosis, and indicated interventions in individuals at clinical high risk for psychosis (CHR-P) are key components of preventive psychiatry. Objective: To provide a comprehensive, evidence-based systematic appraisal of the advancements and limitations of detection, prognosis, and interventions for CHR-P individuals and to formulate updated recommendations. Evidence Review: Web of Science, Cochrane Central Register of Reviews, and Ovid/PsychINFO were searched for articles published from January 1, 2013, to June 30, 2019, to identify meta-analyses conducted in CHR-P individuals. MEDLINE was used to search the reference lists of retrieved articles. Data obtained from each article included first author, year of publication, topic investigated, type of publication, study design and number, sample size of CHR-P population and comparison group, type of comparison group, age and sex of CHR-P individuals, type of prognostic assessment, interventions, quality assessment (using AMSTAR [Assessing the Methodological Quality of Systematic Reviews]), and key findings with their effect sizes. Findings: In total, 42 meta-analyses published in the past 6 years and encompassing 81 outcomes were included. For the detection component, CHR-P individuals were young (mean [SD] age, 20.6 [3.2] years), were more frequently male (58%), and predominantly presented with attenuated psychotic symptoms lasting for more than 1 year before their presentation at specialized services. CHR-P individuals accumulated several sociodemographic risk factors compared with control participants. Substance use (33% tobacco use and 27% cannabis use), comorbid mental disorders (41% with depressive disorders and 15% with anxiety disorders), suicidal ideation (66%), and self-harm (49%) were also frequently seen in CHR-P individuals. CHR-P individuals showed impairments in work (Cohen d = 0.57) or educational functioning (Cohen d = 0.21), social functioning (Cohen d = 1.25), and quality of life (Cohen d = 1.75). Several neurobiological and neurocognitive alterations were confirmed in this study. For the prognosis component, the prognostic accuracy of CHR-P instruments was good, provided they were used in clinical samples. Overall, risk of psychosis was 22% at 3 years, and the risk was the highest in the brief and limited intermittent psychotic symptoms subgroup (38%). Baseline severity of attenuated psychotic (Cohen d = 0.35) and negative symptoms (Cohen d = 0.39) as well as low functioning (Cohen d = 0.29) were associated with an increased risk of psychosis. Controlling risk enrichment and implementing sequential risk assessments can optimize prognostic accuracy. For the intervention component, no robust evidence yet exists to favor any indicated intervention over another (including needs-based interventions and control conditions) for preventing psychosis or ameliorating any other outcome in CHR-P individuals. However, because the uncertainty of this evidence is high, needs-based and psychological interventions should still be offered. Conclusions and Relevance: This review confirmed recent substantial advancements in the detection and prognosis of CHR-P individuals while suggesting that effective indicated interventions need to be identified. This evidence suggests a need for specialized services to detect CHR-P individuals in primary and secondary care settings, to formulate a prognosis with validated psychometric instruments, and to offer needs-based and psychological interventions.
Source: JAMA Psychiatry
Authors: Paolo Fusar-Poli, Gonzalo Salazar de Pablo, Christoph U. Correll, Andreas Meyer-Lindenberg, Mark J. Millan, Stefan Borgwardt, Silvana Galderisi, Andreas Bechdolf, Andrea Pfennig, Lars Vedel Kessing, Therese van Amelsvoort, Dorien H. Nieman, Katharina Domschke, Marie-Odile Krebs, Nikolaos Koutsouleris, Philip McGuire, Kim Q. Do, Celso Arango
Institutions: National Health Service, King's College London, South London and Maudsley NHS Foundation Trust, University of Pavia, National Institute for Health and Care Research, NIHR Maudsley Biomedical Research Centre, Universidad Complutense de Madrid, Hospital General Universitario Gregorio Marañón, Centro de Investigación Biomédica en Red de Salud Mental, Centro de Investigación Biomédica en Red, Northwell Health, Feinstein Institute for Medical Research, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital, Charité – Universitätsmedizin Berlin, Heidelberg University, Central Institute of Mental Health, Medizinische Fakultät Mannheim, University of Basel, University of Lübeck, University of Campania "Luigi Vanvitelli", University of Cologne, Vivantes Klinikum, Orygen, Klinikum im Friedrichshain, University Hospital Carl Gustav Carus, Technische Universität Dresden, Rigshospitalet, Maastricht University Medical Centre, Maastricht University, Amsterdam UMC Location University of Amsterdam, Amsterdam University Medical Centers, University of Freiburg, University Medical Center Freiburg, Centre National de la Recherche Scientifique, Inserm, Université Paris Cité, Institut de Psychiatrie et Neurosciences de Paris, Université Paris Descartes, Ludwig-Maximilians-Universität München, Centre Hospitalier Universitaire Vaudois
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Amsterdam University Medical Centers, King's College London, Institut National de la Santé et de la Recherche Médicale, Universiteit Maastricht, Albert-Ludwigs-Universität Freiburg, Technische Universität Dresden, Maastricht Universitair Medisch Centrum, Centre National de la Recherche Scientifique, Rigshospitalet, Université Paris Descartes, Centre Hospitalier Universitaire Vaudois, Université de Paris, Medizinische Fakultät der Albert-Ludwigs-Universität Freiburg
OpenAlex ID: W2998018164