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. 2021 Jan 13;11(1):43.
doi: 10.1038/s41398-020-01165-x.

Establishing a clinical service to prevent psychosis: What, how and when? Systematic review

Gonzalo Salazar de Pablo #  1   2 , Andrés Estradé #  1   3 , Marcello Cutroni  4 , Olivier Andlauer  5   6 , Paolo Fusar-Poli  7   8   9   10
Affiliations

Establishing a clinical service to prevent psychosis: What, how and when? Systematic review

Gonzalo Salazar de Pablo et al. Transl Psychiatry. .

Abstract

The first rate-limiting step to successfully translate prevention of psychosis in to clinical practice is to establish specialised Clinical High Risk for Psychosis (CHR-P) services. This study systematises the knowledge regarding CHR-P services and provides guidelines for translational implementation. We conducted a PRISMA/MOOSE-compliant (PROSPERO-CRD42020163640) systematic review of Web of Science to identify studies until 4/05/2020 reporting on CHR-P service configuration, outreach strategy and referrals, service user characteristics, interventions, and outcomes. Fifty-six studies (1998-2020) were included, encompassing 51 distinct CHR-P services across 15 countries and a catchment area of 17,252,666 people. Most services (80.4%) consisted of integrated multidisciplinary teams taking care of CHR-P and other patients. Outreach encompassed active (up to 97.6%) or passive (up to 63.4%) approaches: referrals came mostly (90%) from healthcare agencies. CHR-P individuals were more frequently males (57.2%). Most (70.6%) services accepted individuals aged 12-35 years, typically assessed with the CAARMS/SIPS (83.7%). Baseline comorbid mental conditions were reported in two-third (69.5%) of cases, and unemployment in one third (36.6%). Most services provided up to 2-years (72.4%), of clinical monitoring (100%), psychoeducation (81.1%), psychosocial support (73%), family interventions (73%), individual (67.6%) and group (18.9%) psychotherapy, physical health interventions (37.8%), antipsychotics (87.1%), antidepressants (74.2%), anxiolytics (51.6%), and mood stabilisers (38.7%). Outcomes were more frequently ascertained clinically (93.0%) and included: persistence of symptoms/comorbidities (67.4%), transition to psychosis (53.5%), and functional status (48.8%). We provide ten practical recommendations for implementation of CHR-P services. Health service knowledge summarised by the current study will facilitate translational efforts for implementation of CHR-P services worldwide.

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Conflict of interest statement

Dr. Fusar-Poli has received grants from Lundbeck and personal fees from Menarini, Lundbeck, and Angelini. No other disclosures reported.

Figures

Fig. 1
Fig. 1. PRISMA Flowchart.
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flowchart outlining study selection process.
Fig. 2
Fig. 2. CHR-P services map.
Geographical distribution of CHR-P services included in the review.
See this image and copyright information in PMC

References

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