Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Sep 21;24(9):710-720.
doi: 10.1093/ijnp/pyab030.

Negative Prognostic Effect of Baseline Antipsychotic Exposure in Clinical High Risk for Psychosis (CHR-P): Is Pre-Test Risk Enrichment the Hidden Culprit?

Andrea Raballo  1   2 , Michele Poletti  3 , Antonio Preti  4
Affiliations
Meta-Analysis

Negative Prognostic Effect of Baseline Antipsychotic Exposure in Clinical High Risk for Psychosis (CHR-P): Is Pre-Test Risk Enrichment the Hidden Culprit?

Andrea Raballo et al. Int J Neuropsychopharmacol. .

Abstract

Introduction: Sample enrichment is a key factor in contemporary early-detection strategies aimed at the identification of help-seekers at increased risk of imminent transition to psychosis. We undertook a meta-analytic investigation to ascertain the role of sample enrichment in the recently highlighted negative prognostic effect of baseline antipsychotic (AP) exposure in clinical high-risk (CHR-P) of psychosis individuals.

Methods: Systematic review and meta-analysis of all published studies on CHR-P were identified according to a validated diagnostic procedure. The outcome was the proportion of transition to psychosis, which was calculated according to the Freeman-Tukey double arcsine transformation.

Results: Thirty-three eligible studies were identified, including 16 samples with details on AP exposure at baseline and 17 samples with baseline AP exposure as exclusion criterion for enrollment. Those with baseline exposure to AP (n = 395) had higher transition rates (29.9%; 95% CI: 25.1%-34.8%) than those without baseline exposure to AP in the same study (n = 1289; 17.2%; 15.1%-19.4%) and those coming from samples that did not include people who were exposed to AP at baseline (n = 2073; 16.2%; 14.6%-17.8%; P < .05 in both the fixed-effects and the random-effects models). Heterogeneity within studies was substantial, with values above 75% in all comparisons.

Conclusions: Sample enrichment is not a plausible explanation for the higher risk of transition to psychosis of CHR-P individuals who were already exposed to AP at the enrollment in specialized early-detection programs. Baseline exposure to AP at CHR-P assessment is a major index of enhanced, imminent risk of psychosis.

Keywords: Antipsychotic; clinical high risk; prevention; prognosis; psychosis; treatment.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
PRISMA 2009 flow diagram.
Figure 2.
Figure 2.
Forest plot.
See this image and copyright information in PMC

References

    1. Addington J, Piskulic D, Perkins D, Woods SW, Liu L, Penn DL (2012) Affect recognition in people at clinical high risk of psychosis. Schizophr Res 140:87–92. - PMC - PubMed
    1. Akudjedu TN, Tronchin G, McInerney S, Scanlon C, Kenney JPM, McFarland J, Barker GJ, McCarthy P, Cannon DM, McDonald C, Hallahan B (2020) Progression of neuroanatomical abnormalities after first-episode of psychosis: a 3-year longitudinal sMRI study. J Psychiatr Res 130:137–151. - PubMed
    1. Amminger GP, Schäfer MR, Papageorgiou K, Klier CM, Cotton SM, Harrigan SM, Mackinnon A, McGorry PD, Berger GE (2010) Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry 67:146–154. - PubMed
    1. Armando M, Pontillo M, De Crescenzo F, Mazzone L, Monducci E, Lo Cascio N, Santonastaso O, Pucciarini ML, Vicari S, Schimmelmann BG, Schultze-Lutter F (2015) Twelve-month psychosis-predictive value of the ultra-high risk criteria in children and adolescents. Schizophr Res 169:186–192. - PubMed
    1. Bang M, Park JY, Kim KR, Lee SY, Song YY, Kang JI, Lee E, An SK (2019) Psychotic conversion of individuals at ultra-high risk for psychosis: the potential roles of schizotypy and basic symptoms. Early Interv Psychiatry 13:546–554. - PubMed

Substances