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. 2022 Jun;272(4):591-602.
doi: 10.1007/s00406-021-01331-2. Epub 2021 Sep 18.

Further evidence that antipsychotic medication does not prevent long-term psychosis in higher-risk individuals

TianHong Zhang  1 , JunJie Wang #  2 , LiHua Xu  1 , YanYan Wei  1 , XiaoChen Tang  1 , YeGang Hu  1 , HuiRu Cui  1 , YingYing Tang  1 , ChunBo Li  1 , Zheng Ling  3 , JiJun Wang  4   5   6
Affiliations

Further evidence that antipsychotic medication does not prevent long-term psychosis in higher-risk individuals

TianHong Zhang et al. Eur Arch Psychiatry Clin Neurosci. 2022 Jun.

Abstract

Objective: Although existing guidelines have discouraged use of antipsychotics for general clinical high-risk (CHR) individuals, it is unclear if antipsychotics can prevent psychosis in higher-risk population. We aimed to study the comparative real-world effectiveness of antipsychotic treatments for preventing psychosis in higher-risk CHR individuals.

Methods: A total of 300 CHR individuals were identified using the structured interview for prodromal syndromes (SIPS) and followed the participants for 3 years. In total, 228(76.0%) individuals completed baseline assessments using the NAPLS-2 risk calculator (NAPLS-2-RC), and 210(92.1%) completed the follow-up. The sample was further stratified according to risk level. "Higher-risk" was defined based on the NAPLS-2-RC risk score (≥ 20%) and SIPS positive symptom total scores (≥ 10). The main outcome was conversion to psychosis and poor functional outcomes, defined as a global assessment of function (GAF) score lower than 60 at follow-up.

Results: In higher-risk CHR individuals, we found no significant difference in the rate of conversion to psychosis or poor functional outcomes between the antipsychotic and no-antipsychotic groups. Low-risk individuals treated with antipsychotic drugs were more likely exhibit poor functional outcomes compared with the no-antipsychotics group(NAPLS-2-RC estimated risk: χ2 = 8.330, p = 0.004; Positive symptom severity: χ2 = 12.997, p < 0.001). No significant effective factors were identified for prevention of the conversion to psychosis; conversely, CHR individuals who were treated with high dose antipsychotics (olanzapine, aripiprazole) showed a significantly increased risk of poor functional outcomes.

Conclusions: In CHR individuals, antipsychotic treatment should be provided with caution because of the risk of poor functional outcomes. Further, antipsychotic treatment does not appear to prevent onset of psychosis in real-world settings.

Keywords: Antipsychotic drugs; Outcome; Poor function; Transition; Ultra-high risk.

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