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. 2024 Feb 26;12(3):523.
doi: 10.3390/biomedicines12030523.

Physical Health and Transition to Psychosis in People at Clinical High Risk

Andrea De Micheli  1   2 , Umberto Provenzani  3 , Kamil Krakowski  1   3   4 , Dominic Oliver  1   5   6   7 , Stefano Damiani  3 , Natascia Brondino  3 , Philip McGuire  5   6   7 , Paolo Fusar-Poli  1   2   3   8
Affiliations

Physical Health and Transition to Psychosis in People at Clinical High Risk

Andrea De Micheli et al. Biomedicines. .

Abstract

Background: The clinical high risk for psychosis (CHR-P) construct represents an opportunity for prevention and early intervention in young adults, but the relationship between risk for psychosis and physical health in these patients remains unclear.

Methods: We conducted a RECORD-compliant clinical register-based cohort study, selecting the long-term cumulative risk of developing a persistent psychotic disorder as the primary outcome. We investigated associations between primary outcome and physical health data with Electronic Health Records at the South London and Maudsley (SLaM) NHS Trust, UK (January 2013-October 2020). We performed survival analyses using Kaplan-Meier curves, log-rank tests, and Cox proportional hazard models.

Results: The database included 137 CHR-P subjects; 21 CHR-P developed psychosis during follow-up, and the cumulative incidence of psychosis risk was 4.9% at 1 year and 56.3% at 7 years. Log-rank tests suggested that psychosis risk might change between different levels of nicotine and alcohol dependence. Kaplan-Meier curve analyses indicated that non-hazardous drinkers may have a lower psychosis risk than non-drinkers. In the Cox proportional hazard model, nicotine dependence presented a hazard ratio of 1.34 (95% CI: 1.1-1.64) (p = 0.01), indicating a 34% increase in psychosis risk for every additional point on the Fagerström Test for Nicotine Dependence.

Conclusions: Our findings suggest that a comprehensive assessment of tobacco and alcohol use, diet, and physical activity in CHR-P subjects is key to understanding how physical health contributes to psychosis risk.

Keywords: CHR-P; physical health; psychosis; risk.

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Conflict of interest statement

P.F.-P. is supported by #NEXTGENERATIONEU (NGEU), funded by the Ministry of University and Research (MUR), National Recovery and Resilience Plan (NRRP), project MNESYS (PE0000006)—A Multiscale integrated approach to the study of the nervous system in health and disease (DN. 1553 11.10.2022). The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Cumulative incidence of risk of developing psychosis in the OASIS CHR-P sample across the follow-up. The decreasing trajectory is an expression of cumulative transitions to psychosis.
Figure 2
Figure 2
Representation of CHR-P smokers vs. non-smokers (scoring 0 at FTND).
Figure 3
Figure 3
Comparison between CHR-P groups at different levels of nicotine dependence.
Figure 4
Figure 4
Risk of transition to psychosis between CHR-P individuals that drink alcohol vs. non-drinkers.
Figure 5
Figure 5
Risk of transition to psychosis in CHR-P subjects, stratified by level of alcohol dependency.
Figure 6
Figure 6
Comparison of the risk of transition to psychosis between CHR-P subjects with a high, moderate, and low fibre intake.
Figure 7
Figure 7
Psychosis risk comparison between physically active CHR-P subjects (>3000 METs) and inactive subjects (<3000 METs).
Figure 8
Figure 8
Stratification of psychosis risk in CHR-P subjects with normal, low, and high BMI.
See this image and copyright information in PMC

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