Annual Research Review: Prevention of psychosis in adolescents – systematic review and meta‐analysis of advances in detection, prognosis and intervention

TY - JOUR

T1 - Annual Research Review: Prevention of psychosis in adolescents – systematic review and meta‐analysis of advances in detection, prognosis and intervention

AU - Catalan, Ana

AU - Salazar De Pablo, Gonzalo

AU - Vaquerizo Serrano, Julio

AU - Mosillo, Pierluca

AU - Baldwin, Helen

AU - Fernández‐rivas, Aranzazu

AU - Moreno, Carmen

AU - Arango, Celso

AU - Correll, Christoph U.

AU - Bonoldi, Ilaria

AU - Fusar‐poli, Paolo

N1 - Funding Information: G.S.d.P. and J.V.S. are supported by the Alicia Koplowitz Foundation. The study has been supported by the Spanish Ministry of Science, Innovation, and Universities, Instituto de Salud Carlos III, European Regional Development Fund ?A way of making Europe,? Centro de Investigaci?n Biom?dica en Red Salud Mental, Madrid Regional Government; and Fundaci?n Mutua Madrile?a. A.C. has received personal fees from Janssen and grant support from the Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness. C.A. has been a consultant to or has received honoraria or grants from Acadia, Angelini, Gedeon Richter, Janssen Cilag, Lundbeck, Otsuka, Roche, Sage, Servier, Shire, Schering Plough, Sumitomo Dainippon Pharma, Sunovion and Takeda. C.M. has acted as consultant or participated in DMC for Janssen, Servier, Lundbeck, Nuvelution, Angelini and Otsuka and has received grant support from European Union Funds and Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiviness. C.U.C. has been a consultant and/or adviser to or has received honoraria from: Alkermes, Allergan, Angelini, Boehringer-Ingelheim, Gedeon Richter, Gerson Lehrman Group, Indivior, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Merck, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Servier, Sumitomo Dainippon, Sunovion, Supernus, Takeda and Teva. He has provided expert testimony for Bristol-Myers Squibb, Janssen and Otsuka. He served on a Data Safety Monitoring Board for Boehringer-Ingelheim, Lundbeck, Rovi, Supernus, and Teva. He received royalties from UpToDate and grant support from Janssen and Takeda. He is also a shareholder of LB Pharma. P.F-P. has been a consultant to and received research funds from Lundbeck and received honoraria from Menarini and Angelini. The authors have declared that they have no competing or potential conflicts of interest. Key points The clinical high risk for psychosis paradigm involves detecting, formulating a prognosis and offering interventions to those aged 12?18. This study demonstrates that it is feasible to detect and formulate a prognosis in the subgroup of adolescents at risk for psychosis aged 12?18. Evidence of effective interventions to prevent the onset of psychosis in adolescents aged 12?18 is lacking. The clinical high risk for psychosis paradigm involves detecting, formulating a prognosis and offering interventions to those aged 12?18. This study demonstrates that it is feasible to detect and formulate a prognosis in the subgroup of adolescents at risk for psychosis aged 12?18. Evidence of effective interventions to prevent the onset of psychosis in adolescents aged 12?18 is lacking. Funding Information: G.S.d.P. and J.V.S. are supported by the Alicia Koplowitz Foundation. The study has been supported by the Spanish Ministry of Science, Innovation, and Universities, Instituto de Salud Carlos III, European Regional Development Fund ‘A way of making Europe,’ Centro de Investigación Biomédica en Red Salud Mental, Madrid Regional Government; and Fundación Mutua Madrileña. Funding Information: A.C. has received personal fees from Janssen and grant support from the Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness. C.A. has been a consultant to or has received honoraria or grants from Acadia, Angelini, Gedeon Richter, Janssen Cilag, Lundbeck, Otsuka, Roche, Sage, Servier, Shire, Schering Plough, Sumitomo Dainippon Pharma, Sunovion and Takeda. C.M. has acted as consultant or participated in DMC for Janssen, Servier, Lundbeck, Nuvelution, Angelini and Otsuka and has received grant support from European Union Funds and Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiviness. C.U.C. has been a consultant and/or adviser to or has received honoraria from: Alkermes, Allergan, Angelini, Boehringer‐Ingelheim, Gedeon Richter, Gerson Lehrman Group, Indivior, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedAvante‐ProPhase, Medscape, Merck, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Servier, Sumitomo Dainippon, Sunovion, Supernus, Takeda and Teva. He has provided expert testimony for Bristol‐Myers Squibb, Janssen and Otsuka. He served on a Data Safety Monitoring Board for Boehringer‐Ingelheim, Lundbeck, Rovi, Supernus, and Teva. He received royalties from UpToDate and grant support from Janssen and Takeda. He is also a shareholder of LB Pharma. P.F‐P. has been a consultant to and received research funds from Lundbeck and received honoraria from Menarini and Angelini. The authors have declared that they have no competing or potential conflicts of interest. Key points Publisher Copyright: © 2020 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health

PY - 2021/5

Y1 - 2021/5

N2 - Background: The clinical high-risk state for psychosis (CHR-P) paradigm has facilitated the implementation of psychosis prevention into clinical practice; however, advancements in adolescent CHR-P populations are less established. Methods: We performed a PRISMA/MOOSE-compliant systematic review of the Web of Science database, from inception until 7 October 2019, to identify original studies conducted in CHR-P children and adolescents (mean age <18 years). Findings were systematically appraised around core themes: detection, prognosis and intervention. We performed meta-analyses (employing Q statistics and I 2 test) regarding the proportion of CHR-P subgroups, the prevalence of baseline comorbid mental disorders, the risk of psychosis onset and the type of interventions received at baseline. Quality assessment and publication bias were also analysed. Results: Eighty-seven articles were included (n = 4,667 CHR-P individuals). Quality of studies ranged from 3.5 to 8 (median 5.5) on a modified Newcastle–Ottawa scale. Detection: Individuals were aged 15.6 ± 1.2 years (51.5% males), mostly (83%) presenting with attenuated positive psychotic symptoms. CHR-P psychometric accuracy improved when caregivers served as additional informants. Comorbid mood (46.4%) and anxiety (31.4%) disorders were highly prevalent. Functioning and cognition were impaired. Neurobiological studies were inconclusive. Prognosis: Risk for psychosis was 10.4% (95%CI: 5.8%–18.1%) at 6 months, 20% (95%CI: 15%–26%) at 12 months, 23% (95%CI: 18%–29%) at 24 months and 23.3% (95%CI: 17.3%–30.7%) at ≥36 months. Interventions: There was not enough evidence to recommend one specific treatment (including cognitive behavioural therapy) over the others (including control conditions) to prevent the transition to psychosis in this population. Randomised controlled trials suggested that family interventions, cognitive remediation and fish oil supplementation may improve cognition, symptoms and functioning. At baseline, 30% of CHR-P adolescents were prescribed antipsychotics and 60% received psychotherapy. Conclusions: It is possible to detect and formulate a group-level prognosis in adolescents at risk for psychosis. Future interventional research is required.

AB - Background: The clinical high-risk state for psychosis (CHR-P) paradigm has facilitated the implementation of psychosis prevention into clinical practice; however, advancements in adolescent CHR-P populations are less established. Methods: We performed a PRISMA/MOOSE-compliant systematic review of the Web of Science database, from inception until 7 October 2019, to identify original studies conducted in CHR-P children and adolescents (mean age <18 years). Findings were systematically appraised around core themes: detection, prognosis and intervention. We performed meta-analyses (employing Q statistics and I 2 test) regarding the proportion of CHR-P subgroups, the prevalence of baseline comorbid mental disorders, the risk of psychosis onset and the type of interventions received at baseline. Quality assessment and publication bias were also analysed. Results: Eighty-seven articles were included (n = 4,667 CHR-P individuals). Quality of studies ranged from 3.5 to 8 (median 5.5) on a modified Newcastle–Ottawa scale. Detection: Individuals were aged 15.6 ± 1.2 years (51.5% males), mostly (83%) presenting with attenuated positive psychotic symptoms. CHR-P psychometric accuracy improved when caregivers served as additional informants. Comorbid mood (46.4%) and anxiety (31.4%) disorders were highly prevalent. Functioning and cognition were impaired. Neurobiological studies were inconclusive. Prognosis: Risk for psychosis was 10.4% (95%CI: 5.8%–18.1%) at 6 months, 20% (95%CI: 15%–26%) at 12 months, 23% (95%CI: 18%–29%) at 24 months and 23.3% (95%CI: 17.3%–30.7%) at ≥36 months. Interventions: There was not enough evidence to recommend one specific treatment (including cognitive behavioural therapy) over the others (including control conditions) to prevent the transition to psychosis in this population. Randomised controlled trials suggested that family interventions, cognitive remediation and fish oil supplementation may improve cognition, symptoms and functioning. At baseline, 30% of CHR-P adolescents were prescribed antipsychotics and 60% received psychotherapy. Conclusions: It is possible to detect and formulate a group-level prognosis in adolescents at risk for psychosis. Future interventional research is required.

UR - http://www.scopus.com/inward/record.url?scp=85090957516&partnerID=8YFLogxK

U2 - 10.1111/jcpp.13322

DO - 10.1111/jcpp.13322

M3 - Article

SN - 0021-9630

VL - 62

SP - 657

EP - 673

JO - Journal of Child Psychology and Psychiatry

JF - Journal of Child Psychology and Psychiatry

IS - 5

ER -