Clinical outcomes in individuals at clinical high risk of psychosis who do not transition to psychosis: a meta-analysis

Gonzalo Salazar de pablo; Livia Soardo; Anna Cabras; Joana Pereira; Simi Kaur; Filippo Besana; Vincenzo Arienti; Francesco Coronelli; Jae Il Shin; Marco Solmi; Natalia Petros; Andre F. Carvalho; Philip Mcguire; Paolo Fusar-Poli

doi:10.1017/S2045796021000639

Clinical outcomes in individuals at clinical high risk of psychosis who do not transition to psychosis: a meta-analysis

Gonzalo Salazar de pablo, Livia Soardo, Anna Cabras, Joana Pereira, Simi Kaur, Filippo Besana, Vincenzo Arienti, Francesco Coronelli, Jae Il Shin, Marco Solmi, Natalia Petros, Andre F. Carvalho, Philip Mcguire, Paolo Fusar-Poli

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Abstract

Abstract Aims The clinical outcomes of individuals at clinical high risk of psychosis (CHR-P) who do not transition to psychosis are heterogeneous and inconsistently reported. We aimed to comprehensively evaluate longitudinally a wide range of outcomes in CHR-P individuals not developing psychosis. Methods Preferred Reporting Items for Systematic reviews and Meta-Analyses and Meta-Analysis Of Observational Studies in Epidemiology-compliant meta-Analysis (PROSPERO: CRD42021229212) searching original CHR-P longitudinal studies in PubMed and Web of Science databases up to 01/11/2021. As primary analysis, we evaluated the following outcomes within CHR-P non-Transitioning individuals: (a) change in the severity of attenuated psychotic symptoms (Hedge's g); (b) change in the severity of negative psychotic symptoms (Hedge's g); (c) change in the severity of depressive symptoms (Hedge's g); (d) change in the level of functioning (Hedge's g); (e) frequency of remission (at follow-up). As a secondary analysis, we compared these outcomes in those CHR-P individuals who did not transition vs.Those who did transition to psychosis at follow-up. We conducted random-effects model meta-Analyses, sensitivity analyses, heterogeneity analyses, meta-regressions and publication bias assessment. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS). Results Twenty-eight studies were included (2756 CHR-P individuals, mean age = 20.4, 45.5% females). The mean duration of follow-up of the included studies was of 30.7 months. Primary analysis: Attenuated psychotic symptoms [Hedges' g = 1.410, 95% confidence interval (CI) 1.002-1.818]; negative psychotic symptoms (Hedges' g = 0.683, 95% CI 0.371-0.995); depressive symptoms (Hedges' g = 0.844, 95% CI 0.371-1.317); and functioning (Hedges' g = 0.776, 95% CI 0.463-1.089) improved in CHR-P non-Transitioning individuals; 48.7% remitted at follow-up (95% CI 39.3-58.2%). Secondary analysis: Attenuated psychotic symptoms (Hedges' g = 0.706, 95% CI 0.091-1.322) and functioning (Hedges' g = 0.623, 95% CI 0.375-0.871) improved in CHR-P individuals not-Transitioning compared to those transitioning to psychosis, but there were no differences in negative or depressive symptoms or frequency of remission (p > 0.05). Older age was associated with higher improvements of attenuated psychotic symptoms (β = 0.225, p = 0.012); publication years were associated with a higher improvement of functioning (β =-0.124, p = 0.0026); a lower proportion of Brief Limited Intermittent Psychotic Symptoms was associated with higher frequencies of remission (β =-0.054, p = 0.0085). There was no metaregression impact for study continent, the psychometric instrument used, the quality of the study or proportion of females. The NOS scores were 4.4 ± 0.9, ranging from 3 to 6, revealing the moderate quality of the included studies. Conclusions Clinical outcomes improve in CHR-P individuals not transitioning to psychosis but only less than half remit over time. Sustained clinical attention should be provided in the longer term to monitor these outcomes.

Original language	English
Article number	e9
Journal	Epidemiology And Psychiatric Sciences
Volume	31
DOIs	https://doi.org/10.1017/S2045796021000639
Publication status	Published - 19 Jan 2022

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Non-transitioning outcomes 2.08.2021Accepted author manuscript, 406 KB

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Salazar de pablo, G., Soardo, L., Cabras, A., Pereira, J., Kaur, S., Besana, F., Arienti, V., Coronelli, F., Shin, J. I., Solmi, M., Petros, N., Carvalho, A. F., Mcguire, P., & Fusar-Poli, P. (2022). Clinical outcomes in individuals at clinical high risk of psychosis who do not transition to psychosis: a meta-analysis. Epidemiology And Psychiatric Sciences, 31, [e9]. https://doi.org/10.1017/S2045796021000639

@article{d35f9e6780ef453d848be3055234af21,

title = "Clinical outcomes in individuals at clinical high risk of psychosis who do not transition to psychosis: a meta-analysis",

abstract = "Abstract Aims The clinical outcomes of individuals at clinical high risk of psychosis (CHR-P) who do not transition to psychosis are heterogeneous and inconsistently reported. We aimed to comprehensively evaluate longitudinally a wide range of outcomes in CHR-P individuals not developing psychosis. Methods Preferred Reporting Items for Systematic reviews and Meta-Analyses and Meta-Analysis Of Observational Studies in Epidemiology-compliant meta-Analysis (PROSPERO: CRD42021229212) searching original CHR-P longitudinal studies in PubMed and Web of Science databases up to 01/11/2021. As primary analysis, we evaluated the following outcomes within CHR-P non-Transitioning individuals: (a) change in the severity of attenuated psychotic symptoms (Hedge's g); (b) change in the severity of negative psychotic symptoms (Hedge's g); (c) change in the severity of depressive symptoms (Hedge's g); (d) change in the level of functioning (Hedge's g); (e) frequency of remission (at follow-up). As a secondary analysis, we compared these outcomes in those CHR-P individuals who did not transition vs.Those who did transition to psychosis at follow-up. We conducted random-effects model meta-Analyses, sensitivity analyses, heterogeneity analyses, meta-regressions and publication bias assessment. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS). Results Twenty-eight studies were included (2756 CHR-P individuals, mean age = 20.4, 45.5% females). The mean duration of follow-up of the included studies was of 30.7 months. Primary analysis: Attenuated psychotic symptoms [Hedges' g = 1.410, 95% confidence interval (CI) 1.002-1.818]; negative psychotic symptoms (Hedges' g = 0.683, 95% CI 0.371-0.995); depressive symptoms (Hedges' g = 0.844, 95% CI 0.371-1.317); and functioning (Hedges' g = 0.776, 95% CI 0.463-1.089) improved in CHR-P non-Transitioning individuals; 48.7% remitted at follow-up (95% CI 39.3-58.2%). Secondary analysis: Attenuated psychotic symptoms (Hedges' g = 0.706, 95% CI 0.091-1.322) and functioning (Hedges' g = 0.623, 95% CI 0.375-0.871) improved in CHR-P individuals not-Transitioning compared to those transitioning to psychosis, but there were no differences in negative or depressive symptoms or frequency of remission (p > 0.05). Older age was associated with higher improvements of attenuated psychotic symptoms (β = 0.225, p = 0.012); publication years were associated with a higher improvement of functioning (β =-0.124, p = 0.0026); a lower proportion of Brief Limited Intermittent Psychotic Symptoms was associated with higher frequencies of remission (β =-0.054, p = 0.0085). There was no metaregression impact for study continent, the psychometric instrument used, the quality of the study or proportion of females. The NOS scores were 4.4 ± 0.9, ranging from 3 to 6, revealing the moderate quality of the included studies. Conclusions Clinical outcomes improve in CHR-P individuals not transitioning to psychosis but only less than half remit over time. Sustained clinical attention should be provided in the longer term to monitor these outcomes.",

author = "{Salazar de pablo}, Gonzalo and Livia Soardo and Anna Cabras and Joana Pereira and Simi Kaur and Filippo Besana and Vincenzo Arienti and Francesco Coronelli and Shin, {Jae Il} and Marco Solmi and Natalia Petros and Carvalho, {Andre F.} and Philip Mcguire and Paolo Fusar-Poli",

note = "Funding Information: This study is funded by the PSYSCAN project to Professor McGuire and Professor Fusar-Poli through the European Commission. Dr Salazar de Pablo is supported by the Alicia Koplowitz Foundation. Publisher Copyright: Copyright {\textcopyright} The Author(s), 2022. Published by Cambridge University Press.",

year = "2022",

month = jan,

day = "19",

doi = "10.1017/S2045796021000639",

language = "English",

volume = "31",

journal = "Epidemiology And Psychiatric Sciences",

issn = "2045-7960",

publisher = "CAMBRIDGE UNIV PRESS",

}

Salazar de pablo, G, Soardo, L, Cabras, A, Pereira, J, Kaur, S, Besana, F, Arienti, V, Coronelli, F, Shin, JI, Solmi, M, Petros, N, Carvalho, AF, Mcguire, P & Fusar-Poli, P 2022, 'Clinical outcomes in individuals at clinical high risk of psychosis who do not transition to psychosis: a meta-analysis', Epidemiology And Psychiatric Sciences, vol. 31, e9. https://doi.org/10.1017/S2045796021000639

TY - JOUR

T1 - Clinical outcomes in individuals at clinical high risk of psychosis who do not transition to psychosis: a meta-analysis

AU - Salazar de pablo, Gonzalo

AU - Soardo, Livia

AU - Cabras, Anna

AU - Pereira, Joana

AU - Kaur, Simi

AU - Besana, Filippo

AU - Arienti, Vincenzo

AU - Coronelli, Francesco

AU - Shin, Jae Il

AU - Solmi, Marco

AU - Petros, Natalia

AU - Carvalho, Andre F.

AU - Mcguire, Philip

AU - Fusar-Poli, Paolo

N1 - Funding Information: This study is funded by the PSYSCAN project to Professor McGuire and Professor Fusar-Poli through the European Commission. Dr Salazar de Pablo is supported by the Alicia Koplowitz Foundation. Publisher Copyright: Copyright © The Author(s), 2022. Published by Cambridge University Press.

PY - 2022/1/19

Y1 - 2022/1/19

N2 - Abstract Aims The clinical outcomes of individuals at clinical high risk of psychosis (CHR-P) who do not transition to psychosis are heterogeneous and inconsistently reported. We aimed to comprehensively evaluate longitudinally a wide range of outcomes in CHR-P individuals not developing psychosis. Methods Preferred Reporting Items for Systematic reviews and Meta-Analyses and Meta-Analysis Of Observational Studies in Epidemiology-compliant meta-Analysis (PROSPERO: CRD42021229212) searching original CHR-P longitudinal studies in PubMed and Web of Science databases up to 01/11/2021. As primary analysis, we evaluated the following outcomes within CHR-P non-Transitioning individuals: (a) change in the severity of attenuated psychotic symptoms (Hedge's g); (b) change in the severity of negative psychotic symptoms (Hedge's g); (c) change in the severity of depressive symptoms (Hedge's g); (d) change in the level of functioning (Hedge's g); (e) frequency of remission (at follow-up). As a secondary analysis, we compared these outcomes in those CHR-P individuals who did not transition vs.Those who did transition to psychosis at follow-up. We conducted random-effects model meta-Analyses, sensitivity analyses, heterogeneity analyses, meta-regressions and publication bias assessment. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS). Results Twenty-eight studies were included (2756 CHR-P individuals, mean age = 20.4, 45.5% females). The mean duration of follow-up of the included studies was of 30.7 months. Primary analysis: Attenuated psychotic symptoms [Hedges' g = 1.410, 95% confidence interval (CI) 1.002-1.818]; negative psychotic symptoms (Hedges' g = 0.683, 95% CI 0.371-0.995); depressive symptoms (Hedges' g = 0.844, 95% CI 0.371-1.317); and functioning (Hedges' g = 0.776, 95% CI 0.463-1.089) improved in CHR-P non-Transitioning individuals; 48.7% remitted at follow-up (95% CI 39.3-58.2%). Secondary analysis: Attenuated psychotic symptoms (Hedges' g = 0.706, 95% CI 0.091-1.322) and functioning (Hedges' g = 0.623, 95% CI 0.375-0.871) improved in CHR-P individuals not-Transitioning compared to those transitioning to psychosis, but there were no differences in negative or depressive symptoms or frequency of remission (p > 0.05). Older age was associated with higher improvements of attenuated psychotic symptoms (β = 0.225, p = 0.012); publication years were associated with a higher improvement of functioning (β =-0.124, p = 0.0026); a lower proportion of Brief Limited Intermittent Psychotic Symptoms was associated with higher frequencies of remission (β =-0.054, p = 0.0085). There was no metaregression impact for study continent, the psychometric instrument used, the quality of the study or proportion of females. The NOS scores were 4.4 ± 0.9, ranging from 3 to 6, revealing the moderate quality of the included studies. Conclusions Clinical outcomes improve in CHR-P individuals not transitioning to psychosis but only less than half remit over time. Sustained clinical attention should be provided in the longer term to monitor these outcomes.

AB - Abstract Aims The clinical outcomes of individuals at clinical high risk of psychosis (CHR-P) who do not transition to psychosis are heterogeneous and inconsistently reported. We aimed to comprehensively evaluate longitudinally a wide range of outcomes in CHR-P individuals not developing psychosis. Methods Preferred Reporting Items for Systematic reviews and Meta-Analyses and Meta-Analysis Of Observational Studies in Epidemiology-compliant meta-Analysis (PROSPERO: CRD42021229212) searching original CHR-P longitudinal studies in PubMed and Web of Science databases up to 01/11/2021. As primary analysis, we evaluated the following outcomes within CHR-P non-Transitioning individuals: (a) change in the severity of attenuated psychotic symptoms (Hedge's g); (b) change in the severity of negative psychotic symptoms (Hedge's g); (c) change in the severity of depressive symptoms (Hedge's g); (d) change in the level of functioning (Hedge's g); (e) frequency of remission (at follow-up). As a secondary analysis, we compared these outcomes in those CHR-P individuals who did not transition vs.Those who did transition to psychosis at follow-up. We conducted random-effects model meta-Analyses, sensitivity analyses, heterogeneity analyses, meta-regressions and publication bias assessment. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS). Results Twenty-eight studies were included (2756 CHR-P individuals, mean age = 20.4, 45.5% females). The mean duration of follow-up of the included studies was of 30.7 months. Primary analysis: Attenuated psychotic symptoms [Hedges' g = 1.410, 95% confidence interval (CI) 1.002-1.818]; negative psychotic symptoms (Hedges' g = 0.683, 95% CI 0.371-0.995); depressive symptoms (Hedges' g = 0.844, 95% CI 0.371-1.317); and functioning (Hedges' g = 0.776, 95% CI 0.463-1.089) improved in CHR-P non-Transitioning individuals; 48.7% remitted at follow-up (95% CI 39.3-58.2%). Secondary analysis: Attenuated psychotic symptoms (Hedges' g = 0.706, 95% CI 0.091-1.322) and functioning (Hedges' g = 0.623, 95% CI 0.375-0.871) improved in CHR-P individuals not-Transitioning compared to those transitioning to psychosis, but there were no differences in negative or depressive symptoms or frequency of remission (p > 0.05). Older age was associated with higher improvements of attenuated psychotic symptoms (β = 0.225, p = 0.012); publication years were associated with a higher improvement of functioning (β =-0.124, p = 0.0026); a lower proportion of Brief Limited Intermittent Psychotic Symptoms was associated with higher frequencies of remission (β =-0.054, p = 0.0085). There was no metaregression impact for study continent, the psychometric instrument used, the quality of the study or proportion of females. The NOS scores were 4.4 ± 0.9, ranging from 3 to 6, revealing the moderate quality of the included studies. Conclusions Clinical outcomes improve in CHR-P individuals not transitioning to psychosis but only less than half remit over time. Sustained clinical attention should be provided in the longer term to monitor these outcomes.

UR - http://www.scopus.com/inward/record.url?scp=85123429996&partnerID=8YFLogxK

U2 - 10.1017/S2045796021000639

DO - 10.1017/S2045796021000639

M3 - Article

SN - 2045-7960

VL - 31

JO - Epidemiology And Psychiatric Sciences

JF - Epidemiology And Psychiatric Sciences

M1 - e9

ER -

Clinical outcomes in individuals at clinical high risk of psychosis who do not transition to psychosis: a meta-analysis

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