Umbrella Review: Atlas of the Meta-Analytical Evidence of Early-Onset Psychosis

Gonzalo Salazar de Pablo; Victoria Rodriguez; Filippo Besana; Serena Chiara Civardi; Vincenzo Arienti; Laura Maraña Garceo; P. Andrés-Camazón; Ana Catalan; Maria Rogdaki; Chris Abbott; Marinos Kyriakopoulos; Paolo Fusar-Poli; Christoph U. Correll; Celso Arango

doi:10.1016/j.jaac.2023.10.016

Umbrella Review: Atlas of the Meta-Analytical Evidence of Early-Onset Psychosis

Gonzalo Salazar de Pablo^*, Victoria Rodriguez, Filippo Besana, Serena Chiara Civardi, Vincenzo Arienti, Laura Maraña Garceo, P. Andrés-Camazón, Ana Catalan, Maria Rogdaki, Chris Abbott, Marinos Kyriakopoulos, Paolo Fusar-Poli, Christoph U. Correll, Celso Arango

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

8 Citations (Scopus)

Abstract

Objective: Early-onset psychosis (EOP) refers to the development of psychosis before the age of 18 years. We aimed to summarize, for the first time, the meta-analytical evidence in the field of this vulnerable population and to provide evidence-based recommendations. Method: We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)–compliant, pre-registered (PROSPERO: CRD42022350868) systematic review of several databases and registers to identify meta-analyses of studies conducted in EOP individuals to conduct an umbrella review. Literature search, screening, data extraction, and quality assessment were carried out independently. Results were narratively reported, clustered across core domains. Quality assessment was performed with the Assessment of Multiple Systematic Reviews–2 (AMSTAR-2) tool. Results: A total of 30 meta-analyses were included (373 individual studies, 25,983 participants, mean age 15.1 years, 38.3% female). Individuals with EOP showed more cognitive impairments compared with controls and individuals with adult/late-onset psychosis. Abnormalities were observed meta-analytically in neuroimaging markers but not in oxidative stress and inflammatory response markers. In all, 60.1% of EOP individuals had a poor prognosis. Clozapine was the antipsychotic with the highest efficacy for overall, positive, and negative symptoms. Tolerance to medication varied among the evaluated antipsychotics. The risk of discontinuation of antipsychotics for any reason or side effects was low or equal compared to placebo. Conclusion: EOP is associated with cognitive impairment, involuntary admissions, and poor prognosis. Antipsychotics can be efficacious in EOP, but tolerability and safety need to be taken into consideration. Clozapine should be considered in EOP individuals who are resistant to 2 non-clozapine antipsychotics. Further meta-analytical research is needed on response to psychological interventions and other prognostic factors. Plain language summary: This umbrella review summarized the meta-analytical knowledge from 30 meta-analyses on early-onset psychosis. Early-onset psychosis refers to the development of psychosis before the age of 18 years and is associated with cognitive impairment, hospitalization, and poor prognosis. Individuals with early-onset psychosis show more cognitive impairments and abnormalities compared with controls. Clozapine was the antipsychotic with the highest efficacy for positive, negative, and overall symptoms and should be considered in individuals with early-onset psychosis. Study preregistration information: Early Onset Psychosis: Umbrella Review on Diagnosis, Prognosis and Treatment factors; https://www.crd.york.ac.uk/PROSPERO/; CRD42022350868.

Original language	English
Pages (from-to)	684-697
Number of pages	14
Journal	Journal of the American Academy of Child and Adolescent Psychiatry
Volume	63
Issue number	7
DOIs	https://doi.org/10.1016/j.jaac.2023.10.016
Publication status	Published - Jul 2024

Keywords

early-onset psychosis
first-episode
meta-analysis
schizophrenia
umbrella review

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10.1016/j.jaac.2023.10.016

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Salazar de Pablo, G., Rodriguez, V., Besana, F., Civardi, S. C., Arienti, V., Maraña Garceo, L., Andrés-Camazón, P., Catalan, A., Rogdaki, M., Abbott, C., Kyriakopoulos, M., Fusar-Poli, P., Correll, C. U., & Arango, C. (2024). Umbrella Review: Atlas of the Meta-Analytical Evidence of Early-Onset Psychosis. Journal of the American Academy of Child and Adolescent Psychiatry, 63(7), 684-697. https://doi.org/10.1016/j.jaac.2023.10.016

@article{4fbf0d2a2dc14016ab712648f6d3ee1c,

title = "Umbrella Review: Atlas of the Meta-Analytical Evidence of Early-Onset Psychosis",

abstract = "Objective: Early-onset psychosis (EOP) refers to the development of psychosis before the age of 18 years. We aimed to summarize, for the first time, the meta-analytical evidence in the field of this vulnerable population and to provide evidence-based recommendations. Method: We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)–compliant, pre-registered (PROSPERO: CRD42022350868) systematic review of several databases and registers to identify meta-analyses of studies conducted in EOP individuals to conduct an umbrella review. Literature search, screening, data extraction, and quality assessment were carried out independently. Results were narratively reported, clustered across core domains. Quality assessment was performed with the Assessment of Multiple Systematic Reviews–2 (AMSTAR-2) tool. Results: A total of 30 meta-analyses were included (373 individual studies, 25,983 participants, mean age 15.1 years, 38.3% female). Individuals with EOP showed more cognitive impairments compared with controls and individuals with adult/late-onset psychosis. Abnormalities were observed meta-analytically in neuroimaging markers but not in oxidative stress and inflammatory response markers. In all, 60.1% of EOP individuals had a poor prognosis. Clozapine was the antipsychotic with the highest efficacy for overall, positive, and negative symptoms. Tolerance to medication varied among the evaluated antipsychotics. The risk of discontinuation of antipsychotics for any reason or side effects was low or equal compared to placebo. Conclusion: EOP is associated with cognitive impairment, involuntary admissions, and poor prognosis. Antipsychotics can be efficacious in EOP, but tolerability and safety need to be taken into consideration. Clozapine should be considered in EOP individuals who are resistant to 2 non-clozapine antipsychotics. Further meta-analytical research is needed on response to psychological interventions and other prognostic factors. Plain language summary: This umbrella review summarized the meta-analytical knowledge from 30 meta-analyses on early-onset psychosis. Early-onset psychosis refers to the development of psychosis before the age of 18 years and is associated with cognitive impairment, hospitalization, and poor prognosis. Individuals with early-onset psychosis show more cognitive impairments and abnormalities compared with controls. Clozapine was the antipsychotic with the highest efficacy for positive, negative, and overall symptoms and should be considered in individuals with early-onset psychosis. Study preregistration information: Early Onset Psychosis: Umbrella Review on Diagnosis, Prognosis and Treatment factors; https://www.crd.york.ac.uk/PROSPERO/; CRD42022350868.",

keywords = "early-onset psychosis, first-episode, meta-analysis, schizophrenia, umbrella review",

author = "{Salazar de Pablo}, Gonzalo and Victoria Rodriguez and Filippo Besana and Civardi, {Serena Chiara} and Vincenzo Arienti and {Mara{\~n}a Garceo}, Laura and P. Andr{\'e}s-Camaz{\'o}n and Ana Catalan and Maria Rogdaki and Chris Abbott and Marinos Kyriakopoulos and Paolo Fusar-Poli and Correll, {Christoph U.} and Celso Arango",

note = "Publisher Copyright: {\textcopyright} 2024 American Academy of Child and Adolescent Psychiatry",

year = "2024",

month = jul,

doi = "10.1016/j.jaac.2023.10.016",

language = "English",

volume = "63",

pages = "684--697",

journal = "Journal of the American Academy of Child and Adolescent Psychiatry",

issn = "0890-8567",

publisher = "Elsevier",

number = "7",

}

Salazar de Pablo, G , Rodriguez, V, Besana, F, Civardi, SC, Arienti, V, Maraña Garceo, L, Andrés-Camazón, P, Catalan, A, Rogdaki, M, Abbott, C, Kyriakopoulos, M , Fusar-Poli, P, Correll, CU & Arango, C 2024, 'Umbrella Review: Atlas of the Meta-Analytical Evidence of Early-Onset Psychosis', Journal of the American Academy of Child and Adolescent Psychiatry, vol. 63, no. 7, pp. 684-697. https://doi.org/10.1016/j.jaac.2023.10.016

TY - JOUR

T1 - Umbrella Review

T2 - Atlas of the Meta-Analytical Evidence of Early-Onset Psychosis

AU - Salazar de Pablo, Gonzalo

AU - Rodriguez, Victoria

AU - Besana, Filippo

AU - Civardi, Serena Chiara

AU - Arienti, Vincenzo

AU - Maraña Garceo, Laura

AU - Andrés-Camazón, P.

AU - Catalan, Ana

AU - Rogdaki, Maria

AU - Abbott, Chris

AU - Kyriakopoulos, Marinos

AU - Fusar-Poli, Paolo

AU - Correll, Christoph U.

AU - Arango, Celso

PY - 2024/7

Y1 - 2024/7

N2 - Objective: Early-onset psychosis (EOP) refers to the development of psychosis before the age of 18 years. We aimed to summarize, for the first time, the meta-analytical evidence in the field of this vulnerable population and to provide evidence-based recommendations. Method: We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)–compliant, pre-registered (PROSPERO: CRD42022350868) systematic review of several databases and registers to identify meta-analyses of studies conducted in EOP individuals to conduct an umbrella review. Literature search, screening, data extraction, and quality assessment were carried out independently. Results were narratively reported, clustered across core domains. Quality assessment was performed with the Assessment of Multiple Systematic Reviews–2 (AMSTAR-2) tool. Results: A total of 30 meta-analyses were included (373 individual studies, 25,983 participants, mean age 15.1 years, 38.3% female). Individuals with EOP showed more cognitive impairments compared with controls and individuals with adult/late-onset psychosis. Abnormalities were observed meta-analytically in neuroimaging markers but not in oxidative stress and inflammatory response markers. In all, 60.1% of EOP individuals had a poor prognosis. Clozapine was the antipsychotic with the highest efficacy for overall, positive, and negative symptoms. Tolerance to medication varied among the evaluated antipsychotics. The risk of discontinuation of antipsychotics for any reason or side effects was low or equal compared to placebo. Conclusion: EOP is associated with cognitive impairment, involuntary admissions, and poor prognosis. Antipsychotics can be efficacious in EOP, but tolerability and safety need to be taken into consideration. Clozapine should be considered in EOP individuals who are resistant to 2 non-clozapine antipsychotics. Further meta-analytical research is needed on response to psychological interventions and other prognostic factors. Plain language summary: This umbrella review summarized the meta-analytical knowledge from 30 meta-analyses on early-onset psychosis. Early-onset psychosis refers to the development of psychosis before the age of 18 years and is associated with cognitive impairment, hospitalization, and poor prognosis. Individuals with early-onset psychosis show more cognitive impairments and abnormalities compared with controls. Clozapine was the antipsychotic with the highest efficacy for positive, negative, and overall symptoms and should be considered in individuals with early-onset psychosis. Study preregistration information: Early Onset Psychosis: Umbrella Review on Diagnosis, Prognosis and Treatment factors; https://www.crd.york.ac.uk/PROSPERO/; CRD42022350868.

AB - Objective: Early-onset psychosis (EOP) refers to the development of psychosis before the age of 18 years. We aimed to summarize, for the first time, the meta-analytical evidence in the field of this vulnerable population and to provide evidence-based recommendations. Method: We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)–compliant, pre-registered (PROSPERO: CRD42022350868) systematic review of several databases and registers to identify meta-analyses of studies conducted in EOP individuals to conduct an umbrella review. Literature search, screening, data extraction, and quality assessment were carried out independently. Results were narratively reported, clustered across core domains. Quality assessment was performed with the Assessment of Multiple Systematic Reviews–2 (AMSTAR-2) tool. Results: A total of 30 meta-analyses were included (373 individual studies, 25,983 participants, mean age 15.1 years, 38.3% female). Individuals with EOP showed more cognitive impairments compared with controls and individuals with adult/late-onset psychosis. Abnormalities were observed meta-analytically in neuroimaging markers but not in oxidative stress and inflammatory response markers. In all, 60.1% of EOP individuals had a poor prognosis. Clozapine was the antipsychotic with the highest efficacy for overall, positive, and negative symptoms. Tolerance to medication varied among the evaluated antipsychotics. The risk of discontinuation of antipsychotics for any reason or side effects was low or equal compared to placebo. Conclusion: EOP is associated with cognitive impairment, involuntary admissions, and poor prognosis. Antipsychotics can be efficacious in EOP, but tolerability and safety need to be taken into consideration. Clozapine should be considered in EOP individuals who are resistant to 2 non-clozapine antipsychotics. Further meta-analytical research is needed on response to psychological interventions and other prognostic factors. Plain language summary: This umbrella review summarized the meta-analytical knowledge from 30 meta-analyses on early-onset psychosis. Early-onset psychosis refers to the development of psychosis before the age of 18 years and is associated with cognitive impairment, hospitalization, and poor prognosis. Individuals with early-onset psychosis show more cognitive impairments and abnormalities compared with controls. Clozapine was the antipsychotic with the highest efficacy for positive, negative, and overall symptoms and should be considered in individuals with early-onset psychosis. Study preregistration information: Early Onset Psychosis: Umbrella Review on Diagnosis, Prognosis and Treatment factors; https://www.crd.york.ac.uk/PROSPERO/; CRD42022350868.

KW - early-onset psychosis

KW - first-episode

KW - meta-analysis

KW - schizophrenia

KW - umbrella review

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U2 - 10.1016/j.jaac.2023.10.016

DO - 10.1016/j.jaac.2023.10.016

M3 - Review article

C2 - 38280414

AN - SCOPUS:85186090564

SN - 0890-8567

VL - 63

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JO - Journal of the American Academy of Child and Adolescent Psychiatry

JF - Journal of the American Academy of Child and Adolescent Psychiatry

IS - 7

ER -

Umbrella Review: Atlas of the Meta-Analytical Evidence of Early-Onset Psychosis

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