Heterogeneity of psychosis risk within individuals at clinical high risk: a meta-analytical stratification

Fusar-Poli, P. and Cappucciati, M. and Borgwardt, S. and Woods, S. W. and Addington, J. and Nelson, B. and Nieman, D. H. and Stahl, D. R. and Rutigliano, G. and Riecher-Rössler, A. and Simon, A. E. and Mizuno, M. and Lee, T. Y. and Kwon, J. S. and Lam, M. M. and Perez, J. and Keri, S. and Amminger, P. and Metzler, S. and Kawohl, W. and Rössler, W. and Lee, J. and Labad, J. and Ziermans, T. and An, S. K. and Liu, C. C. and Woodberry, K. A. and Braham, A. and Corcoran, C. and McGorry, P. and Yung, A. R. and McGuire, P. K.. (2016) Heterogeneity of psychosis risk within individuals at clinical high risk: a meta-analytical stratification. JAMA Psychiatry, 73. pp. 113-120.

Full text not available from this repository.

Official URL: https://edoc.unibas.ch/68324/

Downloads: Statistics Overview


Importance: Individuals can be classified as being at clinical high risk (CHR) for psychosis if they meet at least one of the ultra-high-risk (UHR) inclusion criteria (brief limited intermittent psychotic symptoms [BLIPS] and/or attenuated psychotic symptoms [APS] and/or genetic risk and deterioration syndrome [GRD]) and/or basic symptoms [BS]. The meta-analytical risk of psychosis of these different subgroups is still unknown. Objective: To compare the risk of psychosis in CHR individuals who met at least one of the major inclusion criteria and in individuals not at CHR for psychosis (CHR-). Data Sources: Electronic databases (Web of Science, MEDLINE, Scopus) were searched until June 18, 2015, along with investigation of citations of previous publications and a manual search of the reference lists of retrieved articles. Study Selection: We included original follow-up studies of CHR individuals who reported the risk of psychosis classified according to the presence of any BLIPS, APS and GRD, APS alone, GRD alone, BS, and CHR-. Data Extraction and Synthesis: Independent extraction by multiple observers and random-effects meta-analysis of proportions. Moderators were tested with meta-regression analyses (Bonferroni corrected). Heterogeneity was assessed with the I2 index. Sensitivity analyses tested robustness of results. Publication biases were assessed with funnel plots and the Egger test. Main Outcomes and Measures: The proportion of each subgroup with any psychotic disorder at 6, 12, 24, 36, and 48 or more months of follow-up. Results: Thirty-three independent studies comprising up to 4227 individuals were included. The meta-analytical proportion of individuals meeting each UHR subgroup at intake was: 0.85 APS (95%CI, 0.79-0.90), 0.1 BLIPS (95%CI, 0.06-0.14), and 0.05 GRD (95%CI, 0.03-0.07). There were no significant differences in psychosis risk at any time point between the APS and GRD and the APS-alone subgroups. There was a higher risk of psychosis in the any BLIPS greater than APS greater than GRD-alone subgroups at 24, 36, and 48 or more months of follow-up. There was no evidence that the GRD subgroup has a higher risk of psychosis than the CHR- subgroup. There were too few BS or BS and UHR studies to allow robust conclusions. Conclusions and Relevance: There is meta-analytical evidence that BLIPS represents separate risk subgroup compared with the APS. The GRD subgroup is infrequent and not associated with an increased risk of psychosis. Future studies are advised to stratify their findings across these different subgroups. The CHR guidelines should be updated to reflect these differences.
Faculties and Departments:03 Faculty of Medicine > Bereich Psychiatrie (Klinik) > Erwachsenenpsychiatrie UPK > Erwachsenenpsychiatrie (Riecher-Rössler)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Psychiatrie (Klinik) > Erwachsenenpsychiatrie UPK > Erwachsenenpsychiatrie (Riecher-Rössler)
UniBasel Contributors:Riecher-Rössler, Anita
Item Type:Article, refereed
Article Subtype:Research Article
ISSN:2168-6238 (Electronic)2168-622X (Linking)
Note:Publication type according to Uni Basel Research Database: Journal article
Related URLs:
Identification Number:
Last Modified:18 May 2020 19:08
Deposited On:18 May 2020 19:08

Repository Staff Only: item control page