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Transition to Psychosis in Individuals at Clinical High Risk: Meta-analysis

Published online by Cambridge University Press:  19 July 2023

G. Salazar De Pablo ,
J. Radua ,
I. Bonoldi ,
V. Arienty ,
F. Besana ,
A. Cabras ,
A. Catalan  and
P. Fusar-Poli
G. Salazar De Pablo*
Affiliation:
Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom
J. Radua
Affiliation:
Hospital Clinic Barcelona, Barcelona, Spain
I. Bonoldi
Affiliation:
Department of Psychosis, King’s College London, London, United Kingdom
V. Arienty
Affiliation:
University of Pavia, Pavia
F. Besana
Affiliation:
University of Pavia, Pavia
A. Cabras
Affiliation:
University of Rome, Rome, Italy
A. Catalan
Affiliation:
Department of Psychosis Studies, IoPPN, King’s College London
P. Fusar-Poli
Affiliation:
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King’s College London, London, United Kingdom
*
*Corresponding author.

Abstract

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Introduction

Estimating the current likelihood of transitioning from a clinical high risk for psychosis (CHR-P) to psychosis holds paramount importance for preventive care and applied research.

Objectives

Our aim was to quantitatively examine the consistency and magnitude of transition risk to psychosis in individuals at CHR-P.

Methods

This meta-analysis is compliant with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. PubMed and Web of Science databases were searched for longitudinal studies reporting transition risks in individuals at CHR-P.

Primary effect size was cumulative risk of transition to psychosis at 0.5, 1, 1.5, 2, 2.5, 3, 4, and more than 4 years’ follow-up, estimated using the numbers of individuals at CHR-P transitioning to psychosis at each time point. Random-effects meta-analysis were conducted.

Results

A total of 130 studies and 9222 individuals at CHR-P were included. The mean (SD) age was 20.3 (4.4) years, and 5100 individuals (55.3%) were male.

The cumulative transition risk was 9% (95% CI = 7-10% k = 37; n = 6485) at 0.5 years, 15% (95% CI = 13-16%; k = 53; n = 7907) at 1 year, 20% (95% CI = 17%-22%; k = 30; n = 5488) at 1.5 years, 19% (95% CI = 17-22%; k = 44; n = 7351) at 2 years, 25% (95% CI, 21-29%) at 2.5 years, 25% (95% CI = 22-29%; k = 29; n = 4029) at 3 years, 27% (95% CI = 23-30%; k = 16; n = 2926) at 4 years, and 28% (95% CI = 20-37%; k = 14; n = 2301) at more than 4 years.

Meta-regressions showed that a lower proportion of female individuals (β = -0.02; 95% CI, -0.04 to -0.01) and a higher proportion of brief limited intermittent psychotic symptoms (β = 0.02; 95% CI, 0.01-0.03) were associated with an increase in transition risk. Other predictors were not statistically significant (p > 0.05).

Heterogeneity across the studies was high (I2 range, 77.91% to 95.73%).

Conclusions

In this meta-analysis, 25% of individuals at CHR-P developed psychosis within 3 years. Transition risk continued increasing in the long term. Extended clinical monitoring and preventive care may be beneficial in this patient population.

Disclosure of Interest

None Declared

Type
Abstract
Information
European Psychiatry , Volume 66 , Special Issue S1: Abstracts of the 31st European Congress of Psychiatry , March 2023 , pp. S367
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the European Psychiatric Association
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