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Individualized risk components guiding antipsychotic delivery in patients with a clinical high risk of psychosis: application of a risk calculator

Published online by Cambridge University Press:  17 February 2021

TianHong Zhang Open the ORCID record for TianHong Zhang [Opens in a new window] ,
LiHua Xu ,
HuiJun Li ,
HuiRu Cui ,
YingYing Tang ,
YanYan Wei ,
XiaoChen Tang ,
YeGang Hu ,
Li Hui  and
ChunBo Li
...Show all authors
TianHong Zhang
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
LiHua Xu
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
HuiJun Li
Affiliation:
Department of Psychology, Florida A & M University, Tallahassee, Florida 32307, USA
HuiRu Cui
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
YingYing Tang
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
YanYan Wei
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
XiaoChen Tang
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
YeGang Hu
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
Li Hui
Affiliation:
Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Soochow University, Suzhou 215137, Jiangsu, PR China
ChunBo Li
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
Margaret A. Niznikiewicz
Affiliation:
Harvard Medical School Department of Psychiatry, Veteran's Administration Medical Center, Boston, MA 02130, USA
Martha E. Shenton
Affiliation:
Brigham and Women's Hospital, Departments of Psychiatry and Radiology, and Harvard Medical School, and VA Boston Healthcare System, Boston, MA, USA
Matcheri S. Keshavan
Affiliation:
Harvard Medical School Department of Psychiatry, Veteran's Administration Medical Center, Boston, MA 02130, USA
William S. Stone
Affiliation:
Harvard Medical School Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, Boston, MA 02115, USA
JiJun Wang*
Affiliation:
Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China
*
Author for correspondence: JiJun Wang, E-mail: [email protected]
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Abstract

Background

Antipsychotics are widely used for treating patients with psychosis, and target threshold psychotic symptoms. Individuals at clinical high risk (CHR) for psychosis are characterized by subthreshold psychotic symptoms. It is currently unclear who might benefit from antipsychotic treatment. Our objective was to apply a risk calculator (RC) to identify people that would benefit from antipsychotics.

Methods

Drawing on 400 CHR individuals recruited between 2011 and 2016, 208 individuals who received antipsychotic treatment were included. Clinical and cognitive variables were entered into an individualized RC for psychosis; personal risk was estimated and 4 risk components (negative symptoms-RC-NS, general function-RC-GF, cognitive performance-RC-CP, and positive symptoms-RC-PS) were constructed. The sample was further stratified according to the risk level. Higher risk was defined based on the estimated risk score (20% or higher).

Results

In total, 208 CHR individuals received daily antipsychotic treatment of an olanzapine-equivalent dose of 8.7 mg with a mean administration duration of 58.4 weeks. Of these, 39 (18.8%) developed psychosis within 2 years. A new index of factors ratio (FR), which was derived from the ratio of RC-PS plus RC-GF to RC-NS plus RC-CP, was generated. In the higher-risk group, as FR increased, the conversion rate decreased. A small group (15%) of CHR individuals at higher-risk and an FR >1 benefitted from the antipsychotic treatment.

Conclusions

Through applying a personal risk assessment, the administration of antipsychotics should be limited to CHR individuals with predominantly positive symptoms and related function decline. A strict antipsychotic prescription strategy should be introduced to reduce inappropriate use.

Keywords

Medicationoutcomeprodromal psychosistransitionultra-high risk
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 15 , November 2022 , pp. 3412 - 3421
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

*

These authors contributed equally and share senior authorship.

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