1. Systematic Review and Meta-analysis: Psychosis Risk in Children and Adolescents With an At-Risk Mental State
- Author
-
Mary Cannon, Finbarr P. Leacy, Ian Kelleher, Fiona McNicholas, Ulla Lång, Mary C. Clarke, and Kathryn Yates
- Subjects
Adult ,Psychosis ,medicine.medical_specialty ,Adolescent ,business.industry ,Psychosis risk ,At risk mental state ,Developmentally Appropriate Practice ,Ultra high risk ,medicine.disease ,Child and adolescent ,Psychiatry and Mental health ,Increased risk ,Psychotic Disorders ,Meta-analysis ,Prevalence ,Developmental and Educational Psychology ,Humans ,Medicine ,Child ,business ,Psychiatry - Abstract
Objective The “At Risk Mental State” (ARMS) approach to psychosis, also called “Clinical/Ultra High Risk,” has had a major impact on psychosis services internationally. Despite well-established developmental differences in the prevalence and expression of psychotic symptoms from childhood into adulthood, there has been no systematic review of psychosis transitions specifically in children and adolescents up to age of 18 years. Evidence for this age group is crucial for developmentally appropriate clinical decisions by child and adolescent psychiatrists. Method Systematic review and meta-analysis of psychosis risk among children diagnosed with ARMS up to age 18 years, with pooled transition rates after 1-year, 2-year and ≥5-year follow-up. Results We retrieved 1,107 records and identified 16 articles from 9 studies reporting transition rates on 436 individuals with ARMS aged 9 to 18 years. The pooled transition rate to psychosis at 1 year was 9.5% (95% CI = 5.5%−14.2%, 7 studies included), at 2-years 12.1% (95% CI = 6.7%−18.6%, 4 studies included), and at ≥5 years 16.1% (95% CI = 5.6%−30.0%, 4 studies included). We did not find evidence that the diagnosis of ARMS was associated with increased risk of psychosis once risk-enriching recruitment strategies were taken into account. Conclusion At 5-year follow-up, 1 in 6 youths diagnosed with an ARMS had transitioned to psychosis, but we did not find evidence that this risk was related to ARMS diagnosis as opposed to sampling/recruitment strategies. Our findings indicate a need for caution in applying ARMS methodology to children and adolescents. and highlight the need for developmentally sensitive approaches when considering psychosis risk.
- Published
- 2022