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Meta-Analyzing the prevalence and prognostic effect of antipsychotic exposure in clinical high-risk (CHR): When things are not what they seem
- Publication Year :
- 2020
-
Abstract
- BackgroundThe clinical high-risk (CHR) for psychosis paradigm is changing psychiatric practice. However, a widespread confounder, i.e. baseline exposure to antipsychotics (AP) in CHR samples, is systematically overlooked. Such exposure might mitigate the initial clinical presentation, increase the heterogeneity within CHR populations, and confound the evaluation of transition to psychosis at follow-up. This is the first meta-analysis examining the prevalence and the prognostic impact on transition to psychosis of ongoing AP treatment at baseline in CHR cohorts.MethodsMajor databases were searched for articles published until 20 April 2020. The variance-stabilizing Freeman-Tukey double arcsine transformation was used to estimate prevalence. The binary outcome of transition to psychosis by group was estimated with risk ratio (RR) and the inverse variance method was used for pooling.ResultsFourteen studies were eligible for qualitative synthesis, including 1588 CHR individuals. Out of the pooled CHR sample, 370 individuals (i.e. 23.3%) were already exposed to AP at the time of CHR status ascription. Transition toward full-blown psychosis at follow-up intervened in 112 (29%; 95% CI 24–34%) of the AP-exposed CHR as compared to 235 (16%; 14–19%) of the AP-naïve CHR participants. AP-exposed CHR had higher RR of transition to psychosis (RR = 1.47; 95% CI 1.18–1.83; z = 3.48; p = 0.0005), without influence by age, gender ratio, overall sample size, duration of the follow-up, or quality of the studies.ConclusionsBaseline AP exposure in CHR samples is substantial and is associated with a higher imminent risk of transition to psychosis. Therefore, such exposure should be regarded as a non-negligible red flag for clinical risk management.
- Subjects :
- Variance method
Psychosis
medicine.medical_specialty
medicine.medical_treatment
Prodromal Symptoms
Antipsychotic
clinical high-risk
prevention
prognosis
psychosis
treatment
03 medical and health sciences
0302 clinical medicine
Theoretical
Models
Internal medicine
medicine
Prevalence
Humans
Applied Psychology
Clinical risk management
Risk Management
Binary outcome
business.industry
Confounding
Models, Theoretical
medicine.disease
Prognosis
030227 psychiatry
Psychiatry and Mental health
Psychotic Disorders
Sample size determination
Relative risk
business
030217 neurology & neurosurgery
Antipsychotic Agents
Subjects
Details
- Language :
- English
- ISSN :
- 00332917
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....6132b1704a8f2c029d51422a6c97cd73