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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

Published online by Cambridge University Press:  17 November 2020

Andrea Raballo Open the ORCID record for Andrea Raballo [Opens in a new window] ,
Michele Poletti Open the ORCID record for Michele Poletti [Opens in a new window]  and
Antonio Preti Open the ORCID record for Antonio Preti [Opens in a new window]
Andrea Raballo*
Affiliation:
Department of Medicine, Section of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy Center for Translational, Phenomenological and Developmental Psychopathology (CTPDP), Perugia University Hospital, Perugia, Italy
Michele Poletti
Affiliation:
Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
Antonio Preti
Affiliation:
Centro Medico ‘Genneruxi’, Cagliari, Italy Center of Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy
*
Author for correspondence: Andrea Raballo, E-mail: [email protected]
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Abstract

Background

The 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.

Methods

Major 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.

Results

Fourteen 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.

Conclusions

Baseline 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.

Keywords

Antipsychoticclinical high-riskpreventionprognosispsychosistreatment
Type
Review Article
Information
Psychological Medicine , Volume 50 , Issue 16 , December 2020 , pp. 2673 - 2681
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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