Background: Prevention of psychotic disorders and recognition of a risk category such as CHR-P in individuals is currently one of the most promising topics in psychiatry. However, clinical outcomes different from transition to psychosis in people at Clinical High- Risk for psychosis (CHR-P) are part of a field of study still largely unexplored. Therefore, the aim of this study is the comprehensive meta-analytical evaluation of consistency and magnitude of a wide range of clinical and functional outcomes other than transition to psychosis in CHR-P individuals. Methods: Up until November 2020, PRISMA and MOOSE were used to research PubMed and Web of Science (registered on PROSPERO; CRD42020206271). Researchers carried out meta-analytic random-effects models, meta-regression analyses, publication-bias assessments and quality assessments. Findings: 75 prospective studies were included (n=5,288, age=20.0 years, females=44.5%). Attenuated positive symptoms improved at 12 (Hedges’ g=0.753, 95%CI=0.495-1.012) and 24 (Hedges’ g=0.836, 95%CI=0.463-1.209), but not ≥36 months (Hedges’ g=0.315 95%CI=-0.176–0.806). Negative symptoms improved at 12 (Hedges’ g=0.496, 95%CI=0.315–0.678), but not 24 (Hedges’ g=0.499, 95%CI=-0.137–1.134) or ≥36 months (Hedges’ g=0.033, 95%CI=-0.439–0.505). Depressive symptoms improved at 12 (Hedges’ g=0.611, 95%CI=0.441–0.782) and 24 (Hedges’ g=0.583, 95%CI=0.364–0.803), but not ≥36 months (Hedges’ g=0.512 95%CI=-0.337–1.361). Functioning improved at 12 (Hedges’ g=0.711, 95%CI=0.488–0.934), 24 (Hedges’ g=0.930, 95%CI=0.553–1.306) and ≥36 months (Hedges’ g=0.392, 95%CI=0.117–0.667). Remission from CHR-P status occurred in 33.4% (95%CI=22.6–44.1%) at 12 months, 41.4% (95%CI=32.3–50.5%) at 24 months and 42.4% (95%CI=23.4–61.3%) at ≥36 months. Interpretation: This study found improvement on symptomatic and functional outcomes over time in CHR-P subjects, but these improvements were not maintained long-term. Only less than half of the patients fully remit. A prolonged duration of care might be useful to optimize outcomes for these patients.
Background: La prevenzione dei disturbi psicotici e il riconoscimento di una categoria di rischio quale quella dei soggetti “CHR-P” è correntemente uno degli argomenti più promettenti in psichiatria. Nonostante questo, gli outcomes clinici diversi dalla transizione a franca psicosi nelle persone ad alto rischio clinico per psicosi (Clinical High Risk for Psychosis – CHR-P) sono parte di un campo di studio ancora largamente inesplorato. Per questo motivo lo scopo di questo studio è di raggiungere una valutazione meta-analitica complessiva della portata e dell’uniformità di un’ampia gamma di esiti clinici e funzionali diversi dalla transizione alla psicosi negli individui CHR-P. Metodi: Fino a novembre 2020 sono stati usati gli strumenti PRISMA e MOOSE per svolgere la ricerca su PubMed e Web of Science (registrati su PROSPERO; CRD42020206271). I ricercatori hanno svolto modelli meta-analitici random-effects, analisi di meta-regressione e valutazioni di bias di pubblicazione e di qualità. Risultati: Sono stati inclusi 75 studi prospettici (n=5,288, età=20.0 anni, percentuale femminile: 44.5%). I sintomi positive attenuate sono migliorati a 12 (Hedges’ g=0.753, 95%CI=0.495-1.012) e 24 (Hedges’ g=0.836, 95%CI=0.463-1.209) mesi, ma non a ≥36 mesi (Hedges’ g=0.315 95%CI=-0.176–0.806). I sintomi negativi sono migliorati a 12 mesi (Hedges’ g=0.496, 95%CI=0.315–0.678) ma non a 24 (Hedges’ g=0.499, 95%CI=-0.137–1.134) o ≥36 mesi (Hedges’ g=0.033, 95%CI=-0.439–0.505). I sintomi depressive sono migliorati a 12 (Hedges’ g=0.496, 95%CI=0.315–0.678) e 24 mesi (Hedges’ g=0.583, 95%CI=0.364–0.803) ma non a ≥36 mesi (Hedges’ g=0.512 95%CI=-0.337–1.361). Il funzionamento è migliorato a 12 (Hedges’ g=0.711, 95%CI=0.488–0.934), 24 (Hedges’ g=0.930, 95%CI=0.553–1.306) e ≥36 mesi (Hedges’ g=0.392, 95%CI=0.117–0.667). La remissione dallo stato CHR-P è avvenuta nel 33.4% dei soggetti a 12 mesi (95%CI=22.6–44.1%), nel 41.4% (95%CI=32.3–50.5%) a 24 mesi e nel 42.4% (95%CI=23.4–61.3%) dei soggetti a ≥36 mesi. Interpretazione: Questo studio ha individuato un miglioramento negli esiti clinici sintomatici e funzionali nel tempo nei soggetti CHR-P, ma questi miglioramenti non sono stati mantenuti nel lungo termine. Solo meno della metà dei pazienti ha raggiunto una remissione completa. Una durata più prolungata delle cure potrebbe essere utile per migliorare gli outcomes per questa tipologia di pazienti.
OUTCOMES OTHER THAN PSYCHOSIS IN PEOPLE AT CLINICAL HIGH RISK: A META-ANALYSIS
CORONELLI, FRANCESCO
2020/2021
Abstract
Background: Prevention of psychotic disorders and recognition of a risk category such as CHR-P in individuals is currently one of the most promising topics in psychiatry. However, clinical outcomes different from transition to psychosis in people at Clinical High- Risk for psychosis (CHR-P) are part of a field of study still largely unexplored. Therefore, the aim of this study is the comprehensive meta-analytical evaluation of consistency and magnitude of a wide range of clinical and functional outcomes other than transition to psychosis in CHR-P individuals. Methods: Up until November 2020, PRISMA and MOOSE were used to research PubMed and Web of Science (registered on PROSPERO; CRD42020206271). Researchers carried out meta-analytic random-effects models, meta-regression analyses, publication-bias assessments and quality assessments. Findings: 75 prospective studies were included (n=5,288, age=20.0 years, females=44.5%). Attenuated positive symptoms improved at 12 (Hedges’ g=0.753, 95%CI=0.495-1.012) and 24 (Hedges’ g=0.836, 95%CI=0.463-1.209), but not ≥36 months (Hedges’ g=0.315 95%CI=-0.176–0.806). Negative symptoms improved at 12 (Hedges’ g=0.496, 95%CI=0.315–0.678), but not 24 (Hedges’ g=0.499, 95%CI=-0.137–1.134) or ≥36 months (Hedges’ g=0.033, 95%CI=-0.439–0.505). Depressive symptoms improved at 12 (Hedges’ g=0.611, 95%CI=0.441–0.782) and 24 (Hedges’ g=0.583, 95%CI=0.364–0.803), but not ≥36 months (Hedges’ g=0.512 95%CI=-0.337–1.361). Functioning improved at 12 (Hedges’ g=0.711, 95%CI=0.488–0.934), 24 (Hedges’ g=0.930, 95%CI=0.553–1.306) and ≥36 months (Hedges’ g=0.392, 95%CI=0.117–0.667). Remission from CHR-P status occurred in 33.4% (95%CI=22.6–44.1%) at 12 months, 41.4% (95%CI=32.3–50.5%) at 24 months and 42.4% (95%CI=23.4–61.3%) at ≥36 months. Interpretation: This study found improvement on symptomatic and functional outcomes over time in CHR-P subjects, but these improvements were not maintained long-term. Only less than half of the patients fully remit. A prolonged duration of care might be useful to optimize outcomes for these patients.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
Per maggiori informazioni e per verifiche sull'eventuale disponibilità del file scrivere a: unitesi@unipv.it.
https://hdl.handle.net/20.500.14239/13019