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At risk for schizophrenic or affective psychoses? A meta-analysis of DSM/ICD diagnostic outcomes in individuals at high clinical risk.
Schizophr Bull. 2013 Jul; 39(4):923-32.SB

Abstract

BACKGROUND

The clinical high-risk state for psychosis (HRP) is associated with an enhanced probability of developing a psychotic episode over a relatively short period of time. However, the extent to which different diagnostic types of illness develop remains unclear.

METHODS

A systematic review was performed to identify studies of HRP participants reporting International Classfication of Diseases/Diagnostic and Statistical Manual of Mental Disorders diagnostic outcomes at follow-up. Demographic, clinical, and methodological variables were extracted from each publication or obtained directly from its authors. A meta-analysis was performed of transition to schizophrenic (SP) or affective psychoses (AP) and to specific diagnostic categories. Statistical heterogeneity and small study bias were assessed, and meta-regressions were performed.

RESULTS

Twenty-three studies were retrieved, including a total of 2182 HRP participants, 560 (26%) of them developed a frank psychotic disorder over the follow-up time (mean = 2.35 y). Among HRP participants who developed psychosis, 73% were diagnosed with SP and only 11% with AP (Risk Ratio, RR = 5.43, 95% CI from 3.35 to 8.83). The specific transition risk to ICD/DSM schizophrenia was of 15.7% (over 2.35y). Heterogeneity was statistically significant and moderate in magnitude. Use of basic symptoms criteria in the baseline clinical assessment was associated with a further increase in the proportion progressing to SP vs AP (RR = 17.1). There was no evidence of publication bias and the sensitivity analysis confirmed robustness of the above results.

CONCLUSIONS

The HRP state is heterogeneous in term of longitudinal diagnoses; however, the current HRP diagnostic criteria appear strongly biased toward an identification of early phases of SP rather than AP.

Authors+Show Affiliations

Department of Psychosis Studies, Institute of Psychiatry, King's College London and OASIS team, South London and the Maudsley NHS Foundation Trust, London, UK. p.fusar@libero.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

22589370

Citation

Fusar-Poli, Paolo, et al. "At Risk for Schizophrenic or Affective Psychoses? a Meta-analysis of DSM/ICD Diagnostic Outcomes in Individuals at High Clinical Risk." Schizophrenia Bulletin, vol. 39, no. 4, 2013, pp. 923-32.
Fusar-Poli P, Bechdolf A, Taylor MJ, et al. At risk for schizophrenic or affective psychoses? A meta-analysis of DSM/ICD diagnostic outcomes in individuals at high clinical risk. Schizophr Bull. 2013;39(4):923-32.
Fusar-Poli, P., Bechdolf, A., Taylor, M. J., Bonoldi, I., Carpenter, W. T., Yung, A. R., & McGuire, P. (2013). At risk for schizophrenic or affective psychoses? A meta-analysis of DSM/ICD diagnostic outcomes in individuals at high clinical risk. Schizophrenia Bulletin, 39(4), 923-32. https://doi.org/10.1093/schbul/sbs060
Fusar-Poli P, et al. At Risk for Schizophrenic or Affective Psychoses? a Meta-analysis of DSM/ICD Diagnostic Outcomes in Individuals at High Clinical Risk. Schizophr Bull. 2013;39(4):923-32. PubMed PMID: 22589370.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - At risk for schizophrenic or affective psychoses? A meta-analysis of DSM/ICD diagnostic outcomes in individuals at high clinical risk. AU - Fusar-Poli,Paolo, AU - Bechdolf,Andreas, AU - Taylor,Matthew John, AU - Bonoldi,Ilaria, AU - Carpenter,William T, AU - Yung,Alison Ruth, AU - McGuire,Philip, Y1 - 2012/05/15/ PY - 2012/5/17/entrez PY - 2012/5/17/pubmed PY - 2014/2/15/medline KW - ARMS KW - BS KW - SIPS KW - affective psychosis KW - bipolar KW - high risk KW - prodromal KW - psychosis KW - schizophrenia SP - 923 EP - 32 JF - Schizophrenia bulletin JO - Schizophr Bull VL - 39 IS - 4 N2 - BACKGROUND: The clinical high-risk state for psychosis (HRP) is associated with an enhanced probability of developing a psychotic episode over a relatively short period of time. However, the extent to which different diagnostic types of illness develop remains unclear. METHODS: A systematic review was performed to identify studies of HRP participants reporting International Classfication of Diseases/Diagnostic and Statistical Manual of Mental Disorders diagnostic outcomes at follow-up. Demographic, clinical, and methodological variables were extracted from each publication or obtained directly from its authors. A meta-analysis was performed of transition to schizophrenic (SP) or affective psychoses (AP) and to specific diagnostic categories. Statistical heterogeneity and small study bias were assessed, and meta-regressions were performed. RESULTS: Twenty-three studies were retrieved, including a total of 2182 HRP participants, 560 (26%) of them developed a frank psychotic disorder over the follow-up time (mean = 2.35 y). Among HRP participants who developed psychosis, 73% were diagnosed with SP and only 11% with AP (Risk Ratio, RR = 5.43, 95% CI from 3.35 to 8.83). The specific transition risk to ICD/DSM schizophrenia was of 15.7% (over 2.35y). Heterogeneity was statistically significant and moderate in magnitude. Use of basic symptoms criteria in the baseline clinical assessment was associated with a further increase in the proportion progressing to SP vs AP (RR = 17.1). There was no evidence of publication bias and the sensitivity analysis confirmed robustness of the above results. CONCLUSIONS: The HRP state is heterogeneous in term of longitudinal diagnoses; however, the current HRP diagnostic criteria appear strongly biased toward an identification of early phases of SP rather than AP. SN - 1745-1701 UR - https://www.unboundmedicine.com/medline/citation/22589370/At_risk_for_schizophrenic_or_affective_psychoses_A_meta_analysis_of_DSM/ICD_diagnostic_outcomes_in_individuals_at_high_clinical_risk_ L2 - https://academic.oup.com/schizophreniabulletin/article-lookup/doi/10.1093/schbul/sbs060 DB - PRIME DP - Unbound Medicine ER -