Antipsychotic Exposure in Clinical High Risk of Psychosis

Baseline antipsychotic prescription and short‐term outcome indicators in individuals at clinical high‐risk for psychosis: Findings from the Parma At‐Risk Mental States (PARMS) program

“…In conclusion, in agreement with increasing empirical evidence (Preti et al, 2022; Raballo et al, 2020b; Zeng et al, 2022), the current study suggests that AP need is a significant prognostic variable in cohorts of CHR‐P individuals and should be included in the current risk calculators. In particular, the results of this study conducted in a real‐world clinical setting indicate that the rate of CHR‐P individuals who were already exposed to AP at the time of CHR‐P status ascription was higher than those reported in recent meta‐analyses on this topic (Raballo et al, 2020b, 2021b).…”

“…At the end of our 1‐year follow‐up period, CHR‐P‐AP+ individuals showed a higher T1 psychosis transition rate compared to CHR‐P‐AP‐ individuals (16.6% vs. 8.1%). This finding is substantially in line with what was found in a recent meta‐analysis (reporting an overall 29% vs. 16% at 1‐year follow‐up) (Raballo et al, 2020b) and in recent single‐cohort studies (reporting 47% vs. 18% at 2‐year follow‐up and 27.0% vs. 10.9% at 3‐year follow‐up) (Preti et al, 2022; Zeng et al, 2022). Overall, these results suggest that in many of the severe CHR‐P cases (as indicated by an increased baseline clinical severity [not limited to the positive dimension but also including negative dimension, depression and impairment in daily functioning] and by AP need), AP medications may delay but not prevent transition to psychosis.…”

“…Overall, these findings suggest that baseline AP exposure may be considered as a simple warning 'flag' for a higher incipient risk of psychosis and for other poor short-term outcomes (such as new hospitalization, more urgent/non-planned visits) as compared to AP-naive In conclusion, in agreement with increasing empirical evidence (Preti et al, 2022;Raballo et al, 2020b;Zeng et al, 2022), the current study suggests that AP need is a significant prognostic variable in cohorts of CHR-P individuals and should be included in the current risk calculators. In particular, the results of this study conducted in a realworld clinical setting indicate that the rate of CHR-P individuals who were already exposed to AP at the time of CHR-P status ascription was higher than those reported in recent meta-analyses on this topic (Raballo et al, 2020b(Raballo et al, , 2021b.…”

“…This finding is substantially in line with what was found in a recent meta-analysis (reporting an overall 29% vs. 16% at 1-year follow-up) (Raballo et al, 2020b) and in recent single-cohort studies (reporting 47% vs. 18% at 2-year follow-up and T A B L E 4 Logistic regression of dichotomized T1 hospitalization condition by clinical and sociodemographic characteristics after the 1-year follow-up period in the CHR-P total group (n = 178). 27.0% vs. 10.9% at 3-year follow-up) (Preti et al, 2022;Zeng et al, 2022). Overall, these results suggest that in many of the severe CHR-P cases (as indicated by an increased baseline clinical severity…”

“…In particular, this risk was not related to differences in pre‐test risk enrichment across the studies (Raballo et al, 2021b). In 2022, other investigations on single, longitudinal CHR‐P cohorts confirmed the negative prognostic value associated with baseline AP exposure (Preti et al, 2022; Zeng et al, 2022), which is probably due to different factors that are still unknown and under‐investigated (Zhang et al, 2022). In particular, baseline AP exposure in CHR‐P individuals may be considered as a functional equivalent of the psychometric transition to psychosis (Preti et al, 2022), as already postulated in the original ‘Ultra High‐Risk’ model (Yung et al, 2003).…”