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

Abstract

AimThe prognostic prediction of outcomes in individuals at clinical high‐risk for psychosis (CHR‐P) is still a significant clinical challenge. Among multiple baseline variables of risk calculator models, the role of ongoing pharmacological medications has been partially neglected, despite meta‐analytical evidence of higher risk of psychosis transition associated with baseline prescription exposure to antipsychotics (AP) in CHR‐P individuals. The main aim of the current study was to test the hypothesis that ongoing AP need at baseline indexes a subgroup of CHR‐P individuals with more severe psychopathology and worse prognostic trajectories along a 1‐year follow‐up period.MethodsThis research was settled within the ‘Parma At‐Risk Mental States’ program. Baseline and 1‐year follow‐up assessment included the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). CHR‐P individuals who were taking AP medications at entry were included in the CHR‐P‐AP+ subgroup. The remaining participants were grouped as CHR‐P‐AP‐.ResultsHundred and seventy‐eight CHR‐P individuals (aged 12–25 years) were enrolled (91 CHR‐P‐AP+, 87 CHR‐P‐AP‐). Compared to CHR‐P AP‐, CHR‐P AP+ individuals had older age, greater baseline PANSS ‘Positive Symptoms’ and ‘Negative Symptoms’ factor subscores and a lower GAF score. At the end of our follow‐up, CHR‐P‐AP+ subjects showed higher rates of psychosis transition, new hospitalizations and urgent/non‐planned visits compared to CHRP‐ AP‐ individuals.ConclusionsIn agreement with increasing empirical evidence, also the results of the current study suggest that AP need is a significant prognostic variable in cohorts of CHR‐P individuals and should be included in risk calculators.

Baseline Antipsychotic Dose and Transition to Psychosis in Individuals at Clinical High Risk

“…The findings in this systematic review and meta-analysis confirmed that among individuals at CHR-P who were exposed to antipsychotics at baseline (ie, a specific CHR-P subgroup with even higher documented higher risk of transition to psychosis [1][2][3][4] ), those who converted to psychosis were prescribed higher antipsychotic doses compared to those who did not convert. The results were congruent between the commoneffects model and the random-effects models, with an effect size approaching a moderate level.…”

“…Our search yielded 2008 articles, 425 of which were assessed by full text and 8 of which met the inclusion criteria (eFigure 1 in Supplement 1). The Table synthetizes the main characteristics of the included studies, 4,[8][9][10][11][12][13][14] whereas their general characteristics are reported in the eResults in Supplement 1.…”

“…Recent meta-analyses have found that baseline exposure to antipsychotics is associated with an increase in risk of transition to psychosis in individuals at clinical high risk for psychosis (CHR-P) compared to individuals at CHR-P not exposed to antipsychotics at baseline (29% vs 16%), independent of pretest risk enrichment and further corroborated in CHR-P cohorts . While additional research is necessary to identify possible underlying causal factors, the clinical implications of such meta-analytic effect for risk stratification, prognostic precision, and personalized treatment are important .…”

“…ecent meta-analyses have found that baseline exposure to antipsychotics is associated with an increase in risk of transition to psychosis in individuals at clinical high risk for psychosis (CHR-P) compared to individuals at CHR-P not exposed to antipsychotics at baseline (29% vs 16%), 1,2 independent of pretest risk enrichment 3 and further corroborated in CHR-P cohorts. 4,5 While additional research is necessary to identify possible underlying causal factors, the clinical implications of such meta-analytic effect for risk stratification, prognostic precision, and personalized treatment are important. [1][2][3] Indeed, individuals at CHR-P already receiving antipsychotic treatment at baseline constitute a readily identifiable subgroup at higher imminent risk of progressing to psychosis, which, although not formally captured by current CHR-P categories, 6 is empirically signaled by the treating clinicians' decision to prescribe antipsychotics.…”

“…Thanks to the growing awareness of the issue of baseline antipsychotic prescription, [1][2][3][4][5][6] recent CHR-P studies have adopted more transparent reporting habits, enabling the search of metaanalytic signals of dose-effect associations within the overall negative prognostic effect of baseline antipsychotic exposure. In this systematic review and meta-analysis, we tested if higher antipsychotic baseline doses among individuals at CHR-P were associated with a higher likelihood of transition to psychosis.…”