Search for protective factors for psychosis – a population‐based sample with special interest in unaffected individuals with parental psychosis

Keskinen, E; Marttila, Riitta; Koivumaa‐Honkanen, Heli; Moilanen, Kristiina; Keinänen‐Kiukaanniemi, Sirkka; Timonen, Markku; Isohanni, Matti; McGrath, John J.; Jääskeläinen, Erika

doi:10.1111/eip.12380

Cited by 14 publications

(17 citation statements)

References 37 publications

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“…After removing duplicates, 2975 studies were considered on the abstract/title level. Of these, 27 studies were then read at the full text stage and four met the criteria for inclusion in the quantitative analysis (Keskinen et al, 2016;Koivukangas et al, 2010;Okkenhaug et al, 2018;Sormunen et al, 2017). The flowchart detailing the number of studies excluded at each step with reasons can be seen in Figure 1.…”

Section: Search Resultsmentioning

confidence: 99%

Does physical activity reduce the risk of psychosis? A systematic review and meta-analysis of prospective studies

Brokmeier

Firth

Vancampfort

et al. 2020

Psychiatry Research

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Section: Search Resultsmentioning

confidence: 99%

Does physical activity reduce the risk of psychosis? A systematic review and meta-analysis of prospective studies

Brokmeier

Firth

Vancampfort

et al. 2020

Psychiatry Research

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“…Our umbrella review also identified only a few putative protective factors, indicating that the vast majority of available studies have focused on the adverse or negative end of several factors. Future research is required to actively seek unstudied protective factors that are not reciprocal to risk factors, such as specific characteristics of the individual, family or wider environment that improve the likelihood of positive outcomes 137 . This study has several conceptual implications.…”

Section: Discussionmentioning

confidence: 99%

What causes psychosis? An umbrella review of risk and protective factors

et al. 2018

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Psychosis is a heterogeneous psychiatric condition for which a multitude of risk and protective factors have been suggested. This umbrella review aimed to classify the strength of evidence for the associations between each factor and psychotic disorders whilst controlling for several biases. The Web of Knowledge database was searched to identify systematic reviews and meta-analyses of observational studies which examined associations between socio-demographic, parental, perinatal, later factors or antecedents and psychotic disorders, and which included a comparison group of healthy controls, published from 1965 to January 31, 2017. The literature search and data extraction followed PRISMA and MOOSE guidelines. The association between each factor and ICD or DSM diagnoses of non-organic psychotic disorders was graded into convincing, highly suggestive, suggestive, weak, or non-significant according to a standardized classification based on: number of psychotic cases, random-effects p value, largest study 95% confidence interval, heterogeneity between studies, 95% prediction interval, small study effect, and excess significance bias. In order to assess evidence for temporality of association, we also conducted sensitivity analyses restricted to data from prospective studies. Fifty-five meta-analyses or systematic reviews were included in the umbrella review, corresponding to 683 individual studies and 170 putative risk or protective factors for psychotic disorders. Only the ultra-high-risk state for psychosis (odds ratio, OR59.32, 95% CI: 4.91-17.72) and Black-Caribbean ethnicity in England (OR54.87, 95% CI: 3.96-6.00) showed convincing evidence of association. Six factors were highly suggestive (ethnic minority in low ethnic density area, second generation immigrants, trait anhedonia, premorbid IQ, minor physical anomalies, and olfactory identification ability), and nine were suggestive (urbanicity, ethnic minority in high ethnic density area, first generation immigrants, North-African immigrants in Europe, winter/spring season of birth in Northern hemisphere, childhood social withdrawal, childhood trauma, Toxoplasma gondii IgG, and non-right handedness). When only prospective studies were considered, the evidence was convincing for ultra-high-risk state and suggestive for urbanicity only. In summary, this umbrella review found several factors to be associated with psychotic disorders with different levels of evidence. These risk or protective factors represent a starting point for further etiopathological research and for the improvement of the prediction of psychosis.

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“…While there is limited direct evidence from exercise studies in ‘clinical high risk’ (CHR) samples, accumulating findings from a variety of sources suggests considerable promise. First, investigators have observed that physical activity is a protective factor against incident psychosis in the general population (Brokmeier et al, 2020 ) .Further, data from the Northern Finland 1966 Birth Cohort demonstrate that adolescents (at age 14) with parental psychosis ( i.e ., the first generation of high-risk studies focused on those at familial or genetic high-risk) that were engaged at physical activity at least once every two days were 24% less likely to develop psychosis compared to those at equivalent genetic risk that performed physical activity less than once per week (Keskinen et al, 2018 ).…”

Section: The Existing Evidence For Physical Activity and Exercise As mentioning

confidence: 99%

Using exercise to protect physical and mental health in youth at risk for psychosis

Firth

Schuch

Mittal

2020

ResPsy

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A large body of literature has demonstrated that exercise interventions can improve a broad range of outcomes in people with established schizophrenia, including reducing psychiatric symptoms, increasing cognitive functioning, and improving physical health. Furthermore, these benefits seem just as pronounced in first-episode psychosis. However, there have been few clinical studies to date examining the effects of exercise in those found to be ‘at-risk’ of psychosis, particularly for those meeting the criteria for ‘Clinical High Risk’ (CHR) state (a classification which includes both those meeting the ‘ultra-high risk for psychosis’ criteria and/or those with ‘atrisk mental states’). This is surprising, as a proportion of those in the CHR state go on to develop psychotic disorders, and a growing body of evidence suggests that early interventions in this period have significant potential to improve the course of illness. In this article, we shall review the existing literature for i) exercise as an adjunctive intervention for those treated for psychosis; ii) exercise as a standalone intervention in CHR groups; and iii) the rationale and supportive evidence for widescale use of exercise to preserve physical and mental health in those identified as at risk for psychosis. From this, we will put forth how the CHR phase represents an under-researched but highly-suitable timepoint for administering structured exercise interventions, in order to improve physical, psychological and neurocognitive outcomes; while also potentially reducing the odds of transition to full-threshold psychotic disorders. Following this, directions, recommendations and considerations around both the clinical implementation and future research around exercise in CHR individuals will be discussed.

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Search for protective factors for psychosis – a population‐based sample with special interest in unaffected individuals with parental psychosis

Cited by 14 publications

References 37 publications

Does physical activity reduce the risk of psychosis? A systematic review and meta-analysis of prospective studies

Does physical activity reduce the risk of psychosis? A systematic review and meta-analysis of prospective studies

What causes psychosis? An umbrella review of risk and protective factors

Using exercise to protect physical and mental health in youth at risk for psychosis

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