Systematic Review and Meta-analysis: Psychosis Risk in Children and Adolescents With an At-Risk Mental State

Lång, Ulla; Yates, Kathryn; Leacy, Finbarr P.; Clarke, Mary; McNicholas, Fiona; Cannon, Mary; Kelleher, Ian

doi:10.1016/j.jaac.2021.07.593

Cited by 28 publications

(16 citation statements)

References 75 publications

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“…In terms of absolute risk, 12.8% of individuals who attended CAMHS received a diagnosis of a psychotic or bipolar disorder, compared to 1.8% of the rest of the population (OR=7.9, 95% CI: 7.2-8.7). This elevated risk is similar to the level of psychosis risk associated with a formal CHR diagnosis in childhood or adolescence: in a recent systematic review of all CHR studies, we found a transition rate to psychosis of 9.5% at 1 year, 12.1% at 2 years, and 16.1% at 5 or more years 51 .…”

Section: Discussionsupporting

confidence: 81%

Potential for prediction of psychosis and bipolar disorder in Child and Adolescent Mental Health Services: a longitudinal register study of all people born in Finland in 1987

Lång

Ramsay

Yates³

et al. 2022

World Psychiatry

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Current strategies to predict psychosis identify only a small proportion of individuals at risk. Additional strategies are needed to increase capacity for pre diction and prevention of serious mental illness, ideally during childhood and adolescence. One possible approach would be to investigate systems in which psychosis risk factors are concentrated during childhood. One notable such system is represented by Child and Adolescent Mental Health Services (CAMHS). Although psychotic disorders are uncommon in CAMHS, many risk factors for psychosis are highly prevalent in young people who enter this system. We hypothesized, therefore, that youth attending CAMHS would be a highrisk group for psychosis if followed into adulthood and, furthermore, that CAMHS systems would capture a substantial proportion of future psychosis cases. We constructed a total population cohort study of all Finns born in 1987 (N=55,875), linking together extensive register data on health care contacts from birth through age 28 years. We identified all individuals diagnosed with a psychotic or bipolar disorder by age 28 (N=1,785). The risk of psychosis/bipolar disorder by age 28 years was 1.8% for individuals who had not attended CAMHS during childhood or adolescence, whereas it was 12.8% for those with a history of any outpatient CAMHS contact (odds ratio, OR=7.9, 95% CI: 7.28.7). Furthermore, the risk of psychosis/bipolar disorder by age 28 years was 2.3% for individuals without a history of inpatient CAMHS admission, whereas it was 24.0% for those with a history of inpatient CAMHS admission (OR=13.3, 95% CI: 11.914.9), and 36.5% for those with a history of inpatient CAMHS admission in adolescence (age 1317 years) (OR=24.2, 95% CI: 21.227.6). Individuals who attended CAMHS but received no mental disorder diagnosis had an equally high risk of subsequently developing a psychosis/bipolar disorder as individuals who did receive a diagnosis (OR=0.9, 99.5% CI: 0.71.1). Compared to other CAMHS attendees, individuals who developed psychosis or bipolar disorder were more likely to have had an initial CAMHS diagnosis of depressive or other mood disorder (OR=2.3, 99.5% CI: 1.63.0) and disruptive behaviour disorder (OR=1.7, 99.5% CI: 1.22.5). Of all psychosis/bipolar diagnoses by age 28 years, 50.2% occurred in individuals who had, at some point in childhood or adolescence, attended CAMHS, indicating that CAMHS represent not only a highrisk but also a highcapacity system for prediction of psychosis/bipolar disorder. These findings suggest an enormous, untapped potential for largescale psychosis/bipolar disorder prediction and prevention research within existing specialist CAMHS.

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Section: Discussionsupporting

confidence: 81%

Potential for prediction of psychosis and bipolar disorder in Child and Adolescent Mental Health Services: a longitudinal register study of all people born in Finland in 1987

Lång

Ramsay

Yates³

et al. 2022

World Psychiatry

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“…We have read with great interest the systematic review and meta-analysis by Dr Lang and colleagues 1 in the Journal of the American Academy of Child and Adolescent Psychiatry. The authors evaluated the transition rates of individuals 18 years old at clinical high risk for psychosis (CHR-P) after 1 year, 2 years and ≥5 years of follow-up, finding remarkably lower transition rates than those reported by previously published meta-analyses 2,3 .…”

Section: Dear Editorsmentioning

confidence: 99%

No Meta-analytic Effect of Age on Probability of Developing Psychosis in Individuals at Clinical High Risk

Fusar‐Poli

Pablo

2022

Journal of the American Academy of Child & Adolescent Psych

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“…Despite its clinical relevance and its association with poorer treatment outcomes ( 13 ), PEs are frequently undetected by clinicians ( 14 ). The clinical significance of PEs in childhood and adolescence and its role in the transition to psychopathology is not fully understood yet ( 15 , 16 ). Although PEs have been suggested as predictors of mental disorders in the general population ( 17 ) and psychotic symptoms in youth at clinical high risk for psychosis ( 18 ), recent studies in the general population have highlighted that what makes such experiences psychopathologically relevant is not the experiences per se , but rather their co-occurrence with other domains of non-psychotic comorbidity (e.g., depression, anxiety and PTSD) ( 9 , 19 ) as well as the presence of other vulnerability factors such as a history of adverse childhood events ( 20 ).…”

Section: Introductionmentioning

confidence: 99%

A Latent Profile Analysis of Psychotic Experiences, Non-psychotic Symptoms, Suicidal Ideation and Underlying Mechanisms in a Sample of Adolescents From the General Population

et al. 2022

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Psychotic experiences (PEs) are prevalent in the general population, particularly in adolescents. PEs are associated with various negative outcomes such as psychotic, depressive, anxiety and post-traumatic stress disorders and suicidal behavior. Recent studies in the general population have suggested that what makes PEs relevant is not so much the experiences per se, but their association with non-psychotic comorbidity and other transdiagnostic domains. Thus, there is a need for a better understanding of how PEs exist in a larger psychopathological context in adolescents. In the present study we aimed to explore this, using latent profile analysis (LPA) to identify different patterns in which PEs, psychiatric symptoms and psychological processes co-occur. LPA was conducted using data from an adolescent general population subsample (n = 335) with PEs. We conducted LPA, using measures of PEs, psychiatric symptoms and behaviors (depression, anxiety post-traumatic stress disorder and suicidal behavior) and cognitive and affective processes of entrapment/defeat and emotional regulation as manifest variables. We found that the best fit was obtained with a four-class solution that distinguished primarily between different levels of overall severity: “low symptomatology” (19.1%), “mild-moderate symptomatology” (39.4%), “moderate symptomatology” (33.7%); “high symptomatology” (7.8%). Levels of depression, post-traumatic stress symptoms and defeat/entrapment were most differentiated between classes. The high symptomatology group showed the highest scores in all psychiatric symptoms suicidal ideation, and emotional/cognitive domains, except in cognitive reappraisal. This group also showed the highest usage of emotional suppression. Our results suggest that the assessment of mental health risk in adolescents should be aware that PEs exist in a broad context of other domains of psychopathology and transdiagnostic cognitive and affective processes.

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Systematic Review and Meta-analysis: Psychosis Risk in Children and Adolescents With an At-Risk Mental State

Cited by 28 publications

References 75 publications

Potential for prediction of psychosis and bipolar disorder in Child and Adolescent Mental Health Services: a longitudinal register study of all people born in Finland in 1987

Potential for prediction of psychosis and bipolar disorder in Child and Adolescent Mental Health Services: a longitudinal register study of all people born in Finland in 1987

No Meta-analytic Effect of Age on Probability of Developing Psychosis in Individuals at Clinical High Risk

A Latent Profile Analysis of Psychotic Experiences, Non-psychotic Symptoms, Suicidal Ideation and Underlying Mechanisms in a Sample of Adolescents From the General Population

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