The Clinical High-Risk State for Psychosis (CHR-P), Version II

Fusar‐Poli, Paolo

doi:10.1093/schbul/sbw158

Cited by 179 publications

(145 citation statements)

References 34 publications

(34 reference statements)

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“…Indeed, some ultra-highrisk individuals already present with severe symptoms, including short-lived psychotic episodes 111,112 , affective symptoms 113 and impaired functioning 114 . Secondly, the ultra-high-risk state is intrinsically heterogeneous 10,115 , including different subgroups 115 and varying diagnostic operationalizations 116 . Furthermore, from an epidemiological perspective, it is a spurious condition, characterized by the accumulation of a number of risk factors 117 which enrich the risk in an uncontrolled manner [118][119][120][121][122] .…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

“…The clinical importance of investigating these factors is threefold. First, they could potentially be used to advance the prediction of psychosis in populations at risk of developing the disorder 10,11 . Second, some, albeit not all, of these factors may be potentially modifiable by preventive interventions 4 .…”

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confidence: 99%

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

et al. 2018

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“…Future advances could also develop stratified preventive treatments targeting the different CHR‐P clinical stages (a, b or c), that may have different characteristics with respect to underlying disease processes and prognosis. On the basis of the increasing risk (clinical stage 1a: 3% at 2 years; clinical stage 1b: 19% at 2 years; clinical stage 1c: 39% at 2 years and 51% at more than 3 years), and symptoms severity (individuals in the clinical stage 1c would formally meet the ICD criteria for a brief psychotic disorder), preventive interventions for the clinical stage 1a can be supplemented by specific psychological therapies and individual psychoeducation for the clinical stage 1b.…”

Section: Primary Preventionmentioning

confidence: 99%

Improving outcomes of first‐episode psychosis: an overview

2017

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Outcomes of psychotic disorders are associated with high personal, familiar, societal and clinical burden. There is thus an urgent clinical and societal need for improving those outcomes. Recent advances in research knowledge have opened new opportunities for ameliorating outcomes of psychosis during its early clinical stages. This paper critically reviews these opportunities, summarizing the state-of-the-art knowledge and focusing on recent discoveries and future avenues for first episode research and clinical interventions. Candidate targets for primary universal prevention of psychosis at the population level are discussed. Potentials offered by primary selective prevention in asymptomatic subgroups (stage 0) are presented. Achievements of primary selected prevention in individuals at clinical high risk for psychosis (stage 1) are summarized, along with challenges and limitations of its implementation in clinical practice. Early intervention and secondary prevention strategies at the time of a first episode of psychosis (stage 2) are critically discussed, with a particular focus on minimizing the duration of untreated psychosis, improving treatment response, increasing patients' satisfaction with treatment, reducing illicit substance abuse and preventing relapses. Early intervention and tertiary prevention strategies at the time of an incomplete recovery (stage 3) are further discussed, in particular with respect to addressing treatment resistance, improving well-being and social skills with reduction of burden on the family, treatment of comorbid substance use, and prevention of multiple relapses and disease progression. In conclusion, to improve outcomes of a complex, heterogeneous syndrome such as psychosis, it is necessary to globally adopt complex models integrating a clinical staging framework and coordinated specialty care programmes that offer pre-emptive interventions to high-risk groups identified across the early stages of the disorder. Only a systematic implementation of these models of care in the national health care systems will render these strategies accessible to the 23 million people worldwide suffering from the most severe psychiatric disorders.

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“…More specifically, the analysis included first-episode psychosis patients (FEP) experiencing their first episode of psychosis and at high clinical risk of psychosis [20] and at-risk mental state (ARMS) patients, who showed signs and symptoms that might precede a first psychotic episode [21]. We hypothesize that we would find and replicate the association between the 186 schizophrenia-associated risk score and total white matter volume in a cohort of ARMS and FEP patients.…”

Section: Introductionmentioning

confidence: 99%

Impact on the Onset of Psychosis of a Polygenic Schizophrenia-Related Risk Score and Changes in White Matter Volume

Harrisberger

Smieskova

Egli

et al. 2018

Cell Physiol Biochem

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Background: Reductions in the volume of brain white matter are a common feature in schizophrenia and bipolar disorder while the association between white matter and polygenic schizophrenia-related risk is unclear. To look at the intermediate state between health and the full-blown disorder, we investigated this aspect in groups of patients before and after the onset of psychosis. Methods: On a 3 Tesla scanner, total and regional white matter volumes were investigated by structural magnetic resonance imaging (MRI) in the following groups: 37 at-risk mental state patients (ARMS), including 30 with no transition to psychosis (ARMS-NT) and 7 with a transition to psychosis (ARMS-T) pooled with 25 first episode psychosis (FEP) patients. These T₁-weighted images were automatically processed with the FreeSurfer software and compared with an odds-ratio-weighted polygenic schizophrenia-related risk score (PSRS) based on the publicly available top white matter single-nucleotide polymorphisms. Results: We found no association, only a trend, between PSRS and white matter volume over all groups (β = 0.24, p = 0.07, 95% confidence interval = [-0.02 – 0.49]). However, a higher PSRS was significantly associated with a higher probability of being assigned to the ARMS-T + FEP group rather than to the ARMS-NT group (β = 0.70, p = 0.02, 95% confidence interval = [0.14 – 1.33]); there was no such association with white matter volume. Additionally, a positive association was found between PSRS and the Brief Psychiatric Rating Scale (BPRS) total score for the pooled ARMS-NT/ARMS-T+FEP sample and for the ARMS-T + FEP group also, but none for the ARMS-NT group only. Conclusion: These findings suggest that at-risk mental state patients with a transition and first-episode psychosis patients have a higher genetic risk for schizophrenia than at-risk mental state patients with no transition to psychosis; this risk was associated with psychopathological symptoms. Further analyses may allow polygenic schizophrenia-related risk scores to be used as biomarkers to predict psychosis.

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The Clinical High-Risk State for Psychosis (CHR-P), Version II

Cited by 179 publications

References 34 publications

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

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

Improving outcomes of first‐episode psychosis: an overview

Impact on the Onset of Psychosis of a Polygenic Schizophrenia-Related Risk Score and Changes in White Matter Volume

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