Cortical gray matter reduction precedes transition to psychosis in individuals at clinical high-risk for psychosis: A voxel-based meta-analysis

Abstract Background The clinical high-risk (CHR) for psychosis paradigm is changing psychiatric practice. However, a widespread confounder, i.e. baseline exposure to antipsychotics (AP) in CHR samples, is systematically overlooked. Such exposure might mitigate the initial clinical presentation, increase the heterogeneity within CHR populations, and confound the evaluation of transition to psychosis at follow-up. This is the first meta-analysis examining the prevalence and the prognostic impact on transition to psychosis of ongoing AP treatment at baseline in CHR cohorts. Methods Major databases were searched for articles published until 20 April 2020. The variance-stabilizing Freeman-Tukey double arcsine transformation was used to estimate prevalence. The binary outcome of transition to psychosis by group was estimated with risk ratio (RR) and the inverse variance method was used for pooling. Results Fourteen studies were eligible for qualitative synthesis, including 1588 CHR individuals. Out of the pooled CHR sample, 370 individuals (i.e. 23.3%) were already exposed to AP at the time of CHR status ascription. Transition toward full-blown psychosis at follow-up intervened in 112 (29%; 95% CI 24–34%) of the AP-exposed CHR as compared to 235 (16%; 14–19%) of the AP-naïve CHR participants. AP-exposed CHR had higher RR of transition to psychosis (RR = 1.47; 95% CI 1.18–1.83; z = 3.48; p = 0.0005), without influence by age, gender ratio, overall sample size, duration of the follow-up, or quality of the studies. Conclusions Baseline AP exposure in CHR samples is substantial and is associated with a higher imminent risk of transition to psychosis. Therefore, such exposure should be regarded as a non-negligible red flag for clinical risk management.

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Longitudinal outcome of attenuated positive symptoms, negative symptoms, functioning and remission in people at clinical high risk for psychosis: a meta-analysis

EClinicalMedicine ◽

10.1016/j.eclinm.2021.100909 ◽

2021 ◽

Vol 36 ◽

pp. 100909

Author(s):

Gonzalo Salazar de Pablo ◽

Filippo Besana ◽

Vincenzo Arienti ◽

Ana Catalan ◽

Julio Vaquerizo-Serrano ◽

...

Keyword(s):

High Risk ◽

Negative Symptoms ◽

Meta Analysis ◽

Positive Symptoms ◽

Clinical High Risk ◽

Longitudinal Outcome

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Autism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-analysis

Journal of Autism and Developmental Disorders ◽

10.1007/s10803-021-05046-0 ◽

2021 ◽

Author(s):

Julio Vaquerizo-Serrano ◽

Gonzalo Salazar de Pablo ◽

Jatinder Singh ◽

Paramala Santosh

Keyword(s):

Systematic Review ◽

High Risk ◽

Literature Search ◽

Meta Analysis ◽

Autism Spectrum ◽

Clinical High Risk ◽

Psychotic Experiences ◽

Attenuated Psychosis Syndrome ◽

The Mean ◽

Spectrum Disorders

AbstractPsychotic experiences can occur in autism spectrum disorders (ASD). Some of the ASD individuals with these experiences may fulfil Clinical High-Risk for Psychosis (CHR-P) criteria. A systematic literature search was performed to review the information on ASD and CHR-P. A meta-analysis of the proportion of CHR-P in ASD was conducted. The systematic review included 13 studies. The mean age of ASD individuals across the included studies was 11.09 years. The Attenuated Psychosis Syndrome subgroup was the most frequently reported. Four studies were meta-analysed, showing that 11.6% of CHR-P individuals have an ASD diagnosis. Symptoms of prodromal psychosis may be present in individuals with ASD. The transition from CHR-P to psychosis is not affected by ASD.

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A Meta-Analysis of Autism and Clinical High-Risk for Psychosis is Too Premature. Comment on: Vaquerizo-Serrano, Salazar de Pablo, Singh & Santosh (2021)

Journal of Autism and Developmental Disorders ◽

10.1007/s10803-021-05345-6 ◽

2021 ◽

Author(s):

Tim Ziermans ◽

Annabeth Groenman ◽

Rik Schalbroeck

Keyword(s):

High Risk ◽

Meta Analysis ◽

Clinical High Risk

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Basic symptoms and gray matter volumes of patients at clinical high risk for psychosis

Psychological Medicine ◽

10.1017/s0033291720001282 ◽

2020 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Daniela Hubl ◽

Chantal Michel ◽

Frauke Schultze-Lutter ◽

Martinus Hauf ◽

Benno G. Schimmelmann ◽

...

Keyword(s):

High Risk ◽

Gray Matter ◽

First Episode ◽

Clinical High Risk ◽

Significant Group ◽

Basic Symptoms ◽

Conversion Rates ◽

Episode Psychosis ◽

Ultra High Risk ◽

Gray Matter Volumes

Abstract Background Clinical high-risk (CHR) for psychosis is indicated by ultra-high risk (UHR) and basic symptom (BS) criteria; however, conversion rates are highest when both UHR and BS criteria are fulfilled (UHR&BS). While BSs are considered the most immediate expression of neurobiological aberrations underlying the development of psychosis, research on neurobiological correlates of BS is scarce. Methods We investigated gray matter volumes (GMV) of 20 regions of interest (ROI) previously associated with UHR criteria in 90 patients from the Bern early detection service: clinical controls (CC), first-episode psychosis (FEP), UHR, BS and UHR&BS. We expected lowest GMV in FEP and UHR&BS, and highest volume in CC with UHR and BS in-between. Results Significantly, lower GMV was detected in FEP and UHR&BS patients relative to CC with no other significant between-group differences. When ROIs were analyzed separately, seven showed a significant group effect (FDR corrected), with five (inferior parietal, medial orbitofrontal, lateral occipital, middle temporal, precuneus) showing significantly lower GM volume in the FEP and/or UHR&BS groups than in the CC group (Bonferroni corrected). In the CHR group, only COGDIS scores correlated negatively with cortical volumes. Conclusions This is the first study to demonstrate that patients who fulfill both UHR and BS criteria – a population that has been associated with higher conversion rates – exhibit more severe GMV reductions relative to those who satisfy BS or UHR criteria alone. This result was mediated by the BS in the UHR&BS group, as only the severity of BS was linked to GMV reductions.

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S154. TOBACCO SMOKING AND CLINICAL HIGH RISK: A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE EVIDENCE

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.220 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S94-S95

Author(s):

Andrea De Micheli ◽

Albertine van Lawick van Pabst ◽

Enass Yossef ◽

Philip McGuire ◽

Paolo Fusar-Poli

Keyword(s):

Systematic Review ◽

High Risk ◽

Physical Health ◽

Tobacco Use ◽

Citation Index ◽

Meta Analysis ◽

Assessment Tools ◽

Clinical High Risk ◽

Increased Risk ◽

Russian Science Citation Index

Abstract Background There is converging evidence that youths at clinical high risk (CHR) are not only likely to develop the first episode of psychosis but also to develop poor physical outcomes. Some physical health risk factors - such as smoking - have been shown to increase the probability of a frank onset of psychosis in those at risk. A meta-analysis conducted in psychotic patients confirmed that daily tobacco use is associated with an increased risk of psychosis. A significant association between any attenuated psychotic symptoms (that characterize CHR state) and cigarette smoking has been recently shown in a study conducted in South London. Nowadays, it is not completely clear how these findings would translate to the CHR population but a better understanding of how physical health parameters could affect psychopathological outcomes could be beneficial for these vulnerable clinical populations. To shed light on the percentage of smokers in CHR populations, an updated systematic review and meta-analysis of the literature has been carried out. Our main aim was to test whether the probability of being a smoker was higher in the CHR subjects or in the control group. Methods The literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We systematically scrutinized from literature inception to 2019 the following on-line databases: Web of Science Core Collection, BIOSIS Citation Index, KCL-Korean Journal Database, MEDLINE, Russian Science Citation Index, SCiELO Citation Index. We have considered all the relevant studies reporting the smoking status in CHR subjects and in control groups. We used the odds ratio (OR) as effect size measure and data were pooled using a random effect approach. Results Preliminary data show that CHR individuals were more likely to use tobacco that matched healthy controls. Specifically, the overall OR of 2.016 (p<.001 95%CI=1.476–2.749) indicated a higher likelihood that CHR individuals would use tobacco compared to controls. Heterogeneity was not significant (I²=30.193 p=0.11). The visual inspection of funnel plots did not reveal a clear suggestion for publication bias and the Egger’s test was non-significant (p=0.10). Discussion Our systematic review and meta-analysis suggest that is crucial to investigate physical health outcomes such as tobacco use as part of clinical practice in CHR services. Unfortunately, current CHR assessment tools are entirely based on the measurement of psychopathological features and do not include an assessment of these parameters on a regular basis.

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