Abstract
The clinical high-risk state for psychosis (CHR-P) paradigm has facilitated the implementation of psychosis prevention into clinical practice; however, advancements in adolescent CHR-P populations are less established. We performed a PRISMA/MOOSE-compliant systematic review of the Web of Science database, from inception until 7 October 2019, to identify original studies conducted in CHR-P children and adolescents (mean age <18years). Findings were systematically appraised around core themes: detection, prognosis and intervention. We performed meta-analyses (employing Q statistics and I 2 test) regarding the proportion of CHR-P subgroups, the prevalence of baseline comorbid mental disorders, the risk of psychosis onset and the type of interventions received at baseline. Quality assessment and publication bias were also analysed. Eighty-seven articles were included (n=4,667 CHR-P individuals). Quality of studies ranged from 3.5 to 8 (median 5.5) on a modified Newcastle-Ottawa scale. Detection: Individuals were aged 15.6±1.2years (51.5% males), mostly (83%) presenting with attenuated positive psychotic symptoms. CHR-P psychometric accuracy improved when caregivers served as additional informants. Comorbid mood (46.4%) and anxiety (31.4%) disorders were highly prevalent. Functioning and cognition were impaired. Neurobiological studies were inconclusive. Risk for psychosis was 10.4% (95%CI: 5.8%-18.1%) at 6months, 20% (95%CI: 15%-26%) at 12months, 23% (95%CI: 18%-29%) at 24months and 23.3% (95%CI: 17.3%-30.7%) at ≥36months. There was not enough evidence to recommend one specific treatment (including cognitive behavioural therapy) over the others (including control conditions) to prevent the transition to psychosis in this population. Randomised controlled trials suggested that family interventions, cognitive remediation and fish oil supplementation may improve cognition, symptoms and functioning. At baseline, 30% of CHR-P adolescents were prescribed antipsychotics and 60% received psychotherapy. It is possible to detect and formulate a group-level prognosis in adolescents at risk for psychosis. Future interventional research is required.
Highlights
Psychotic disorders typically onset in adolescence and early adulthood, with the peak of risk occurring between the ages of 12 and 25 years (Radua et al, 2018)
The first rate-limiting step involves the detection (Fusar-Poli et al, 2020) of individuals aged 12–35 who accumulate risk factors for psychosis (Fusar-Poli, Tantardini, de Simone, RamellaCravaro, et al, 2017; Oliver, Reilly, et al, 2019) and functional impairment (Fusar-Poli, Rocchetti, et al, 2015), seeking help (Falkenberg et al, 2015) at specialised mental health clinics (Fusar-Poli, Estrade, et al, 2019). These individuals are assessed with specific psychometric interviews which discriminate between those meeting clinical high-risk state for psychosis (CHR-P) criteria (Table 1), those already psychotic and those not at risk (Fusar-Poli, Cappucciati, et al, 2015), formulating a grouplevel prognosis (Fusar-Poli, Hijazi, Stahl, & Steyerberg, 2018)
Original studies in CHR-P children and adolescents report inconclusive findings across these three mainstream clinical research areas (Schlosser et al, 2012; Welsh & Tiffin, 2014). This study addresses these gaps and advances understanding in the field of prevention of psychosis for children and adolescents at CHR-P, summarising the available evidence relating to detection, prognosis and intervention in this field
Summary
Psychotic disorders typically onset in adolescence and early adulthood, with the peak of risk occurring between the ages of 12 and 25 years (Radua et al, 2018). Primary indicated prevention in individuals at clinical high-risk state for psychosis (CHR-P) has grown exponentially over the past two decades and has become one of the most established preventive approaches in psychiatry There is consensus that the key elements of the CHR-P paradigm encompass three concatenated steps: detection, prognosis and intervention (FusarPoli et al, 2020; Oliver, Radua, Reichenberg, Uher, & Fusar-Poli, 2019). We performed meta-analyses (employing Q statistics and I2 test) regarding the proportion of CHR-P subgroups, the prevalence of baseline comorbid mental disorders, the risk of psychosis onset and the type of interventions received at baseline.
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