Incidence Of Psychosis Research Articles

The Incidence of Psychosis Among Parkinson's Disease Patients and Associated Factors: A Meta-Analysis

Introduction: Parkinson's-induced psychosis is rather prevalent, and it has continuously been linked to poor outcomes. Therefore, detecting this presentation early on, can enhance the quality of life of Parkinson’s disease patients and is therefore a clinical and societal necessity. This systematic review and meta-analysis aimed to estimate the pooled incidence of induced psychosis or psychosis associated with neurodegeneration in Parkinson’s disease. Materials and Methods: PubMed, Scopus, and Cochrane Library were searched to identify studies reporting the prevalence of psychosis in Parkinson’s disease patients. A random-effect meta-analysis was used to pool data from the included studies. The objectives, inclusion criteria, and methods of analysis for this review were specified in advance and documented in a priori protocol (PROSPERO reg. num. CRD42022318920). Results: Twenty studies including 5,123 Parkinson’s disease patients which explored the incidence of presenting symptoms of psychosis in Parkinson’s disease patients were included in the final analysis. The meta-analysis showed that the incidence of psychosis among Parkinson’s disease patients was 35%. A subgroup analysis was performed which showed that disease duration could explain the statistical heterogeneity in this meta-analysis. Conclusion: This systematic review and meta-analysis revealed that psychotic disorders are highly prevalent among Parkinson’s disease patients, indicating an urgent need for further studies to help develop better mechanisms of prevention, detection, and treatment of those disorders among Parkinson’s disease patients in an effort to improve their quality of life.

Reconsidering evidence for psychedelic-induced psychosis: an overview of reviews, a systematic review, and meta-analysis of human studies.

Persons with schizophrenia are excluded from psychedelic-assisted therapy due to concerns about the risk of triggering or worsening psychosis. However, there is limited meta-analytic data on the risk of psychedelic-induced psychosis in individuals with pre-existing psychotic disorders. We conducted a systematic review, meta-analysis, and overview of reviews to assess the incidence of psychedelic-induced psychosis and symptom exacerbation in schizophrenia. Our pre-registered protocol (CRD42023399591) covered: LSD, psilocybin, mescaline, DMT, and MDMA, using data from Embase, PubMed, PsyARTICLES, PsyINFO, and trial registries up to November 2023. A random-effects model was used to calculate psychosis incidence, with standardized assessments of study quality. From 131 publications, we analyzed 14 systematic reviews, 20 reviews, 35 randomized-controlled trials (RCTs), 10 case-control studies, 30 uncontrolled trials (UCTs), and 22 cohort studies, most of which were low quality. Meta-analysis of nine studies showed an incidence of psychedelic-induced psychosis at 0.002% in population studies, 0.2% in UCTs, and 0.6% in RCTs. In UCTs including individuals with schizophrenia, 3.8% developed long-lasting psychotic symptoms. Of those with psychedelic-induced psychosis, 13.1% later developed schizophrenia. Sensitivity analyses confirmed the results. In summary, the reviewed evidence suggests that schizophrenia might not be a definite exclusion criterion for clinical trials exploring safety and efficacy of psychedelics for treatment-resistant depression and negative symptoms. However, given the low quality and limited number of studies, more high-quality research is needed, and a conservative approach is recommended until further data is available.

Joint-trajectories of clinical severity, social functioning and cannabis use in first-episode psychosis: A 5-year longitudinal study in 2 urban early intervention services

Cannabis use is associated with increased psychosis incidence alongside worse outcomes. The role of cannabis may be complex, vary across patients and over time. Yet, few have examined the longer-term trajectories of cannabis use, symptoms and functioning and their inter-relationships. We conducted a 5-year longitudinal study to estimate joint-trajectories of clinical severity, social functioning, and cannabis use via group-based multi-trajectory modelling on a sample of 395 incident FEP cases. Associations of trajectories with socio-demographic and clinical factors were tested using multinomial regression. The best-fitting model identified 5 joint-trajectories. A first group (N = 93,23.7 %) presented only marginal improvement despite not using cannabis, while a second with no cannabis use and a third group with low-decreasing use showed clinical amelioration. Among those with baseline harmful cannabis use, a fourth group progressively discontinued use and improved clinically (N = 78,19.9 %). A fifth group with continued use did not significantly improve over follow-up (N = 74,18.8 %), and also had the highest odds of homelessness (OR = 22.5,95 %CI = 6.25–81.1) and childhood adversities (OR = 2.25,95 %CI = 1.71–2.97). There is substantial heterogeneity in the joint-trajectories of cannabis use and FEP outcomes. Our findings support the need for intervention aimed at cannabis reduction among heavy users. Multi-disciplinary, trauma-informed interventions may benefit those with persistent cannabis use, given its associations with childhood and social adversity.

Diagnosis of Schizophrenia and Psychosis in Māori People Using Speech Assay: A Natural Language Processing Approach

Indigenous peoples and ethnic minorities worldwide have a higher incidence of psychosis, primarily schizophrenia. In New Zealand, Māori individuals experience greater rates of anxiety and depression compared to non-Māori, with a significantly higher incidence of mental illness among Māori. We propose natural language processing (NLP) trained on speech samples from Māori patients as a potential solution to the problem of culturally biased psychometric screening tools for psychosis and schizophrenia. This research examines NLP's ability to diagnose psychosis in Māori patients by analysing speech and language abnormalities as indicators of severe mental illnesses such as schizophrenia. Our research emphasizes the need for inclusive language models and investigates cross-cultural applicability. We employed a three-part method: conducting clinical interviews, pre-processing data with the Natural Language Toolkit (NLTK) and applying language classifiers. The study's results demonstrate the promise of NLP, but limited patient data necessitates further research, including standardizing datasets and integrating NLP with indigenous languages. This research represents a step towards improving diagnostic accuracy and support for Māori people suffering from psychosis, aligning with healthcare's goal of fair and culturally responsive mental health screening.

The Role of Social Deprivation and Cannabis Use in Explaining Variation in the Incidence of Psychotic Disorders: Findings From the EU-GEI Study.

Recent findings suggest the incidence of first-episode psychotic disorders (FEP) varies according to setting-level deprivation and cannabis use, but these factors have not been investigated together. We hypothesized deprivation would be more strongly associated with variation in FEP incidence than the prevalence of daily or high-potency cannabis use between settings. We used incidence data in people aged 18-64 years from 14 settings of the EU-GEI study. We estimated the prevalence of daily and high-potency cannabis use in controls as a proxy for usage in the population at-risk; multiple imputations by chained equations and poststratification weighting handled missing data and control representativeness, respectively. We modeled FEP incidence in random intercepts negative binomial regression models to investigate associations with the prevalence of cannabis use in controls, unemployment, and owner-occupancy in each setting, controlling for population density, age, sex, and migrant/ethnic group. Lower owner-occupancy was independently associated with increased FEP (adjusted incidence rate ratio [aIRR]: 0.76, 95% CI: 0.61-0.95) and non-affective psychosis incidence (aIRR: 0.68, 95% CI: 0.55-0.83), after multivariable adjustment. Prevalence of daily cannabis use in controls was associated with the incidence of affective psychoses (aIRR: 1.53, 95% CI: 1.02-2.31). We found no association between FEP incidence and unemployment or high-potency cannabis use prevalence. Sensitivity analyses supported these findings. Lower setting-level owner-occupancy and increased prevalence of daily cannabis use in controls independently contributed to setting-level variance in the incidence of different psychotic disorders. Public health interventions that reduce exposure to these harmful environmental factors could lower the population-level burden of psychotic disorders.

Institutional pathways to psychosis for Indigenous Māori: A qualitative exploration of experiences

BackgroundInequities in the incidence and outcomes of first episode psychosis (FEP) for Indigenous peoples are impacted by multiple institutional systems. This study examines Indigenous experiences of these systems to gain an understanding of how to improve institutional responses to FEP inequity. MethodsCritical race theory informed the methods used. Twenty-three participants participated in four focus group interviews, and thirteen individual interviews, including nine Māori youth and young adults with FEP, ten family members, and four Māori health professionals. Participants were asked about lifetime experiences of institutions (health, social, and criminal-justice). An adapted WHO framework for addressing mental health inequities was used to organize and analyse the first round of structural coding, followed by descriptive and pattern coding. ResultsTwo themes were identified. The first theme signposted opportunities for institutional intervention. Participants critique being processed quickly through institutions that are driven by socio-political agendas, namely perceived risk, threat or crisis. Subsequently, opportunities for meaningful intervention were missed. The second theme identified scope for family orientated responses across sectors. Participants described short-term social interventions and institutional structures that focused on individuals rather than families, emphasizing the need to broaden cross-sector scope to structural interventions for families. DiscussionThe findings highlight institutional responses are focused on organisational drivers and downstream issues, that fail to address the fabric of the family social-environmental conditions that maintain Indigenous exposure to psychosis risk and poor outcomes. A pathway to equity would require a shared framework of social responsibility across sectors, that targets structural factors responsive to Indigenous family needs.

Ethnic density and first episode psychosis in the British Pakistani population: findings from the East Lancashire Early Intervention Service.

Elevated risk of psychosis for ethnic minority groups has generally been shown to be mitigated by high ethnic density. However, past survey studies examining UK Pakistani populations have shown an absence of protective ethnic density effects, which is not observed in other South Asian groups. To assess the ethnic density effect at a local neighbourhood level, in the UK Pakistani population in East Lancashire. Data was collected by the East Lancashire Early Intervention Service, identifying all cases of first episode psychosis (FEP) within their catchment area between 2012 and 2020. Multilevel Poisson regression analyses were used to compare incidence rates between Pakistani and White majority groups, while controlling for age, gender and area-level deprivation. The ethnic density effect was also examined by comparing incidence rates across high and low density areas. A total of 455 cases of FEP (364 White, 91 Pakistani) were identified. The Pakistani group had a higher incidence of FEP compared to the White majority population. A clear effect of ethnic density on rates of FEP was shown, with those in low density areas having higher incidence rates compared to the White majority, whereas incidence rates in high density areas did not significantly differ. Within the Pakistani group, a dose-response effect was also observed, with risk of FEP increasing incrementally as ethnic density decreased. Higher ethnic density related to lower risk of FEP within the Pakistani population in East Lancashire, highlighting the impact of local social context on psychosis incidence.

The characteristics and clinical outcomes of a pluripotent high-risk group with the potential to develop a diverse range of psychiatric disorders

BackgroundRecent studies have indicated that clinical high risk for psychosis (CHR-P) is highly specific for psychotic disorders other than pluripotential to various serious mental illnesses. However, not all CHR-P develop psychotic disorder only, and psychosis can occur in non-psychotic disorders as well. Our prospective cohort study aims to investigate the characteristics and clinical outcomes of a pluripotent high-risk group with the potential to develop a diverse range of psychiatric disorders. MethodsThe SPRIM study is a prospective naturalistic cohort program that focuses on the early detection of those at risk of developing serious mental illness, including psychosis (CHR-P), bipolar (CHR-B), and depressive disorder (CHR-D), as well as undifferentiated risk participants (UCHR). Our study has a longitudinal design with a baseline assessment and eight follow-up evaluations at 6, 12, 18, 24, 30, 36, 42, and 48 months to determine whether participants have transitioned to psychosis or mood disorders. ResultsThe SPRIM sample consisted of 90 CHR participants. The total cumulative incidence rate of transition was 53.3% (95% CI 32.5–77.2). CHR-P, CHR-B, CHR-D, and UCHR had cumulative incidence rates of 13.7% (95% CI 3.4–46.4), 52.4% (95% CI 28.1–81.1), 66.7% (95% CI 24.6–98.6) and 54.3% (95% CI 20.5–93.1), respectively. The cumulative incidence of psychosis, bipolar, and depressive disorder among all participants was 3.3% (95% CI 0.8–11.5), 45.7% (95% CI 24.4–73.6), and 11.2% (95% CI 3.1–36.2), respectively. ConclusionsOur study suggests that the concept of pluripotent high-risk for a diverse range of psychiatric disorders is an integrative approach to examining transdiagnostic interactions between illnesses with a high transition rate and minimizing stigma.

Psychosis and psychogenic polydipsia in CV2/CRMP5 antibody‐related PLE

This case report expands the reported range of clinical presentations of CV2/CRMP5 antibody‐related syndromes with two novel findings (manic psychosis and psychogenic polydipsia). A systematic literature review highlights a potentially higher incidence of psychosis than previously reported, clinical features that should prompt antibody testing, and the potential for treatment response.

Variation of subclinical psychosis across 16 sites in Europe and Brazil: findings from the multi-national EU-GEI study.

Incidence of first-episode psychosis (FEP) varies substantially across geographic regions. Phenotypes of subclinical psychosis (SP), such as psychotic-like experiences (PLEs) and schizotypy, present several similarities with psychosis. We aimed to examine whether SP measures varied across different sites and whether this variation was comparable with FEP incidence within the same areas. We further examined contribution of environmental and genetic factors to SP. We used data from 1497 controls recruited in 16 different sites across 6 countries. Factor scores for several psychopathological dimensions of schizotypy and PLEs were obtained using multidimensional item response theory models. Variation of these scores was assessed using multi-level regression analysis to estimate individual and between-sites variance adjusting for age, sex, education, migrant, employment and relational status, childhood adversity, and cannabis use. In the final model we added local FEP incidence as a second-level variable. Association with genetic liability was examined separately. Schizotypy showed a large between-sites variation with up to 15% of variance attributable to site-level characteristics. Adding local FEP incidence to the model considerably reduced the between-sites unexplained schizotypy variance. PLEs did not show as much variation. Overall, SP was associated with younger age, migrant, unmarried, unemployed and less educated individuals, cannabis use, and childhood adversity. Both phenotypes were associated with genetic liability to schizophrenia. Schizotypy showed substantial between-sites variation, being more represented in areas where FEP incidence is higher. This supports the hypothesis that shared contextual factors shape the between-sites variation of psychosis across the spectrum.

A CROSS-SECTIONAL STUDY OF PSYCHOSIS AND PERSONALITY PROFILE IN PATIENTS DIAGNOSED WITH ALCOHOL USE DISORDER

Objectives: The objectives of the study are (1) to study personality profile in patients diagnosed with alcohol use disorder (AUD) and (2) to study incidence of psychosis in patients with AUD. Methods: This was a cross-sectional study conducted in the department of psychiatry of a tertiary care medical college. 70 patients presenting with a history of alcohol intake underwent diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for AUD were enrolled in the study on the basis of pre-defined inclusion and exclusion criteria. Post a 2-week detoxification period, psychiatric symptoms encompassing depression, anxiety, hallucinations, and unusual behavior were assessed using the brief psychiatric rating scale (BPRS), while personality profiles were evaluated with the NEO Personality Inventory-3. Alcohol dependence levels were measured using the Severity of Alcohol Dependence Questionnaire. Results: There were 60 (85.71%) males and 10 (14.29%) females. There was a significant male preponderance in studied cases with M:F ratio of 1:0.16. Highest number of patients, i.e., 63 (90%) patients were married, followed by 4 (5.71%) patients were unmarried and 3 (4.29%) patients were divorced. Among 70 studied cases, 5 (7.14%) patients were found to have some or the other degree of psychotic symptoms. There was a significant correlation between being unskilled worker and having low literacy or low income and AUD (p<0.05). There was no statistically significant association between severity of AUD and education (p=0.70), occupation (p=0.94), income (p=0.84), and family history of alcohol consumption (p=0.58). Participants have mild severity shown low to average score on neuroticism, average scores on extraversion, very low to low scores on openness, high to very high scores on agreeableness, and high to very high scores on conscientiousness. Conclusion: We found a significant correlation of AUD with increasing age, male gender, early alcohol initiation, and prolonged dependence. Lower education and unskilled occupations were also linked to AUD. Personality trait analysis revealed distinct patterns based on the severity of physical dependency.

Social disadvantage in early psychosis and its effect on clinical presentation and service access, engagement and use

Incidence of psychosis varies geographically due to factors such as social disadvantage. Whether this influences the clinical presentation and/or engagement of those experiencing psychosis remains relatively understudied. This study analysed data from young people across Australia accessing ultra-high risk (UHR) or first episode psychosis (FEP) services delivered through the headspace Early Psychosis (hEP) program between June 2017 and March 2021. The cohort was categorised into low, middle, and high tertiles of social disadvantage using the Index of Relative Socioeconomic Disadvantage (IRSD). Data from 3089 participants aged 15–25 were included (1515 UHR, 1574 FEP). The low and middle tertiles for both cohorts had greater percentages of those not in education or employment (NEET), with First Nations or culturally and linguistically diverse backgrounds. Clinical presentations to services were similar across all tertiles in both cohorts, however, functioning at presentation varied significantly within the FEP cohort. Significantly lower numbers of direct services were provided in the low tertile of both cohorts, with significantly poorer engagement in the initial three-months also occurring for these young people. This variation in early psychosis service patterns associated with geographical variation in social deprivation demonstrates the need for further research and fine tuning of national early psychosis services.

Racism, early psychosis, and institutional contact: A qualitative study of Indigenous experiences.

There is evidence of Indigenous and ethnic minority inequities in the incidence and outcomes of early psychosis. Racism has been implicated as having an important role. To use Indigenous experiences to develop a more detailed understanding of how racism operates to impact early psychosis outcomes. Critical Race Theory informed the methodology used. Twenty-three Indigenous participants participated in four family focus group interviews and thirteen individual interviews, comprising of 9 Māori youth with early psychosis, 10 family members and 4 Māori mental health professionals. An analysis of the data was undertaken using deductive structural coding to identify descriptions of racism, followed by inductive descriptive and pattern coding. Participant experiences revealed how racism operates as a socio-cultural phenomenon that interacts with institutional policy and culture across systems pertaining to social responsiveness, risk discourse, and mental health service structures. This is described across three major themes: 1) selective responses based on racial stereotypes, 2) race related risk assessment bias and 3) institutional racism in the mental health workforce. The impacts of racism were reported as inaction in the face of social need, increased use of coercive practices and an under resourced Indigenous mental health workforce. The study illustrated the inter-related nature of interpersonal, institutional and structural racism with examples of interpersonal racism in the form of negative stereotypes interacting with organizational, socio-cultural and political priorities. These findings indicate that organizational cultures may differentially impact Indigenous and minority people and that social responsiveness, risk discourse and the distribution of workforce expenditure are important targets for anti-racism efforts.

Treated incidence of first episode psychosis in Sinop, Turkey: results of a 4-year admission-based study - SINOPsy.

The incidence of psychotic disorders varies in different geographic areas. As there has been no report from Turkey, this study aimed to provide the treated incidence rate of first-episode psychosis (FEP) in a defined area. All individuals, aged 15-64 years, presenting with FEP (ICD-10 F20-29, F30-33) to mental health services in a defined catchment-area in Sinop which is located in the Black Sea region of the northern Turkey were recorded over a 4-year period (2009 to 2012). Incidence rates of psychotic disorders and their 95% confidence intervals (CIs) were estimated. Poisson regression was applied to estimate the differences in incidence rate ratio (IRR) by age, sex, and urbanicity. One hundred and fifteen FEP participants were identified during the 4 years. Crude incidence rates of all psychoses, schizophrenia, other psychotic disorders, and affective psychotic disorders were respectively 38.5 (95% CI 27.1-49.9), 10.7 (95% CI 6.6-14.8), 10.0 (95% CI 5.7-14.3) and 17.7 (95% CI 11.3-24.2) per 100 000 person-years. After age-sex standardisation the rates increased slightly. There were no gender differences in the incidence rates. IRR of any psychotic disorder was highest in the youngest age group (15-24 years) compared to the oldest age group (55-64 years), 7.9 (95% CI 2.8-30.5). In contrast with previous studies, the incidence rate of any psychotic disorder was not significantly increased in urban areas compared with rural areas. The current study, the first of its kind from Turkey, indicates that the risk of schizophrenia and other psychotic disorders in a lowly urbanised area of Turkey is comparable to those reported in Western European cities.

Differences in Patterns of Stimulant Use and Their Impact on First-Episode Psychosis Incidence: An Analysis of the EUGEI Study.

Use of illegal stimulants is associated with an increased risk of psychotic disorder. However, the impact of stimulant use on odds of first-episode psychosis (FEP) remains unclear. Here, we aimed to describe the patterns of stimulant use and examine their impact on odds of FEP. We included patients with FEP aged 18-64 years who attended psychiatric services at 17 sites across 5 European countries and Brazil, and recruited controls representative of each local population (FEP = 1130; controls = 1497). Patterns of stimulant use were described. We computed fully adjusted logistic regression models (controlling for age, sex, ethnicity, cannabis use, and education level) to estimate their association with odds of FEP. Assuming causality, we calculated the population-attributable fractions for stimulant use associated with the odds for FEP. Prevalence of lifetime and recent stimulant use in the FEP sample were 14.50% and 7.88% and in controls 10.80% and 3.8%, respectively. Recent and lifetime stimulant use was associated with increased odds of FEP compared with abstainers [fully adjusted odds ratio 1.74,95% confidence interval (CI) 1.20-2.54, P = .004 and 1.62, 95% CI 1.25-2.09, P < .001, respectively]. According to PAFs, a substantial number of FEP cases (3.35% [95% CI 1.31-4.78] for recent use and 7.61% [95% CI 3.68-10.54] for lifetime use) could have been prevented if stimulants were no longer available and the odds of FEP and PAFs for lifetime and recent stimulant use varied across countries. Illegal stimulant use has a significant and clinically relevant influence on FEP incidence, with varying impacts across countries.

A comparison of neighbourhood level variation and risk factors for affective versus non-affective psychosis.

Studies typically highlight area level variation in the incidence of non-affective but not affective psychoses. We compared neighbourhood-level variation for both types of disorder, and the specific effects of neighbourhood urbanicity and ethnic density, using Danish national registry data. Population based cohort (2,224,464 people) followed from 1980 to 2013 with neighbourhood exposure measured at age 15 and incidence modelled using multilevel Poisson regression. Neighbourhood variation was similar for both disorders with an adjusted median risk ratio of 1.37 (95% CI 1.34-1.39) for non-affective psychosis and 1.43 (1.38-1.49) for affective psychosis. Associations with neighbourhood urbanicity differed: living in the most compared to the least urban quintile at age 15 was associated with a minimal increase in subsequent affective psychosis, IRR 1.13 (1.01-1.27) but a substantial increase in rates of non-affective psychosis, IRR 1.66 (1.57-1.75). Mixed results were found for neighbourhood ethnic density: for Middle Eastern migrants there was an increased average incidence of both affective, IRR 1.54 (1.19-1.99), and non-affective psychoses, 1.13 (1.04-1.23) associated with each decrease in ethnic density quintile, with a similar pattern for African migrants, but for European migrants ethnic density appeared to be associated with non-affective psychosis only. While overall variation and the effect of neighbourhood ethnic density were similar for both types of disorder, associations with urbanicity were largely confined to non-affective psychosis. This may reflect differences in aetiological pathways although the mechanism behind these differences remains unknown.

Influence of cannabis use on incidence of psychosis in people at clinical high risk.

Evidence for case-control studies suggests that cannabis use is a risk factor for the development of psychosis. However, there have been limited prospective studies and the direction of this association remains controversial. The primary aim of the present study was to examine the association between cannabis use and the incidence of psychotic disorders in people at clinical high risk of psychosis. Secondary aims were to assess associations between cannabis use and the persistence of psychotic symptoms, and with functional outcome. Current and previous cannabis use were assessed in individuals at clinical high risk of psychosis (n = 334) and healthy controls (n = 67), using a modified version of the Cannabis Experience Questionnaire. Participants were assessed at baseline and followed up for 2 years. Transition to psychosis and persistence of psychotic symptoms were assessed using the Comprehensive Assessment of At-Risk Mental States criteria. Level of functioning at follow up was assessed using the Global Assessment of Functioning disability scale. During follow up, 16.2% of the clinical high-risk sample developed psychosis. Of those who did not become psychotic, 51.4% had persistent symptoms and 48.6% were in remission. There was no significant association between any measure of cannabis use at baseline and either transition to psychosis, the persistence of symptoms, or functional outcome. These findings contrast with epidemiological data that suggest that cannabis use increases the risk of psychotic disorder.

Cannabis, cannabinoids and psychosis: a balanced view.

Cannabis, cannabinoids and psychosis: a balanced view.

Prevalence of tobacco smoking in people at clinical high-risk for psychosis: Systematic review and meta-analysis.

Several hypotheses have been proposed to explain why individuals with psychosis consume more tobacco compared with the general population, but the reasons remain unclear. The phases predating the onset of psychosis could provide an interesting framework to clarify this association. The aim of this systematic review and meta-analysis is to provide an updated and comprehensive synthesis of the association between tobacco smoking and Clinical High Risk for Psychosis (CHRP) status. We performed a multistep systematic PRISMA/MOOSE-compliant electronic search for articles published from inception until October 1st, 2021. Web of Science was searched, complemented by a manual search of original articles reporting the outcome of tobacco consumption (defined as the number of individuals which were smoking tobacco at baseline) in a group of CHR-P patients versus healthy controls (HC). We employed quality assessment of the included studies with Newcastle Ottawa Scale (NOS). The effect size for the primary outcome was the odds ratio (OR) of smoking tobacco in CHR-P samples vs HC. We performed a random-effects model meta-analysis, assessment of heterogeneity with I2 index, sensitivity analyses excluding one study at a time for primary outcome, meta-regressions with four independent moderators (mean age, female ratio, sample size, NOS) and assessment of publication bias with funnel plot and Egger's test. We included 21 independent articles, totalling 2018 CHR-P individuals (mean age of 21.35±2.91years and average female ratio of 41±7%) and 1160 HC (mean age of 22.42±3.70years and average female ratio of 45±11%). The NOS score was 6.52±1.25 (range from 0 to 9). The OR of smoking status was 2.22 (95%CI 1.74-2.84, p<0.01). Heterogeneity (I2) was 24.09 (p=0.16). Sensitivity analyses, removing one study at a time, revealed the robustness of our main finding. Meta-regressions did not reveal any significant association between the moderators and the main outcome. Visual inspection of the funnel plot and Egger's test did not reveal evident publication bias. Our main finding of an increased OR of smokers in the CHR-P individuals compared to healthy controls corroborates the accumulation of unhealthy lifestyles in this vulnerable group. This does not demonstrate any causal association between tobacco smoking and incidence of psychosis, which should be investigated in future prospective cohorts. In conclusion, the window of opportunity represented by CHR-P status should involve more efficient physical health screening and better investigating the aetiological impact of smoking in the development of psychosis.

Long-term effects of childhood trauma subtypes on adult brain function.

Childhood trauma is prevalent in our society, whereas little is known about why and how different forms of early traumatic experiences exert long-term effects on differential brain function in adulthood. This study aimed to scale experience-specific neural correlates of distinct subtypes of childhood trauma. We used resting-state functional magnetic resonance imaging data from 216 adults with different degrees of childhood trauma. Graph analysis was combined with the Childhood Trauma Questionnaire to inspect the impact of distinct subtypes of childhood trauma on the brain. We found that childhood trauma experiences have a detrimental effect on depression and anxiety behavior. On one hand, childhood neglect scores were positively associated with network transmission efficiency of regions involved in cognitive and executive functions, such as temporal lobe, insular cortex, and parahippocampal gyrus. On the other hand, childhood abuse scores were tightly linked to functional reorganizations of regions mediated by immature ego defense system and damaged emotion representation. Specifically, the abuse scores were positively associated with network transmission efficiency of the visual, auditory, linguistic, and motor cortex. Isolated communications in temporal cortex and supplementary motor cortex were related to emotional and physical abuse scores. Our data showed the differential associations of abusive and neglectful experiences with brain function in adulthood. These experience-specific associations could underpin potentially differential risks of specific forms of psychiatric sequelae in adulthood. More attentions to maltreated children and timely psychological treatment are needed to reduce the incidence of psychosis.