Raballo Andrea, Poletti Michele, Preti Antonio, McGorry Patrick
Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy.
Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda Unità Sanitaria Locale-IRCSS di Reggio Emilia, Reggio Emilia, Italy.
Schizophr Res. 2022 May;243:254-261. doi: 10.1016/j.schres.2020.03.063. Epub 2020 Apr 16.
The strategic value of early, preventive intervention in psychosis has been a catalytic stepping stone to promoting early intervention in Mental Health. Central to such momentum is the construct of clinical high risk states for psychosis (CHR). While CHR emerge in developmental years, the meta-analytical risk of psychosis among children and adolescents (age 9-18 years) at CHR is still unknown. We conducted a meta-analysis according to PRISMA guidelines including all studies that assessed CHR in children and adolescents (age ≤ 18 years) with validated instruments and provided follow-data on transition to psychosis up to December 31, 2018. We identified 11 eligible studies. Mean age was 15.8 ± 0.8 years, range: 13.8 to 16.8. Transition to psychosis occurred in 93 CHR subjects out of 533 that were enrolled at inception, over a follow-up period ranging from 6 to 72 months. Conversion prevalence was 17.5% (95% CI: 9.9% to 26.5%) in the random-effects model (Q = 30.9; p < .001; I = 68%), and slightly lower (16.0; 12.9% to 19.5%) in the fixed-effect model. Gender ratio, the criteria used to diagnose the CHR status, and quality of studies had an impact on the estimates of conversion prevalence in the intention-to-treat model without the outlier. Studies of fair quality produced lower estimates of conversion prevalence (11%; 95% CI: 2% to 24%) than those produced by studies of good quality (19%; 95% CI: 11% to 28%). These findings suggest that CHR in adolescence presents commensurable transition prevalences to those found in adult samples, confirming the relevance of CHR criteria for timely risk inception in developmental years. Outcomes other than transition to psychosis (e.g. remission, persistent CHR, socio-functional status or treatment responses) were not systematically reported thereby preventing further, more sophisticated, prognostic stratifications.
早期预防性干预精神病的战略价值，一直是推动心理健康早期干预的关键垫脚石。这种发展势头的核心是精神病临床高危状态（CHR）这一概念。虽然CHR在发育阶段出现，但儿童和青少年（9至18岁）处于CHR状态时患精神病的荟萃分析风险仍不明确。我们根据PRISMA指南进行了一项荟萃分析，纳入了所有使用经过验证的工具评估儿童和青少年（年龄≤18岁）CHR状态，并提供截至2018年12月31日向精神病转变随访数据的研究。我们确定了11项符合条件的研究。平均年龄为15.8±0.8岁，范围为13.8至16.8岁。在最初纳入的533名CHR受试者中，有93人在6至72个月的随访期内转变为精神病。随机效应模型中的转化率为17.5%（95%置信区间：9.9%至26.5%）（Q=30.9；p<.001；I=68%），固定效应模型中的转化率略低（16.0；12.9%至19.5%）。在排除异常值的意向性分析模型中，性别比例、用于诊断CHR状态的标准以及研究质量对转化率估计有影响。质量一般的研究得出的转化率估计值（11%；95%置信区间：2%至24%）低于质量良好的研究（19%；95%置信区间：11%至28%）。这些发现表明，青少年CHR的转变患病率与成人样本中的患病率相当，证实了CHR标准在发育阶段及时识别风险的相关性。除转变为精神病之外的其他结果（如缓解、持续CHR、社会功能状态或治疗反应）未得到系统报告，因此无法进行进一步、更精细的预后分层。
