PMID- 26719911 OWN - NLM STAT- MEDLINE DCOM- 20160617 LR - 20230508 IS - 2168-6238 (Electronic) IS - 2168-622X (Linking) VI - 73 IP - 2 DP - 2016 Feb TI - Heterogeneity of Psychosis Risk Within Individuals at Clinical High Risk: A Meta-analytical Stratification. PG - 113-20 LID - 10.1001/jamapsychiatry.2015.2324 [doi] AB - IMPORTANCE: Individuals can be classified as being at clinical high risk (CHR) for psychosis if they meet at least one of the ultra-high-risk (UHR) inclusion criteria (brief limited intermittent psychotic symptoms [BLIPS] and/or attenuated psychotic symptoms [APS] and/or genetic risk and deterioration syndrome [GRD]) and/or basic symptoms [BS]. The meta-analytical risk of psychosis of these different subgroups is still unknown. OBJECTIVE: To compare the risk of psychosis in CHR individuals who met at least one of the major inclusion criteria and in individuals not at CHR for psychosis (CHR-). DATA SOURCES: Electronic databases (Web of Science, MEDLINE, Scopus) were searched until June 18, 2015, along with investigation of citations of previous publications and a manual search of the reference lists of retrieved articles. STUDY SELECTION: We included original follow-up studies of CHR individuals who reported the risk of psychosis classified according to the presence of any BLIPS, APS and GRD, APS alone, GRD alone, BS, and CHR-. DATA EXTRACTION AND SYNTHESIS: Independent extraction by multiple observers and random-effects meta-analysis of proportions. Moderators were tested with meta-regression analyses (Bonferroni corrected). Heterogeneity was assessed with the I2 index. Sensitivity analyses tested robustness of results. Publication biases were assessed with funnel plots and the Egger test. MAIN OUTCOMES AND MEASURES: The proportion of each subgroup with any psychotic disorder at 6, 12, 24, 36, and 48 or more months of follow-up. RESULTS: Thirty-three independent studies comprising up to 4227 individuals were included. The meta-analytical proportion of individuals meeting each UHR subgroup at intake was: 0.85 APS (95%CI, 0.79-0.90), 0.1 BLIPS (95%CI, 0.06-0.14), and 0.05 GRD (95%CI, 0.03-0.07). There were no significant differences in psychosis risk at any time point between the APS and GRD and the APS-alone subgroups. There was a higher risk of psychosis in the any BLIPS greater than APS greater than GRD-alone subgroups at 24, 36, and 48 or more months of follow-up. There was no evidence that the GRD subgroup has a higher risk of psychosis than the CHR- subgroup. There were too few BS or BS and UHR studies to allow robust conclusions. CONCLUSIONS AND RELEVANCE: There is meta-analytical evidence that BLIPS represents separate risk subgroup compared with the APS. The GRD subgroup is infrequent and not associated with an increased risk of psychosis. Future studies are advised to stratify their findings across these different subgroups. The CHR guidelines should be updated to reflect these differences. FAU - Fusar-Poli, Paolo AU - Fusar-Poli P AD - Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom2OASIS Clinic, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom. FAU - Cappucciati, Marco AU - Cappucciati M AD - Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom3Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. FAU - Borgwardt, Stefan AU - Borgwardt S AD - University of Basel Psychiatric Clinics, Basel, Switzerland. FAU - Woods, Scott W AU - Woods SW AD - Department of Psychiatry, Yale University, New Haven, Connecticut. FAU - Addington, Jean AU - Addington J AD - Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada. FAU - Nelson, Barnaby AU - Nelson B AD - Orygen, the National Centre of Excellence in Youth Mental Health, and Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia. FAU - Nieman, Dorien H AU - Nieman DH AD - Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. FAU - Stahl, Daniel R AU - Stahl DR AD - Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. FAU - Rutigliano, Grazia AU - Rutigliano G AD - Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. FAU - Riecher-Rossler, Anita AU - Riecher-Rossler A AD - University of Basel Psychiatric Clinics, Basel, Switzerland. FAU - Simon, Andor E AU - Simon AE AD - University of Basel Psychiatric Clinics, Basel, Switzerland9Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, Bruderholz, Switzerland. FAU - Mizuno, Masafumi AU - Mizuno M AD - Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan. FAU - Lee, Tae Young AU - Lee TY AD - Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea. FAU - Kwon, Jun Soo AU - Kwon JS AD - Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea. FAU - Lam, May M L AU - Lam MM AD - Kwai Chung Hospital, New Territories, Hong Kong, People's Republic of China. FAU - Perez, Jesus AU - Perez J AD - Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom. FAU - Keri, Szabolcs AU - Keri S AD - Nyiro Gyula Hospital, National Institute of Psychiatry and Addictions, Budapest, Hungary. FAU - Amminger, Paul AU - Amminger P AD - Orygen, the National Centre of Excellence in Youth Mental Health, and Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia. FAU - Metzler, Sibylle AU - Metzler S AD - Centre for Social Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland. FAU - Kawohl, Wolfram AU - Kawohl W AD - Centre for Social Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland. FAU - Rossler, Wulf AU - Rossler W AD - Centre for Social Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland. FAU - Lee, Jimmy AU - Lee J AD - Department of General Psychiatry, Institute of Mental Health, Singapore, Singapore. FAU - Labad, Javier AU - Labad J AD - Department of Psychiatry, Corporacio Sanitaria Parc Tauli Sabadell, Barcelona, Spain. FAU - Ziermans, Tim AU - Ziermans T AD - Department of Clinical Child and Adolescent Studies, Leiden University, Leiden, the Netherlands. FAU - An, Suk Kyoon AU - An SK AD - Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea. FAU - Liu, Chen-Chung AU - Liu CC AD - Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan. FAU - Woodberry, Kristen A AU - Woodberry KA AD - Center for Psychiatric Research, Maine Medical Center, Portland, Maine22Departments of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. FAU - Braham, Amel AU - Braham A AD - Psychiatry Department, University Hospital Farhat Hached, Sousse, Tunisia. FAU - Corcoran, Cheryl AU - Corcoran C AD - Department of Psychiatry, Columbia University, New York, New York. FAU - McGorry, Patrick AU - McGorry P AD - Orygen, the National Centre of Excellence in Youth Mental Health, and Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia. FAU - Yung, Alison R AU - Yung AR AD - Institute of Brain, Behaviour and Mental Health, University of Manchester, and Greater Manchester West National Health Service Mental Health Foundation Trust, Manchester, United Kingdom. FAU - McGuire, Philip K AU - McGuire PK AD - Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom. LA - eng GR - K23 MH066279/MH/NIMH NIH HHS/United States GR - R03 MH108933/MH/NIMH NIH HHS/United States GR - R21 MH086125/MH/NIMH NIH HHS/United States GR - U01 MH066160/MH/NIMH NIH HHS/United States PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PL - United States TA - JAMA Psychiatry JT - JAMA psychiatry JID - 101589550 SB - IM CIN - JAMA Psychiatry. 2016 Feb;73(2):105-6. PMID: 26720422 MH - Humans MH - Psychotic Disorders/*classification MH - *Risk EDAT- 2016/01/01 06:00 MHDA- 2016/06/18 06:00 CRDT- 2016/01/01 06:00 PHST- 2016/01/01 06:00 [entrez] PHST- 2016/01/01 06:00 [pubmed] PHST- 2016/06/18 06:00 [medline] AID - 2478069 [pii] AID - 10.1001/jamapsychiatry.2015.2324 [doi] PST - ppublish SO - JAMA Psychiatry. 2016 Feb;73(2):113-20. doi: 10.1001/jamapsychiatry.2015.2324.