PMID- 33593473
OWN - NLM
STAT- Publisher
LR  - 20240222
IS  - 1469-8978 (Electronic)
IS  - 0033-2917 (Linking)
DP  - 2021 Feb 17
TI  - Individualized risk components guiding antipsychotic delivery in patients with a 
      clinical high risk of psychosis: application of a risk calculator.
PG  - 1-10
LID - 10.1017/S0033291721000064 [doi]
AB  - BACKGROUND: Antipsychotics are widely used for treating patients with psychosis, 
      and target threshold psychotic symptoms. Individuals at clinical high risk (CHR) 
      for psychosis are characterized by subthreshold psychotic symptoms. It is 
      currently unclear who might benefit from antipsychotic treatment. Our objective 
      was to apply a risk calculator (RC) to identify people that would benefit from 
      antipsychotics. METHODS: Drawing on 400 CHR individuals recruited between 2011 
      and 2016, 208 individuals who received antipsychotic treatment were included. 
      Clinical and cognitive variables were entered into an individualized RC for 
      psychosis; personal risk was estimated and 4 risk components (negative 
      symptoms-RC-NS, general function-RC-GF, cognitive performance-RC-CP, and positive 
      symptoms-RC-PS) were constructed. The sample was further stratified according to 
      the risk level. Higher risk was defined based on the estimated risk score (20% or 
      higher). RESULTS: In total, 208 CHR individuals received daily antipsychotic 
      treatment of an olanzapine-equivalent dose of 8.7 mg with a mean administration 
      duration of 58.4 weeks. Of these, 39 (18.8%) developed psychosis within 2 years. 
      A new index of factors ratio (FR), which was derived from the ratio of RC-PS plus 
      RC-GF to RC-NS plus RC-CP, was generated. In the higher-risk group, as FR 
      increased, the conversion rate decreased. A small group (15%) of CHR individuals 
      at higher-risk and an FR >1 benefitted from the antipsychotic treatment. 
      CONCLUSIONS: Through applying a personal risk assessment, the administration of 
      antipsychotics should be limited to CHR individuals with predominantly positive 
      symptoms and related function decline. A strict antipsychotic prescription 
      strategy should be introduced to reduce inappropriate use.
FAU - Zhang, TianHong
AU  - Zhang T
AUID- ORCID: 0000-0002-5379-7119
AD  - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 
      Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China.
FAU - Xu, LiHua
AU  - Xu L
AD  - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 
      Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China.
FAU - Li, HuiJun
AU  - Li H
AD  - Department of Psychology, Florida A & M University, Tallahassee, Florida32307, 
      USA.
FAU - Cui, HuiRu
AU  - Cui H
AD  - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 
      Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China.
FAU - Tang, YingYing
AU  - Tang Y
AD  - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 
      Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China.
FAU - Wei, YanYan
AU  - Wei Y
AD  - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 
      Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China.
FAU - Tang, XiaoChen
AU  - Tang X
AD  - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 
      Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China.
FAU - Hu, YeGang
AU  - Hu Y
AD  - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 
      Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China.
FAU - Hui, Li
AU  - Hui L
AD  - Institute of Mental Health, The Affiliated Guangji Hospital of Soochow 
      University, Soochow University, Suzhou215137, Jiangsu, PR China.
FAU - Li, ChunBo
AU  - Li C
AD  - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 
      Shanghai Key Laboratory of Psychotic Disorders, Shanghai200030, PR China.
FAU - Niznikiewicz, Margaret A
AU  - Niznikiewicz MA
AD  - Harvard Medical School Department of Psychiatry, Veteran's Administration Medical 
      Center, Boston, MA02130, USA.
FAU - Shenton, Martha E
AU  - Shenton ME
AD  - Brigham and Women's Hospital, Departments of Psychiatry and Radiology, and 
      Harvard Medical School, and VA Boston Healthcare System, Boston, MA, USA.
FAU - Keshavan, Matcheri S
AU  - Keshavan MS
AD  - Harvard Medical School Department of Psychiatry, Veteran's Administration Medical 
      Center, Boston, MA02130, USA.
FAU - Stone, William S
AU  - Stone WS
AD  - Harvard Medical School Department of Psychiatry, Beth Israel Deaconess Medical 
      Center, 75 Fenwood Rd, Boston, MA02115, USA.
FAU - Wang, JiJun
AU  - Wang J
AD  - Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, 
      Shanghai, PR China.
LA  - eng
PT  - Journal Article
DEP - 20210217
PL  - England
TA  - Psychol Med
JT  - Psychological medicine
JID - 1254142
SB  - IM
OTO - NOTNLM
OT  - Medication
OT  - outcome
OT  - prodromal psychosis
OT  - transition
OT  - ultra-high risk
EDAT- 2021/02/18 06:00
MHDA- 2021/02/18 06:00
CRDT- 2021/02/17 05:39
PHST- 2021/02/17 05:39 [entrez]
PHST- 2021/02/18 06:00 [pubmed]
PHST- 2021/02/18 06:00 [medline]
AID - S0033291721000064 [pii]
AID - 10.1017/S0033291721000064 [doi]
PST - aheadofprint
SO  - Psychol Med. 2021 Feb 17:1-10. doi: 10.1017/S0033291721000064.