PMID- 35324095 OWN - NLM STAT- MEDLINE DCOM- 20220502 LR - 20220531 IS - 1555-2101 (Electronic) IS - 0160-6689 (Linking) VI - 83 IP - 3 DP - 2022 Mar 21 TI - Antipsychotic Exposure in Clinical High Risk of Psychosis: Empirical Insights From a Large Cohort Study. LID - 21m14092 [pii] LID - 10.4088/JCP.21m14092 [doi] AB - Objective: Current treatment guidelines for individuals at clinical high risk (CHR) for psychosis do not recommend the prescription of antipsychotics (not even second-generation ones) as the first treatment option for preventing psychosis. Yet, recent meta-analytic evidence indicates that antipsychotic exposure in CHR is relatively widespread and associated with a higher imminent risk of transition to psychosis. Therefore, we undertook this study to better delineate which clinical characteristics of CHR individuals may lead to the choice of antipsychotic prescription and whether it identifies a subgroup at higher risk for conversion to psychosis. Methods: Consecutively referred CHR individuals (N = 717) were assessed for demographic and clinical characteristics and followed up for 3 years (200 did not reach the end of the follow-up time) from 2016 to 2021. The sample was then dichotomized, on the basis of antipsychotic prescription, to prescribed (CHRAP+, n = 492) or not-prescribed (CHRAP-, n = 225) groups, which were subsequently compared for sociodemographic and clinical characteristics. The risks of conversion to psychosis in CHRAP+ versus CHRAP- groups were tested via survival analysis. Results: Of the 717 CHR individuals, 492 (68.62%) were prescribed antipsychotics; among these antipsychotics, the highest proportion used was for aripiprazole (n = 152), followed by olanzapine (n = 106), amisulpride (n = 76), and risperidone (n = 64). The CHRAP+ group had younger age (t = 2.138, P = .033), higher proportion of female individuals (chi(2) = 5.084, P = .024), psychotic symptoms of greater severity (t = 7.910, P < .001), and more impaired general function (t = 5.846, P < .001) than the CHRAP- group. The CHRAP+ group had greater risk for conversion to psychosis (27.0% in the CHRAP+ group vs 10.9% in the CHRAP- group, P < .001). Factors related to positive symptoms were the most likely to influence doctors' decision-making regarding prescripton of antipsychotics, without influence of age, sex, and education levels. Conclusions: Clinicians may prescribe antipsychotics mainly based on the severity of positive and disorganization symptoms of CHR individuals. The CHRAP+ group was associated with a higher risk of conversion to psychosis. In pragmatic terms, this finding indicates that baseline antipsychotic prescription in CHR cohorts is a warning flag for higher incipient risk of psychosis and designates as hyper-CHR subgroup as compared to antipsychotic-naive CHR. Trial Registration: ClinicalTrials.gov identifier: NCT04010864. CI - (c) Copyright 2022 Physicians Postgraduate Press, Inc. FAU - Zeng, JiaHui AU - Zeng J AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Raballo, Andrea AU - Raballo A AD - Department of Medicine, Section of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy. AD - Center for Translational, Phenomenological and Developmental Psychopathology (CTPDP), Perugia University Hospital, Perugia, Italy. FAU - Gan, RanPiao AU - Gan R AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Wu, GuiSen AU - Wu G AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Wei, YanYan AU - Wei Y AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Xu, LiHua AU - Xu L AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Tang, XiaoChen AU - Tang X AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Hu, YeGang AU - Hu Y AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Tang, YingYing AU - Tang Y AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Chen, Tao AU - Chen T AD - Big Data Research Laboratory, University of Waterloo, Waterloo, Ontario, Canada. AD - Labor and Worklife Program, Harvard University, Cambridge, Massachusetts, United States. FAU - Li, ChunBo AU - Li C AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. FAU - Wang, JiJun AU - Wang J AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. AD - CAS Center for Excellence in Brain Science and Intelligence Technology (CEBSIT), Chinese Academy of Science, Shanghai, PR China. AD - Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China. AD - This author contributed equally in the role of corresponding author. FAU - Zhang, TianHong AU - Zhang T AD - Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China. AD - Corresponding author: TianHong Zhang, MD, PhD, Shanghai Key Laboratory of Psychotic Disorders (No.13dz2260500), Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, 600 Wanping Nan Rd, Shanghai 200030, China (zhang_tianhong@126.com). LA - eng SI - ClinicalTrials.gov/NCT04010864 PT - Clinical Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20220321 PL - United States TA - J Clin Psychiatry JT - The Journal of clinical psychiatry JID - 7801243 RN - 0 (Antipsychotic Agents) RN - 82VFR53I78 (Aripiprazole) RN - L6UH7ZF8HC (Risperidone) SB - IM MH - *Antipsychotic Agents/therapeutic use MH - Aripiprazole/therapeutic use MH - Cohort Studies MH - Female MH - Humans MH - Male MH - *Psychotic Disorders/drug therapy/epidemiology MH - Risk Assessment MH - Risperidone/therapeutic use EDAT- 2022/03/25 06:00 MHDA- 2022/05/03 06:00 CRDT- 2022/03/24 12:17 PHST- 2022/03/24 12:17 [entrez] PHST- 2022/03/25 06:00 [pubmed] PHST- 2022/05/03 06:00 [medline] AID - 21m14092 [pii] AID - 10.4088/JCP.21m14092 [doi] PST - epublish SO - J Clin Psychiatry. 2022 Mar 21;83(3):21m14092. doi: 10.4088/JCP.21m14092.