Annual Research Review: Prevention of psychosis in adolescents – systematic review and meta‐analysis of advances in detection, prognosis and intervention
Bibliographic record
Abstract
Background The clinical high‐risk state for psychosis (CHR‐P) paradigm has facilitated the implementation of psychosis prevention into clinical practice; however, advancements in adolescent CHR‐P populations are less established. Methods We performed a PRISMA/MOOSE‐compliant systematic review of the Web of Science database, from inception until 7 October 2019, to identify original studies conducted in CHR‐P children and adolescents (mean age <18 years). Findings were systematically appraised around core themes: detection, prognosis and intervention. We performed meta‐analyses (employing Q statistics and I 2 test) regarding the proportion of CHR‐P subgroups, the prevalence of baseline comorbid mental disorders, the risk of psychosis onset and the type of interventions received at baseline. Quality assessment and publication bias were also analysed. Results Eighty‐seven articles were included ( n = 4,667 CHR‐P individuals). Quality of studies ranged from 3.5 to 8 (median 5.5) on a modified Newcastle–Ottawa scale. Detection : Individuals were aged 15.6 ± 1.2 years (51.5% males), mostly (83%) presenting with attenuated positive psychotic symptoms. CHR‐P psychometric accuracy improved when caregivers served as additional informants. Comorbid mood (46.4%) and anxiety (31.4%) disorders were highly prevalent. Functioning and cognition were impaired. Neurobiological studies were inconclusive. Prognosis : Risk for psychosis was 10.4% (95%CI: 5.8%–18.1%) at 6 months, 20% (95%CI: 15%–26%) at 12 months, 23% (95%CI: 18%–29%) at 24 months and 23.3% (95%CI: 17.3%–30.7%) at ≥36 months. Interventions : There was not enough evidence to recommend one specific treatment (including cognitive behavioural therapy) over the others (including control conditions) to prevent the transition to psychosis in this population. Randomised controlled trials suggested that family interventions, cognitive remediation and fish oil supplementation may improve cognition, symptoms and functioning. At baseline, 30% of CHR‐P adolescents were prescribed antipsychotics and 60% received psychotherapy. Conclusions It is possible to detect and formulate a group‐level prognosis in adolescents at risk for psychosis. Future interventional research is required.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.006 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".