Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-10T05:02:40.287Z Has data issue: false hasContentIssue false
  • English
  • Français

Individualized risk components guiding antipsychotic delivery in patients with a clinical high risk of psychosis: application of a risk calculator

Published online by Cambridge University Press:  17 February 2021

TianHong Zhang Open the ORCID record for TianHong Zhang [Opens in a new window] ,
LiHua Xu ,
HuiJun Li ,
HuiRu Cui ,
YingYing Tang ,
YanYan Wei ,
XiaoChen Tang ,
YeGang Hu ,
Li Hui  and
ChunBo Li
...Show all authors
TianHong Zhang
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
LiHua Xu
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
HuiJun Li
Affiliation:
Department of Psychology, Florida A & M University, Tallahassee, Florida 32307, USA
HuiRu Cui
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
YingYing Tang
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
YanYan Wei
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
XiaoChen Tang
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
YeGang Hu
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
Li Hui
Affiliation:
Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Soochow University, Suzhou 215137, Jiangsu, PR China
ChunBo Li
Affiliation:
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China
Margaret A. Niznikiewicz
Affiliation:
Harvard Medical School Department of Psychiatry, Veteran's Administration Medical Center, Boston, MA 02130, USA
Martha E. Shenton
Affiliation:
Brigham and Women's Hospital, Departments of Psychiatry and Radiology, and Harvard Medical School, and VA Boston Healthcare System, Boston, MA, USA
Matcheri S. Keshavan
Affiliation:
Harvard Medical School Department of Psychiatry, Veteran's Administration Medical Center, Boston, MA 02130, USA
William S. Stone
Affiliation:
Harvard Medical School Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, Boston, MA 02115, USA
JiJun Wang*
Affiliation:
Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, PR China
*
Author for correspondence: JiJun Wang, E-mail: jijunwang27@163.com
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Keywords

Medicationoutcomeprodromal psychosistransitionultra-high risk
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 15 , November 2022 , pp. 3412 - 3421
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

These authors contributed equally and share senior authorship.

References

Amminger, G. P., Nelson, B., Markulev, C., Yuen, H. P., Schafer, M. R., Berger, M., … McGorry, P. D. (2020). The NEURAPRO biomarker analysis: Long-chain Omega-3 fatty acids improve 6-month and 12-month outcomes in youths at ultra-high risk for psychosis. Biological Psychiatry, 87(3), 243–252. doi: 10.1016/j.biopsych.2019.08.030.CrossRefGoogle ScholarPubMed
Bosnjak Kuharic, D., Kekin, I., Hew, J., Rojnic Kuzman, M., & Puljak, L. (2019). Interventions for prodromal stage of psychosis. Cochrane Database Systemtic Reviews, 2019(11), CD012236. doi:10.1002/14651858.CD012236.pub2.Google ScholarPubMed
Cannon, T. D., Yu, C., Addington, J., Bearden, C. E., Cadenhead, K. S., Cornblatt, B. A., … Kattan, M. W. (2016). An individualized risk calculator for research in prodromal psychosis. The American Journal of Psychiatry, 173(10), 980–988. doi:10.1176/appi.ajp.2016.15070890.CrossRefGoogle ScholarPubMed
Davies, C., Cipriani, A., Ioannidis, J. P. A., Radua, J., Stahl, D., Provenzani, U., … Fusar-Poli, P. (2018). Lack of evidence to favor specific preventive interventions in psychosis: A network meta-analysis. World Psychiatry, 17(2), 196–209. doi:10.1002/wps.20526.CrossRefGoogle ScholarPubMed
Fusar-Poli, P., Bonoldi, I., Yung, A. R., Borgwardt, S., Kempton, M. J., Valmaggia, L., … McGuire, P. (2012). Predicting psychosis: Meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry, 69(3), 220–229. doi:10.1001/archgenpsychiatry.2011.1472.CrossRefGoogle ScholarPubMed
Fusar-Poli, P., Borgwardt, S., Bechdolf, A., Addington, J., Riecher-Rossler, A., Schultze-Lutter, F., … Yung, A. (2013). The psychosis high-risk state: A comprehensive state-of-the-art review. JAMA Psychiatry, 70(1), 107–120. doi: 10.1001/jamapsychiatry.2013.269.CrossRefGoogle Scholar
Fusar-Poli, P., Cappucciati, M., Bonoldi, I., Hui, L. M., Rutigliano, G., Stahl, D. R., … McGuire, P. K. (2016a). Prognosis of brief psychotic episodes: A meta-analysis. JAMA Psychiatry, 73(3), 211–220. doi: 10.1001/jamapsychiatry.2015.2313.CrossRefGoogle ScholarPubMed
Fusar-Poli, P., Cappucciati, M., Borgwardt, S., Woods, S. W., Addington, J., Nelson, B., … McGuire, P. K. (2016b). Heterogeneity of psychosis risk within individuals at clinical high risk: A meta-analytical stratification. JAMA Psychiatry, 73(2), 113–120. doi:10.1001/jamapsychiatry.2015.2324.CrossRefGoogle Scholar
Fusar-Poli, P., Davies, C., Solmi, M., Brondino, N., De Micheli, A., Kotlicka-Antczak, M., … Radua, J. (2019). Preventive treatments for psychosis: Umbrella review (just the evidence). Frontiers in Psychiatry, 10, 764. doi: 10.3389/fpsyt.2019.00764.CrossRefGoogle ScholarPubMed
Fusar-Poli, P., De Micheli, A., Patel, R., Signorini, L., Miah, S., Spencer, T., … McGuire, P. (2020a). Real-World clinical outcomes two years after transition to psychosis in individuals at clinical high risk: Electronic health record cohort study. Schizophrenia Bulletin, 46(5), 1114–1125. doi:10.1093/schbul/sbaa040.CrossRefGoogle ScholarPubMed
Fusar-Poli, P., Frascarelli, M., Valmaggia, L., Byrne, M., Stahl, D., Rocchetti, M., … McGuire, P. (2015). Antidepressant, antipsychotic and psychological interventions in subjects at high clinical risk for psychosis: OASIS 6-year naturalistic study. Psychological Medicine, 45(6), 1327–1339. doi:10.1017/S003329171400244X.CrossRefGoogle ScholarPubMed
Fusar-Poli, P., Salazar de Pablo, G., Correll, C. U., Meyer-Lindenberg, A., Millan, M. J., Borgwardt, S., … Arango, C. (2020b). Prevention of psychosis: Advances in detection, prognosis, and intervention. JAMA Psychiatry, 77(7), 755–765. doi:10.1001/jamapsychiatry.2019.4779.CrossRefGoogle ScholarPubMed
Hafner, H., Riecher-Rossler, A., Maurer, K., Fatkenheuer, B., & Loffler, W. (1992). First onset and early symptomatology of schizophrenia. A chapter of epidemiological and neurobiological research into age and sex differences. European Archives of Psychiatry and Clinical Neuroscience, 242(2–3), 109–118. doi:10.1007/bf02191557.CrossRefGoogle ScholarPubMed
Harvey, R. C., James, A. C., & Shields, G. E. (2016). A systematic review and network meta-analysis to assess the relative efficacy of antipsychotics for the treatment of positive and negative symptoms in early-onset schizophrenia. CNS Drugs, 30(1), 27–39. doi:10.1007/s40263-015-0308-1.CrossRefGoogle ScholarPubMed
Kern, R. S., Nuechterlein, K. H., Green, M. F., Baade, L. E., Fenton, W. S., Gold, J. M., … Marder, S. R. (2008). The MATRICS consensus cognitive battery, part 2: Co-norming and standardization. The American Journal of Psychiatry, 165(2), 214–220. doi:10.1176/appi.ajp.2007.07010043.CrossRefGoogle ScholarPubMed
Leucht, S., Corves, C., Arbter, D., Engel, R. R., Li, C., & Davis, J. M. (2009). Second-generation versus first-generation antipsychotic drugs for schizophrenia: A meta-analysis. Lancet (London, England), 373(9657), 31–41. doi: 10.1016/S0140-6736(08)61764-X.CrossRefGoogle ScholarPubMed
Leucht, S., Samara, M., Heres, S., & Davis, J. M. (2016). Dose equivalents for antipsychotic drugs: The DDD method. Schizophrenia Bulletin, 42(Suppl 1), S90–S94. doi:10.1093/schbul/sbv167.CrossRefGoogle ScholarPubMed
Liu, C. C., & Demjaha, A. (2013). Antipsychotic interventions in prodromal psychosis: Safety issues. CNS Drugs, 27(3), 197–205. doi:10.1007/s40263-013-0046-1.CrossRefGoogle ScholarPubMed
McGlashan, T., Walsh, B., & Woods, S. (2010). The psychosis-risk syndrome: Handbook for diagnosis and follow-up. New York: Oxford University Press.Google Scholar
McGlashan, T. H., Zipursky, R. B., Perkins, D., Addington, J., Miller, T., Woods, S. W., … Breier, A. (2006). Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. The American Journal of Psychiatry, 163(5), 790–799. doi:10.1176/ajp.2006.163.5.790.CrossRefGoogle ScholarPubMed
McGorry, P. D., Yung, A. R., Phillips, L. J., Yuen, H. P., Francey, S., Cosgrave, E. M., … Jackson, H. (2002). Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Archives of General Psychiatry, 59(10), 921–928.CrossRefGoogle Scholar
Miller, T. J., McGlashan, T. H., Rosen, J. L., Cadenhead, K., Cannon, T., Ventura, J., … Woods, S. W. (2003). Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: Predictive validity, interrater reliability, and training to reliability. Schizophrenia Bulletin, 29(4), 703–715.CrossRefGoogle ScholarPubMed
Miller, T. J., McGlashan, T. H., Rosen, J. L., Somjee, L., Markovich, P. J., Stein, K., & Woods, S. W. (2002). Prospective diagnosis of the initial prodrome for schizophrenia based on the structured interview for prodromal syndromes: Preliminary evidence of interrater reliability and predictive validity. The American Journal of Psychiatry, 159(5), 863–865.CrossRefGoogle ScholarPubMed
Miyamoto, S., Miyake, N., Jarskog, L. F., Fleischhacker, W. W., & Lieberman, J. A. (2012). Pharmacological treatment of schizophrenia: A critical review of the pharmacology and clinical effects of current and future therapeutic agents. Molecular Psychiatry, 17(12), 1206–1227. doi:10.1038/mp.2012.47.CrossRefGoogle ScholarPubMed
Morrison, A. P., French, P., Walford, L., Lewis, S. W., Kilcommons, A., Green, J., … Bentall, R. P. (2004). Cognitive therapy for the prevention of psychosis in people at ultra-high risk: Randomised controlled trial. The British Journal of Psychiatry, 185, 291–297. doi:10.1192/bjp.185.4.291.CrossRefGoogle ScholarPubMed
Nuechterlein, K. H., Green, M. F., Kern, R. S., Baade, L. E., Barch, D. M., Cohen, J. D., … Marder, S. R. (2008). The MATRICS consensus cognitive battery, part 1: Test selection, reliability, and validity. The American Journal of Psychiatry, 165(2), 203–213. doi:10.1176/appi.ajp.2007.07010042.CrossRefGoogle ScholarPubMed
Schultze-Lutter, F., Ruhrmann, S., Berning, J., Maier, W., & Klosterkotter, J. (2010). Basic symptoms and ultrahigh risk criteria: Symptom development in the initial prodromal state. Schizophrenia Bulletin, 36(1), 182–191. doi: 10.1093/schbul/sbn072.CrossRefGoogle ScholarPubMed
Seeman, P. (1992). Dopamine receptor sequences. Therapeutic levels of neuroleptics occupy D2 receptors, clozapine occupies D4. Neuropsychopharmacology, 7(4), 261–284.Google ScholarPubMed
Seidman, L. J., Giuliano, A. J., Meyer, E. C., Addington, J., Cadenhead, K. S., Cannon, T. D., … North American Prodrome Longitudinal Study, G. (2010). Neuropsychology of the prodrome to psychosis in the NAPLS consortium: Relationship to family history and conversion to psychosis. Archives of General Psychiatry, 67(6), 578–588. doi: 10.1001/archgenpsychiatry.2010.66.CrossRefGoogle ScholarPubMed
Seidman, L. J., Shapiro, D. I., Stone, W. S., Woodberry, K. A., Ronzio, A., Cornblatt, B. A., … Woods, S. W. (2016). Association of neurocognition with transition to psychosis: Baseline functioning in the second phase of the north American prodrome longitudinal study. JAMA Psychiatry, 73(12), 1239–1248. doi: 10.1001/jamapsychiatry.2016.2479.CrossRefGoogle ScholarPubMed
Shi, C., He, Y., Cheung, E. F., Yu, X., & Chan, R. C. (2013). An ecologically valid performance-based social functioning assessment battery for schizophrenia. Psychiatry Research, 210(3), 787–793. doi: S0165-1781(13)00613-6 [pii]10.1016/j.psychres.2013.09.023.CrossRefGoogle ScholarPubMed
Solis, M. (2014). Prevention: Before the break. Nature, 508(7494), S12–S13. doi:10.1038/508S12a.CrossRefGoogle ScholarPubMed
Thornton, A. E., Van Snellenberg, J. X., Sepehry, A. A., & Honer, W. (2006). The impact of atypical antipsychotic medications on long-term memory dysfunction in schizophrenia spectrum disorder: A quantitative review. Journal of Psychopharmacology, 20(3), 335–346. doi:10.1177/0269881105057002.CrossRefGoogle ScholarPubMed
Woods, S. W., Breier, A., Zipursky, R. B., Perkins, D. O., Addington, J., Miller, T. J., … McGlashan, T. H. (2003). Randomized trial of olanzapine versus placebo in the symptomatic acute treatment of the schizophrenic prodrome. Biological Psychiatry, 54(4), 453–464.CrossRefGoogle ScholarPubMed
Yung, A. R., Yuen, H. P., McGorry, P. D., Phillips, L. J., Kelly, D., Dell'Olio, M., … Buckby, J. (2005). Mapping the onset of psychosis: The comprehensive assessment of At-risk mental states. Australian & New Zealand Journal of Psychiatry, 39(11–12), 964–971. doi:10.1111/j.1440-1614.2005.01714.x.CrossRefGoogle ScholarPubMed
Zhang, T., Li, H., Tang, Y., Niznikiewicz, M. A., Shenton, M. E., Keshavan, M. S., … Wang, J. (2018). Validating the predictive accuracy of the NAPLS-2 psychosis risk calculator in a clinical high-risk sample from the SHARP (Shanghai at risk for psychosis) program. The American Journal of Psychiatry, 175(9), 906–908. doi: 10.1176/appi.ajp.2018.18010036.CrossRefGoogle Scholar
Zhang, T., Li, H., Woodberry, K. A., Seidman, L. J., Zheng, L., Li, H., … Wang, J. (2014). Prodromal psychosis detection in a counseling center population in China: An epidemiological and clinical study. Schizophrenia Research, 152(2–3), 391–399. doi:10.1016/j.schres.2013.11.039.CrossRefGoogle Scholar
Zhang, T. H., Li, H. J., Woodberry, K. A., Xu, L. H., Tang, Y. Y., Guo, Q., … Wang, J. J. (2017). Two-year follow-up of a Chinese sample at clinical high risk for psychosis: Timeline of symptoms, help-seeking and conversion. Epidemiology and Psychiatric Sciences, 26(3), 287–298. doi:10.1017/S2045796016000184.CrossRefGoogle ScholarPubMed
Zhang, T., Tang, X., Li, H., Woodberry, K. A., Kline, E. R., Xu, L., … Wang, J. (2021). Clinical subtypes that predict conversion to psychosis: A canonical correlation analysis study from the ShangHai At risk for psychosis program. Australian & New Zealand Journal of Psychiatry, 54(1), 23–30. doi:10.1177/0004867419872248.Google Scholar
Zhang, T., Xu, L., Li, H., Woodberry, K. A., Kline, E. R., Jiang, J., … Wang, J. (2019a). Calculating individualized risk components using a mobile app-based risk calculator for clinical high risk of psychosis: Findings from ShangHai At risk for psychosis (SHARP) program. Psychological Medicine. doi: 10.1017/S003329171900360X.Google ScholarPubMed
Zhang, T., Xu, L., Tang, Y., Li, H., Tang, X., Cui, H., … Group, S. S. (2019b). Prediction of psychosis in prodrome: Development and validation of a simple, personalized risk calculator. Psychological Medicine, 49(12), 1990–1998. doi:10.1017/S0033291718002738.CrossRefGoogle ScholarPubMed
Zhang, T., Xu, L., Wei, Y., Tang, X., Hu, Y., Cui, H., … Wang, J. (2020). When to initiate antipsychotic treatment for psychotic symptoms: At the premorbid phase or first episode of psychosis? Australian & New Zealand Journal of Psychiatry. doi: 4867420969810. doi:10.1177/0004867420969810.Google ScholarPubMed
Zheng, L., Wang, J., Zhang, T., Li, H., Li, C., & Jiang, K. (2012). The Chinese version of the SIPS/SOPS: A pilot study of reliability and validity. Chinese Mental Health Journal, 26(8), 571–576.Google Scholar