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- Title
Prognosis of Brief Psychotic Episodes: A Meta-analysis.
- Authors
Fusar-Poli, Paolo; Cappucciati, Marco; Bonoldi, Ilaria; Christy Hui, L. M.; Rutigliano, Grazia; Stahl, Daniel R.; Borgwardt, Stefan; Politi, Pierluigi; Mishara, Aaron L.; Lawrie, Stephen M.; Carpenter Jr, William T.; McGuire, Philip K.; Hui, L M Christy; Carpenter, William T Jr
- Abstract
<bold>Importance: </bold>The prognostic significance of competing constructs and operationalizations for brief psychotic episodes (acute and transient psychotic disorder [ATPD], brief psychotic disorder [BPD], brief intermittent psychotic symptoms [BIPS], and brief limited intermittent psychotic symptoms [BLIPS]) is unknown.<bold>Objective: </bold>To provide a meta-analytical prognosis of the risk of psychotic recurrence in patients with remitted first-episode ATPD, BPD, BIPS, and BLIPS and in a benchmark group of patients with remitted first-episode schizophrenia (FES). We hypothesized a differential risk: FES > ATPD > BPD > BIPS > BLIPS.<bold>Data Sources: </bold>The Web of Knowledge and Scopus databases were searched up to May 18, 2015; the articles identified were reviewed as well as citations of previous publications and results of a manual search of the reference lists of retrieved articles.<bold>Study Selection: </bold>We included original articles that reported the risk of psychotic recurrence at follow-up for patients in remission from first-episode ATPD, BPD, BLIPS, BIPS, and FES.<bold>Data Extraction and Synthesis: </bold>Independent extraction by multiple observers. Random-effects meta-analysis was performed, and moderators were tested with meta-regression analyses, Bonferroni corrected. Heterogeneity was assessed with the I2 index. Sensitivity analyses tested the robustness of the results. Publication bias was assessed with funnel plots and the Egger test.<bold>Main Outcomes and Measures: </bold>Proportion of patients with baseline ATPD, BPD, BLIPS, and BIPS who had any psychotic recurrence at 6, 12, 24, and 36 or more months of follow-up.<bold>Results: </bold>Eighty-two independent studies comprising up to 11,133 patients were included. There was no prognostic difference in risk of psychotic recurrence between ATPD, BPD, BLIPS, and BIPS at any follow-up (P > .03). In the long-term analysis, risk of psychotic recurrence (reported as mean [95% CI]) was significantly higher in the FES group (0.78 [0.58-0.93] at 24 months and 0.84 [0.70-0.94] at ≥ 36 months; P < .02 and P < .001, respectively) compared with the other 4 groups (0.39 [0.32-0.47] at 24 months and 0.51 [0.41-0.61] at ≥ 36 months). There were no publication biases. Sex and exposure to antipsychotic medication modulated the meta-analytical estimates (.002 < P < .03).<bold>Conclusions and Relevance: </bold>There are no prognostic differences in risk of psychotic recurrence between ATPD, BPD, BLIPS, and BIPS constructs of brief psychotic episodes. Conversely, there is consistent meta-analytical evidence for better long-term prognosis of brief psychotic episodes compared with remitted first-episode schizophrenia. These findings should influence the diagnostic practice and clinical services in the management of early psychosis.
- Subjects
PSYCHOSES; SYMPTOMS; META-analysis; DISEASE relapse; SCHIZOPHRENIA; DRUG therapy for psychoses; DRUG therapy for schizophrenia; DIAGNOSIS of schizophrenia; COMPARATIVE studies; DIFFERENTIAL diagnosis; RESEARCH methodology; MEDICAL cooperation; PROGNOSIS; PSYCHOLOGY; RESEARCH; SYSTEMATIC reviews; EVALUATION research; PREDICTIVE tests; ACUTE diseases; PSYCHOLOGICAL factors; DIAGNOSIS
- Publication
JAMA Psychiatry, 2016, Vol 73, Issue 3, p211
- ISSN
2168-622X
- Publication type
journal article
- DOI
10.1001/jamapsychiatry.2015.2313