Watch this video abstract from Professor Paolo Fusar-Poli, on his JCPP paper on the prevention of psychosis in adolescents.
Paper: ‘Annual Research Review: Prevention of psychosis in adolescents – systematic review and meta-analysis of advances in detection, prognosis and intervention’
Authors: Ana Catalan, Gonzalo Salazar de Pablo, Julio Vaquerizo Serrano, Pierluca Mosillo, Helen Baldwin, Aranzazu Fernández-Rivas, Carmen Moreno, Celso Arango, Christoph U. Correll, Ilaria Bonoldi, Paolo Fusar-Poli
First published: 14 September 2020
Watch it via our YouTube channel or via the embedded video below.
Paolo Fusar-Poli is a Professor of Preventive Psychiatry at the Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London (KCL), where he heads the Early Psychosis: Intervention and Clinical-detection Laboratory (EPIC Lab). He is also a consultant psychiatrist in the Outreach And Support In South-London (OASIS) mental health service at the South London and Maudsley NHS Foundation Trust, one of the oldest and largest preventive services worldwide. Much of his research utilises evidence-based medicine, clinical prediction, neuroscience and experimental therapeutics and aims to develop new and effective strategies to improve the prevention of mental disorders.
He completed his medical studies, psychiatric training, PhD and first consultant job at the University of Pavia, Italy, where he is Associate Professor. During his PhD he moved to the IoPPN: this collaborative relationship has continued ever since.
He is author of about 400 publications in PubMed journals, with h-index of 94 (up to 2021), invited speaker and/or chairman in several national and international scientific conferences and principal investigator or co-investigator of national and international grants focused on the prevention of mental disorders. He chairs national and international clinical research networks for the prevention of mental disorders. (Bio from Kings College London)
Transcript
[00:00:07.415] Professor Paolo Fusar-Poli: Good morning, good afternoon, good evening, depending on where you are in the globe. My name is Paolo Fusar-Poli. I’m a Professor of Preventive Psychiatry at King’s College London and University of Pavia in Italy. With my team and with my colleagues, we have recently published an Annual Research Review in the Journal of Child Psychology and Psychiatry, titled, as you can see here, “Prevention of Psychosis in Adolescents – Systematic Review and Meta-analysis of Advance in Detection, Prognosis and Intervention.” And in this very short video abstract, I’m going today share with you our rationale for the study, our methods, and our core findings, as well as their impact for clinical practice.
So, prevention of psychosis is one of the most promising ways of improving outcomes in young people, in particular the clinical – the so-called clinical high-risk state for psychosis paradigm is a so-called indicated prevention approach for young people at clinical high-risk of developing psychosis. The clinical high-risk paradigm is, essentially, transitional. What does it mean? Basically, it includes both adolescents and young adults, typically aged from 12 to 35 years. And by doing that, it overcomes the arbitrary threshold and split between the children and adult mental health services, clinical research and care, which does not reflect the true neurodevelopmental nature of psychotic disorders.
And the clinical high-risk paradigm has facilitated implementation of psychosis prevention in clinical practice in the NHS, in the UK, in Europe and in the US, Australasia and also, a little bit in the developing countries. However, there is less knowledge specifically looking at the progress in – with respect to detection, prognosis and intervention in under-age participants, because those are more difficult to recruit and therefore, to study.
We, therefore, performed a systematic review of the existing international databases to identify original studies conducting in this patient population and specifically in adolescents with – and cohorts with a mean age less than 18 years. We did not restrict our inclusion criteria to cohorts with all individuals aged less than 18-years-old, because this would have conflicted with the transitional nature of the Preventional Paradigm and also, because then we would have not been able to test the actual impact of the age cutoff at around 18 years.
We then perform a state-of-the-art meta-analysis and also conducted a sensitivity analysis, and we, basically, summarised the available evidence for – with respect to the detection, prognosis and intervention in adolescents at clinical high-risk for psychosis. We found 87 articles relating to about 4,000 adolescents at clinical risk for psychosis, with a mean age of these cohorts of less than 18 years, and these still today represents the largest database and meta-analysis in adolescents at clinical high-risk for psychosis.
With respect to detection, we found that individuals were, on average, aged 15-years-old, mostly males and presenting with attenuated psychotic – positive psychotic symptoms. And we found the detection of these young people improved when family members were involved in the initial assessments. We found, also, that comorbid non-psychotic mental disorders were highly prevalent, in particular mood and anxiety disorders, and these were impacting the functioning of these young people.
With respect to the prognosis, we meta-analytically estimate the cumulative risk of developing a first episode of psychosis from a clinical high-risk stage, which peak to about 30 – to 23% at two years. And importantly, then we ran sensitivity analysis checking whether there were differences between cohorts, enrolling only under aged participants, but we found no substantial differences in transition risks.
With respect to intervention, basically preventive interventions, we found not enough evidence to recommend specific treatments, including cognitive behavioural therapy. This is a hot area. At the moment, there is no strong evidence to favour any preventive interventions over each other. The confidence intervals are quite large, so basically, we do not know which treatment should be preferred and clearly, there is a need for additional research in this field.
Overall, this study provides an updated, comprehensive evidence, which can inform clinical practice with respect to prevention of psychosis in adolescents worldwide. We confirmed that it is definitely possible to detect and formulate – to detecting young people at risk for psychosis and also to formulate, at least a group level prognostication, so at – being at risk or not at risk for developing psychosis in adolescence.
At the same time, we also highlighted that future research, as I said before, is needed to develop and to discover more effective preventive treatment. Some large-scale randomised controlled trials are undergoing. Hence, we hope that it will soon deliver the much needed preventive intervention for this vulnerable group.
Thank you very much for your attention. I hope you can enjoy and read this paper. Thank you very much. Goodbye.
