干旱区生态环境知识资源中心(Arid): Real-world long-term outcomes in individuals at clinical risk for psychosis: The case for extending duration of care

Arid

DOI	10.1016/j.eclinm.2020.100578
	Real-world long-term outcomes in individuals at clinical risk for psychosis: The case for extending duration of care
	Fusar-Poli, Paolo; De Micheli, Andrea; Signorini, Lorenzo; Baldwin, Helen; de Pablo, Gonzalo Salazar; McGuire, Philip
通讯作者	Fusar-Poli, P (corresponding author), Kings Coll London, Inst Psychiat Psychol & Neurosci, Dept Psychosis Studies, Early Psychosis Intervent & Clin Detect EPIC Lab, 5th Floor,PO63,16 De Crespigny Pk, London SE5 8AF, England.
来源期刊	ECLINICALMEDICINE
EISSN	2589-5370
出版年	2020
卷号	28
英文摘要	Background: Most services for individuals at Clinical High Risk for Psychosis (CHR-P) provide short-term clinical care. This study determines the real-world and long-term clinical outcomes beyond transition to psychosis in a large cohort of CHR-P individuals. Method: Retrospective RECORD-compliant real-world Electronic Health Records (EHR) cohort study in secondary mental health care (the South London and the Maudsley -SLaM- NHS Foundation Trust). All CHR-P patients accessing the CHR-P service at SLaM in the period 2001-2018 were included. Main outcomes were long-term cumulative risk of first: (i) developing an ICD-10 psychotic disorder (primary outcome), receiving a treatment with (iia) antipsychotic medication, (iib) benzodiazepines, (iic) other psychotropic medications, (iid) psychotherapy, receiving an (iiia) informal or (iiib) compulsory admission into a mental health hospital, and the time to these events; (iiic) number of days spent in hospital and (iv) cumulative risk of death for any reason and age/gender Standardised Mortality Ratio (SMR). Data were extracted from the EHR and analysed with Kaplan Meier failure functions, Cox and zero-inflated negative binomial regressions. Findings: 600 CHR-P patients (80.43% Attenuated Psychotic Symptoms, APS; 18.06%, Brief and Limited Intermittent Psychotic Symptoms, BLIPS, 1.51% Genetic Risk and Deterioration Syndrome) were included (mean age 22.63 years, range 13-36; 55.33% males; 46.44% white, mean duration of untreated attenuated psychotic symptoms 676.32 days, 1105.40 SD). The cumulative risk to first psychosis was 0.365 (95%CI 0.302-0.437) at 11 years; first antipsychotic 0.777 (95%CI 0.702-0.844) at 9 years; first benzodiazepine 0.259 (95%CI 0.183-0.359) at 12 years; first other types of medications 0.630 (95%CI 0.538-0.772) at 9 years; first psychotherapy 0.814 (95%CI 0.764-0.859) at 9 years; first informal admission 0.378 (95%CI 0.249-0.546) at 12 years; first compulsory admission 0.251 (95%CI 0.175-0.352) at 12 years; those admitted spent on average 94.84 (SD=169.94) days in hospital; the cumulative risk of death for any reason was 0.036 (95%CI 0.012-0.103) at 9 years, with an SMR of 3.9 (95%CI 1.20-6.6). Compared to APS, BLIPS had a higher risk of developing psychosis, being admitted compulsorily into hospital, receiving antipsychotics and benzodiazepines and lower probability of receiving psychotherapy. Other prognostic factors of long-term outcomes included age, symptoms severity, duration of untreated attenuated psychotic symptoms, ethnicity and employment status. Interpretation: Duration of care provided by CHR-P services should be expanded to address long-term real-world outcomes. (C) 2020 The Author(s). Published by Elsevier Ltd.
英文关键词	Psychosis Prevention Schizophrenia Clinical high risk Long-term outcome Real-world Electronic health record
类型	Article
语种	英语
开放获取类型	gold, Green Published
收录类别	SCI-E ; SSCI
WOS记录号	WOS:000645903100008
WOS关键词	ULTRA-HIGH RISK ; PREDICTION ; STATE ; METAANALYSIS ; PEOPLE ; INTERVENTIONS ; TRANSITION ; VALIDITY ; OASIS ; ONSET
WOS类目	Medicine, General & Internal
WOS研究方向	General & Internal Medicine
来源机构	University of London
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/348812
作者单位	[Fusar-Poli, Paolo; De Micheli, Andrea; Signorini, Lorenzo; Baldwin, Helen; de Pablo, Gonzalo Salazar] Kings Coll London, Inst Psychiat Psychol & Neurosci, Dept Psychosis Studies, Early Psychosis Intervent & Clin Detect EPIC Lab, 5th Floor,PO63,16 De Crespigny Pk, London SE5 8AF, England; [Fusar-Poli, Paolo; De Micheli, Andrea; McGuire, Philip] South London & Maudsley NHS Fdn Trust, OASIS Serv, London, England; [Fusar-Poli, Paolo] Univ Pavia, Dept Brain & Behav Sci, Pavia, Italy; [Fusar-Poli, Paolo; Baldwin, Helen; McGuire, Philip] South London & Maudsley NHS Fdn Trust, Maudsley Biomed Res Ctr, Natl Inst Hlth Res, London, England; [de Pablo, Gonzalo Salazar] Univ Complutense, Inst Invest Sanitaria Gregorio Maranon IiSGM, CIBERSAM,Dept Child & Adolescent Psychiat, Hosp Gen Univ Gregorio Maranon,Sch Med,Inst Psych, Madrid, Spain; [McGuire, Philip] Kings Coll London, Inst Psychiat Psychol & Neurosci, Dept Psychosis Studies, London, England
推荐引用方式 GB/T 7714	Fusar-Poli, Paolo,De Micheli, Andrea,Signorini, Lorenzo,et al. Real-world long-term outcomes in individuals at clinical risk for psychosis: The case for extending duration of care[J]. University of London,2020,28.
APA	Fusar-Poli, Paolo,De Micheli, Andrea,Signorini, Lorenzo,Baldwin, Helen,de Pablo, Gonzalo Salazar,&McGuire, Philip.(2020).Real-world long-term outcomes in individuals at clinical risk for psychosis: The case for extending duration of care.ECLINICALMEDICINE,28.
MLA	Fusar-Poli, Paolo,et al."Real-world long-term outcomes in individuals at clinical risk for psychosis: The case for extending duration of care".ECLINICALMEDICINE 28(2020).