Baseline antipsychotic prescription and short‐term outcome indicators in individuals at clinical high‐risk for psychosis: Findings from the Parma At‐Risk Mental States (PARMS) program

Abstract

AbstractAimThe prognostic prediction of outcomes in individuals at clinical high‐risk for psychosis (CHR‐P) is still a significant clinical challenge. Among multiple baseline variables of risk calculator models, the role of ongoing pharmacological medications has been partially neglected, despite meta‐analytical evidence of higher risk of psychosis transition associated with baseline prescription exposure to antipsychotics (AP) in CHR‐P individuals. The main aim of the current study was to test the hypothesis that ongoing AP need at baseline indexes a subgroup of CHR‐P individuals with more severe psychopathology and worse prognostic trajectories along a 1‐year follow‐up period.MethodsThis research was settled within the ‘Parma At‐Risk Mental States’ program. Baseline and 1‐year follow‐up assessment included the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). CHR‐P individuals who were taking AP medications at entry were included in the CHR‐P‐AP+ subgroup. The remaining participants were grouped as CHR‐P‐AP‐.ResultsHundred and seventy‐eight CHR‐P individuals (aged 12–25 years) were enrolled (91 CHR‐P‐AP+, 87 CHR‐P‐AP‐). Compared to CHR‐P AP‐, CHR‐P AP+ individuals had older age, greater baseline PANSS ‘Positive Symptoms’ and ‘Negative Symptoms’ factor subscores and a lower GAF score. At the end of our follow‐up, CHR‐P‐AP+ subjects showed higher rates of psychosis transition, new hospitalizations and urgent/non‐planned visits compared to CHRP‐ AP‐ individuals.ConclusionsIn agreement with increasing empirical evidence, also the results of the current study suggest that AP need is a significant prognostic variable in cohorts of CHR‐P individuals and should be included in risk calculators.