Background and Hypothesis Antipsychotic (AP) prescription in clinical high risk for psychosis (CHR-P) subjects remains a divisive issue. Although official guidelines currently discourage AP treatment in CHR-P, it is common in clinical practice, especially for psychosis prevention. The aim of this study was to investigate whether baseline AP need (especially in high-dose) indexes a CHR-P subgroup with poorer prognosis and differs from AP-naïve subjects in terms of sociodemographic, clinical, and outcome parameters across a 2-year follow-up. Study Design CHR-P participants were treated within an “Early Intervention in Psychosis” program and completed the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale both at baseline and every 12 months. Individuals with baseline AP prescription were included in the high-dose or low-dose CHR-P-AP+ subgroup. The others were grouped as AP-naïve. Cox regression analyses and mixed-design ANOVA were performed. Study Results 180 CHR-P individuals were enrolled (32 high-dose, 60 low-dose, and 88 AP-naïve). Compared to AP-naive, CHR-P AP+ subgroups showed older age and more severe clinical presentation. High-dose subgroup also had grater functioning decline at entry and poorer functional recovery at follow-up. No inter-group differences in psychosis transition and symptomatic remission were found. Significant improvement in clinical outcomes were found over time in all subgroups. Baseline AP prescription was specifically associated with a more relevant improvement in PANSS total score, and in negative and disorganized symptoms. Conclusions Our results suggest that baseline AP need is an important prognostic parameter in CHR-P and should be considered in risk/benefit calculators.

中文翻译：

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基于基线抗精神病药物暴露的精神病临床高风险亚组：2 年随访期间的临床和结果比较


背景和假设临床高危精神病（CHR-P）受试者的抗精神病（AP）处方仍然是一个有争议的问题。尽管官方指南目前不鼓励 CHR-P 患者接受 AP 治疗，但在临床实践中很常见，尤其是在精神病预防方面。本研究的目的是调查基线 AP 需求（尤其是高剂量）是否表明 CHR-P 亚组预后较差，并且在 2 年的社会人口统计学、临床和结果参数方面与未接受过 AP 的受试者存在差异后续行动。研究设计 CHR-P 参与者接受“精神病早期干预”计划的治疗，并在基线和每 12 个月完成阳性和阴性综合征量表 (PANSS) 和整体功能评估 (GAF) 量表。具有基线 AP 处方的个体被纳入高剂量或低剂量 CHR-P-AP+ 亚组。其他人则被归为未接触过 AP 的人。进行了 Cox 回归分析和混合设计方差分析。研究结果 招募了 180 名 CHR-P 个体（32 名高剂量患者、60 名低剂量患者和 88 名未接受过 AP 治疗的患者）。与未经 AP 治疗的患者相比，CHR-P AP+ 亚组的年龄更大，临床表现更严重。高剂量亚组在进入时的功能下降也更大，随访时的功能恢复也更差。在精神病转变和症状缓解方面没有发现组间差异。随着时间的推移，所有亚组的临床结果均出现显着改善。基线 AP 处方与 PANSS 总分以及阴性和紊乱症状的更相关改善特别相关。结论 我们的结果表明，基线 AP 需求是 CHR-P 的重要预后参数，应在风险/效益计算器中考虑。