Disorder, not just state of risk: meta-analysis of functioning and quality of life in people at high risk of psychosis

Paolo Fusar-Poli; Matteo Rocchetti; Alberto Sardella; Alessia Avila; Martina Brandizzi; Edgardo Caverzasi; Pierluigi Politi; Stephan Ruhrmann; Philip McGuire

doi:10.1192/bjp.bp.114.157115

Disorder, not just state of risk: meta-analysis of functioning and quality of life in people at high risk of psychosis

Br J Psychiatry. 2015 Sep;207(3):198-206. doi: 10.1192/bjp.bp.114.157115.

Authors

Paolo Fusar-Poli¹, Matteo Rocchetti², Alberto Sardella², Alessia Avila², Martina Brandizzi², Edgardo Caverzasi², Pierluigi Politi², Stephan Ruhrmann², Philip McGuire²

Affiliations

¹ Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK paolo.fusar-poli@kcl.ac.uk.
² Paolo Fusar-Poli, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and Outreach and Support in South London (OASIS) prodromal team, South London and the Maudsley National Health Service (NHS) Foundation Trust, London; Matteo Rocchetti, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Alberto Sardella, PsyD, Alessia Avila, PsyD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Martina Brandizzi, MD, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK, and Neurosciences, Mental Health and Sensory Functions Department, Sapienza University of Rome, Rome, Italy; Edgardo Caverzasi, Professor, Pierluigi Politi, Professor, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Stephan Ruhrmann, PhD, Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany; Philip McGuire, Professor, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and OASIS prodromal team, South London and the Maudsley NHS Foundation Trust, London, UK.

PMID: 26329563
DOI: 10.1192/bjp.bp.114.157115

Abstract

Background: The nosology of the psychosis high-risk state is controversial. Traditionally conceived as an 'at risk' state for the development of psychotic disorders, it is also conceptualised as a clinical syndrome associated with functional impairment.

Aims: To investigate meta-analytically the functional status of patients at high clinical risk for psychosis and its association with longitudinal outcomes.

Method: Three meta-analyses compared level of functioning (n = 3012) and quality of life (QoL) (n = 945) between a high-risk group, a healthy control group and group with psychosis, and baseline functioning in people in the high-risk group who did or did not have a transition to psychosis at follow-up (n = 654).

Results: People at high risk had a large impairment in functioning (P<0.001) and worse QoL (P = 0.001) than the healthy control group, but only small to moderately better functioning (P = 0.012) and similar QoL (P = 0.958) compared with the psychosis group. Among the high-risk group, those who did not develop psychosis reported better functioning (P = 0.001) than those who did.

Conclusions: Our results indicate that the high-risk state is characterised by consistent and large impairments of functioning and reduction in QoL similar to those in other coded psychiatric disorders.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review

MeSH terms

Behavior / physiology
Case-Control Studies
Female
Humans
Male
Psychotic Disorders / physiopathology
Psychotic Disorders / psychology*
Quality of Life*
Risk Factors
Young Adult