Negative symptoms in children and adolescents with early-onset psychosis and at clinical high-risk for psychosis: systematic review and meta-analysis

Gonzalo Salazar de Pablo; Ana Catalan; Julio Vaquerizo Serrano; Borja Pedruzo; Luis Alameda; Veronica Sandroni; Alvaro Armendariz; Victoria Rodriguez; Celso Arango; Carmen Moreno; Johnny Downs; Chris Abbott; Jae Il Shin; Marco Solmi; Paolo Fusar-Poli; Christoph U Correll

doi:10.1192/bjp.2022.203

Negative symptoms in children and adolescents with early-onset psychosis and at clinical high-risk for psychosis: systematic review and meta-analysis

Br J Psychiatry. 2023 Jul;223(1):282-294. doi: 10.1192/bjp.2022.203.

Authors

Gonzalo Salazar de Pablo¹, Ana Catalan², Julio Vaquerizo Serrano³, Borja Pedruzo⁴, Luis Alameda⁵, Veronica Sandroni⁶, Alvaro Armendariz⁷, Victoria Rodriguez⁸, Celso Arango⁹, Carmen Moreno⁹, Johnny Downs³, Chris Abbott¹⁰, Jae Il Shin¹¹, Marco Solmi¹², Paolo Fusar-Poli¹³, Christoph U Correll¹⁴

Affiliations

¹ Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK; and Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain.
² Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; and Mental Health Department, Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Facultad de Medicina y Odontología, Campus de Leioa, University of the Basque Country, UPV/EHU, Vizcaya, Spain.
³ Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
⁴ Department of Psychiatry, Basurto University Hospital, Bilbao, Spain.
⁵ Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program, University Hospital (CHUV), Lausanne, Switzerland; and Centro Investigacion Biomedica en Red de Salud Mental (CIBERSAM), Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio, Departamento de Psiquiatria, Universidad de Sevilla, Sevilla, Spain.
⁶ Department of Psychiatry, Faculty of Medicine, Université Paris Cité, Paris, France; and Department of Psychiatry, Groupe Hospitalier Paul Guiraud, Villejuif, France.
⁷ Department of Psychiatry and Psychology, Hospital Sant Joan de Déu de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
⁸ Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
⁹ Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain.
¹⁰ Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK.
¹¹ Department of Paediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
¹² Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada; and Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
¹³ Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; OASIS service, South London and Maudsley NHS Foundation Trust, London, UK; and National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK.
¹⁴ Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/ Northwell, Hempstead, New York, USA; and Center for Psychiatric Neuroscience, The Feinstein Institutes for Medical Research, Manhasset, New York, USA.

Abstract

Background: Early-onset psychosis (EOP) refers to the development of a first episode of psychosis before 18 years of age. Individuals at clinical high risk for psychosis (CHR-P) include adolescents and young adults, although most evidence has focused on adults. Negative symptoms are important prognostic indicators in psychosis. However, research focusing on children and adolescents is limited.

Aims: To provide meta-analytical evidence and a comprehensive review of the status and advances in the diagnosis, prognosis and treatment of negative symptoms in children and adolescents with EOP and at CHR-P.

Method: PRISMA/MOOSE-compliant systematic review (PROSPERO: CRD42022360925) from inception to 18 August 2022, in any language, to identify individual studies conducted in EOP/CHR-P children and adolescents (mean age <18 years) providing findings on negative symptoms. Findings were systematically appraised. Random-effects meta-analyses were performed on the prevalence of negative symptoms, carrying out sensitivity analyses, heterogeneity analyses, publication bias assessment and quality assessment using the Newcastle-Ottawa Scale.

Results: Of 3289 articles, 133 were included (n = 6776 EOP, mean age 15.3 years (s.d. = 1.6), males = 56.1%; n = 2138 CHR-P, mean age 16.1 years (s.d. = 1.0), males = 48.6%). There were negative symptoms in 60.8% (95% CI 46.4%-75.2%) of the children and adolescents with EOP and 79.6% (95% CI 66.3-92.9%) of those at CHR-P. Prevalence and severity of negative symptoms were associated with poor clinical, functional and intervention outcomes in both groups. Different interventions were piloted, with variable results requiring further replication.

Conclusions: Negative symptoms are common in children and adolescents at early stages of psychosis, particularly in those at CHR-P, and are associated with poor outcomes. Future intervention research is required so that evidence-based treatments will become available.

Keywords: Early-onset psychosis; clinical high risk of psychosis; meta-analysis; prevention; psychotic disorders.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Child
Humans
Male
Prognosis
Psychotic Disorders* / diagnosis
Psychotic Disorders* / epidemiology
Psychotic Disorders* / therapy