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Adverse outcome analysis in people at clinical high risk for psychosis: results from a 2-year Italian follow-up study

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Abstract

Purpose

Since January 2016, the Parma Department of Mental Health (in Italy) developed a specialized care program for Early Intervention (EI) in individuals at Clinical High Risk for Psychosis (CHR-P). As unfavorable outcomes other than transition to psychosis were not systematically reported in the current literature (thereby compromising more sophisticated prognostic stratifications), the aims of this research were (1) to investigate adverse outcome indicators (i.e., service disengagement, psychosis transition, hospitalization, prolonged functioning impairment, prolonged persistence of CHR-P criteria, suicide attempts) in an Italian CHR-P population enrolled within a specialized EI service across a 2-year follow-up period, and (2) to examine their relevant associations with sociodemographic and clinical characteristics of the CHR-P total sample at baseline.

Methods

All participants were young CHR-P help-seekers aged 12–25 years. They completed the “Comprehensive Assessment of At-Risk Mental States” (CAARMS) and the Health of the Nation Outcome Scale (HoNOS). Both univariate and multivariate Cox regression analyses were performed.

Results

164 CHR-P individuals were enrolled in this study. Across the follow-up, 30 (18.0%) dropped out the EI program, 23 (14%) transitioned to psychosis, 24 (14.6%) were hospitalized, 23 (14%) had a prolonged persistence of CHR-P criteria and 54 (47%) showed prolonged impairment in socio-occupational functioning.

Conclusion

As almost half of our participants did not functionally remit over time, sustained clinical attention for young CHR individuals people should be offered in the longer term, also to monitor unfavorable outcomes and to improve long-term prognosis.

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Data availability statement

The data that support the findings of this investigation are available on reasonable request from the corresponding author. The data are not publicly available due to privacy/ethical restrictions.

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The PARMS program was partly financed through a special, treatment-oriented regional fund (“Progetto Esordi Psicotici della Regione Emilia Romagna”). For their facilitating technical and administrative support in the PARMS program, the authors gratefully acknowledge the “Early Psychosis Facilitators Group” members (Sabrina Adorni, Andrea Affaticati, Anahi Alzapiedi, Paolo Ampollini, Patrizia Caramanico, Maria Teresa Gaggiotti, Tiziana Guglielmetti, Mauro Mozzani, Matteo Rossi, Lucilla Maglio, Matteo Tonna, Fabio Vanni and Matteo Zito) and the “Quality Staff Group” members (Patrizia Ceroni, Stefano Giovanelli, Leonardo Tadonio) of the Parma Department of Mental Health and Pathological Addictions. The authors also wish to thank all the patients and family members who actively participated to the PARMS program.

Funding

This research received no specific grant from any funding agencies in the public, commercial, or not-for-profit sectors. However, the “Parma At-Risk Mental States” (PARMS) program protocol was partly financed through a special, treatment-oriented regional fund (“Progetto Esordi Psicotici della Regione Emilia Romagna”) from January 2013 to December 2018.

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Authors and Affiliations

  1. Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, PR, Italy

    Lorenzo Pelizza, Emanuela Leuci, Emanuela Quattrone, Giuseppina Paulillo & Pietro Pellegrini

  2. Department of Biomedical and Neuromotor Sciences, Istituto di Psichiatria “Paolo Ottonello”, “Alma Mater Studiorum”-Università di Bologna, Via Pepoli, 5, 40126, Bologna, BO, Italy

    Lorenzo Pelizza & Marco Menchetti

  3. Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, RE, Italy

    Silvia Azzali

  4. Pain Therapy Service, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, PR, Italy

    Simona Pupo

Authors
  1. Lorenzo Pelizza
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  2. Emanuela Leuci
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  3. Emanuela Quattrone
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  4. Silvia Azzali
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  5. Simona Pupo
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  6. Giuseppina Paulillo
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  7. Marco Menchetti
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  8. Pietro Pellegrini
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Contributions

LP and EL: conceptualization and study design; SP: literature search; EL, EQ and SA: data collection and curation; LP: formal analysis; LP: writing—original draft; all authors: writing—review and editing.

Corresponding author

Correspondence to Lorenzo Pelizza.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

Local relevant ethical approvals were obtained for the study (AVEN Ethics Committee protocol n. 559/2020/OSS*/AUSLPR). This research was also conducted according to the Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments including humans.

Consent to participate

All individuals and their parents (if minors) agreed to participate to the research and gave their written informed consent prior to their inclusion in the study.

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Pelizza, L., Leuci, E., Quattrone, E. et al. Adverse outcome analysis in people at clinical high risk for psychosis: results from a 2-year Italian follow-up study. Soc Psychiatry Psychiatr Epidemiol (2023). https://doi.org/10.1007/s00127-023-02597-8

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