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Meta-analysis shows no prognostic differences in psychosis recurrence among brief psychotic episode types

There were no prognostic differences in risk for psychotic recurrence between individuals with acute and transient psychotic disorder, brief psychotic disorder, brief intermittent psychotic symptoms, or brief limited intermittent psychotic symptoms, according to a meta-analysis.

To establish a prognosis of risk for psychotic recurrence in individuals with remitted first-episode acute and transient psychotic disorder, brief psychotic disorder, brief intermittent psychotic symptoms, and brief limited intermittent psychotic symptoms and those with remitted first-episode schizophrenia, Paolo Fusar-Poli, MD, PhD, of King’s College London, Institute of Psychiatry, and colleagues conducted a meta-analysis of 82 studies across 11,133 patients.

There was no prognostic difference in risk for psychotic recurrence between individuals with acute and transient psychotic disorder, brief psychotic disorder, brief intermittent psychotic symptoms, or brief limited intermittent psychotic symptoms at any follow-up (P > .03).

In long-term analysis, risk for psychotic recurrence was significantly higher among individuals with remitted first-episode schizophrenia at 24 months (P < .02) and at 36 months and later (P <.001), compared with individuals with acute and transient psychotic disorder, brief psychotic disorder, brief intermittent psychotic symptoms, or brief limited intermittent psychotic symptoms.

Sex and exposure to antipsychotics significantly modulated meta-analytical estimates.

“Retrospective analyses like the study of Fusar-Poli also have the major limitation that only psychotic and schizophrenia outcomes have been considered,” Patrick McGorry, MD, PhD, FRCP, FRANZCP, and Barnaby Nelson, PhD, of the University of Melbourne, Australia, wrote in an accompanying editorial. “Like the original Ultra-High Risk/At-Risk Mental State studies, decisions on new criteria can only be soundly based on prospective studies conducted from a transdiagnostic perspective, where a range of phenotypic and functional outcomes are examined. Where to precisely draw the boundaries for stages to guide treatment changes may depend on linking psychopathological, psychological, and neurobiological mechanisms.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.