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Original Investigation
March 2016

Prognosis of Brief Psychotic EpisodesA Meta-analysis

Author Affiliations
  • 1Department of Psychosis Studies, King’s College London, Institute of Psychiatry, London, England
  • 2OASIS Service, South London and the Maudsley National Health Service Foundation Trust, London, England
  • 3Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
  • 4Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
  • 5Department of Biostatistics, King's College London, Institute of Psychiatry, London, England
  • 6Department of Psychiatry, University of Basel Psychiatric Clinics, Basel, Switzerland
  • 7Department of Clinical Psychology, Chicago School of Professional Psychology, Southern California Campus, Los Angeles, California
  • 8Division of Psychiatry, University of Edinburgh, Edinburgh, Scotland
  • 9Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore
  • 10Veterans Affairs Capitol Health Care Network, Mental Illness Research, Education, and Clinical Center, Veterans Integrated Service Network, Baltimore, Maryland
JAMA Psychiatry. 2016;73(3):211-220. doi:10.1001/jamapsychiatry.2015.2313

Importance  The prognostic significance of competing constructs and operationalizations for brief psychotic episodes (acute and transient psychotic disorder [ATPD], brief psychotic disorder [BPD], brief intermittent psychotic symptoms [BIPS], and brief limited intermittent psychotic symptoms [BLIPS]) is unknown.

Objective  To provide a meta-analytical prognosis of the risk of psychotic recurrence in patients with remitted first-episode ATPD, BPD, BIPS, and BLIPS and in a benchmark group of patients with remitted first-episode schizophrenia (FES). We hypothesized a differential risk: FES > ATPD > BPD > BIPS > BLIPS.

Data Sources  The Web of Knowledge and Scopus databases were searched up to May 18, 2015; the articles identified were reviewed as well as citations of previous publications and results of a manual search of the reference lists of retrieved articles.

Study Selection  We included original articles that reported the risk of psychotic recurrence at follow-up for patients in remission from first-episode ATPD, BPD, BLIPS, BIPS, and FES.

Data Extraction and Synthesis  Independent extraction by multiple observers. Random-effects meta-analysis was performed, and moderators were tested with meta-regression analyses, Bonferroni corrected. Heterogeneity was assessed with the I2 index. Sensitivity analyses tested the robustness of the results. Publication bias was assessed with funnel plots and the Egger test.

Main Outcomes and Measures  Proportion of patients with baseline ATPD, BPD, BLIPS, and BIPS who had any psychotic recurrence at 6, 12, 24, and 36 or more months of follow-up.

Results  Eighty-two independent studies comprising up to 11 133 patients were included. There was no prognostic difference in risk of psychotic recurrence between ATPD, BPD, BLIPS, and BIPS at any follow-up (P > .03). In the long-term analysis, risk of psychotic recurrence (reported as mean [95% CI]) was significantly higher in the FES group (0.78 [0.58-0.93] at 24 months and 0.84 [0.70-0.94] at ≥36 months; P < .02 and P < .001, respectively) compared with the other 4 groups (0.39 [0.32-0.47] at 24 months and 0.51 [0.41-0.61] at ≥36 months). There were no publication biases. Sex and exposure to antipsychotic medication modulated the meta-analytical estimates (.002 < P < .03).

Conclusions and Relevance  There are no prognostic differences in risk of psychotic recurrence between ATPD, BPD, BLIPS, and BIPS constructs of brief psychotic episodes. Conversely, there is consistent meta-analytical evidence for better long-term prognosis of brief psychotic episodes compared with remitted first-episode schizophrenia. These findings should influence the diagnostic practice and clinical services in the management of early psychosis.