Introduction Sample enrichment is a key factor in contemporary early-detection strategies aimed at the identification of help-seekers at increased risk of imminent transition to psychosis. We undertook a meta-analytic investigation to ascertain the role of sample enrichment in the recently highlighted negative prognostic effect of baseline antipsychotic (AP) exposure in clinical high-risk (CHR-P) of psychosis individuals. Methods Systematic review and meta-analysis of all published studies on CHR-P were identified according to a validated diagnostic procedure. The outcome was the proportion of transition to psychosis, which was calculated according to the Freeman-Tukey double arcsine transformation. Results Thirty-three eligible studies were identified, including 16 samples with details on AP exposure at baseline and 17 samples with baseline AP exposure as exclusion criterion for enrollment. Those with baseline exposure to AP (n = 395) had higher transition rates (29.9%; 95% CI: 25.1%–34.8%) than those without baseline exposure to AP in the same study (n = 1289; 17.2%; 15.1%–19.4%) and those coming from samples that did not include people who were exposed to AP at baseline (n = 2073; 16.2%; 14.6%–17.8%; P < .05 in both the fixed-effects and the random-effects models). Heterogeneity within studies was substantial, with values above 75% in all comparisons. Conclusions Sample enrichment is not a plausible explanation for the higher risk of transition to psychosis of CHR-P individuals who were already exposed to AP at the enrollment in specialized early-detection programs. Baseline exposure to AP at CHR-P assessment is a major index of enhanced, imminent risk of psychosis.

中文翻译：

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基线抗精神病药物暴露对临床高风险精神病 (CHR-P) 的负面预后影响：测试前风险丰富是隐藏的罪魁祸首吗？

引言 样本富集是当代早期检测策略中的一个关键因素，旨在识别即将转变为精神病的风险增加的求助者。我们进行了一项荟萃分析调查，以确定样本富集在最近强调的基线抗精神病药物 (AP) 暴露对精神病患者临床高危 (CHR-P) 的负面预后影响中的作用。方法 根据经过验证的诊断程序对所有已发表的 CHR-P 研究进行系统评价和荟萃分析。结果是转变为精神病的比例，这是根据 Freeman-Tukey 双反正弦变换计算的。结果 确定了 33 项符合条件的研究，包括 16 个样本在基线 AP 暴露的详细信息和 17 个样本的基线 AP 暴露作为排除标准。在同一研究中，基线暴露于 AP 的人 (n = 395) 的转变率 (29.9%; 95% CI: 25.1%–34.8%) 高于基线暴露于 AP 的人 (n = 1289; 17.2%; 15.1%) –19.4%）和那些来自不包括基线时暴露于 AP 的人的样本（n = 2073；16.2%；14.6%–17.8%；在固定效应和随机效应中 P < .05）效果模型）。研究中的异质性很大，所有比较中的值均高于 75%。结论 样本富集并不是一个合理的解释，即在注册专门的早期检测项目时已经暴露于 AP 的 CHR-P 个体转变为精神病的风险较高。