Objective

The “At Risk Mental State” (ARMS) approach to psychosis, also called “Clinical/Ultra High Risk,” has had a major impact on psychosis services internationally. Despite well-established developmental differences in the prevalence and expression of psychotic symptoms from childhood into adulthood, there has been no systematic review of psychosis transitions specifically in children and adolescents up to age of 18 years. Evidence for this age group is crucial for developmentally appropriate clinical decisions by child and adolescent psychiatrists.

Method

Systematic review and meta-analysis of psychosis risk among children diagnosed with ARMS up to age 18 years, with pooled transition rates after 1-year, 2-year and ≥5-year follow-up.

Results

We retrieved 1,107 records and identified 16 articles from 9 studies reporting transition rates on 436 individuals with ARMS aged 9 to 18 years. The pooled transition rate to psychosis at 1 year was 9.5% (95% CI = 5.5%-14.2%, 7 studies included), at 2-years 12.1% (95% CI = 6.7%-18.6%, 4 studies included), and at ≥5 years 16.1% (95% CI = 5.6%-30.0%, 4 studies included). We did not find evidence that the diagnosis of ARMS was associated with increased risk of psychosis once risk-enriching recruitment strategies were taken into account.

Conclusion

At 5-year follow-up, 1 in 6 youths diagnosed with an ARMS had transitioned to psychosis, but we did not find evidence that this risk was related to ARMS diagnosis as opposed to sampling/recruitment strategies. Our findings indicate a need for caution in applying ARMS methodology to children and adolescents. and highlight the need for developmentally sensitive approaches when considering psychosis risk.

中文翻译：

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系统评价和荟萃分析：精神状态高危儿童和青少年的精神病风险

客观的

精神病的“处于危险中的精神状态”（ARMS）方法，也称为“临床/超高风险”，对国际上的精神病服务产生了重大影响。尽管从儿童期到成年期精神病症状的患病率和表现存在公认的发育差异，但尚未对 18 岁以下儿童和青少年的精神病转变进行系统评价。该年龄组的证据对于儿童和青少年精神科医生做出适合发育的临床决策至关重要。

方法

对 18 岁以下被诊断为 ARMS 的儿童的精神病风险进行系统回顾和荟萃分析，以及 1 年、2 年和 5 年以上随访后的汇总转变率。

结果

我们检索了 1,107 条记录，并从 9 项研究中确定了 16 篇文章，这些研究报告了 436 名年龄在 9 至 18 岁的 ARMS 患者的过渡率。1 年时向精神病的汇总转变率为 9.5%（95% CI = 5.5%-14.2%，包括 7 项研究），2 年时为 12.1%（95% CI = 6.7%-18.6%，包括 4 项研究）， ≥5 年时为 16.1%（95% CI = 5.6%-30.0%，包括 4 项研究）。一旦考虑到风险丰富的招募策略，我们没有发现证据表明 ARMS 的诊断与精神病风险增加有关。

结论

在 5 年的随访中，每 6 名被诊断患有 ARMS 的年轻人中就有 1 人转变为精神病，但我们没有发现证据表明这种风险与 ARMS 诊断有关，而不是与抽样/招募策略有关。我们的研究结果表明，在将 ARMS 方法应用于儿童和青少年时需要谨慎。并强调在考虑精神病风险时需要对发育敏感的方法。