Twenty percent of individuals at clinical high risk for psychosis (CHR-P) develop the disorder within 2 years. Extensive research has explored the factors that differentiate those who develop psychosis and those who do not, but the results are conflicting. The current systematic review and meta-analysis comprehensively addresses the consistency and magnitude of evidence for non-purely genetic risk and protective factors associated with the risk of developing psychosis in CHR-P individuals. Random effects meta-analyses, standardized mean difference (SMD) and odds ratio (OR) were used, in combination with an established stratification of evidence that assesses the association of each factor and the onset of psychotic disorders (from class I, convincing evidence to class IV weak evidence), while controlling for several types of biases. A total of 128 original controlled studies relating to 26 factors were retrieved. No factors showed class I-convincing evidence. Two further factors were associated with class II-highly suggestive evidence: attenuated positive psychotic symptoms (SMD = 0.348, 95% CI: 0.280, 0.415) and global functioning (SMD = -0.291, 95% CI: -0.370, -0.211). There was class III-suggestive evidence for negative psychotic symptoms (SMD = 0.393, 95% CI: 0.317, 0.469). There was either class IV-weak or no evidence for all other factors. Our findings suggest that despite the large number of putative risk factors investigated in the literature, only attenuated positive psychotic symptoms, global functioning, and negative psychotic symptoms show suggestive evidence or greater for association with transition to psychosis. The current findings may inform the refinement of clinical prediction models and precision medicine in this field.

中文翻译：

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是什么导致临床高危人群精神病发作？风险和保护因素的荟萃分析。

临床上有精神病高风险（CHR-P）的个体中有20％在2年内发展为该疾病。广泛的研究已经探究了导致精神病的人和没有精神病的人的区别因素，但是结果是矛盾的。当前的系统评价和荟萃分析全面地解决了CHR-P个体非纯遗传风险和与患精神病风险相关的保护因素的证据的一致性和重要性。使用随机效应荟萃分析，标准化均值差（SMD）和优势比（OR），并结合已建立的证据分层，评估每种因素与精神病发作之间的关系（从I类，令人信服的证据IV类弱证据），同时控制几种类型的偏见。共检索到涉及26个因素的128项原始对照研究。没有任何因素显示出令人信服的I类证据。与II类高度提示证据相关的另外两个因素是：精神病性阳性症状减弱（SMD = 0.348，95％CI：0.280，0.415）和整体功能（SMD = -0.291，95％CI：-0.370，-0.211）。有III级暗示性精神病症状的证据（SMD = 0.393，95％CI：0.317，0.469）。没有IV级弱点或没有其他所有因素的证据。我们的发现表明，尽管文献中调查了许多假定的危险因素，但只有减轻的阳性精神病症状，整体功能和阴性精神病症状显示出暗示性证据或与过渡到精神病的关联更大。