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Paolo Fusar-Poli is a Professor of Preventive Psychiatry at the Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, where he heads the Early Psychosis: Intervention and Clinical-detection Laboratory (EPIC Lab). He is also a consultant psychiatrist in the Outreach And Support In South-London (OASIS) mental health service at the South London and Maudsley NHS Foundation Trust. He has been involved in the External Advisory, DSM-5 and DSM-5TR Psychosis Working Group in 2012 and 2019 respectively. Much of his research utilises evidence-based medicine, clinical prediction, neuroscience and experimental therapeutics and aims to develop new and effective strategies to improve the prevention of mental disorders.

He is author of about 400 publications in PubMed journals, with h-index of 99 (up to 2021), invited speaker and/or chairman in several national and international scientific conferences and principal investigator or co-investigator of national and international grants focused on the prevention of mental disorders. He chairs national and international clinical research networks for the prevention of mental disorders.

Prof Fusar-Poli has been ranked as the number two expert in psychosis in the world in 2019 (top 0.004% out of 49,886 ranked scientists up to 2021).

This lecture will summarise the achievements and challenges of detection, prognosis, prevention of individuals at Clinical High Risk for Psychosis (CHR-P). CHR-P individuals are typically young (mean [SD] age, 20.6 [3.2] years), more frequently male (58%), and predominantly present with attenuated psychotic symptoms lasting for more than 1 year before their presentation at specialized services. CHR-P individuals accumulate several sociodemographic risk factors compared with control participants.

Substance use, comorbid mental disorders, suicidal ideation, and self-harm are also frequently seen in CHR-P individuals. CHR-P individuals show impairments in work (Cohen d = 0.57) or educational functioning (Cohen d = 0.21), social functioning (Cohen d = 1.25), and quality of life (Cohen d = 1.75). Several neurobiological and neurocognitive alterations have been confirmed. The prognostic accuracy of CHR-P instruments is good, provided they are used in clinical samples. Overall, risk of psychosis is 22% at 3 years, and the risk is the highest in the brief and limited intermittent psychotic symptoms subgroup (38%).

Baseline severity of attenuated psychotic (Cohen d = 0.35) and negative symptoms (Cohen d = 0.39) as well as low functioning (Cohen d = 0.29) are associated with an increased risk of psychosis. Controlling risk enrichment and implementing sequential risk assessments can optimize prognostic accuracy. No robust evidence yet exists to favour any indicated intervention over another for preventing psychosis or ameliorating any other outcome in CHR-P individuals. However, because the uncertainty of this evidence is high, needs-based and psychological interventions should still be offered.

As a service to the psychiatric profession, Recordati is pleased to announce its 6th series of webinars for mental health professionals.

This Webinar series has been organised and funded solely by Recordati Pharmaceuticals Limited. 

Please access prescribing information using the links at the end of this message.