title: Prognosis of Brief Psychotic Episodes: A Meta-analysis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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
  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.
authors.affiliation: Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, England2OASIS Service, South London and the Maudsley National Health Service Foundation Trust, London, England3Department of Brain and Behavioral Sciences, University.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fusar-Poli
authors.affiliation: Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, England3Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cappucciati
authors.affiliation: Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, England3Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Bonoldi
authors.affiliation: Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China.
authors.forename: L M Christy
authors.initials: LM
authors.lastname: Hui
authors.affiliation: Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, England.
authors.forename: Grazia
authors.initials: G
authors.lastname: Rutigliano
authors.affiliation: Department of Biostatistics, King's College London, Institute of Psychiatry, London, England.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Stahl
authors.affiliation: Department of Psychiatry, University of Basel Psychiatric Clinics, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Borgwardt
authors.affiliation: Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Politi
authors.affiliation: Department of Clinical Psychology, Chicago School of Professional Psychology, Southern California Campus, Los Angeles, California.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Mishara
authors.affiliation: Division of Psychiatry, University of Edinburgh, Edinburgh, Scotland.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Lawrie
authors.affiliation: Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore10Veterans Affairs Capitol Health Care Network, Mental Illness Research, Education, and Clinical Center, Veterans Integrated Service Network, Baltimore, Maryland.
authors.forename: William T
authors.initials: WT
authors.lastname: Carpenter
authors.affiliation: Department of Psychosis Studies, King's College London, Institute of Psychiatry, London, England.
authors.forename: Philip K
authors.initials: PK
authors.lastname: McGuire
mesh_terms: D000208:Acute Disease; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D012008:Recurrence; D012559:Schizophrenia / Q000175:diagnosis* / Q000188:drug therapy; D012565:Schizophrenic Psychology