title: Cardiometabolic risk factors in young people at ultra-high risk for psychosis: A systematic review and meta-analysis.
abstract: BACKGROUND
  The physical health of people with schizophrenia is poor, and associated with increased morbidity and mortality. Unhealthy lifestyles and side-effects of antipsychotic medication contribute to cardiometabolic dysfunction. Yet it is unclear when this unhealthy profile starts. We aimed to see if people at ultra-high risk for psychosis (UHR) have increased rates of cardiometabolic risk factors.
  
  
  METHODS
  An electronic search of MEDLINE, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials was conducted on 1st May 2015 using terms associated with the ultra-high risk state and health. Eligible studies were peer-reviewed English language research articles with populations that met at-risk diagnostic criteria and reported cardiometabolic risk factors. A meta-analysis was conducted on smoking data, the cardiometabolic risk factor that yielded the most studies.
  
  
  RESULTS
  Forty-seven eligible studies were identified. UHR samples had low levels of physical activity, and high rates of smoking and alcohol abuse compared with controls. No differences were found for body mass index. An overall pooled rate of smoking for UHR participants was 33% (95% CI=0.24-0.42) and significantly more UHR individuals smoked compared with controls with a pooled odds ratio of 2.3 (P<0.05; 95% CI=-1.48-3.48).
  
  
  CONCLUSIONS
  UHR samples display cardiometabolic risk factors which are largely modifiable. The UHR phase is an important opportunity for early intervention services to improve physical health.
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, M13 9PL, UK. Electronic address: rebekah.carney@postgrad.manchester.ac.uk.
authors.forename: Rebekah
authors.initials: R
authors.lastname: Carney
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, M13 9PL, UK.
authors.forename: Jack
authors.initials: J
authors.lastname: Cotter
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, M13 9PL, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Bradshaw
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, M13 9PL, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Firth
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, M13 9PL, UK.
authors.forename: Alison R
authors.initials: AR
authors.lastname: Yung
mesh_terms: D018849:Controlled Clinical Trials as Topic; D006331:Heart Diseases / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008659:Metabolic Diseases / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D062706:Prodromal Symptoms; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000503:physiopathology; D012306:Risk
keywords: At-risk mental state; Cardiometabolic; Clinical high risk; Risk factors; Smoking; Ultra high risk