title: Deconstructing vulnerability for psychosis: Meta-analysis of environmental risk factors for psychosis in subjects at ultra high-risk.
abstract: Subjects at ultra high-risk (UHR) for psychosis have an enhanced vulnerability to develop the disorder but the risk factors accounting for this accrued risk are undetermined.
  
  
  
  Systematic review of associations between genetic or environmental risk factors for psychosis that are widely established in the literature and UHR state, based on comparisons to controls.
  
  
  
  Forty-four studies encompassing 170 independent datasets and 54 risk factors were included. There were no studies on association between genetic or epigenetic risk factors and the UHR state that met the inclusion criteria. UHR subjects were more likely to show obstetric complications, tobacco use, physical inactivity, childhood trauma/emotional abuse/physical neglect, high perceived stress, childhood and adolescent low functioning, affective comorbidities, male gender, single status, unemployment and low educational level as compared to controls.
  
  
  
  The increased vulnerability of UHR subjects can be related to environmental risk factors like childhood trauma, adverse life events and affective dysfunction. The role of genetic and epigenetic risk factors awaits clarification.
authors.affiliation: King'sCollege London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; OASIS service, South London and the Maudsley NHS Foundation Trust, London, United Kingdom. Electronic address: p.fusar@libero.it.
authors.forename: P
authors.initials: P
authors.lastname: Fusar-Poli
authors.affiliation: Brain and Behaviour Department, University of Pavia, Pavia, Italy; Department of Child Neurology and Psychiatry, C. Mondino National Institute of Neurology, Pavia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Tantardini
authors.affiliation: Department of Psychiatry, University of Naples SUN, Naples, Italy.
authors.forename: S
authors.initials: S
authors.lastname: De Simone
authors.affiliation: King'sCollege London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; Department of neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Ramella-Cravaro
authors.affiliation: King'sCollege London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Oliver
authors.affiliation: King'sCollege London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Kingdon
authors.affiliation: Medical University of Lodz, Department of Affective and Psychotic Disorders, Lodz, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Kotlicka-Antczak
authors.affiliation: King'sCollege London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Valmaggia
authors.affiliation: Department of General Psychiatry, Institute of Mental Health, Singapore, Singapore.
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.affiliation: Institut de Recherche (IDR) Servier, Pole for Innovation in Neuropsychiatry, Croissy-sur-Seine, France.
authors.forename: M J
authors.initials: MJ
authors.lastname: Millan
authors.affiliation: Department of Psychiatry, University of Naples SUN, Naples, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Galderisi
authors.affiliation: Brain and Behaviour Department, University of Pavia, Pavia, Italy; Department of Child Neurology and Psychiatry, C. Mondino National Institute of Neurology, Pavia, Italy.
authors.forename: U
authors.initials: U
authors.lastname: Balottin
authors.affiliation: Department of neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Ricca
authors.affiliation: King'sCollege London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: McGuire
mesh_terms: D000293:Adolescent; D004777:Environment; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000523:psychology*; D012307:Risk Factors; D012917:Social Adjustment; D012931:Social Environment
keywords: ARMS; Meta-analysis; Prevention; Psychosis; Schizophrenia; UHR