Early-onset psychosis (EOP) refers to the development of psychosis before the age of 18 years. We aimed to summarize, for the first time, the meta-analytical evidence in the field of this vulnerable population and to provide evidence-based recommendations. We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)–compliant, pre-registered (PROSPERO: CRD42022350868) systematic review of several databases and registers to identify meta-analyses of studies conducted in EOP individuals to conduct an umbrella review. Literature search, screening, data extraction, and quality assessment were carried out independently. Results were narratively reported, clustered across core domains. Quality assessment was performed with the Assessment of Multiple Systematic Reviews–2 (AMSTAR-2) tool. A total of 30 meta-analyses were included (373 individual studies, 25,983 participants, mean age 15.1 years, 38.3% female). Individuals with EOP showed more cognitive impairments compared with controls and individuals with adult/late-onset psychosis. Abnormalities were observed meta-analytically in neuroimaging markers but not in oxidative stress and inflammatory response markers. In all, 60.1% of EOP individuals had a poor prognosis. Clozapine was the antipsychotic with the highest efficacy for overall, positive, and negative symptoms. Tolerance to medication varied among the evaluated antipsychotics. The risk of discontinuation of antipsychotics for any reason or side effects was low or equal compared to placebo. EOP is associated with cognitive impairment, involuntary admissions, and poor prognosis. Antipsychotics can be efficacious in EOP, but tolerability and safety need to be taken into consideration. Clozapine should be considered in EOP individuals who are resistant to 2 non-clozapine antipsychotics. Further meta-analytical research is needed on response to psychological interventions and other prognostic factors. This umbrella review summarized the meta-analytical knowledge from 30 meta-analyses on early-onset psychosis. Early-onset psychosis refers to the development of psychosis before the age of 18 years and is associated with cognitive impairment, hospitalization, and poor prognosis. Individuals with early-onset psychosis show more cognitive impairments and abnormalities compared with controls. Clozapine was the antipsychotic with the highest efficacy for positive, negative, and overall symptoms and should be considered in individuals with early-onset psychosis. Early Onset Psychosis: Umbrella Review on Diagnosis, Prognosis and Treatment factors; ; CRD42022350868.

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伞评论：早发性精神病的荟萃分析证据图谱


早发性精神病（EOP）是指18岁之前出现精神病。我们的目的是首次总结这一弱势群体领域的荟萃分析证据，并提供基于证据的建议。我们对多个数据库和登记册进行了符合系统评价和荟萃分析首选报告项目 (PRISMA) 的预注册 (PROSPERO: CRD42022350868) 系统评价，以确定在 EOP 个体中进行的研究的荟萃分析，以进行总体评价。独立进行文献检索、筛选、数据提取、质量评估。结果以叙述方式报告，集中在核心领域。使用多重系统评价评估–2 (AMSTAR-2) 工具进行质量评估。总共纳入了 30 项荟萃分析（373 项单独研究，25,983 名参与者，平均年龄 15.1 岁，38.3% 为女性）。与对照组和成人/晚发性精神病患者相比，EOP 患者表现出更多的认知障碍。通过荟萃分析，在神经影像标记物中观察到异常，但在氧化应激和炎症反应标记物中未观察到异常。总体而言，60.1% 的 EOP 个体预后较差。氯氮平是对总体症状、阳性症状和阴性症状疗效最高的抗精神病药。所评估的抗精神病药物之间的药物耐受性各不相同。与安慰剂相比，因任何原因或副作用而停用抗精神病药物的风险较低或相同。 EOP 与认知障碍、非自愿入院和预后不良相关。抗精神病药物对 EOP 可能有效，但需要考虑耐受性和安全性。 对 2 种非氯氮平抗精神病药耐药的 EOP 个体应考虑氯氮平。需要对心理干预和其他预后因素的反应进行进一步的荟萃分析研究。这篇总括性综述总结了 30 项早发性精神病荟萃分析的荟萃分析知识。早发性精神病是指18岁之前出现精神病，与认知障碍、住院治疗和预后不良有关。与对照组相比，早发性精神病患者表现出更多的认知障碍和异常。氯氮平是对阳性、阴性和整体症状疗效最高的抗精神病药，对于早发性精神病患者应考虑使用。早发性精神病：诊断、预后和治疗因素的总体回顾； ; CRD42022350868。