{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T08:38:48Z","timestamp":1780389528775,"version":"3.54.1"},"reference-count":52,"publisher":"Cambridge University Press (CUP)","issue":"14","license":[{"start":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T00:00:00Z","timestamp":1692748800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0033291723002180_sec_a1\"><jats:title>Background<\/jats:title><jats:p>Emerging meta-analytical evidence indicates that baseline exposure to antipsychotics and to antidepressants in individuals at clinical high-risk for psychosis (CHR-P) have opposite prognostic effects as regards imminent transition to psychosis, with antipsychotics associated with higher risk and antidepressants associated with a lower risk in comparison to not-exposed individuals. Despite their common use, baseline exposure to benzodiazepines (BDZ) in CHR-P has surprisingly received poor attention as a potential risk modulator for transition to psychosis. The current systematic review and meta-analysis were performed to fix such a knowledge gap.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291723002180_sec_a2\" sec-type=\"methods\"><jats:title>Methods<\/jats:title><jats:p>Systematic scrutiny of Medline and Cochrane library, performed up to 31 December 2022, searching for English-language studies on CHR-P reporting numeric data about the sample, the transition outcome at a predefined follow-up time and raw data on BDZ baseline exposure in relation to such outcome.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291723002180_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Of 1893 identified records, five studies were included in the systematic review and meta-analysis. The proportion of participants with exposure to BDZ at baseline ranged from 5.5% (one study) to 46.2%, with an average of 16.8%. At the end of the period of observation, i.e., the follow-up as reported in the study, 28.4% [95% confidence interval (CI) 19.7\u201339.1%] participants developed psychosis among the BDZ-exposed against 9.3% (7.3 to 11.9%) among the controls. CHR-P participants who were already under BDZ treatment at baseline had more than double chance of transition to psychosis than CHR-P participants who were BDZ-na\u00efve. The risk ratio (RR) was 2.42 (95% CI 1.38\u20134.23) in the common effects model (<jats:italic>z<\/jats:italic> = 3.09; <jats:italic>p<\/jats:italic> = 0.002), and 2.40 (1.53 to 3.77) in the random-effects model (z = 5.40; <jats:italic>p<\/jats:italic> = 0.006; tau-squared = 0.0). There was no relevant heterogeneity: Cochran's <jats:italic>Q<\/jats:italic> = 1.49; df = 4; <jats:italic>p<\/jats:italic> = 0.828; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> = 0.0% (95% CI 0.0\u201379%). Quality was good in four studies.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291723002180_sec_a4\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Ongoing BDZ exposure at inception in CHR-P is associated with a higher risk of transition to psychosis at follow up. This meta-analytic association, which echoes a similar effect of baseline antipsychotic exposure, plausibly indicates that the clinicians' prescription of pharmacological intervention captures some form of prognostically-relevant information (e.g. an anxiety permeated mental state requiring BDZ prescription) that are not adequately encompassed by current CHR-P categorical criteria.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0033291723002180","type":"journal-article","created":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T09:39:33Z","timestamp":1692783573000},"page":"6417-6423","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":8,"title":["Baseline benzodiazepine exposure is associated with greater risk of transition in clinical high-risk for psychosis (CHR-P): a meta-analysis"],"prefix":"10.1017","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3709-4111","authenticated-orcid":false,"given":"Andrea","family":"Raballo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3306-8197","authenticated-orcid":false,"given":"Michele","family":"Poletti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9003-9838","authenticated-orcid":false,"given":"Antonio","family":"Preti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2023,8,23]]},"reference":[{"key":"S0033291723002180_ref15","doi-asserted-by":"publisher","DOI":"10.1037\/1082-989X.11.2.193"},{"key":"S0033291723002180_ref14","doi-asserted-by":"publisher","DOI":"10.1037\/1082-989X.3.4.486"},{"key":"S0033291723002180_ref10","doi-asserted-by":"publisher","DOI":"10.1214\/aoms\/1177729756"},{"key":"S0033291723002180_ref47","doi-asserted-by":"publisher","DOI":"10.1126\/science.177.4044.180"},{"key":"S0033291723002180_ref7","doi-asserted-by":"publisher","DOI":"10.1177\/096228029300200202"},{"key":"S0033291723002180_ref40","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4040"},{"key":"S0033291723002180_ref8","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-016-1039-7"},{"key":"S0033291723002180_ref5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"S0033291723002180_ref39","doi-asserted-by":"publisher","DOI":"10.1177\/0269881114541013"},{"key":"S0033291723002180_ref36","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-21416-0"},{"key":"S0033291723002180_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2016.09.002"},{"key":"S0033291723002180_ref45","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v036.i03"},{"key":"S0033291723002180_ref11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1976.tb00065.x"},{"key":"S0033291723002180_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajp.2023.103639"},{"key":"S0033291723002180_ref52","unstructured":"R Core Team (2022). 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