Development and validation of a non-remission risk prediction model in first episode psychosis: an analysis of two longitudinal studies

Leighton, S. P. et al. (2021) Development and validation of a non-remission risk prediction model in first episode psychosis: an analysis of two longitudinal studies. Schizophrenia Bulletin Open, 2(1), sgab041. (doi: 10.1093/schizbullopen/sgab041) (PMID:34568827) (PMCID:PMC8458108)

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Psychosis is a major mental illness with first onset in young adults. The prognosis is poor in around half of the people affected, and difficult to predict. The few tools available to predict prognosis have major weaknesses which limit their use in clinical practice. We aimed to develop and validate a risk prediction model of symptom non-remission in first-episode psychosis. Our development cohort consisted of 1027 patients with first-episode psychosis recruited between 2005 to 2010 from 14 early intervention services across the National Health Service in England. Our validation cohort consisted of 399 patients with first-episode psychosis recruited between 2006 to 2009 from a further 11 English early intervention services. The one-year non-remission rate was 52% and 54% in the development and validation cohorts, respectively. Multivariable logistic regression was used to develop a risk prediction model for non-remission, which was externally validated. The prediction model showed good discrimination (C-statistic of 0.73 (0.71, 0.75) and adequate calibration with intercept alpha of 0.12 (0.02, 0.22) and slope beta of 0.98 (0.85, 1.11). Our model improved the net-benefit by 15% at a risk threshold of 50% compared to the strategy of treating all, equivalent to 15 more detected non-remitted first-episode psychosis individuals per 100 without incorrectly classifying remitted cases. Once prospectively validated, our first episode psychosis prediction model could help identify patients at increased risk of non-remission at initial clinical contact.

Item Type:Articles
Additional Information:This work was supported by the following funders. NEDEN was funded by the UK Department of Health (RDD/ARF2); National Institute of Health Research under the Programme Grants for Applied Research Programme (RP-PG-0109-10074). The Outlook study was part of the PsyGrid study, which was funded by the UK Medical Research Council and Department of Health (G0300610). We wish to thank the participants of the NEDEN and Outlook studies. SPL is funded by a Clinical Academic Fellowship from the Chief Scientist Office, Scotland (CAF/19/04). JC is funded by the Wellcome Trust (104025/Z/14/Z). MB was the Chief Investigator (CI) for the NEDEN studies. SL was the CI for PsyGrid / Outlook study. MB and SPS are part-funded by the National Institute for Health Research (NIHR) through the APPLIED RESEARCH COLLABORATION (ARC) West Midlands.
Glasgow Author(s) Enlighten ID:Cavanagh, Professor Jonathan and Leighton, Dr Samuel and Rogers, Dr Simon and Krishnadas, Dr Rajeev
Authors: Leighton, S. P., Krishnadas, R., Upthegrove, R., Marwaha, S., Steyerberg, E. W., Gkoutos, G. V., Broome, M. R., Liddle, P. F., Everard, L., Singh, S. P., Freemantle, N., Fowler, D., Jones, P. B., Sharma, V., Murray, R., Wykes, T., Drake, R. J., Buchan, I., Rogers, S., Cavanagh, J., Lewis, S. W., Birchwood, M., and Mallikarjun, P. K.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
College of Medical Veterinary and Life Sciences > School of Infection & Immunity
College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
College of Science and Engineering > School of Computing Science
Journal Name:Schizophrenia Bulletin Open
Publisher:Oxford University Press
ISSN (Online):2632-7899
Published Online:31 August 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Schizophrenia Bulletin Open 2021
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
171331Consortium of Neuroimmunology of Mood Disorders and Alzheimer's DiseaseJonathan CavanaghWellcome Trust (WELLCOTR)104025/Z/14/ZHW - Mental Health and Wellbeing