TY - JOUR
T1 - Development and Validation of a Nonremission Risk Prediction Model in First-Episode Psychosis
T2 - An Analysis of 2 Longitudinal Studies
AU - Leighton, Samuel P.
AU - Krishnadas, Rajeev
AU - Upthegrove, Rachel
AU - Marwaha, Steven
AU - Steyerberg, Ewout W.
AU - Gkoutos, Georgios V.
AU - Broome, Matthew R.
AU - Liddle, Peter F.
AU - Everard, Linda
AU - Singh, Swaran P.
AU - Freemantle, Nicholas
AU - Fowler, David
AU - Jones, Peter B.
AU - Sharma, Vimal
AU - Murray, Robin
AU - Wykes, Til
AU - Drake, Richard J.
AU - Buchan, Iain
AU - Rogers, Simon
AU - Cavanagh, Jonathan
AU - Lewis, Shon W.
AU - Birchwood, Max
AU - Mallikarjun, Pavan K.
N1 - Funding Information:
P.K.M. has received honorariums from Sunovion and Sage and is a Director of Noux Technologies Limited. R.U. has received honorariums from Sunovion. J.C. has received grants from Wellcome Trust and Sackler Trust and honorariums from Johnson & Johnson. S.P.S. and M.B. are part-funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care WM (CLAHRC-WM). G.V.G. has received support from H2020-EINFRA, the NIHR Birmingham ECMC, NIHR Birmingham SRMRC, the NIHR Birmingham Biomedical Research Centre, and the MRC HDR UK, an initiative funded by UK Research and Innovation, Department of Health and Social Care (England), the devolved administrations, and leading medical research charities. S.W.L. is Director of the not-for-profit digital health company Affigo; and Medical Director of Kooth PLC. R. All other authors declare no competing interests.
Funding 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). S.P.L. is funded by a Clinical Academic Fellowship from the Chief Scientist Office, Scotland (CAF/19/04). J.C. is funded by the Wellcome Trust (104025/Z/14/Z). M.B. was the Chief Investigator (CI) for the NEDEN studies. S.L. was the CI for PsyGrid/ Outlook study. M.B. and S.P.S. are part-funded by the National Institute for Health Research through the APPLIED RESEARCH COLLABORATION (ARC) West Midlands.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - 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 nonremission in first-episode psychosis. Our development cohort consisted of 1027 patients with first-episode psychosis recruited between 2005 and 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 and 2009 from a further 11 English early intervention services. The one-year nonremission rate was 52% and 54% in the development and validation cohorts, respectively. Multivariable logistic regression was used to develop a risk prediction model for nonremission, 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 nonremitted 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 nonremission at initial clinical contact.
AB - 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 nonremission in first-episode psychosis. Our development cohort consisted of 1027 patients with first-episode psychosis recruited between 2005 and 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 and 2009 from a further 11 English early intervention services. The one-year nonremission rate was 52% and 54% in the development and validation cohorts, respectively. Multivariable logistic regression was used to develop a risk prediction model for nonremission, 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 nonremitted 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 nonremission at initial clinical contact.
UR - http://www.scopus.com/inward/record.url?scp=85118996369&partnerID=8YFLogxK
U2 - 10.1093/schizbullopen/sgab041
DO - 10.1093/schizbullopen/sgab041
M3 - Article
AN - SCOPUS:85118996369
SN - 2632-7899
VL - 2
JO - Schizophrenia Bulletin Open
JF - Schizophrenia Bulletin Open
IS - 1
ER -
