TY - JOUR
T1 - Meta-analytical prognostic accuracy of the Comprehensive Assessment of At Risk Mental States (CAARMS)
T2 - the need for refined prediction
AU - Oliver, D.
AU - Kotlicka-Antczak , M.
AU - Minichino, A.
AU - Spada, G.
AU - McGuire, P.
AU - Fusar-Poli, P.
PY - 2018/3
Y1 - 2018/3
N2 - Primary indicated prevention of psychosis is reliant on accurate tools to predict the onset of psychosis. The gold standard assessment for detecting individuals at clinical high risk (CHR-P) for psychosis in the UK and many other countries is the Comprehensive Assessment for At Risk Mental States (CAARMS). While the prognostic accuracy of CHR-P instruments has been assessed in general, this is the first study to specifically analyse that of the CAARMS. As such, the CAARMS was used as the index test, with the reference index being psychosis onset within 2 years. 6 independent studies were analysed using MIDAS (STATA 14), with a total of 1876 help-seeking subjects referred to high risk services (CHR-P+: N=892; CHR-P-: N=984). Area under the curve (AUC), summary receiver operating characteristic curves, quality assessment, likelihood ratios, and probability modified plots were computed, along with sensitivity analyses and meta-regressions. The current meta-analysis confirmed that the 2-year prognostic accuracy of the CAARMS is only acceptable (AUC=0.79 95%CI: 0.75-0.83) and not outstanding as previously reported. In particular, specificity was poor. Sensitivity of the CAARMS is inferior compared to the SIPS, while Specificity is comparably low. However, due to the difficulties in performing these types of studies means that power in this meta-analysis was low. These results indicate that refining and improving the prognostic accuracy of the CAARMS should be the mainstream area of research for the next era. Avenues of prediction improvement are critically discussed and presented to better benefit patients and improve outcomes of first episode psychosis.
AB - Primary indicated prevention of psychosis is reliant on accurate tools to predict the onset of psychosis. The gold standard assessment for detecting individuals at clinical high risk (CHR-P) for psychosis in the UK and many other countries is the Comprehensive Assessment for At Risk Mental States (CAARMS). While the prognostic accuracy of CHR-P instruments has been assessed in general, this is the first study to specifically analyse that of the CAARMS. As such, the CAARMS was used as the index test, with the reference index being psychosis onset within 2 years. 6 independent studies were analysed using MIDAS (STATA 14), with a total of 1876 help-seeking subjects referred to high risk services (CHR-P+: N=892; CHR-P-: N=984). Area under the curve (AUC), summary receiver operating characteristic curves, quality assessment, likelihood ratios, and probability modified plots were computed, along with sensitivity analyses and meta-regressions. The current meta-analysis confirmed that the 2-year prognostic accuracy of the CAARMS is only acceptable (AUC=0.79 95%CI: 0.75-0.83) and not outstanding as previously reported. In particular, specificity was poor. Sensitivity of the CAARMS is inferior compared to the SIPS, while Specificity is comparably low. However, due to the difficulties in performing these types of studies means that power in this meta-analysis was low. These results indicate that refining and improving the prognostic accuracy of the CAARMS should be the mainstream area of research for the next era. Avenues of prediction improvement are critically discussed and presented to better benefit patients and improve outcomes of first episode psychosis.
KW - psychosis
KW - CAARMS
KW - prevention
KW - prognostic accuracy
KW - clinical utility
UR - http://www.scopus.com/inward/record.url?scp=85041408126&partnerID=8YFLogxK
U2 - 10.1016/j.eurpsy.2017.10.001
DO - 10.1016/j.eurpsy.2017.10.001
M3 - Article
SN - 0924-9338
VL - 49
SP - 62
EP - 68
JO - European Psychiatry
JF - European Psychiatry
ER -