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Development and temporal validation of a clinical prediction model of transition to psychosis in individuals at ultra-high risk in the UHR 1000+ cohort.
Hartmann, Simon; Dwyer, Dominic; Cavve, Blake; Byrne, Enda M; Scott, Isabelle; Gao, Caroline; Wannan, Cassandra; Yuen, Hok Pan; Hartmann, Jessica; Lin, Ashleigh; Wood, Stephen J; Wigman, Johanna T W; Middeldorp, Christel M; Thompson, Andrew; Amminger, Paul; Schlögelhofer, Monika; Riecher-Rössler, Anita; Chen, Eric Y H; Hickie, Ian B; Phillips, Lisa J; Schäfer, Miriam R; Mossaheb, Nilufar; Smesny, Stefan; Berger, Gregor; de Haan, Lieuwe; Nordentoft, Merete; Verma, Swapna; Nieman, Dorien H; McGorry, Patrick D; Yung, Alison R; Clark, Scott R; Nelson, Barnaby.
Afiliación
  • Hartmann S; Discipline of Psychiatry, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
  • Dwyer D; Orygen, Melbourne, VIC, Australia.
  • Cavve B; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
  • Byrne EM; Orygen, Melbourne, VIC, Australia.
  • Scott I; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
  • Gao C; Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.
  • Wannan C; School of Population and Global Health, University of Western Australia, Perth, WA, Australia.
  • Yuen HP; Orygen, Melbourne, VIC, Australia.
  • Hartmann J; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
  • Lin A; Orygen, Melbourne, VIC, Australia.
  • Wood SJ; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
  • Wigman JTW; Orygen, Melbourne, VIC, Australia.
  • Middeldorp CM; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
  • Thompson A; Orygen, Melbourne, VIC, Australia.
  • Amminger P; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
  • Schlögelhofer M; Orygen, Melbourne, VIC, Australia.
  • Riecher-Rössler A; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
  • Chen EYH; Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
  • Hickie IB; School of Population and Global Health, University of Western Australia, Perth, WA, Australia.
  • Phillips LJ; Orygen, Melbourne, VIC, Australia.
  • Schäfer MR; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
  • Mossaheb N; School of Psychology, University of Birmingham, Birmingham, UK.
  • Smesny S; Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
  • Berger G; Child Health Research Centre, University of Queensland, St. Lucia, QLD, Australia.
  • de Haan L; Department of Child and Adolescent Psychiatry and Psychology, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
  • Nordentoft M; Arkin Mental Health Care, Amsterdam, The Netherlands.
  • Verma S; Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands.
  • Nieman DH; Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia.
  • McGorry PD; Orygen, Melbourne, VIC, Australia.
  • Yung AR; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
  • Clark SR; Orygen, Melbourne, VIC, Australia.
  • Nelson B; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
World Psychiatry ; 23(3): 400-410, 2024 Oct.
Article en En | MEDLINE | ID: mdl-39279417
ABSTRACT
The concept of ultra-high risk for psychosis (UHR) has been at the forefront of psychiatric research for several decades, with the ultimate goal of preventing the onset of psychotic disorder in high-risk individuals. Orygen (Melbourne, Australia) has led a range of observational and intervention studies in this clinical population. These datasets have now been integrated into the UHR 1000+ cohort, consisting of a sample of 1,245 UHR individuals with a follow-up period ranging from 1 to 16.7 years. This paper describes the cohort, presents a clinical prediction model of transition to psychosis in this cohort, and examines how predictive performance is affected by changes in UHR samples over time. We analyzed transition to psychosis using a Cox proportional hazards model. Clinical predictors for transition to psychosis were investigated in the entire cohort using multiple imputation and Rubin's rule. To assess performance drift over time, data from 1995-2016 were used for initial model fitting, and models were subsequently validated on data from 2017-2020. Over the follow-up period, 220 cases (17.7%) developed a psychotic disorder. Pooled hazard ratio (HR) estimates showed that the Comprehensive Assessment of At-Risk Mental States (CAARMS) Disorganized Speech subscale severity score (HR=1.12, 95% CI 1.02-1.24, p=0.024), the CAARMS Unusual Thought Content subscale severity score (HR=1.13, 95% CI 1.03-1.24, p=0.009), the Scale for the Assessment of Negative Symptoms (SANS) total score (HR=1.02, 95% CI 1.00-1.03, p=0.022), the Social and Occupational Functioning Assessment Scale (SOFAS) score (HR=0.98, 95% CI 0.97-1.00, p=0.036), and time between onset of symptoms and entry to UHR service (log transformed) (HR=1.10, 95% CI 1.02-1.19, p=0.013) were predictive of transition to psychosis. UHR individuals who met the brief limited intermittent psychotic symptoms (BLIPS) criteria had a higher probability of transitioning to psychosis than those who met the attenuated psychotic symptoms (APS) criteria (HR=0.48, 95% CI 0.32-0.73, p=0.001) and those who met the Trait risk criteria (a first-degree relative with a psychotic disorder or a schizotypal personality disorder plus a significant decrease in functioning during the previous year) (HR=0.43, 95% CI 0.22-0.83, p=0.013). Models based on data from 1995-2016 displayed good calibration at initial model fitting, but showed a drift of 20.2-35.4% in calibration when validated on data from 2017-2020. Large-scale longitudinal data such as those from the UHR 1000+ cohort are required to develop accurate psychosis prediction models. It is critical to assess existing and future risk calculators for temporal drift, that may reduce their utility in clinical practice over time.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: World Psychiatry Año: 2024 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Italia

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: World Psychiatry Año: 2024 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Italia