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Development and Validation of a Nonremission Risk Prediction Model in First-Episode Psychosis: An Analysis of 2 Longitudinal Studies.
Leighton, Samuel P. Krishnadas, Rajeev Upthegrove, Rachel Marwaha, Steven Steyerberg, Ewout W. Gkoutos, Georgios V. Broome, Matthew R. Liddle, Peter F. Everard, Linda Singh, Swaran P.
Leighton, Samuel P.
Krishnadas, Rajeev
Upthegrove, Rachel
Marwaha, Steven
Steyerberg, Ewout W.
Gkoutos, Georgios V.
Broome, Matthew R.
Liddle, Peter F.
Everard, Linda
Singh, Swaran P.
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Publication Date
2021-01-01
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Abstract
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.
Citation
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., ... Mallikarjun, P. K. (2021). Development and validation of a nonremission risk prediction model in first-episode psychosis: An analysis of 2 longitudinal studies. Schizophrenia Bulletin Open, 2(1), sgab041. https://doi.org/10.1093/schizbullopen/sgab041
Publisher
Oxford University Press
Journal
Schizophrenia Bulletin Open
Research Unit
DOI
10.1093/schizbullopen/sgab041
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PubMed Central ID
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Article
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Description
A correction has been published: Schizophrenia Bulletin Open, Volume 3, Issue 1, January 2022, sgac070, https://doi.org/10.1093/schizbullopen/sgac070
A correction has been published: Schizophrenia Bulletin Open, Volume 4, Issue 1, January 2023, sgad007, https://doi.org/10.1093/schizbullopen/sgad007
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ISSN
EISSN
2632-7899
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Sponsors
Funder: UK Department of Health; Grant(s): RDD/ARF2
Funder: National Institute of Health Research; Grant(s): RP-PG-0109-10074
Funder: UK Medical Research Council and Department of Health; Grant(s): G0300610
Funder: Chief Scientist Office, Scotland; Grant(s): CAF/19/04
Funder: Chief Scientist Office; Grant(s): CAF/19/04
Funder: Wellcome Trust; Grant(s): 104025/Z/14/Z