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Prediction of clinical outcomes beyond psychosis in the ultra‐high risk for psychosis population


Polari, Andrea; Yuen, Hok Pan; Amminger, Paul; Berger, Gregor; Chen, Eric; deHaan, Lieuwe; Hartmann, Jessica; Markulev, Connie; McGorry, Patrick; Nieman, Dorien; Nordentoft, Merete; Riecher‐Rössler, Anita; Smesny, Stefan; Stratford, John; Verma, Swapna; Yung, Alison; Lavoie, Suzie; Nelson, Barnaby (2020). Prediction of clinical outcomes beyond psychosis in the ultra‐high risk for psychosis population. Early intervention in psychiatry:Epub ahead of print.

Abstract

Aim
Several prediction models have been introduced to identify young people at greatest risk of transitioning to psychosis. To date, none has examined the possibility of developing a clinical prediction model of outcomes other than transition. The aims of this study were to examine the association between baseline clinical predictors and outcomes including, but not limited to, transition to psychosis in young people at risk for psychosis, and to develop a prediction model for these outcomes.

Methods
Several evidence‐based variables previously associated with transition to psychosis and some important clinical comorbidities experienced by ultra‐high risk (UHR) individuals were identified in 202 UHR individuals. Secondary analysis of the Neurapro clinical trial were conducted to investigate the associations between these variables and favourable (remission and recovery) or unfavourable (transition to psychosis, no remission, any recurrence and relapse) clinical outcomes. Logistic regression, best subset selection, Akaike Information Criterion and receiver operating characteristic curves were used to seek the best prediction model for clinical outcomes from all combinations of possible predictors.

Results
When considered individually, only higher general psychopathology levels (P = .023) was associated with the unfavourable outcomes. Prediction models suggest that general psychopathology and functioning are predictive of unfavourable outcomes.

Conclusion
The predictive performance of the resulting models was modest and further research is needed. Nonetheless, when designing early intervention centres aiming to support individuals in the early phases of a mental disorder, the proper assessment of general psychopathology and functioning should be considered in order to inform interventions and length of care provided.

Abstract

Aim
Several prediction models have been introduced to identify young people at greatest risk of transitioning to psychosis. To date, none has examined the possibility of developing a clinical prediction model of outcomes other than transition. The aims of this study were to examine the association between baseline clinical predictors and outcomes including, but not limited to, transition to psychosis in young people at risk for psychosis, and to develop a prediction model for these outcomes.

Methods
Several evidence‐based variables previously associated with transition to psychosis and some important clinical comorbidities experienced by ultra‐high risk (UHR) individuals were identified in 202 UHR individuals. Secondary analysis of the Neurapro clinical trial were conducted to investigate the associations between these variables and favourable (remission and recovery) or unfavourable (transition to psychosis, no remission, any recurrence and relapse) clinical outcomes. Logistic regression, best subset selection, Akaike Information Criterion and receiver operating characteristic curves were used to seek the best prediction model for clinical outcomes from all combinations of possible predictors.

Results
When considered individually, only higher general psychopathology levels (P = .023) was associated with the unfavourable outcomes. Prediction models suggest that general psychopathology and functioning are predictive of unfavourable outcomes.

Conclusion
The predictive performance of the resulting models was modest and further research is needed. Nonetheless, when designing early intervention centres aiming to support individuals in the early phases of a mental disorder, the proper assessment of general psychopathology and functioning should be considered in order to inform interventions and length of care provided.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Psychiatric University Hospital Zurich > Department of Child and Adolescent Psychiatry
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Phychiatric Mental Health, Biological Psychiatry, Psychiatry and Mental health
Language:English
Date:17 June 2020
Deposited On:02 Dec 2020 16:06
Last Modified:07 Feb 2021 08:48
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1751-7885
OA Status:Closed
Publisher DOI:https://doi.org/10.1111/eip.13002
PubMed ID:32558302

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