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Development and validation of a nonremission risk prediction model in first-episode psychosis: an analysis of 2 longitudinal studies
Version 2 2023-06-12, 08:06
Version 1 2023-06-10, 01:10
journal contribution
posted on 2023-06-12, 08:06 authored by Samuel P Leighton, Rajeev Krishnadas, Rachel Upthegrove, Steven Marwaha, Ewout W Steyerberg, Georgios V Gkoutos, Matthew R Broome, Peter F Liddle, Linda Everard, Swaran P Singh, Nicholas Freemantle, David FowlerDavid Fowler, Peter B Jones, Vimal Shama, Robin Murray, Til Wykes, Richard J Drake, Iain Buchan, Simon Rogers, Jonathan Cavanagh, Shon W Lewis, Max Birchwood, Pavan K MallikarjunPsychosis 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.
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Publication status
- Published
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- Published version
Journal
Schizophrenia Bulletin OpenISSN
2632-7899Publisher
Oxford University PressExternal DOI
Issue
1Volume
2Page range
1-8Department affiliated with
- Psychology Publications
Full text available
- Yes
Peer reviewed?
- Yes
Legacy Posted Date
2021-09-28First Open Access (FOA) Date
2021-10-13First Compliant Deposit (FCD) Date
2021-09-27Usage metrics
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