Towards clinical application of prediction models for transition to psychosis: A systematic review and external validation study in the PRONIA sample

NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS

卷:125

Review

Rosen, Marlene^1,2  Betz, Linda T.^1,2  Schultze-Lutter, Frauke^3,4,5  Chisholm, Katharine^6,7,8  Haidl, Theresa K.^1,2  Kambeitz-Ilankovic, Lana^1,2,9  Bertolino, Alessandro¹⁰  Borgwardt, Stefan^11,12  Brambilla, Paolo^13,14  Lencer, Rebekka^11,15  Meisenzahl, Eva³  Ruhrmann, Stephan^1,2  Salokangas, Raimo K. R.¹⁶  Upthegrove, Rachel^6,7  Wood, Stephen J.^6,7,17,18  Koutsouleris, Nikolaos^19,20  Kambeitz, Joseph^1,2 

[1] Fac Med, Dept Psychiat & Psychotherapy, Cologne, Germany

[2] Univ Hosp Cologne, Cologne, Germany

[3] Heinrich Heine Univ, Fac Med, Dept Psychiat & Psychotherapy, Dusseldorf, Germany

[4] Airlangga Univ, Fac Psychol, Dept Psychol & Mental Hlth, Surabaya, Indonesia

[5] Univ Bern, Univ Hosp Child & Adolescent Psychiat & Psychothe, Bern, Switzerland

[6] Univ Birmingham, Inst Mental Hlth, Birmingham, W Midlands, England

[7] Univ Birmingham, Ctr Human Brain Hlth, Birmingham, W Midlands, England

[8] Aston Univ, Dept Psychol, Birmingham, W Midlands, England

[9] Ludwig Maximilians Univ Munchen, Dept Psychiat & Psychotherapy, Munich, Germany

[10] Univ Bari, Dept Neurol & Psychiat Sci, Bari, Italy

[11] Univ Lubeck, Dept Psychiat & Psychotherapy, Lubeck, Germany

[12] Univ Basel, Psychiat Univ Hosp, Dept Psychiat, Basel, Switzerland

[13] Univ Milan, Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Neurosci & Mental Hlth, Milan, Italy

[14] Univ Milan, Dept Pathophysiol & Transplantat, Milan, Italy

[15] Univ Munster, Dept Psychiat, Munster, Germany

[16] Univ Turku, Dept Psychiat, Turku, Finland

[17] Orygen, Melbourne, Vic, Australia

[18] Univ Melbourne, Ctr Youth Mental Hlth, Melbourne, Vic, Australia

[19] Max Planck Inst Psychiat, Munich, Germany

[20] Kings Coll London, Inst Psychiat Psychol & Neurosci, London, England

关键词: Psychosis;    Clinical high-risk;    Prediction;    Model validation;    Early intervention;    Precision medicine;    Translational psychiatry;   

DOI  :  10.1016/j.neubiorev.2021.02.032

来源: Elsevier

【 摘 要 】

A multitude of prediction models for a first psychotic episode in individuals at clinical high-risk (CHR) for psychosis have been proposed, but only rarely validated. We identified transition models based on clinical and neuropsychological data through a registered systematic literature search and evaluated their external validity in 173 CHRs from the Personalised Prognostic Tools for Early Psychosis Management (PRONIA) study. Discrimination performance was assessed with the area under the receiver operating characteristic curve (AUC), and compared to the prediction of clinical raters. External discrimination performance varied considerably across the 22 identified models (AUC 0.40-0.76), with two models showing good discrimination performance. None of the tested models significantly outperformed clinical raters (AUC = 0.75). Combining predictions of clinical raters and the best model descriptively improved discrimination performance (AUC = 0.84). Results show that personalized prediction of transition in CHR is potentially feasible on a global scale. For implementation in clinical practice, further rounds of external validation, impact studies, and development of an ethical framework is necessary.

【 授权许可】

Free