Transdiagnostic risk calculator for the automatic detection of individuals at risk and the prediction of psychosis: Second replication in an independent national health service trust

Paolo Fusar-Poli, Nomi Werbeloff, Grazia Rutigliano, Dominic Oliver, Cathy Davies, Daniel Stahl, Philip McGuire, David Osborn

Research output: Contribution to journalArticlepeer-review

72 Scopus citations

Abstract

Background: The benefits of indicated primary prevention among individuals at Clinical High Risk for Psychosis (CHR-P) are limited by the difficulty in detecting these individuals. To overcome this problem, a transdiagnostic, clinically based, individualized risk calculator has recently been developed and subjected to a first external validation in 2 different catchment areas of the South London and Maudsley (SLaM) NHS Trust. Methods: Second external validation of real world, real-time electronic clinical register-based cohort study. All individuals who received a first ICD-10 index diagnosis of nonorganic and nonpsychotic mental disorder within the Camden and Islington (C&I) NHS Trust between 2009 and 2016 were included. The model previously validated included age, gender, ethnicity, age by gender, and ICD-10 index diagnosis to predict the development of any ICD-10 nonorganic psychosis. The model's performance was measured using Harrell's C-index. Results: This study included a total of 13 702 patients with an average age of 40 (range 16-99), 52% were female, and most were of white ethnicity (64%). There were no CHR-P or child/adolescent services in the C&I Trust. The C&I and SLaM Trust samples also differed significantly in terms of age, gender, ethnicity, and distribution of index diagnosis. Despite these significant differences, the original model retained an acceptable predictive performance (Harrell's C of 0.73), which is comparable to that of CHR-P tools currently recommended for clinical use. Conclusions: This risk calculator may pragmatically support an improved transdiagnostic detection of at-risk individuals and psychosis prediction even in NHS Trusts in the United Kingdom where CHR-P services are not provided.

Original languageEnglish
Pages (from-to)562-570
Number of pages9
JournalSchizophrenia Bulletin
Volume45
Issue number3
DOIs
StatePublished - 25 Apr 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

Funding

This study was supported by the King’s College London Confidence in Concept award from the Medical Research Council (MRC) (MC_PC_16048 to P.F.P).

FundersFunder number
Medical Research CouncilMC_PC_16048

    Keywords

    • Psychosis
    • Risk calculator
    • Schizophrenia
    • Transdiagnostic
    • Validation

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