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

PRONIA Consortium

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)
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Abstract

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.

Original languageEnglish
Pages (from-to)478-492
Number of pages15
JournalNeuroscience and biobehavioral reviews
Volume125
Early online date23 Feb 2021
DOIs
Publication statusPublished - Jun 2021

Bibliographical note

Funding: PRONIA is a Collaboration Project funded by the European Union under the 7th Framework Programme under grant agreement n° 602152 . J.K. has received funding from the German Research Foundation (DFG ; grant agreement n° KA 4413/1-1 ). These funding sources had no role in the design and execution of this study, nor in analyses, interpretation of the data, or decision to submit results.

Keywords

  • Clinical high-risk
  • Early intervention
  • Model validation
  • Precision medicine
  • Prediction
  • Psychosis
  • Translational psychiatry

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Cognitive Neuroscience
  • Behavioral Neuroscience

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