Development and Validation of a Clinically Based Risk Calculator for the Transdiagnostic Prediction of Psychosis
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Importance: The overall effect of At Risk Mental State (ARMS) services for the detection of individuals who will develop psychosis in secondary mental health care is undetermined. Objective: To measure the proportion of individuals with a first episode of psychosis detected by ARMS services in secondary mental health services, and to develop and externally validate a practical web-based individualized risk calculator tool for the transdiagnostic prediction of psychosis in secondary mental health care. Design, Setting, and Participants: Clinical register-based cohort study. Patients were drawn from electronic, real-world, real-time clinical records relating to 2008 to 2015 routine secondary mental health care in the South London and the Maudsley National Health Service Foundation Trust. The study included all patients receiving a first index diagnosis of nonorganic and nonpsychotic mental disorder within the South London and the Maudsley National Health Service Foundation Trust in the period between January 1, 2008, and December 31, 2015. Data analysis began on September 1, 2016. Main Outcomes and Measures: Risk of development of nonorganic International Statistical Classification of Diseases and Related Health Problems, Tenth Revision psychotic disorders. Results: A total of 91 199 patients receiving a first index diagnosis of nonorganic and nonpsychotic mental disorder within South London and the Maudsley National Health Service Foundation Trust were included in the derivation (n = 33 820) or external validation (n = 54 716) data sets. The mean age was 32.97 years, 50.88% were men, and 61.05% were white race/ethnicity. The mean follow-up was 1588 days. The overall 6-year risk of psychosis in secondary mental health care was 3.02 (95% CI, 2.88-3.15), which is higher than the 6-year risk in the local general population (0.62). Compared with the ARMS designation, all of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses showed a lower risk of psychosis, with the exception of bipolar mood disorders (similar risk) and brief psychotic episodes (higher risk). The ARMS designation accounted only for a small proportion of transitions to psychosis (n = 52 of 1001; 5.19% in the derivation data set), indicating the need for transdiagnostic prediction of psychosis in secondary mental health care. A prognostic risk stratification model based on preselected variables, including index diagnosis, age, sex, age by sex, and race/ethnicity, was developed and externally validated, showing good performance and potential clinical usefulness. Conclusions and Relevance: This online individualized risk calculator can be of clinical usefulness for the transdiagnostic prediction of psychosis in secondary mental health care. The risk calculator can help to identify those patients at risk of developing psychosis who require an ARMS assessment and specialized care. The use of this calculator may eventually facilitate the implementation of an individualized provision of preventive focused interventions and improve outcomes of first episode psychosis.
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It is true that CHR-P clinics can currently detect only a minority of individuals who will later develop psychosis (similarly, early intervention services can only detect about half of first episode cases).
“It is true that CHR-P clinics can currently detect only a minority of individuals who will later develop psychosis 199 (similarly, early intervention services can only detect about half of first episode cases 200 )”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [199]
The Fusar-Poli et al. model predicts transdiagnostic psychosis onset in secondary mental health care patients with a C-index of 0.80 in the development sample (n=33,820, mean age 34.4, UK).
“33,820 (34.4, UK); 0.80 (C- index) 199”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [199]
The Fusar-Poli et al. model has external validation C-indexes of 0.79 (n=54,716, mean age 32.0, UK), 0.73 (n=13,702, mean age 40.9, UK), 0.79 (n=33,710, mean age 22.7, UK), 0.68 (n=2,430,333, mean age 34.2, US), and 0.85 (n=54,716, mean age 33, UK).
“54,716 (32.0, UK); 0.79 (C-index) 199 13,702 (40.9, UK); 0.73 (C-index) 296 33,710 (22.7, UK), 0.79 (C-index) 297 2,430,333 (34.2, US); 0.68 (C-index) 298 54,716 (33); 0.85 (C-index) 299”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [199]
A narrowed psychosis-risk approach guarantees a limited detection, approximately 5%, even for those patients who will eventually develop a first episode of psychosis.
“a so narrowed approach guarantees a limited detection, approximately 5%, even for those patients who will eventually develop a first episode of psychosis [93]”
From Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care? (2020) · cites this paper as [93]
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Self-citationBirmaher, B., Merranko, J. A., Goldstein, T. R., Gill, M. K., Goldstein, B. I., Hower, H., Yen, S., Hafeman, D., Strober, M., Diler, R. S., et al. (2018) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2018.05.023 · Cited by 81 · see citing works
Sanfelici, R., Dwyer, D. B., Antonucci, L. A., & Koutsouleris, N. (2020) · Biological Psychiatry · doi:10.1016/j.biopsych.2020.02.009 · Cited by 82 · see citing works
Raket, L. L., Jaskolowski, J., Kinon, B. J., Brasen, J. C., Jönsson, L., Wehnert, A., & Fusar-Poli, P. (2020) · The Lancet Digital Health · doi:10.1016/s2589-7500(20)30024-8 · Cited by 60 · see citing works
Self-citationOliver, D., Spada, G., Colling, C., Broadbent, M., Baldwin, H., Patel, R., Stewart, R., Stahl, D., Dobson, R., McGuire, P., et al. (2021) · Schizophrenia Research · doi:10.1016/j.schres.2020.05.007 · Cited by 49 · see citing works
Self-citationOliver, D., Arribas, M., Radua, J., Salazar de Pablo, G., De Micheli, A., Spada, G., Mensi, M. M., Kotlicka-Antczak, M., Borgatti, R., Solmi, M., et al. (2022) · Molecular Psychiatry · doi:10.1038/s41380-022-01611-w · Cited by 49 · see citing works
Self-citationTRANSD recommendations: improving transdiagnostic research in psychiatry
Fusar‐Poli, P. (2019) · World Psychiatry · doi:10.1002/wps.20681 · Cited by 43 · see citing works
Self-citationOsborne, K. J., & Mittal, V. A. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.06.034 · Cited by 31 · see citing works
Real-world digital implementation of the Psychosis Polyrisk Score (PPS): A pilot feasibility study
Oliver, D., Spada, G., Englund, A., Chesney, E., Radua, J., Reichenberg, A., Uher, R., McGuire, P., & Fusar-Poli, P. (2020) · Schizophrenia Research · doi:10.1016/j.schres.2020.04.015 · Cited by 27 · see citing works
Self-citationFusar-Poli, P., De Micheli, A., Patel, R., Signorini, L., Miah, S., Spencer, T., & McGuire, P. (2020) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaa040 · Cited by 22 · see citing works
Self-citationPuntis, S., Oliver, D., & Fusar-Poli, P. (2021) · Schizophrenia Research · doi:10.1016/j.schres.2021.01.005 · Cited by 21 · see citing works
Self-citation
- Authors
- Fusar-Poli, P., Rutigliano, G., Stahl, D., Davies, C., Bonoldi, I., Reilly, T., & McGuire, P.
- Affiliations
- Early Psychosis: Interventions and Clinical Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
- University of Pisa (IT)
- King's College London (GB)
- National Health Service (GB)
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2017-05-01
- Volume
- 74
- Issue
- 5
- Pages
- 493
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC5470394
- OpenAlex
- W2593674607
- Cited by
- 246
- References
- 58
- Citations by year
- 2026: 16 · 2025: 14 · 2024: 17 · 2023: 24 · 2022: 17 · 2021: 33 · 2020: 43 · 2019: 45 · 2018: 24 · 2017: 13
- FWCI
- 27.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- Medical Research Council (MR/N026063/1)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- psychosis prediction, clinical high risk for psychosis, first-episode psychosis, secondary mental health care, online risk calculator, bipolar disorder, external validation, South London and Maudsley NHS Foundation Trust
- MeSH terms
- Adolescent, Adult, Mental Disorders, Female, Follow-Up Studies, Humans, London, Male, Mental Health Services, Middle Aged, Prognosis, Psychotic Disorders, Registries, Reproducibility of Results, Risk Assessment, Internet, Young Adult, Secondary Health Care
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