Cited by 95Schizophrenia research and treatmentPsychopathy, Forensic Psychiatry, Sexual OffendingBipolar Disorder and Treatment

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

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Fusar-Poli, Paolo, Werbeloff, Nomi, Rutigliano, Grazia, Oliver, Dominic, Davies, Cathy, Stahl, Daniel, McGuire, Philip, Osborn, David·2019·Schizophrenia Bulletin

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 13702 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.

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  • 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”

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  1. [49]McGorrian C, Leong T, D’Agostino R, Graham IM Risk estimation systems in clinical use: SCORE, heart score and the Framingham system. In: D’Agostino R, Graham IM, eds. Therapeutic Strategies in Cardiovascular Risk. 1st ed. Oxford, UK: Clinical Publishing; 2008 159– 172.

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Authors
Fusar-Poli, P., Werbeloff, N., Rutigliano, G., Oliver, D., Davies, C., Stahl, D., McGuire, P., & Osborn, D.
Affiliations
  • Early Psychosis: Interventions and Clinical Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
  • University College London (GB)
  • King's College London (GB)
Venue
Schizophrenia Bulletin
Published
2018-06-12
Volume
45
Issue
3
Pages
562-570
ISSN
  • 0586-7614 (ISSN-L)
  • 1745-1701
OpenAlex
W2808198584
Cited by
95
References
59
Citations by year
2026: 8 · 2025: 5 · 2024: 7 · 2023: 9 · 2022: 6 · 2021: 17 · 2020: 23 · 2019: 18 · 2018: 2
FWCI
11.72
Type
journal article
Language
en
Open access
Locations
  • Schizophrenia Bulletin (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (publishedVersion, cc-by-nc)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
Medical Research Council (MC_PC_16048)
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
clinical high risk for psychosis
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, London, Male, Middle Aged, National Health Programs, Psychotic Disorders, Registries, Schizophrenia, Cohort Studies, Risk Assessment, Young Adult

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