PMID- 27784037
OWN - NLM
STAT- MEDLINE
DCOM- 20170508
LR  - 20220310
IS  - 2168-6238 (Electronic)
IS  - 2168-622X (Linking)
VI  - 73
IP  - 12
DP  - 2016 Dec 1
TI  - Deconstructing Pretest Risk Enrichment to Optimize Prediction of Psychosis in 
      Individuals at Clinical High Risk.
PG  - 1260-1267
LID - 10.1001/jamapsychiatry.2016.2707 [doi]
AB  - IMPORTANCE: Pretest risk estimation is routinely used in clinical medicine to 
      inform further diagnostic testing in individuals with suspected diseases. To our 
      knowledge, the overall characteristics and specific determinants of pretest risk 
      of psychosis onset in individuals undergoing clinical high risk (CHR) assessment 
      are unknown. OBJECTIVES: To investigate the characteristics and determinants of 
      pretest risk of psychosis onset in individuals undergoing CHR assessment and to 
      develop and externally validate a pretest risk stratification model. DESIGN, 
      SETTING, AND PARTICIPANTS: Clinical register-based cohort study. Individuals were 
      drawn from electronic, real-world, real-time clinical records relating to routine 
      mental health care of CHR services in South London and the Maudsley National 
      Health Service Trust in London, United Kingdom. The study included nonpsychotic 
      individuals referred on suspicion of psychosis risk and assessed by the Outreach 
      and Support in South London CHR service from 2002 to 2015. Model development and 
      validation was performed with machine-learning methods based on Least Absolute 
      Shrinkage and Selection Operator for Cox proportional hazards model. MAIN 
      OUTCOMES AND MEASURES: Pretest risk of psychosis onset in individuals undergoing 
      CHR assessment. Predictors included age, sex, age x sex interaction, 
      race/ethnicity, socioeconomic status, marital status, referral source, and 
      referral year. RESULTS: A total of 710 nonpsychotic individuals undergoing CHR 
      assessment were included. The mean age was 23 years. Three hundred ninety-nine 
      individuals were men (56%), their race/ethnicity was heterogenous, and they were 
      referred from a variety of sources. The cumulative 6-year pretest risk of 
      psychosis was 14.55% (95% CI, 11.71% to 17.99%), confirming substantial pretest 
      risk enrichment during the recruitment of individuals undergoing CHR assessment. 
      Race/ethnicity and source of referral were associated with pretest risk 
      enrichment. The predictive model based on these factors was externally validated, 
      showing moderately good discrimination and sufficient calibration. It was used to 
      stratify individuals undergoing CHR assessment into 4 classes of pretest risk 
      (6-year): low, 3.39% (95% CI, 0.96% to 11.56%); moderately low, 11.58% (95% CI, 
      8.10% to 16.40%); moderately high, 23.69% (95% CI, 16.58% to 33.20%); and high, 
      53.65% (95% CI, 36.78% to 72.46%). CONCLUSIONS AND RELEVANCE: Significant risk 
      enrichment occurs before individuals are assessed for a suspected CHR state. 
      Race/ethnicity and source of referral are associated with pretest risk enrichment 
      in individuals undergoing CHR assessment. A stratification model can identify 
      individuals at differential pretest risk of psychosis. Identification of these 
      subgroups may inform outreach campaigns and subsequent testing and eventually 
      optimize psychosis prediction.
FAU - Fusar-Poli, Paolo
AU  - Fusar-Poli P
AD  - King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 
      London, United Kingdom2Outreach and Support in South London service, South London 
      and the Maudsley National Health Service Foundation Trust, London, United 
      Kingdom.
FAU - Rutigliano, Grazia
AU  - Rutigliano G
AD  - King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 
      London, United Kingdom3Department of Clinical and Experimental Medicine, 
      University of Pisa, Pisa, Italy.
FAU - Stahl, Daniel
AU  - Stahl D
AD  - King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 
      London, United Kingdom.
FAU - Schmidt, Andre
AU  - Schmidt A
AD  - King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 
      London, United Kingdom.
FAU - Ramella-Cravaro, Valentina
AU  - Ramella-Cravaro V
AD  - King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 
      London, United Kingdom4Department of Neurosciences, Psychology, Drug Research and 
      Child Health, University of Florence, Florence, Italy.
FAU - Hitesh, Shetty
AU  - Hitesh S
AD  - South London and the Maudsley National Health Service Foundation Trust, 
      Biomedical Research Centre Nucleus, London, United Kingdom.
FAU - McGuire, Philip
AU  - McGuire P
AD  - King's College London, Institute of Psychiatry, Psychology, and Neuroscience, 
      London, United Kingdom.
LA  - eng
GR  - MR/N026063/1/MRC_/Medical Research Council/United Kingdom
PT  - Journal Article
PL  - United States
TA  - JAMA Psychiatry
JT  - JAMA psychiatry
JID - 101589550
SB  - IM
EIN - JAMA Psychiatry. 2016 Dec 1;73(12):1295. PMID: 27926770
MH  - Adult
MH  - Cohort Studies
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - London
MH  - Male
MH  - Patient Acceptance of Health Care
MH  - Proportional Hazards Models
MH  - Psychotic Disorders/*diagnosis/epidemiology/*psychology
MH  - Referral and Consultation
MH  - Risk Assessment/*statistics & numerical data
MH  - Young Adult
EDAT- 2016/10/27 06:00
MHDA- 2017/05/10 06:00
CRDT- 2016/10/27 06:00
PHST- 2016/10/27 06:00 [pubmed]
PHST- 2017/05/10 06:00 [medline]
PHST- 2016/10/27 06:00 [entrez]
AID - 2569453 [pii]
AID - 10.1001/jamapsychiatry.2016.2707 [doi]
PST - ppublish
SO  - JAMA Psychiatry. 2016 Dec 1;73(12):1260-1267. doi: 
      10.1001/jamapsychiatry.2016.2707.