Risk Calculator May Aid Transdiagnostic Detection of At-Risk Individuals, Psychosis
Patients who are at high risk for psychosis may present with subtle symptoms and overall impairment. The transdiagnostic risk calculator may improve detection in these individuals.
A clinically-based, transdiagnostic risk calculator designed to automatically detect individuals at high risk of developing psychosis and thereby allow for prevention measures can change the direction of the psychosis, shorten the duration, and/or mitigate the severity of the first psychotic episode. This risk calculator has been shown to perform well across different National Health Service (NHS) Trusts with different services and socioeconomic characteristics, according to a study published in Schizophrenia Bulletin.
This risk calculator for identifying individuals with a clinically high risk for psychosis was developed in the Lambeth and Southward boroughs of South London and Maudsley NHS Trust and uses electronic health data, which allows it to determine risk even for individuals in secondary NHS mental health care and where clinical high risk for psychosis detection tools and treatment are not provided. This register-based, clinical cohort study sought to determine how this calculator would perform in the Camden and Islington NHS Trust. Between January 2009 and October 2016, 13,702 patients received an ICD-10 diagnosis, indicating a nonorganic and nonpsychotic mental health problem. These data were analyzed using the transdiagnostic clinical high risk for psychosis risk calculator, which uses a Cox model to predict individualized risk for psychosis.
The study found that the calculator could predict clinical high risk for psychosis to an acceptable degree, making it the only available way to practically increase detection rates for individuals at risk of developing psychosis across different service configurations and sociodemographic groups. Almost all the data used for detection are collected as a standard part of NHS clinical practice and are made part of the interactive electronic health data system, allowing for automatic detection.
Study investigators conclude, “This calculator may support an improved detection of at-risk cases in secondary mental health care, as well as the transdiagnostic prediction of psychosis even in NHS Trust that do not provide [clinical high risk for psychosis] services.”
Fusar-Poli P, Werbeloff N, Rutigliano G, et al. 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 [published online June 12, 2018]. Schizophr Bull. 2018 Jun. doi: 10.1093/schbul/sby070