Universität zu Köln

Malda, Aaltsje, Boonstra, Nynke, Barf, Hans ORCID: 0000-0002-3619-886X, de Jong, Steven, Aleman, Andre, Addington, Jean, Pruessner, Marita, Nieman, Dorien ORCID: 0000-0002-9846-4254, de Haan, Lieuwe, Morrison, Anthony, Riecher-Roessler, Anita, Studerus, Erich ORCID: 0000-0003-4233-0182, Ruhrmann, Stephan ORCID: 0000-0002-6022-2364, Schultze-Lutter, Frauke, An, Suk Kyoon ORCID: 0000-0003-4576-6184, Koike, Shinsuke, Kasai, Kiyoto ORCID: 0000-0002-4443-4535, Nelson, Barnaby ORCID: 0000-0002-6263-2332, McGorry, Patrick, Wood, Stephen, Lin, Ashleigh ORCID: 0000-0002-4054-0242, Yung, Alison Y., Kotlicka-Antczak, Magdalena, Armando, Marco ORCID: 0000-0001-7074-7212, Vicari, Stefano, Katsura, Masahiro, Matsumoto, Kazunori, Durston, Sarah, Ziermans, Tim, Wunderink, Lex, Ising, Helga, van der Gaag, Mark ORCID: 0000-0002-3525-6415, Fusar-Poli, Paolo ORCID: 0000-0003-3582-6788 and Pijnenborg, Gerdina Hendrika Maria (2019). Individualized Prediction of Transition to Psychosis in 1,676 Individuals at Clinical High Risk: Development and Validation of a Multivariable Prediction Model Based on Individual Patient Data Meta-Analysis. Front. Psychiatry, 10. LAUSANNE: FRONTIERS MEDIA SA. ISSN 1664-0640

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Abstract

Background: The Clinical High Risk state for Psychosis (CHR-P) has become the cornerstone of modern preventive psychiatry. The next stage of clinical advancements rests on the ability to formulate a more accurate prognostic estimate at the individual subject level. Individual Participant Data Meta-Analyses (IPD-MA) are robust evidence synthesis methods that can also offer powerful approaches to the development and validation of personalized prognostic models. The aim of the study was to develop and validate an individualized, clinically based prognostic model for forecasting transition to psychosis from a CHR-P stage. Methods: A literature search was performed between January 30, 2016, and February 6, 2016, consulting PubMed, Psychinfo, Picarta, Embase, and ISI Web of Science, using search terms (ultra high risk OR clinical high risk OR at risk mental state) AND [(conver* OR transition* OR onset OR emerg* OR develop*) AND psychosis] for both longitudinal and intervention CHR-P studies. Clinical knowledge was used to a priori select predictors: age, gender, CHR-P subgroup, the severity of attenuated positive psychotic symptoms, the severity of attenuated negative psychotic symptoms, and level of functioning at baseline. The model, thus, developed was validated with an extended form of internal validation. Results: Fifteen of the 43 studies identified agreed to share IPD, for a total sample size of 1,676. There was a high level of heterogeneity between the CHR-P studies with regard to inclusion criteria, type of assessment instruments, transition criteria, preventive treatment offered. The internally validated prognostic performance of the model was higher than chance but only moderate [Harrell's C-statistic 0.655, 95% confidence interval (CIs), 0.627-0.682]. Conclusion: This is the first IPD-MA conducted in the largest samples of CHR-P ever collected to date. An individualized prognostic model based on clinical predictors available in clinical routine was developed and internally validated, reaching only moderate prognostic performance. Although personalized risk prediction is of great value in the clinical practice, future developments are essential, including the refinement of the prognostic model and its external validation. However, because of the current high diagnostic, prognostic, and therapeutic heterogeneity of CHR-P studies, IPD-MAs in this population may have an limited intrinsic power to deliver robust prognostic models.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Malda, Aaltsje UNSPECIFIED UNSPECIFIED UNSPECIFIED Boonstra, Nynke UNSPECIFIED UNSPECIFIED UNSPECIFIED Barf, Hans UNSPECIFIED orcid.org/0000-0002-3619-886X UNSPECIFIED de Jong, Steven UNSPECIFIED UNSPECIFIED UNSPECIFIED Aleman, Andre UNSPECIFIED UNSPECIFIED UNSPECIFIED Addington, Jean UNSPECIFIED UNSPECIFIED UNSPECIFIED Pruessner, Marita UNSPECIFIED UNSPECIFIED UNSPECIFIED Nieman, Dorien UNSPECIFIED orcid.org/0000-0002-9846-4254 UNSPECIFIED de Haan, Lieuwe UNSPECIFIED UNSPECIFIED UNSPECIFIED Morrison, Anthony UNSPECIFIED UNSPECIFIED UNSPECIFIED Riecher-Roessler, Anita UNSPECIFIED UNSPECIFIED UNSPECIFIED Studerus, Erich UNSPECIFIED orcid.org/0000-0003-4233-0182 UNSPECIFIED Ruhrmann, Stephan UNSPECIFIED orcid.org/0000-0002-6022-2364 UNSPECIFIED Schultze-Lutter, Frauke UNSPECIFIED UNSPECIFIED UNSPECIFIED An, Suk Kyoon UNSPECIFIED orcid.org/0000-0003-4576-6184 UNSPECIFIED Koike, Shinsuke UNSPECIFIED UNSPECIFIED UNSPECIFIED Kasai, Kiyoto UNSPECIFIED orcid.org/0000-0002-4443-4535 UNSPECIFIED Nelson, Barnaby UNSPECIFIED orcid.org/0000-0002-6263-2332 UNSPECIFIED McGorry, Patrick UNSPECIFIED UNSPECIFIED UNSPECIFIED Wood, Stephen UNSPECIFIED UNSPECIFIED UNSPECIFIED Lin, Ashleigh UNSPECIFIED orcid.org/0000-0002-4054-0242 UNSPECIFIED Yung, Alison Y. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kotlicka-Antczak, Magdalena UNSPECIFIED UNSPECIFIED UNSPECIFIED Armando, Marco UNSPECIFIED orcid.org/0000-0001-7074-7212 UNSPECIFIED Vicari, Stefano UNSPECIFIED UNSPECIFIED UNSPECIFIED Katsura, Masahiro UNSPECIFIED UNSPECIFIED UNSPECIFIED Matsumoto, Kazunori UNSPECIFIED UNSPECIFIED UNSPECIFIED Durston, Sarah UNSPECIFIED UNSPECIFIED UNSPECIFIED Ziermans, Tim UNSPECIFIED UNSPECIFIED UNSPECIFIED Wunderink, Lex UNSPECIFIED UNSPECIFIED UNSPECIFIED Ising, Helga UNSPECIFIED UNSPECIFIED UNSPECIFIED van der Gaag, Mark UNSPECIFIED orcid.org/0000-0002-3525-6415 UNSPECIFIED Fusar-Poli, Paolo UNSPECIFIED orcid.org/0000-0003-3582-6788 UNSPECIFIED Pijnenborg, Gerdina Hendrika Maria UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-148029
DOI:	10.3389/fpsyt.2019.00345
Journal or Publication Title:	Front. Psychiatry
Volume:	10
Date:	2019
Publisher:	FRONTIERS MEDIA SA
Place of Publication:	LAUSANNE
ISSN:	1664-0640
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ULTRA-HIGH RISK; FOLLOW-UP; MENTAL STATE; EXTERNAL VALIDATION; SYMPTOM ASSESSMENT; NEGATIVE SYMPTOMS; GLOBAL ASSESSMENT; ONSET; PREVENTION; SCALE Multiple languages Psychiatry Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14802