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Online risk calculator useful for prediction of psychosis in secondary settings

Following mediocre efficacy of At Risk Mental State services, researchers developed an online individualized risk calculator for transdiagnostic prediction of psychosis in secondary mental health care.

“The overall clinical impact of the [At Risk Mental State (ARMS)] on psychosis prevention in secondary mental health care and the value of using the ARMS designation compared with standard mental diagnoses (eg, those defined by the ICD-10) is not completely clear,” Paolo Fusar-Poli, MD, PhD, of King’s College London, and colleagues wrote. “Whether we can pragmatically predict psychosis outside the ARMS designation or not remains unclear because, to our knowledge, no studies have ever addressed this issue. Such a gap of knowledge may have clinical implications for the provision of preventive intervention services and policy makers.”

To assess validity of ARMS for first-episode psychosis in secondary mental health services and develop a web-based individualized risk calculator tool for transdiagnostic prediction of psychosis in secondary mental health care, researchers analyzed electronic medical record data for 91,199 individuals diagnosed with nonorganic and nonpsychotic mental disorder. Study participants had a mean age of 32.97 years. Mean follow-up was 1,588 days.

Overall 6-year risk for psychosis in secondary mental health care was 3.02 (95% CI, 2.88-3.15), which was higher than the 6-year risk for the general population (0.62).

Compared with ARMS designation, all ICD-10 diagnoses exhibited lower risk for psychosis, except for bipolar mood disorders and brief psychotic episodes, which showed similar or higher risk, respectively.

ARMS designation accounted for a small proportion of transitions to psychosis (5.19%), indicating a need for transdiagnostic prediction of psychosis in secondary mental health care.

Researchers developed a prognostic risk stratification model based on preselected variables, which was validated. The model performed well and exhibited potential clinical utility.

“Individuals accessing secondary mental health services are at enhanced risk of developing psychosis compared with the local general population. The use of this novel individualized risk calculator can be of clinical usefulness to improve the transdiagnostic detection of at-risk individuals and prevention of psychosis in secondary mental health care,” the researchers concluded. – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.