Individualized pretest risk estimates to guide treatment decisions in patients with clinical high risk for psychotic disorders

Article Article scientifique Article Individualized pretest risk estimates to guide treatment decisions in patients with clinical high risk for psychotic disorders eng 2024-09-18 2025-04 author Spruengli-Toffel Elodie General Psychiatry Service, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland. Electronic address: elodie.sprungli-toffel@chuv.ch. 727468 Département de psychiatrie (PSYAT) Elodie Toffel author Studerus Erich Institute for Information Systems, University of Applied Sciences and Arts Northwestern Switzerland, Basel, Switzerland. author Curtis Logos Simian Department of Psychiatry, University of Geneva, Geneva, Switzerland; Department of Adult Psychiatry, Department of Psychiatry, Geneva University Hospital, University of Geneva, Geneva, Switzerland. 28777 Département de psychiatrie (PSYAT) author Conchon Caroline General Psychiatry Service, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland. author Alameda Luis General Psychiatry Service, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland; King's College of London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; Centro Investigacion Biomedica en Red de Salud Mental (CIBERSAM), Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio, Departamento de Psiquiatria, Universidad de Sevilla, Sevilla, Spain. author Bailey Barbara University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland. author Caron Camille University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland. author Haase Carmina University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland. author Gros Julia University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland. author Herbrecht Evelyn University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland. author Huber Christian G University Psychiatric Clinics (UPK) Basel, University of Basel, Basel, Switzerland. author Riecher-Rössler Anita Medical Faculty, University of Basel, Basel, Switzerland. author Conus Philippe General Psychiatry Service, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland. author Solida Alessandra General Psychiatry Service, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland; Center of Psychiatry of Neuchâtel (CNP), Neuchâtel, Switzerland. author Armando Marco Division of Child and Adolescent Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. author Kapsaridi Afroditi Division of Child and Adolescent Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland. author Ducommun Mathieu Mercapide Division of Child and Adolescent Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland. author Klauser Paul Division of Child and Adolescent Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland; Center for Psychiatric Neuroscience, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland. author Plessen Kerstin Jessica Division of Child and Adolescent Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. author Urben Sébastien Division of Child and Adolescent Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. author Edan Anne Child and Adolescent Psychiatric Service, Geneva University Hospitals, University of Geneva, Geneva, Switzerland. 779657 Département de psychiatrie (PSYAT) author Nanzer Nathalie 0000-0003-4146-0399 Child and Adolescent Psychiatric Service, Geneva University Hospitals, University of Geneva, Geneva, Switzerland. 81184 Département de psychiatrie (PSYAT) author Liso Navarro Ana Medico-Pedagogical Office, State of Geneva, Geneva, Switzerland. 651522 author Schneider Maude Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland. 594384 Section de psychologie (PSICO) author Genoud Davina Division of Child and Adolescent Psychiatry, Lausanne University Hospital and the University of Lausanne, Lausanne, Switzerland. author Michel Chantal University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland. author Kindler Jochen University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland. author Kaess Michael University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland. author Oliver Dominic Department of Psychiatry, University of Oxford, Oxford, United Kingdom. author Fusar-Poli Paolo King's College of London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; OASIS Service, South London and the Maudsley NHS Foundation Trust, London, United Kingdom; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany. author Borgwardt Stefan Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany. author Andreou Christina Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany. 133-140 10.1016/j.sjpmh.2024.09.001 39303874 2950-2853 https://www.sciencedirect.com/science/article/pii/S2950285324000528 Introduction: Clinical high risk for psychosis (CHR) states are associated with an increased risk of transition to psychosis. However, the predictive value of CHR screening interviews is dependent on pretest risk enrichment in referred patients. This poses a major obstacle to CHR outreach campaigns since they invariably lead to risk dilution through enhanced awareness. A potential compensatory strategy is to use estimates of individual pretest risk as a 'gatekeeper' for specialized assessment. We aimed to test a risk stratification model previously developed in London, UK (OASIS) and to train a new predictive model for the Swiss population. Method: The sample was composed of 513 individuals referred for CHR assessment from six Swiss early psychosis detection services. Sociodemographic variables available at referral were used as predictors whereas the outcome variable was transition to psychosis. Results: Replication of the risk stratification model developed in OASIS resulted in poor performance (Harrel's c=0.51). Retraining resulted in moderate discrimination (Harrel's c=0.67) which significantly differentiated between different risk groups. The lowest risk group had a cumulative transition incidence of 6.4% (CI: 0-23.1%) over two years. Conclusion: Failure to replicate the OASIS risk stratification model might reflect differences in the public health care systems and referral structures between Switzerland and London. Retraining resulted in a model with adequate discrimination performance. The developed model in combination with CHR assessment result, might be useful for identifying individuals with high pretest risk, who might benefit most from specialized intervention. CHR Early detection Pretest risk Psychosis Humans Psychotic Disorders / diagnosis Psychotic Disorders / therapy Female Adult Risk Assessment / methods Male Young Adult Switzerland Adolescent Prodromal Symptoms Early Diagnosis Dewey 150 Dewey 618 58 Département de pédiatrie, gynécologie et obstétrique 223 108 Section de psychologie 71 false 1302 Unité de psychologie clinique des situations de handicap Spanish journal of psychiatry and mental health 18 2 c88f18d7-4e6c-4c27-9d1a-3ebb47f04cb8 Article (Published version) Public 1-s2.0-S2950285324000528-main.pdf 417694 application/pdf CC BY-4.0 e9489884520a1b8a9ae7528e28d07bf309dd70b1a0d35aec568476385a93c532 b45ca03f-4064-436a-bb7b-be763a27a407 Supplemental data Public 1-s2.0-S2950285324000528-mmc1.doc 211968 application/msword d40e74ac5d2d8df723329268091106e2f28f3a229d28ea12414297d466f0ab75 openAccess Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique Faculté de psychologie et des sciences de l'éducation / Section de psychologie

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Individualized pretest risk estimates to guide treatment decisions in patients with clinical high risk for psychotic disorders	Spanish journal of psychiatry and mental health			2025	8	126

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Liso Navarro, Ana