Development and initial evaluation of a clinical prediction model for risk of treatment resistance in first-episode psychosis: Schizophrenia Prediction of Resistance to Treatment (SPIRIT)
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Le résumé fourni par la source
BACKGROUND: A clinical tool to estimate the risk of treatment-resistant schizophrenia (TRS) in people with first-episode psychosis (FEP) would inform early detection of TRS and overcome the delay of up to 5 years in starting TRS medication. AIMS: To develop and evaluate a model that could predict the risk of TRS in routine clinical practice. METHOD: We used data from two UK-based FEP cohorts (GAP and AESOP-10) to develop and internally validate a prognostic model that supports identification of patients at high-risk of TRS soon after FEP diagnosis. Using sociodemographic and clinical predictors, a model for predicting risk of TRS was developed based on penalised logistic regression, with missing data handled using multiple imputation. Internal validation was undertaken via bootstrapping, obtaining optimism-adjusted estimates of the model's performance. Interviews and focus groups with clinicians were conducted to establish clinically relevant risk thresholds and understand the acceptability and perceived utility of the model. RESULTS: We included seven factors in the prediction model that are predominantly assessed in clinical practice in patients with FEP. The model predicted treatment resistance among the 1081 patients with reasonable accuracy; the model's C-statistic was 0.727 (95% CI 0.723-0.732) prior to shrinkage and 0.687 after adjustment for optimism. Calibration was good (expected/observed ratio: 0.999; calibration-in-the-large: 0.000584) after adjustment for optimism. CONCLUSIONS: We developed and internally validated a prediction model with reasonably good predictive metrics. Clinicians, patients and carers were involved in the development process. External validation of the tool is needed followed by co-design methodology to support implementation in early intervention services.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Development and initial evaluation of a clinical prediction model for risk of treatment resistance in first-episode psychosis: Schizophrenia Prediction of Resistance to Treatment (SPIRIT)
- Date Crossref
- 05/08/2024
- Éditeur
- Royal College of Psychiatrists
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Midlands Partnership NHS Foundation Trust pays non établi dans la noticeÉtablissement de santé
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St George's Hospital pays non établi dans la noticeÉtablissement de santé
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Keele University pays non établi dans la noticeUniversité ou école supérieure
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NIHR Birmingham Liver Biomedical Research Unit pays non établi dans la noticeOrganisme public
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NIHR Birmingham Biomedical Research Centre pays non établi dans la noticeStructure de recherche
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University of Birmingham pays non établi dans la noticeUniversité ou école supérieure
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King's College London Department of Biostatistics & Health Informatics pays non établi dans la noticeUniversité ou école supérieure
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University College London Department of Behavioural Science and Health pays non établi dans la noticeUniversité ou école supérieure
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University of Palermo Department of Psychiatry pays non établi dans la noticeUniversité ou école supérieure
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University of Cambridge Department of Psychiatry pays non établi dans la noticeUniversité ou école supérieure
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University of Nottingham Division of Psychiatry and Applied Psychology pays non établi dans la noticeUniversité ou école supérieure
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Greater Manchester Mental Health NHS Foundation Trust pays non établi dans la noticeÉtablissement de santé
Midlands Partnership NHS Foundation Trust, St George's Hospital et Keele University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.