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Prognostic accuracy...
Prognostic accuracy and clinical utility of psychometric instruments for individuals at clinical high-risk of psychosis: a systematic review and meta-analysis
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Oliver, D (author)
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Arribas, M (author)
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Radua, J (author)
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de Pablo, GS (author)
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De Micheli, A (author)
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Spada, G (author)
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Mensi, MM (author)
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Kotlicka-Antczak, M (author)
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Borgatti, R (author)
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Solmi, M (author)
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Shin, JI (author)
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Woods, SW (author)
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Addington, J (author)
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McGuire, P (author)
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Fusar-Poli, P (author)
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- 2022-06-03
- 2022
- English.
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In: Molecular psychiatry. - : Springer Science and Business Media LLC. - 1476-5578 .- 1359-4184. ; 27:9, s. 3670-3678
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http://kipublication...
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https://doi.org/10.1...
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Abstract
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- Accurate prognostication of individuals at clinical high-risk for psychosis (CHR-P) is an essential initial step for effective primary indicated prevention. We aimed to summarise the prognostic accuracy and clinical utility of CHR-P assessments for primary indicated psychosis prevention. Web of Knowledge databases were searched until 1st January 2022 for longitudinal studies following-up individuals undergoing a psychometric or diagnostic CHR-P assessment, reporting transition to psychotic disorders in both those who meet CHR-P criteria (CHR-P + ) or not (CHR-P−). Prognostic accuracy meta-analysis was conducted following relevant guidelines. Primary outcome was prognostic accuracy, indexed by area-under-the-curve (AUC), sensitivity and specificity, estimated by the number of true positives, false positives, false negatives and true negatives at the longest available follow-up time. Clinical utility analyses included: likelihood ratios, Fagan’s nomogram, and population-level preventive capacity (Population Attributable Fraction, PAF). A total of 22 studies (n = 4 966, 47.5% female, age range 12–40) were included. There were not enough meta-analysable studies on CHR-P diagnostic criteria (DSM-5 Attenuated Psychosis Syndrome) or non-clinical samples. Prognostic accuracy of CHR-P psychometric instruments in clinical samples (individuals referred to CHR-P services or diagnosed with 22q.11.2 deletion syndrome) was excellent: AUC = 0.85 (95% CI: 0.81–0.88) at a mean follow-up time of 34 months. This result was driven by outstanding sensitivity (0.93, 95% CI: 0.87–0.96) and poor specificity (0.58, 95% CI: 0.50–0.66). Being CHR-P + was associated with a small likelihood ratio LR + (2.17, 95% CI: 1.81–2.60) for developing psychosis. Being CHR-P- was associated with a large LR- (0.11, 95%CI: 0.06−0.21) for developing psychosis. Fagan’s nomogram indicated a low positive (0.0017%) and negative (0.0001%) post-test risk in non-clinical general population samples. The PAF of the CHR-P state is 10.9% (95% CI: 4.1–25.5%). These findings consolidate the use of psychometric instruments for CHR-P in clinical samples for primary indicated prevention of psychosis. Future research should improve the ability to rule in psychosis risk.
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- By the author/editor
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Oliver, D
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Arribas, M
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Radua, J
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de Pablo, GS
-
De Micheli, A
-
Spada, G
-
show more...
-
Mensi, MM
-
Kotlicka-Antczak ...
-
Borgatti, R
-
Solmi, M
-
Shin, JI
-
Woods, SW
-
Addington, J
-
McGuire, P
-
Fusar-Poli, P
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show less...
- Articles in the publication
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Molecular psychi ...
- By the university
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Karolinska Institutet