Andreou, C; Bailey, B; Armando, M; Solida, A; Huber, C; Michel, C; Kindler, J; von Plessen, K; Conus, P; Borgwardt, S (11 July 2023). Using individualized estimates of pretest risk to guide treatment decisions in patients with clinical high risk for psychosis: Project PsyYoung (Unpublished). In: IEPA's 14th International Conference on Early Intervention in Mental Health. Lausanne, Switzerland. 10.07.-12.07.2023.
Aims: The clinical high-risk (CHR) paradigm enables early identification and treatment of patients at risk for psychotic disorders, thereby improving their clinical outcomes. However, only a minority of CHR patients go on to develop overt psychosis. Moreover, the prognostic accuracy of CHR assessment instruments depends on pretest risk, which is widely heterogeneous in different populations. This creates a delicate balance between the need to create sufficient awareness to detect and address clinical needs timely, and the risk of pretest risk dilution through liberal referral practices and ensuing over-consumption of specialized services. To address this issue, the Swiss transcantonal project PsyYoung developed a pretest risk calculator to be used as a gatekeeper for specialized services within a stepped-care model of CHR assessment and intervention.
Methods: Six Swiss CHR services (three adult services, one child and adolescent service, and two mixed services) contributed data of patients referred for CHR assessment between 2014 and January 2022. The outcome of interest was time to transition. Leaning on a previously published predictive model from Great Britain, we used variables usually available at referral as predictors: sex, age (linear and quadratic effect) and their interaction, race/ethnicity, relationship status, and referral source. We trained a Cox proportional hazards model (LASSO method, nested cross-validation).
Results and conclusion: The model achieved adequate discrimination (Harrell’s C = 0.68) with significant differences in survival curves between low- and high-risk groups. The clinical utility of the model as a stratification instrument to guide treatment decisions is currently being evaluated within PsyYoung.
Item Type: |
Conference or Workshop Item (Speech) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > University Psychiatric Services > University Hospital of Child and Adolescent Psychiatry and Psychotherapy |
UniBE Contributor: |
Michel, Chantal, Kindler, Jochen |
Subjects: |
600 Technology > 610 Medicine & health |
Language: |
English |
Submitter: |
Chantal Michel |
Date Deposited: |
21 Aug 2023 11:48 |
Last Modified: |
21 Aug 2023 11:48 |
URI: |
https://boris.unibe.ch/id/eprint/185606 |
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