Department of Psychology, Yale University, New Haven, CT, USA.
Department of Psychiatry, Hotchkiss Brain Institute, Calgary, AB, Canada.
Schizophr Bull. 2022 Mar 1;48(2):395-404. doi: 10.1093/schbul/sbab115.
The clinical high-risk period before a first episode of psychosis (CHR-P) has been widely studied with the goal of understanding the development of psychosis; however, less attention has been paid to the 75%-80% of CHR-P individuals who do not transition to psychosis. It is an open question whether multivariable models could be developed to predict remission outcomes at the same level of performance and generalizability as those that predict conversion to psychosis. Participants were drawn from the North American Prodrome Longitudinal Study (NAPLS3). An empirically derived set of clinical and demographic predictor variables were selected with elastic net regularization and were included in a gradient boosting machine algorithm to predict prodromal symptom remission. The predictive model was tested in a comparably sized independent sample (NAPLS2). The classification algorithm developed in NAPLS3 achieved an area under the curve of 0.66 (0.60-0.72) with a sensitivity of 0.68 and specificity of 0.53 when tested in an independent external sample (NAPLS2). Overall, future remitters had lower baseline prodromal symptoms than nonremitters. This study is the first to use a data-driven machine-learning approach to assess clinical and demographic predictors of symptomatic remission in individuals who do not convert to psychosis. The predictive power of the models in this study suggest that remission represents a unique clinical phenomenon. Further study is warranted to best understand factors contributing to resilience and recovery from the CHR-P state.
首次精神病发作前的临床高风险期(CHR-P)已被广泛研究,目的是了解精神病的发展;然而,对于未发展为精神病的 CHR-P 个体的 75%-80%,关注较少。是否可以开发多变量模型来预测缓解结果,其性能和泛化程度与预测向精神病转化的模型一样,这是一个悬而未决的问题。参与者来自北美前驱纵向研究(NAPLS3)。使用弹性网络正则化选择了一组经验衍生的临床和人口统计学预测变量,并将其包含在梯度提升机算法中,以预测前驱症状缓解。该预测模型在规模相当的独立样本(NAPLS2)中进行了测试。在独立的外部样本(NAPLS2)中进行测试时,在 NAPLS3 中开发的分类算法的曲线下面积为 0.66(0.60-0.72),灵敏度为 0.68,特异性为 0.53。总体而言,未来的缓解者的前驱症状基线水平低于非缓解者。这项研究首次使用数据驱动的机器学习方法来评估未发展为精神病的个体中症状缓解的临床和人口统计学预测因素。该研究模型的预测能力表明缓解代表一种独特的临床现象。需要进一步研究以更好地了解导致 CHR-P 状态恢复和缓解的因素。