Centre for Academic Mental Health, and National Institute for Health and Care Research Bristol Biomedical Research Centre, University of Bristol, Bristol.
Centre for Academic Primary Care, Population Health Sciences Institute, University of Bristol, Bristol.
Br J Gen Pract. 2024 Nov 28;74(749):e854-e860. doi: 10.3399/BJGP.2024.0017. Print 2024 Dec.
Early detection could reduce the duration of untreated psychosis. GPs are a vital part of the psychosis care pathway, but find it difficult to detect the early features. An accurate risk prediction tool, P Risk, was developed to detect these.
To externally validate P Risk.
This retrospective cohort study used a validation dataset of 1 647 934 UK Clinical Practice Research Datalink (CPRD) primary care records linked to secondary care records.
The same predictors (age; sex; ethnicity; social deprivation; consultations for suicidal behaviour, depression/anxiety, and substance misuse; history of consultations for suicidal behaviour; smoking history; substance misuse; prescribed medications for depression/anxiety/post-traumatic stress disorder/obsessive compulsive disorder; and total number of consultations) were used as for the development of P Risk. Predictive risk, sensitivity, specificity, and likelihood ratios were calculated for various risk thresholds. Discrimination (Harrell's C-index) and calibration were calculated. Results were compared between the development (CPRD GOLD) and validation (CPRD Aurum) datasets.
Psychosis risk increased with values of the P Risk prognostic index. Incidence was highest in younger age groups and, in the main, higher in males. Harrell's C was 0.79 (95% confidence interval = 0.78 to 0.79) in the validation dataset and 0.77 in the development dataset. A risk threshold of 1.0% gave sensitivity of 65.9% and specificity of 86.6%.
Further testing is required, but P Risk has the potential to be used in primary care to detect future risk of psychosis.
早期发现可以缩短未治疗的精神病的持续时间。全科医生是精神病治疗途径的重要组成部分，但他们发现很难发现早期特征。一个准确的风险预测工具 P Risk 被开发出来用于检测这些特征。
验证 P Risk。
这项回顾性队列研究使用了一个包含 1647934 名英国临床实践研究数据链接（CPRD）初级保健记录的验证数据集，这些记录与二级保健记录相关联。
与 P Risk 开发时一样，使用相同的预测因子（年龄；性别；种族；社会贫困；自杀行为、抑郁/焦虑和物质滥用咨询；自杀行为咨询史；吸烟史；物质滥用；抑郁/焦虑/创伤后应激障碍/强迫症的处方药物；以及总咨询次数）。为不同的风险阈值计算预测风险、敏感性、特异性和似然比。计算了区分度（哈雷尔 C 指数）和校准。将结果在开发（CPRD GOLD）和验证（CPRD Aurum）数据集之间进行比较。
精神病风险随着 P Risk 预后指数值的增加而增加。发病率在年龄较小的群体中最高，且男性的发病率总体较高。验证数据集中哈雷尔 C 指数为 0.79（95%置信区间=0.78 至 0.79），而开发数据集中为 0.77。风险阈值为 1.0%时，敏感性为 65.9%，特异性为 86.6%。
需要进一步测试，但 P Risk 有可能在初级保健中用于检测未来的精神病风险。
