Predicting the onset of psychosis in patients at clinical high risk: practical guide to probabilistic prognostic reasoning

Evidence-based Mental Health
Paolo Fusar-Poli, Frauke Schultze-Lutter

Abstract

Prediction of psychosis in patients at clinical high risk (CHR) has become a mainstream focus of clinical and research interest worldwide. When using CHR instruments for clinical purposes, the predicted outcome is but only a probability; and, consequently, any therapeutic action following the assessment is based on probabilistic prognostic reasoning. Yet, probabilistic reasoning makes considerable demands on the clinicians. We provide here a scholarly practical guide summarising the key concepts to support clinicians with probabilistic prognostic reasoning in the CHR state. We review risk or cumulative incidence of psychosis in, person-time rate of psychosis, Kaplan-Meier estimates of psychosis risk, measures of prognostic accuracy, sensitivity and specificity in receiver operator characteristic curves, positive and negative predictive values, Bayes' theorem, likelihood ratios, potentials and limits of real-life applications of prognostic probabilistic reasoning in the CHR state. Understanding basic measures used for prognostic probabilistic reasoning is a prerequisite for successfully implementing the early detection and prevention of psychosis in clinical practice. Future refinement of these measures for CHR patients may actu...Continue Reading

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Citations

Oct 8, 2016·World Psychiatry : Official Journal of the World Psychiatric Association (WPA)·Maude SchneiderStephan Eliez
Oct 23, 2018·JAMA Psychiatry·Paolo Fusar-PoliEwout W Steyerberg
Oct 5, 2018·Evidence-based Mental Health·Sinan Guloksuz, Jim van Os
Mar 15, 2019·European Psychiatry : the Journal of the Association of European Psychiatrists·Magdalena Kotlicka-AntczakPaolo Fusar-Poli
Feb 19, 2020·Molecular Psychiatry·Christina Andreou, Stefan Borgwardt
Mar 12, 2020·JAMA Psychiatry·Paolo Fusar-PoliCelso Arango
Jan 6, 2017·Schizophrenia Bulletin·Paolo Fusar-Poli
Sep 25, 2017·World Psychiatry : Official Journal of the World Psychiatric Association (WPA)·Paolo Fusar-PoliJohn M Kane
Jan 21, 2018·World Psychiatry : Official Journal of the World Psychiatric Association (WPA)·Joaquim RaduaPaolo Fusar-Poli
Apr 9, 2020·Frontiers in Psychiatry·Cristiana MontemagniPaola Rocca
Jan 1, 2017·Schizophrenia Bulletin·Paolo Fusar-PoliJosef Parnas
Feb 8, 2018·European Psychiatry : the Journal of the Association of European Psychiatrists·D OliverP Fusar-Poli
May 13, 2017·World Psychiatry : Official Journal of the World Psychiatric Association (WPA)·Paolo Fusar-Poli
Dec 20, 2016·European Psychiatry : the Journal of the Association of European Psychiatrists·P Fusar-PoliP McGuire
Feb 18, 2017·European Psychiatry : the Journal of the Association of European Psychiatrists·P Fusar-PoliP McGuire
Jan 11, 2020·Frontiers in Psychiatry·Paolo Fusar-PoliJoaquim Radua

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