Abstract
Recent studies have reported an association between psychopathology and subsequent clinical and functional outcomes in people at ultra-high risk (UHR) for psychosis. This has led to the suggestion that psychopathological information could be used to make prognostic predictions in this population. However, because the current literature is based on inferences at group level, the translational value of the findings for everyday clinical practice is unclear. Here we examined whether psychopathological information could be used to make individualized predictions about clinical and functional outcomes in people at UHR. Participants included 416 people at UHR followed prospectively at the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne, Australia. The data were analysed using Support Vector Machine (SVM), a supervised machine learning technique that allows inferences at the individual level. SVM predicted transition to psychosis with a specificity of 60.6%, a sensitivity of 68.6% and an accuracy of 64.6% (p<0.001). In addition, SVM predicted functioning with a specificity of 62.5%, a sensitivity of 62.5% and an accuracy of 62.5% (p=0.008). Prediction of transition was driven by disorder of thought content, attenuated positive symptoms and functioning, whereas functioning was best predicted by attention disturbances, anhedonia–asociality and disorder of thought content. These results indicate that psychopathological information allows individualized prognostic predictions with statistically significant accuracy. However, this level of accuracy may not be sufficient for clinical translation in real-world clinical practice. Accuracy might be improved by combining psychopathological information with other types of data using a multivariate machine learning framework.
Highlights
The onset of a psychotic disorder is typically preceded by a prodromal phase, known as the ultra high risk (UHR) state, involving the emergence of attenuated positive symptoms and a marked decline in functioning (Fusar-Poli et al, 2013; Yung et al, 1996)
Because effects that are statistically significant at a group level do not necessarily permit accurate inferences at the level of the individual, the translational potential of the findings for everyday clinical practice is unclear
Support Vector Machine (SVM) was able to discriminate between individuals at UHR who subsequently did and did not make transition to psychosis with specificity of 60.6%, a sensitivity of 68.6% and an accuracy of 64.6%; permutation testing indicated that this was statistically significant (p b 0.001)
Summary
The onset of a psychotic disorder is typically preceded by a prodromal phase, known as the ultra high risk (UHR) state, involving the emergence of attenuated positive symptoms and a marked decline in functioning (Fusar-Poli et al, 2013; Yung et al, 1996). Disorganised symptoms (Carrion et al, 2013; Ziermans et al, 2014) and negative symptoms (Lin et al, 2011; Meyer et al, 2014) have been found to be predictive of functional outcomes irrespective of transition to psychosis. These findings indicate that it may be possible to use careful clinical assessment to predict transition to psychosis as well as psychosocial functioning in individuals at UHR for psychosis
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