title: Personalized Prediction of Psychosis: External Validation of the NAPLS-2 Psychosis Risk Calculator With the EDIPPP Project.
abstract: OBJECTIVE
  As part of the second phase of the North American Prodrome Longitudinal Study (NAPLS-2), Cannon and colleagues report, concurrently with the present article, on a risk calculator for the individualized prediction of a psychotic disorder in a 2-year period. The present study represents an external validation of the NAPLS-2 psychosis risk calculator using an independent sample of patients at clinical high risk for psychosis collected as part of the Early Detection, Intervention, and Prevention of Psychosis Program (EDIPPP).
  
  
  METHODS
  Of the total EDIPPP sample of 210 subjects rated as being at clinical high risk based on the Structured Interview for Prodromal Syndromes, 176 had at least one follow-up assessment and were included in the construction of a new prediction model with six predictor variables in the NAPLS-2 psychosis risk calculator (unusual thoughts and suspiciousness, symbol coding test performance, verbal learning test performance, decline in social functioning, baseline age, and family history). Discrimination performance was assessed with the area under the receiver operating characteristic curve (AUC). The NAPLS-2 risk calculator was then used to generate a psychosis risk estimate for each case in the external validation sample.
  
  
  RESULTS
  The external validation model showed good discrimination, with an AUC of 0.790 (95% CI=0.644-0.937). In addition, the personalized risk generated by the risk calculator provided a solid estimation of the actual conversion outcome in the validation sample.
  
  
  CONCLUSIONS
  Two independent samples of clinical high-risk patients converge to validate the NAPLS-2 psychosis risk calculator. This prediction calculator represents a meaningful step toward early intervention and the personalized treatment of psychotic disorders.
authors.affiliation: From the Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry, University of Michigan, Ann Arbor; the Department of Psychiatry, Stanford University, Palo Alto, Calif.; the Imaging Research Center and the Center for Neuroscience, University of California Davis, Sacramento, Calif.; Portland State University Regional Research Institute, Portland, Ore.; the Mid-Valley Behavioral Care Network, Marion County Health Department, Salem, Ore.; Tufts University School of Medicine, Boston; and Maine Medical Center Research Institute, Portland.
authors.forename: Ricardo E
authors.initials: RE
authors.lastname: Carrión
authors.affiliation: From the Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry, University of Michigan, Ann Arbor; the Department of Psychiatry, Stanford University, Palo Alto, Calif.; the Imaging Research Center and the Center for Neuroscience, University of California Davis, Sacramento, Calif.; Portland State University Regional Research Institute, Portland, Ore.; the Mid-Valley Behavioral Care Network, Marion County Health Department, Salem, Ore.; Tufts University School of Medicine, Boston; and Maine Medical Center Research Institute, Portland.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Cornblatt
authors.affiliation: From the Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry, University of Michigan, Ann Arbor; the Department of Psychiatry, Stanford University, Palo Alto, Calif.; the Imaging Research Center and the Center for Neuroscience, University of California Davis, Sacramento, Calif.; Portland State University Regional Research Institute, Portland, Ore.; the Mid-Valley Behavioral Care Network, Marion County Health Department, Salem, Ore.; Tufts University School of Medicine, Boston; and Maine Medical Center Research Institute, Portland.
authors.forename: Cynthia Z
authors.initials: CZ
authors.lastname: Burton
authors.affiliation: From the Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry, University of Michigan, Ann Arbor; the Department of Psychiatry, Stanford University, Palo Alto, Calif.; the Imaging Research Center and the Center for Neuroscience, University of California Davis, Sacramento, Calif.; Portland State University Regional Research Institute, Portland, Ore.; the Mid-Valley Behavioral Care Network, Marion County Health Department, Salem, Ore.; Tufts University School of Medicine, Boston; and Maine Medical Center Research Institute, Portland.
authors.forename: Ivy F
authors.initials: IF
authors.lastname: Tso
authors.affiliation: From the Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry, University of Michigan, Ann Arbor; the Department of Psychiatry, Stanford University, Palo Alto, Calif.; the Imaging Research Center and the Center for Neuroscience, University of California Davis, Sacramento, Calif.; Portland State University Regional Research Institute, Portland, Ore.; the Mid-Valley Behavioral Care Network, Marion County Health Department, Salem, Ore.; Tufts University School of Medicine, Boston; and Maine Medical Center Research Institute, Portland.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Auther
authors.affiliation: From the Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry, University of Michigan, Ann Arbor; the Department of Psychiatry, Stanford University, Palo Alto, Calif.; the Imaging Research Center and the Center for Neuroscience, University of California Davis, Sacramento, Calif.; Portland State University Regional Research Institute, Portland, Ore.; the Mid-Valley Behavioral Care Network, Marion County Health Department, Salem, Ore.; Tufts University School of Medicine, Boston; and Maine Medical Center Research Institute, Portland.
authors.forename: Steven
authors.initials: S
authors.lastname: Adelsheim
authors.affiliation: From the Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry, University of Michigan, Ann Arbor; the Department of Psychiatry, Stanford University, Palo Alto, Calif.; the Imaging Research Center and the Center for Neuroscience, University of California Davis, Sacramento, Calif.; Portland State University Regional Research Institute, Portland, Ore.; the Mid-Valley Behavioral Care Network, Marion County Health Department, Salem, Ore.; Tufts University School of Medicine, Boston; and Maine Medical Center Research Institute, Portland.
authors.forename: Roderick
authors.initials: R
authors.lastname: Calkins
authors.affiliation: From the Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry, University of Michigan, Ann Arbor; the Department of Psychiatry, Stanford University, Palo Alto, Calif.; the Imaging Research Center and the Center for Neuroscience, University of California Davis, Sacramento, Calif.; Portland State University Regional Research Institute, Portland, Ore.; the Mid-Valley Behavioral Care Network, Marion County Health Department, Salem, Ore.; Tufts University School of Medicine, Boston; and Maine Medical Center Research Institute, Portland.
authors.forename: Cameron S
authors.initials: CS
authors.lastname: Carter
authors.affiliation: From the Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry, University of Michigan, Ann Arbor; the Department of Psychiatry, Stanford University, Palo Alto, Calif.; the Imaging Research Center and the Center for Neuroscience, University of California Davis, Sacramento, Calif.; Portland State University Regional Research Institute, Portland, Ore.; the Mid-Valley Behavioral Care Network, Marion County Health Department, Salem, Ore.; Tufts University School of Medicine, Boston; and Maine Medical Center Research Institute, Portland.
authors.forename: Tara
authors.initials: T
authors.lastname: Niendam
authors.affiliation: From the Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry, University of Michigan, Ann Arbor; the Department of Psychiatry, Stanford University, Palo Alto, Calif.; the Imaging Research Center and the Center for Neuroscience, University of California Davis, Sacramento, Calif.; Portland State University Regional Research Institute, Portland, Ore.; the Mid-Valley Behavioral Care Network, Marion County Health Department, Salem, Ore.; Tufts University School of Medicine, Boston; and Maine Medical Center Research Institute, Portland.
authors.forename: Tamara G
authors.initials: TG
authors.lastname: Sale
authors.affiliation: From the Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry, University of Michigan, Ann Arbor; the Department of Psychiatry, Stanford University, Palo Alto, Calif.; the Imaging Research Center and the Center for Neuroscience, University of California Davis, Sacramento, Calif.; Portland State University Regional Research Institute, Portland, Ore.; the Mid-Valley Behavioral Care Network, Marion County Health Department, Salem, Ore.; Tufts University School of Medicine, Boston; and Maine Medical Center Research Institute, Portland.
authors.forename: Stephan F
authors.initials: SF
authors.lastname: Taylor
authors.affiliation: From the Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Glen Oaks, N.Y.; the Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Northwell Health, Manhasset, N.Y.; the Departments of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, N.Y.; the Department of Psychiatry, University of Michigan, Ann Arbor; the Department of Psychiatry, Stanford University, Palo Alto, Calif.; the Imaging Research Center and the Center for Neuroscience, University of California Davis, Sacramento, Calif.; Portland State University Regional Research Institute, Portland, Ore.; the Mid-Valley Behavioral Care Network, Marion County Health Department, Salem, Ore.; Tufts University School of Medicine, Boston; and Maine Medical Center Research Institute, Portland.
authors.forename: William R
authors.initials: WR
authors.lastname: McFarlane
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008960:Models, Psychological; D011237:Predictive Value of Tests; D062706:Prodromal Symptoms; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis*; D012307:Risk Factors; D055815:Young Adult