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Article: Development of an individualized risk calculator of treatment resistance in patients with first-episode psychosis (TRipCal) using automated machine learning: a 12-year follow-up study with clozapine prescription as a proxy indicator

TitleDevelopment of an individualized risk calculator of treatment resistance in patients with first-episode psychosis (TRipCal) using automated machine learning: a 12-year follow-up study with clozapine prescription as a proxy indicator
Authors
Issue Date22-Jan-2024
PublisherSpringer Nature [academic journals on nature.com]
Citation
Translational Psychiatry, 2024, v. 14, n. 1 How to Cite?
Abstract

About 15-40% of patients with schizophrenia are treatment resistance (TR) and require clozapine. Identifying individuals who have higher risk of development of TR early in the course of illness is important to provide personalized intervention. A total of 1400 patients with FEP enrolled in the early intervention for psychosis service or receiving the standard psychiatric service between July 1, 1998, and June 30, 2003, for the first time were included. Clozapine prescriptions until June 2015, as a proxy of TR, were obtained. Premorbid information, baseline characteristics, and monthly clinical information were retrieved systematically from the electronic clinical management system (CMS). Training and testing samples were established with random subsampling. An automated machine learning (autoML) approach was used to optimize the ML algorithm and hyperparameters selection to establish four probabilistic classification models (baseline, 12-month, 24-month, and 36-month information) of TR development. This study found 191 FEP patients (13.7%) who had ever been prescribed clozapine over the follow-up periods. The ML pipelines identified with autoML had an area under the receiver operating characteristic curve ranging from 0.676 (baseline information) to 0.774 (36-month information) in predicting future TR. Features of baseline information, including schizophrenia diagnosis and age of onset, and longitudinal clinical information including symptoms variability, relapse, and use of antipsychotics and anticholinergic medications were important predictors and were included in the risk calculator. The risk calculator for future TR development in FEP patients (TRipCal) developed in this study could support the continuous development of data-driven clinical tools to assist personalized interventions to prevent or postpone TR development in the early course of illness and reduce delay in clozapine initiation.


Persistent Identifierhttp://hdl.handle.net/10722/339887
ISSN
2023 Impact Factor: 5.8
2023 SCImago Journal Rankings: 2.203
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorWong, TY-
dc.contributor.authorLuo, H-
dc.contributor.authorTang, J-
dc.contributor.authorMoore, TM-
dc.contributor.authorGur, RC-
dc.contributor.authorSuen, YN-
dc.contributor.authorHui, CLM-
dc.contributor.authorLee, EHM-
dc.contributor.authorChang, WC-
dc.contributor.authorYan, WC-
dc.contributor.authorChui, E-
dc.contributor.authorPoon, LT-
dc.contributor.authorLo, A-
dc.contributor.authorCheung, KM-
dc.contributor.authorKan, CK-
dc.contributor.authorChen, EYH-
dc.contributor.authorChan, SKW-
dc.date.accessioned2024-03-11T10:40:03Z-
dc.date.available2024-03-11T10:40:03Z-
dc.date.issued2024-01-22-
dc.identifier.citationTranslational Psychiatry, 2024, v. 14, n. 1-
dc.identifier.issn2158-3188-
dc.identifier.urihttp://hdl.handle.net/10722/339887-
dc.description.abstract<p>About 15-40% of patients with schizophrenia are treatment resistance (TR) and require clozapine. Identifying individuals who have higher risk of development of TR early in the course of illness is important to provide personalized intervention. A total of 1400 patients with FEP enrolled in the early intervention for psychosis service or receiving the standard psychiatric service between July 1, 1998, and June 30, 2003, for the first time were included. Clozapine prescriptions until June 2015, as a proxy of TR, were obtained. Premorbid information, baseline characteristics, and monthly clinical information were retrieved systematically from the electronic clinical management system (CMS). Training and testing samples were established with random subsampling. An automated machine learning (autoML) approach was used to optimize the ML algorithm and hyperparameters selection to establish four probabilistic classification models (baseline, 12-month, 24-month, and 36-month information) of TR development. This study found 191 FEP patients (13.7%) who had ever been prescribed clozapine over the follow-up periods. The ML pipelines identified with autoML had an area under the receiver operating characteristic curve ranging from 0.676 (baseline information) to 0.774 (36-month information) in predicting future TR. Features of baseline information, including schizophrenia diagnosis and age of onset, and longitudinal clinical information including symptoms variability, relapse, and use of antipsychotics and anticholinergic medications were important predictors and were included in the risk calculator. The risk calculator for future TR development in FEP patients (TRipCal) developed in this study could support the continuous development of data-driven clinical tools to assist personalized interventions to prevent or postpone TR development in the early course of illness and reduce delay in clozapine initiation.</p>-
dc.languageeng-
dc.publisherSpringer Nature [academic journals on nature.com]-
dc.relation.ispartofTranslational Psychiatry-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.titleDevelopment of an individualized risk calculator of treatment resistance in patients with first-episode psychosis (TRipCal) using automated machine learning: a 12-year follow-up study with clozapine prescription as a proxy indicator-
dc.typeArticle-
dc.identifier.doi10.1038/s41398-024-02754-w-
dc.identifier.scopuseid_2-s2.0-85182859865-
dc.identifier.volume14-
dc.identifier.issue1-
dc.identifier.eissn2158-3188-
dc.identifier.isiWOS:001155057800002-
dc.identifier.issnl2158-3188-

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