Early intervention in psychosis: another triumph of hope over experience?

Mortimer, Ann; Brown, Timothy L.

doi:10.1002/pnp.379

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…Early intervention studies report falling case/non-case ratios among patients with first-episode psychosis (O‘Donoghue 2012). In my own service, approaching half of new patients have persistent substance-induced psychotic disorder (Mortimer 2015). Although patients may later attract a schizophrenia-spectrum diagnosis (Niemi-Pynttar 2013), there is a flaw in any contention that such patients really had schizophrenia all the time.…”

Section: Not All Psychosis Is Schizophreniamentioning

confidence: 99%

‘Deprescribing’ antipsychotics in schizophrenia: witless and dangerous?

Mortimer

2018

BJPsych advances

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SUMMARY‘Deprescribing’ here comprises arguments against treating patients who have been psychotic beyond first episode. Nevertheless, four out of five patients relapse, compared with only two of five still taking medication. However, much first-episode psychosis is not schizophrenia, but persistent substance-induced psychotic disorder. Virtually nothing is known about factors which facilitate this in the minority who develop it, nor how to decide if the patient will relapse off medication. Patients who are well, stable and tolerating minimal doses of medication should be the first to suggest that they try to do without it, not us.DECLARATION OF INTERESTA.M. has worked with pharmaceutical companies regarding the introduction of atypical antipsychotic treatments for schizophrenia, received research funding and spoken at conferences.

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Section: Not All Psychosis Is Schizophreniamentioning

confidence: 99%

‘Deprescribing’ antipsychotics in schizophrenia: witless and dangerous?

Mortimer

2018

BJPsych advances

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“…1 Early interventions are typically delivered by a specialist team for early psychosis (STEP). [7][8][9][10][11][12] However the referral process to STEPs is far from being optimal. Although most STEP referrals are from primary care,14/01/2023 14:13:00 many general practitioners lack awareness of high-risk symptoms or are not confident with recognising the psychotic state, both of which could lead to young people not receiving the care they need.…”

Section: Introductionmentioning

confidence: 99%

Digital behavioural tests as diagnostic aid for psychosis

Słowiński

White

Lison

et al. 2023

Preprint

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Background: Timely interventions have a proven benefit for people experiencing psychotic illness. One bottleneck to accessing timely interventions is the referral process to the specialist team for early psychosis (STEP). Many general practitioners lack awareness or confidence in recognising psychotic symptoms or state. Additionally, referrals for people without apparent psychotic symptoms, although beneficial at a population level, lead to excessive workload for STEPs. There is a clear unmet need for accurate stratification of STEPs users and healthy cohorts that this study aimed to investigate by applying digital behavioural tests. Methods: To discriminate between the STEPs users (SU; n=32) and controls (n=32, age and sex matched), we employed naive Bayes classifier, and applied it to objective, quantitative and interpretable features of a "mirror game" (MG) and trail making task (TMT). The MG is a movement coordination task shown to be a potential socio-motor biomarker of schizophrenia, while TMT is a neuropsychiatric test of cognitive function. Findings: The proposed classifier shows an excellent performance, AUC = 0.92 (95%CI 0.75-1), Sensitivity = 0.88 (95%CI 0.62-1), Specificity = 1 (95%CI 0.75-1), evaluated on 25% hold-out and 1000 folds. The study demonstrates that cheap off-the-shelf equipment (laptop computer and a leap motion sensor) records clinically relevant behavioural data sufficiently. We also find that MG and TMT are unsuitable in isolation to successfully differentiate between SU with and without at-risk-mental-state or first episode psychosis with sufficient level of performance. Interpretation: Including digital behavioural tests into healthcare practice could allow improvements in care for people at risk of developing psychotic illness. Our findings show that introduction of standardised battery of digital behavioural tests would benefit both clinical and research practice. It would allow standardization of referrals, while the high specificity of digital behavioural tests would benefit research on prognostic instruments for psychosis by enriching and homogenising clinical high-risk populations. Here we demonstrate that digital behavioural tests can be successfully used and could help to address this need. Funding: EPSRC Impact Acceleration Account, Impact & Knowledge Exchange Award, Jean Golding Institute seed corn, Avon & Wiltshire Mental Health Partnership NHS Trust Research Capability Funding. PS was generously supported by the Wellcome Trust Institutional Strategic Support Award 204909/Z/16/Z. KTA gratefully acknowledges the financial support of the EPSRC via grant EP/T017856/1.

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“…Early interventions are typically delivered by a specialist team for early psychosis (STEP) [7][8][9][10][11][12]. However, the referral process to STEPs is far from being optimal.…”

Section: Introductionmentioning

confidence: 99%

The potential of digital behavioural tests as a diagnostic aid for psychosis

Słowiński,

White,

Lison

et al. 2023

PLOS Digit Health

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Timely interventions have a proven benefit for people experiencing psychotic illness. One bottleneck to accessing timely interventions is the referral process to the specialist team for early psychosis (STEP). Many general practitioners lack awareness or confidence in recognising psychotic symptoms or state. Additionally, referrals for people without apparent psychotic symptoms, although beneficial at a population level, lead to excessive workload for STEPs. There is a clear unmet need for accurate stratification of STEPs users and healthy cohorts. Here we propose a new approach to addressing this need via the application of digital behavioural tests. To demonstrate that digital behavioural tests can be used to discriminate between the STEPs users (SU; n = 32) and controls (n = 32, age and sex matched), we compared performance of five different classifiers applied to objective, quantitative and interpretable features derived from the ‘mirror game’ (MG) and trail making task (TMT). The MG is a movement coordination task shown to be a potential socio-motor biomarker of schizophrenia, while TMT is a neuropsychiatric test of cognitive function. All classifiers had AUC in the range of 0.84–0.92. The best of the five classifiers (linear discriminant classifier) achieved an outstanding performance, AUC = 0.92 (95%CI 0.75–1), Sensitivity = 0.75 (95%CI 0.5–1), Specificity = 1 (95%CI 0.75–1), evaluated on 25% hold-out and 1000 folds. Performance of all analysed classifiers is underpinned by the large effect sizes of the differences between the cohorts in terms of the features used for classification what ensures generalisability of the results. We also found that MG and TMT are unsuitable in isolation to successfully differentiate between SU with and without at-risk-mental-state or first episode psychosis with sufficient level of performance. Our findings show that standardised batteries of digital behavioural tests could benefit both clinical and research practice. Including digital behavioural tests into healthcare practice could allow precise phenotyping and stratification of the highly heterogenous population of people referred to STEPs resulting in quicker and more personalised diagnosis. Moreover, the high specificity of digital behavioural tests could facilitate the identification of more homogeneous clinical high-risk populations, benefiting research on prognostic instruments for psychosis. In summary, our study demonstrates that cheap off-the-shelf equipment (laptop computer and a leap motion sensor) can be used to record clinically relevant behavioural data that could be utilised in digital mental health applications.

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Early intervention in psychosis: another triumph of hope over experience?

Cited by 4 publications

References 21 publications

‘Deprescribing’ antipsychotics in schizophrenia: witless and dangerous?

‘Deprescribing’ antipsychotics in schizophrenia: witless and dangerous?

Digital behavioural tests as diagnostic aid for psychosis

The potential of digital behavioural tests as a diagnostic aid for psychosis

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