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Prediction of psychosis in prodrome: development and validation of a simple, personalized risk calculator

  • TianHong Zhang (a1), LiHua Xu (a1), YingYing Tang (a1), HuiJun Li (a2), XiaoChen Tang (a1), HuiRu Cui (a1), YanYan Wei (a1), Yan Wang (a1), Qiang Hu (a1), XiaoHua Liu (a1), ChunBo Li (a1), Zheng Lu (a1) (a3), Robert W. McCarley (a4), Larry J. Seidman (a4), JiJun Wang (a1) (a5) (a6) and on behalf of the SHARP (ShangHai At Risk for Psychosis) Study Group (a1) (a2) (a3) (a4) (a5) (a6)...



This study aim to derive and validate a simple and well-performing risk calculator (RC) for predicting psychosis in individual patients at clinical high risk (CHR).


From the ongoing ShangHai-At-Risk-for-Psychosis (SHARP) program, 417 CHR cases were identified based on the Structured Interview for Prodromal Symptoms (SIPS), of whom 349 had at least 1-year follow-up assessment. Of these 349 cases, 83 converted to psychosis. Logistic regression was used to build a multivariate model to predict conversion. The area under the receiver operating characteristic (ROC) curve (AUC) was used to test the effectiveness of the SIPS-RC. Second, an independent sample of 100 CHR subjects was recruited based on an identical baseline and follow-up procedures to validate the performance of the SIPS-RC.


Four predictors (each based on a subset of SIPS-based items) were used to construct the SIPS-RC: (1) functional decline; (2) positive symptoms (unusual thoughts, suspiciousness); (3) negative symptoms (social anhedonia, expression of emotion, ideational richness); and (4) general symptoms (dysphoric mood). The SIPS-RC showed moderate discrimination of subsequent transition to psychosis with an AUC of 0.744 (p < 0.001). A risk estimate of 25% or higher had around 75% accuracy for predicting psychosis. The personalized risk generated by the SIPS-RC provided a solid estimate of conversion outcomes in the independent validation sample, with an AUC of 0.804 [95% confidence interval (CI) 0.662–0.951].


The SIPS-RC, which is simple and easy to use, can perform in the same manner as the NAPLS-2 RC in the Chinese clinical population. Such a tool may be used by clinicians to counsel appropriately their patients about clinical monitor v. potential treatment options.


Corresponding author

Author for correspondence: JiJun Wang, E-mail: and Lu Zheng, E-mail:


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Dr Larry J. Seidman passed away on 7 September 2017. Dr Robert W. McCarley passed away on 27 May 2017. Both were founders and core members of the SHARP (ShangHai At Risk for Psychosis) project.



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