Background to the P risk study
Psychosis is a term for a group of serious, long-term mental illnesses characterised by loss of contact with reality, e.g. schizophrenia. The World Health Organisation ranks psychosis as the third most disabling condition worldwide. Most people with psychosis in the UK enter specialist mental health care (i.e. Early Intervention for Psychosis Teams – EITs) via a referral from their GP. It is consequently important that GPs recognise the warning signs of psychosis to expedite referral to EITs, but this is difficult to achieve. There is potential to help GPs identify the early warning signs of psychosis by using the data already available in the primary care electronic health records (EHRs).
A previous nested case control study in primary care EHRs found that 12 predefined non-psychotic warning symptoms and signs (depression, obsessive compulsive disorder, attention deficit hyperactivity disorder, mania, blunted affect, problems with cannabis, problems with cigarette smoking, sleeping problems, suicidal behaviour, bizarre behaviour, social isolation, role functioning problems), sociodemographic factors and consultation frequency were associated with later psychosis (Sullivan et al., 2018). Using these findings we have developed and internally validated a prediction model (P Risk) whose ability to discriminate between those who later develop psychosis and those do not is good. External validation of P Risk is ongoing and is expected to show similar performance. The external validation work will produce a psychosis risk probability thresholds for low, medium, and high risk of psychosis. P Risk could be automated for use on GP IT systems in a similar way to other tools already in use, such as Q Risk for detecting cardiac risk.
Although we have evidence that P Risk is statistically accurate, a feasibility and implementation study is required to investigate its operationalisation and acceptability in real-world clinical situations and to inform the design and delivery of a future evaluation to establish effectiveness and cost-effectiveness.
Research Question, Aims and Objectives
Research question: Is it feasible and acceptable to practitioners, patients and carers to implement a psychosis risk prediction algorithm in primary care.
Overall Aim: To determine the operationalisation and acceptability of using P Risk in real-world clinical situations.
Objectives:
1.Demonstrate whether P Risk can be implemented in primary care data systems.
2. Collect baseline values of the outcome and investigate outcome data collection methods.
3. Investigate the accuracy of P Risk using real-world primary care data systems
4. Investigate the acceptability of P Risk to practitioners, patients, and carers.