The importance of external validation to advance precision psychiatry

Oliver, Dominic

doi:10.1016/j.lanepe.2022.100498

Cited by 2 publications

(1 citation statement)

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“…Preliminary work has been encouraging [ 290 ], for example using polyenvironmental risk scores [ 285 , 286 , 291 ] but large, generalisable samples are needed to develop and validate these tools. External validation studies, where independent datasets are used to replicate model performance, are rare in psychiatry [ 288 ] but are needed in order to provide evidence that precision psychiatry tools can perform well in multiple settings and are viable for use in real-world clinical care [ 292 ].…”

Section: Discussionmentioning

confidence: 99%

The Translational Future of Stress Neurobiology and Psychosis Vulnerability: A Review of the Evidence

Cullen

Labad

Oliver

et al. 2024

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Psychosocial stress is a well-established risk factor for psychosis, yet the neurobiological mechanisms underlying this relationship have yet to be fully elucidated. Much of the research in this field has investigated hypothalamic-pituitary-adrenal (HPA) axis function and immuno-inflammatory processes among individuals with established psychotic disorders. However, as such studies are limited in their ability to provide knowledge that can be used to develop preventative interventions, it is important to shift the focus to individuals with increased vulnerability for psychosis (i.e., high-risk groups). In the present article, we provide an overview of the current methods for identifying individuals at high-risk for psychosis and review the psychosocial stressors that have been most consistently associated with psychosis risk. We then describe a network of interacting physiological systems that are hypothesised to mediate the relationship between psychosocial stress and the manifestation of psychotic illness and critically review evidence that abnormalities within these systems characterise high risk populations. We found that studies of high-risk groups have yielded highly variable findings, likely due to (i) the heterogeneity both within and across high-risk samples, (ii) the diversity of psychosocial stressors implicated in psychosis, and (iii) that most studies examine single markers of isolated neurobiological systems. We propose that to move the field forward, we require well-designed, large- scale translational studies that integrate multi-domain, putative stress-related biomarkers to determine their prognostic value in high-risk samples. We advocate that such investigations are highly warranted, given that psychosocial stress is undoubtedly a relevant risk factor for psychotic disorders.

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