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

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...

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Autores principales: Słowiński, Piotr, White, Alexander, Lison, Sian, Sullivan, Sarah, Emmens, Tobit, Self, Philip, Wileman, Jane, Karl, Anke, Tsaneva-Atanasova, Krasimira
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503702/
https://www.ncbi.nlm.nih.gov/pubmed/37713385
http://dx.doi.org/10.1371/journal.pdig.0000339
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author Słowiński, Piotr
White, Alexander
Lison, Sian
Sullivan, Sarah
Emmens, Tobit
Self, Philip
Wileman, Jane
Karl, Anke
Tsaneva-Atanasova, Krasimira
author_facet Słowiński, Piotr
White, Alexander
Lison, Sian
Sullivan, Sarah
Emmens, Tobit
Self, Philip
Wileman, Jane
Karl, Anke
Tsaneva-Atanasova, Krasimira
author_sort Słowiński, Piotr
collection PubMed
description 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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spelling pubmed-105037022023-09-16 The potential of digital behavioural tests as a diagnostic aid for psychosis Słowiński, Piotr White, Alexander Lison, Sian Sullivan, Sarah Emmens, Tobit Self, Philip Wileman, Jane Karl, Anke Tsaneva-Atanasova, Krasimira PLOS Digit Health Research Article 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. Public Library of Science 2023-09-15 /pmc/articles/PMC10503702/ /pubmed/37713385 http://dx.doi.org/10.1371/journal.pdig.0000339 Text en © 2023 Słowiński et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Słowiński, Piotr
White, Alexander
Lison, Sian
Sullivan, Sarah
Emmens, Tobit
Self, Philip
Wileman, Jane
Karl, Anke
Tsaneva-Atanasova, Krasimira
The potential of digital behavioural tests as a diagnostic aid for psychosis
title The potential of digital behavioural tests as a diagnostic aid for psychosis
title_full The potential of digital behavioural tests as a diagnostic aid for psychosis
title_fullStr The potential of digital behavioural tests as a diagnostic aid for psychosis
title_full_unstemmed The potential of digital behavioural tests as a diagnostic aid for psychosis
title_short The potential of digital behavioural tests as a diagnostic aid for psychosis
title_sort potential of digital behavioural tests as a diagnostic aid for psychosis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503702/
https://www.ncbi.nlm.nih.gov/pubmed/37713385
http://dx.doi.org/10.1371/journal.pdig.0000339
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