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Validation and refinement of the clinical staging model in a French cohort of outpatient with schizophrenia (FACE-SZ)

Ophélia Godin 1, 2, 3 Guillaume Fond 4 Ewa Bulzacka 5 Frank Schürhoff 5 Laurent Boyer 5, 6 Andre Myrtille 7 Isabelle Chéreau Sylvain Leignier 8 Paul Roux 9 Dominique Costagliola 1, 3 Meja Andrianarisoa Bruno Aouizerate 10 Fabrice Berna 11 Olivier Blanc Lore Brunel Delphine Capdevielle 7 Isabelle Chereau-Boudet 12 Gabrielle Chesnoy-Servanin Jean-Marie Danion 13 Thierry d'Amato 14 Arnaud Deloge 15 Claire Delorme 16 Hélène Denizot Jean-Michel Dorey 17 Caroline Dubertret Julien Dubreucq 8 Catherine Faget 6 Cécile Fluttaz Sandrine Fonteneau Franck Gabayet Elisabeth Giraud-Baro 18 Christine Hardy-Baylé Delphine Lacelle 19 Christophe Lançon 6 Hakim Laouamri Marion Leboyer 20 Tifenn Le Gloahec 21 Yann Le Strat 22 Pierre Llorca 23 Jasmina Mallet Emeline Metairie David Misdrahi Christine Passerieux 24 Paul Peri Sylvie Pires Céline Portalier 25 Romain Rey Celine Roman 26 Mathilde Sebilleau 27 Aurélie Schandrin 28 Priscille Schneider 29 Franck Schurhoff 20 Arnaud Tessier 30 Anne-Marie Tronche Mathieu Urbach Florence Vaillant 6 Aurélie Vehier 31 Pierre Vidailhet 32 Estelle Vilà 15 Hanan Yazbek 33 Anna Zinetti-Bertschy 29
Abstract : Objective: Existing staging models have not been fully validated. Thus, after classifying patients with schizophrenia according to the staging model proposed by McGorry et al. (2010), we explored the validity of this staging model and its stability after one-year of follow-up. Method: Using unsupervised machine-learning algorithm, we classified 770 outpatients into 5 clinical stages, the highest being the most severe. Analyses of (co)variance were performed to compare each stage in regard to socio-demographics factors, clinical characteristics, co-morbidities, ongoing treatment and neuropsychological profiles. Results: The precision of clinical staging can be improved by sub-dividing intermediate stages (II and III). Clinical validators of class IV include the presence of concomitant major depressive episode (42.6% in stage IV versus 3.4% in stage IIa), more severe cognitive profile, lower adherence to medication and prescription of >3 psychotropic medications. Follow-up at one-year showed good stability of each stage. Conclusion: Clinical staging in schizophrenia could be improved by adding clinical elements such as mood symptoms and cognition to severity, relapses and global functioning. In terms of therapeutic strategies, attention needs to be paid on the factors associated with the more stages of schizophrenia such as treatment of comorbid depression, reduction of the number of concomitant psychotropic medications, improvement of treatment adherence, and prescription of cognitive remediation.
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Submitted on : Tuesday, April 9, 2019 - 3:01:03 PM
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Ophélia Godin, Guillaume Fond, Ewa Bulzacka, Frank Schürhoff, Laurent Boyer, et al.. Validation and refinement of the clinical staging model in a French cohort of outpatient with schizophrenia (FACE-SZ). Progress in Neuro-Psychopharmacology and Biological Psychiatry, Elsevier, 2019, 92, pp.226-234. ⟨10.1016/j.pnpbp.2019.01.003⟩. ⟨hal-02094195⟩



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