• Sarah A Sullivan, Richard Morris, Daphne Kounali, David Kessler, Willie Hamilton, Glyn Lewis, Philippa Lilford, and Irwin Nazareth.
• Centre for Academic Mental Health, and National Institute for Health and Care Research Bristol Biomedical Research Centre, University of Bristol, Bristol.
• Br J Gen Pract. 2024 Oct 14.

BackgroundEarly detection could reduce the duration of untreated psychosis. GPs are a vital part of the psychosis care pathway, but find it difficult to detect the early features. An accurate risk prediction tool, P Risk, was developed to detect these.AimTo externally validate P Risk.Design And SettingThis retrospective cohort study used a validation dataset of 1 647 934 UK Clinical Practice Research Datalink (CPRD) primary care records linked to secondary care records.MethodThe same predictors (age; sex; ethnicity; social deprivation; consultations for suicidal behaviour, depression/anxiety, and substance misuse; history of consultations for suicidal behaviour; smoking history; substance misuse; prescribed medications for depression/anxiety/post-traumatic stress disorder/obsessive compulsive disorder; and total number of consultations) were used as for the development of P Risk. Predictive risk, sensitivity, specificity, and likelihood ratios were calculated for various risk thresholds. Discrimination (Harrell's C-index) and calibration were calculated. Results were compared between the development (CPRD GOLD) and validation (CPRD Aurum) datasets.ResultsPsychosis risk increased with values of the P Risk prognostic index. Incidence was highest in younger age groups and, in the main, higher in males. Harrell's C was 0.79 (95% confidence interval = 0.78 to 0.79) in the validation dataset and 0.77 in the development dataset. A risk threshold of 1.0% gave sensitivity of 65.9% and specificity of 86.6%.ConclusionFurther testing is required, but P Risk has the potential to be used in primary care to detect future risk of psychosis.© The Authors.

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