预测患者的复发风险在第一集双相情感障碍:机器学习模型的开发,外部验证和药物治疗协会的复发风险预测
Johannes Lieslehto1,2,3, Jari Tiihonen4,5,6, Markku Lähteenvuo4
1University of Eastern Finland, Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland. johannes.lieslehto@ki.se.
Molecular psychiatry
|October 23, 2025
概括
一个新的机器学习模型使用可访问的因素预测了第一期双相情感障碍 (FEBD) 中的复发风险. 高风险的FEBD患者从早期的长效注射抗精神病药物治疗中获益最多,以减少再入院.
科学领域:
- 精神病学和心理健康 精神病学和心理健康
- 机器学习在医学中的应用
- 药物治疗研究 药物治疗研究
背景情况:
- 第一次双极性情绪障碍 (FEBD) 缺乏验证的预后工具来预测复发风险.
- 针对FEBD的个性化治疗策略受到缺乏可靠的风险分层方法的限制.
- 准确预测复发对于及时干预和改善FEBD患者结果至关重要.
研究的目的:
- 开发和验证一种机器学习 (ML) 模型,用于预测第一期双相情感障碍 (FEBD) 患者的复发.
- 评估在FEBD中不同预测复发风险层中不同药物疗法的有效性.
- 确定复发的关键预测因素,这些预测因素可以很容易地纳入临床实践.
主要方法:
- 利用来自瑞典 (n=30,402) 和芬兰 (n=13,790) 的全国性注册表数据进行模型开发和外部验证.
- 开发了一种结合七个可访问预测因素的ML模型:初始药物治疗,门诊随访,住院时间,先前的精神病史和病缺.
- 通过使用接收器操作特征曲线 (AUROC) 下的面积验证了模型的预测性能,并通过危险比率 (HR) 评估了药物治疗的有效性.
主要成果:
- 机器学习模型表现出良好的预测性能,瑞典的AUROC为0.71,芬兰的AUROC为0.68.
- 关键预测因素包括早期的药物治疗 (,组合治疗,抗精神病药物),早期门诊随访,长时间住院治疗,先前的精神病医院住院治疗和病缺.
- 在高危FEBD患者中,长效注射 (LAI) 抗精神病药物显著降低了重新住院的风险 (HR=0.44).
- 在低风险患者中,特定的组合药物 (quetiapine与氨酸或拉莫特里金) 与重新住院的减少有关.
结论:
- 开发和验证的ML预后模型有效地使用可访问的临床数据预测FEBD复发风险.
- 该模型可以识别那些可能受益于早期启动特定治疗的高风险个体,例如LAI抗精神病药物.
- 这些发现支持在FEBD中转向主动,以风险为导向的治疗策略,可能改善患者的治疗结果并减少医疗保健利用率.
相关概念视频
Bipolar Disorder
616
Bipolar disorder is a chronic mental health condition marked by significant mood fluctuations, including episodes of mania and depression. Elevated energy levels, heightened mood or irritability, impulsive behavior, reduced sleep needs, rapid speech, racing thoughts, inflated self-esteem, and distractibility characterize mania. Individuals with bipolar disorder often alternate between depressive and manic states, with periods of emotional stability lasting an average of six months to a year.
616
Psychosis: Goals of Pharmacotherapy
466
Antipsychotic drugs are a crucial treatment method for acute and chronic psychoses, bipolar illness, and behavioral disorders. The selection of these drugs depends on several factors, including the state of the disease, clinical judgment, possible drug interactions, and the patient's sensitivity to adverse effects. In immediate scenarios, such as delirium and dementia, short-term treatment with low doses of high-potency typical or atypical agents can effectively manage symptom exacerbation.
466
Mania and Antimanic Drugs: Overview
545
Mania, a psychological condition characterized by elevated mood, increased energy, and reduced sleep need, is part of the bipolar disorder cycle. The exact cause of mania isn't entirely known, but it is thought to be a combination of genetic, environmental, and neurological factors. Bipolar disorder involves alternating manic and depressive episodes. Mood stabilizers like lithium, antipsychotics, and anticonvulsants help manage these episodes. Lithium carbonate is particularly effective as...
545
Drug Therapy
239
The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
Antianxiety Medications
239
Psychosis and Antipsychotic Drugs: Overview
811
The term "psychosis" refers to a spectrum of mental disorders characterized by abnormal thoughts, perceptions, and behaviors. It can manifest as mood disorders, dementia, delirium with psychotic features, substance-induced psychosis with psychotic features, brief psychotic disorder, delusional disorder, schizoaffective disorder, and schizophrenia. Among all these disorders, schizophrenia is the most common psychotic disorder, affecting 1% of the worldwide population. Psychotic...
811


