{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T16:02:31Z","timestamp":1792166551651,"version":"4.4.0"},"reference-count":84,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["World Psychiatry"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>Most research into the clinical high risk for psychosis (CHR\u2010P) state has focused on predicting transition to psychosis in the short term, and largely in research samples that are not representative of real\u2010world preventive care. However, CHR\u2010P individuals experience a broad range of poor long\u2010term clinical outcomes in real\u2010world settings, such as hospitalization for psychiatric reasons, initiation of a new antipsychotic treatment, or suicide. Improving the detection of individuals at greater risk of these long\u2010term poor outcomes is critical to advance preventive care in real\u2010world clinical settings. This study aims to develop and internally validate a personalized clinical prediction model for real\u2010world, long\u2010term poor outcomes beyond transition risk in CHR\u2010P individuals. This RECORD\u2010compliant, real\u2010world, long\u2010term prospective cohort study included electronic health records (EHR) data from all CHR\u2010P individuals receiving preventive care from the Outreach and Support in South London (OASIS) service in South London and Maudsley National Health Service Foundation Trust in the UK from 2001 to 2024. The primary outcome was the long\u2010term cumulative risk of first real\u2010world poor outcome, operationalized by pragmatic parameters informing clinical practice: transition to psychosis, receiving a first antipsychotic treatment at a dosage necessary to treat first\u2010episode psychosis, receiving a first voluntary or compulsory hospitalization for psychiatric reasons, or dying by suicide. A clinical prediction model (regularized Cox regression) was developed and validated using internal\u2010external cross\u2010validation to predict long\u2010term poor outcomes, utilizing real\u2010world predictors available in routine care. Model performance was indexed by discrimination (Harrell's C), calibration (slope, intercept), overall performance (Brier score), and potential clinical utility (decision curve analysis). One thousand CHR\u2010P OASIS patients were included (mean age: 22.51\u00b14.99 years; 53.60% males, 44.73% White) and followed up to a maximum of 21 years. The cumulative risk of real\u2010world poor outcome was 0.644 (95% CI: 0.547\u20100.742) at 14\u201018 years. The validated clinical prediction model showed statistically significant discrimination (C=0.69; 95% CI: 0.63\u20100.74), calibration (slope = 1.61, 95% CI: 0.74\u20102.48; intercept = \u22120.03, 95% CI: \u22120.62 to 0.55) and overall performance (Brier score = 0.18; 95% CI: 0.13\u20100.22). Decision curve analysis demonstrated that the model was associated with greater net benefit than the clinical alternatives at risk thresholds from 0% to 50%. These data suggest that most CHR\u2010P individuals have long\u2010term poor outcomes, beyond transition to psychosis, in real\u2010world care, which should become the focus of a new generation of research. The clinical prediction model presented here can identify these individuals and facilitate the personalized provision of preventive care, thereby improving outcomes in this population. CHR\u2010P services should extend their duration of care to address the substantial long\u2010term clinical outcomes experienced by young individuals.<\/jats:p>","DOI":"10.1002\/wps.70063","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T07:48:21Z","timestamp":1778831301000},"page":"295-306","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Predicting long\u2010term poor outcomes in individuals at clinical high risk for psychosis using real\u2010world clinical data: the\n                    <scp>OASIS1000<\/scp>\n                    prospective study"],"prefix":"10.1002","volume":"25","author":[{"given":"Yanakan","family":"Logeswaran","sequence":"first","affiliation":[{"name":"Early Psychosis: Interventions and Clinical\u2010detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London  London 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King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas R.","family":"Livingston","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamil","family":"Krakowski","sequence":"additional","affiliation":[{"name":"Early Psychosis: Interventions and Clinical\u2010detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience King's College London  London UK"},{"name":"Department of Brain and Behavioural Sciences University of Pavia  Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Oliver","sequence":"additional","affiliation":[{"name":"Early Psychosis: Interventions and Clinical\u2010detection (EPIC) lab, Department of Psychosis Studies, Institute of 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