Evidence map›Paper›PMID 41965367›Full record

ArticleTranslational psychiatry2026

Development and validation of a precision treatment rules for first-line antipsychotic recommendations in first episode psychosis jointly incorporating effectiveness, side effects and patient preferences.

Kamil Krakowski, Dominic Oliver, Maite Arribas, Yanakan Logeswaran, Andrea de Micheli, Rashmi Patel, Daniel Stahl, Paolo Fusar-Poli

Abstract readValidation Study
In one paragraph

Article in Translational psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Kamil KrakowskiDepartment of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy. kamil.krakowski01@universitadipavia.it.ORCID http://orcid.org/0009-0006-1414-0321
Dominic OliverEarly Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.ORCID http://orcid.org/0000-0002-8920-3407
Maite ArribasEarly Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.ORCID http://orcid.org/0000-0002-0182-3493
Yanakan LogeswaranEarly Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Andrea de MicheliEarly Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Rashmi PatelInstitute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.ORCID http://orcid.org/0000-0002-9259-8788
Daniel Stahl *Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID http://orcid.org/0000-0001-7987-6619
Paolo Fusar-Poli *Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.ORCID http://orcid.org/0000-0003-3582-6788

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Selecting first-line antipsychotic medication for first episode of psychosis patients is a very challenging task requiring the clinicians to empirically weight multiple criteria. Precision treatment rules developed using health records offer a pragmatic approach to support clinicians' treatment selection, however, they don't incorporate side effects and patient preferences. We used Electronic Health Records from Early Intervention for Psychosis services in South London and the Maudsley NHS Trust and followed the RECORD and TRIPOD + AI guidelines. Precision treatment rules were developed using causal machine learning methods and estimated effectiveness (change of medication, hospitalisation) and side effects (extrapyramidal side effects, hyperprolactinemia, sedation, sexual side effects, and weight gain) using clinical, demographic, symptom and substance use predictors. Patient preferences regarding side effects were incorporated by ranking method. 1709 patients (mean age 26.7 years and 64% male) were included. Aripiprazole was recommended to between 80 and 98% of patients depending on selected patients' preferences. Compared to the observed treatment decisions we estimated that under treatment rules recommendations hyperprolactinemia would be reduced by 4.7 percentage points (pp), sedation by 15.8 pp, sexual side effects by 4.3 pp and weight gain by 15.2 pp with no change in hospitalisation and change of medications outcomes. However, extrapyramidal side effects were estimated to increase by 5.5 pp. This study presents the first precision treatment rules for early psychosis that integrate effectiveness, side effects and patient preferences. Further research using larger data sets, more predictors and treatment options is suggested.

Indexed as

Antipsychotic AgentsClinical Decision RulesPatient PreferencePrecision MedicinePsychotic DisordersAdolescentAdultAripiprazoleElectronic Health RecordsFemaleHumansMachine LearningMaleWeight GainYoung AdultAntipsychotic AgentsAripiprazole

Identifiers

PMID41965367
PMCPMC13184226

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.