Peer-Reviewed Publication
BMJ Ment Health2026;29(1)September 28, 2026Journal Article
External validation and refinement of the Psychosis Polyrisk Score to detect individuals at clinical high risk for psychosis.
Riccardo Stefanelli1, Dominic Oliver2,3,4,5, Stefano Damiani6, Marika Orlandi6,7, Umberto Provenzani6, Elisa Bortolin6,8, Margherita Rovida6, Jean Addington9, Luis Alameda10,11,12, Celso Arango13, Nicholas J Breitborde14, Matthew Broome15,16, Kristin S Cadenhead17, Monica E Calkins18, Ricardo E Carrion19,20,21, Rolando I Castillo-Passi22,23, Yu Hai Eric Chen24, Jimmy Choi25, Philippe Conus10, Barbara A Cornblatt20,21, Covadonga M Díaz-Caneja26,27, Lauren M Ellman28, Pablo A Gaspar29, Carla Gerber30, Louise Birkedal Glenthøj31,32, Leslie E Horton33, Christy Lm Hui24, Joseph Kambeitz34, Lana Kambeitz-Ilankovic34, Matcheri S Keshavan35, Minah Kim36,37,38, Sung-Wan Kim39,40, Nikolaos Koutsouleris41, Jun Soo Kwon42,43,44, Kerstin Langbein45, Daniel Mamah46, Daniel H Mathalon47,48, Vijay A Mittal49, Meredete Nordentoft50,51, Godfrey D Pearlson25,52, Nora Penzel53, Jesus Perez54,55, Diana O Perkins56, Albert R Powers52,57, Jack R Rogers58, Fred W Sabb59, Jason Schiffman60, Jai Shah61,62, Steven M Silverstein63,64,65, Stefan Smesny45, William S Stone35, Gregory P Strauss66, Judy L Thompson67, Rachel Upthegrove15,16, Swapna Verma68, Jijun Wang69, Daniel H Wolf18, TianHong Zhang70, Sylvain Bouix71, Cheryl M Corcoran72, Tina Kapur73, Ofer Pasternak74,75, Carrie Bearden76,77, Rene S Kahn72, John M Kane20,78, Patrick D McGorry79,80, Barnaby Nelson79,80, Martha E Shenton53,73,81, Scott W Woods52,57, , Paolo Fusar-Poli6,5,82
1Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy riccardoste99@gmail.com.
2Department of Psychiatry, University of Oxford, Oxford, UK.
3NIHR Oxford Health Biomedical Research Centre, Oxford, UK.
4OPEN Early Detection Service, Oxford Health NHS Foundation Trust, Oxford, UK.
5Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
6Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
7Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.
8Università Vita-Salute San Raffaele, Milan, Italy.
9Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada.
10TiPP Program Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
11Department of Psychiatry, Centro Investigación Biomedica en Red de Salud Mental (CIBERSAM), Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío, University of Sevilla, Sevilla, Spain.
12Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
13Department of Child and Adolescent Psychiatry, Hospital Universitario La Paz, IdiPAZ, CIBERSAM, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
14Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Columbus, OH, USA.
15School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, UK.
16Early Intervention for Psychosis Services, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
17Department of Psychiatry, University of California, San Diego, CA, USA.
18Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
19Northwell Health, New Hyde Park, New York, USA.
20Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
21Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health System, Manhasset, NY, USA.
22Department of Psychiatry, University of Chile, University of Chile, Santiago, Chile.
23Department of Neurology, Psychology and Psychiatry, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.
24Department of Psychiatry, University of Hong Kong, Pok Fu Lam, Hong Kong.
25Olin Neuropsychiatry Research Center, Hartford HealthCare, Hartford, CT, USA.
26Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Menthal Health, Hospital General Universitario Gregorio Maranon, IiSMG, CIBERSAM, Instituo de Salud Carlos III, School of Medicine, Universidad Complutense, Madrid, Spain.
27Fundación para la Investigación Biomédica del Hospital Universitario La Paz, Madrid, Spain.
28Department of Psychology & Neuroscience, Temple University, Philadelphia, PA, USA.
29Department of Psychiatry, University of Chile, Santiago, Chile.
30Behavioral Health Services, PeaceHealth Medical Group, Eugene, OR, USA.
31VIRTU Research Group, Mental Health Copenhagen, University of Copenhagen, Copenhagen, Denmark.
32Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
33Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
34Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
35Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
36Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.
37Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
38Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea.
39Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea.
40Mindlink, Gwangju Bukgu Mental Health Center, Gwangju, Korea.
41Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany.
42Department of Psychiatry, Hanyang University College of Medicine, Seoul, Korea.
43Department of Neuropsychiatry, Hanyang University Hospital, Seoul, Korea.
44Institute of Human Behavioral Medicine, SNU-MRCInstitute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea.
45Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany.
46Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA.
47Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
48Mental Health Service 116D, Veterans Affairs San Francisco Health Care System, San Francisco, CA, USA.
49Department of Psychology, Northwestern University, Evanston, IL, USA.
50Copenhagen Research Centre for Mental Health, Mental Health Copenhagen, University of Copenhagen, Copenhagen, Denmark.
51Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
52Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
53Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
54CAMEO, Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
55Institute of Biomedical Research (IBSAL), Department of Medicine, Universidad de Salamanca, Salamanca, Spain.
56Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
57Connecticut Mental Health Center, New Haven, Connecticut, USA.
58Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK.
59Prevention Science Institute, University of Oregon, Eugene, OR, USA.
60Department of Psychological Science, University of California, Irvine, CA, USA.
61Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
62PEPP-Montreal, Douglas Research Centre, Montreal, Quebec, Canada.
63Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
64Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA.
65Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA.
66Department of Psychology, University of Georgia, Athens, GA, USA.
67Departments of Psychiatry and Neuroscience, University of Rochester Medical Center, Rochester, NY, USA.
68Department of Psychosis, Institute of Mental Health, Singapore.
69Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
70Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Neuromodulation Center, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shangai, China.
71Department of Software Engineering and Information Technology, École de technologie supérieure, Montréal, Quebec, Canada.
72Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
73Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
74Department of Psychiatry, Mass General Brigham Hospital, Harvard Medical School, Boston, MA, USA.
75Department of Radiology, Mass General Brigham Hospital, Harvard Medical School, Boston, MA, USA.
76Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA.
77Department of Psychology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA.
78Institute of Behavioral Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
79Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
80Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.
81Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
82Outreach and Support in South-London (OASIS) service, South London and Maudsley (SLaM) NHS Foundation Trust, London, UK.
Abstract
BACKGROUND: The Psychosis Polyrisk Score (PPS) was developed to characterise exposure to environmental and developmental risk factors for psychosis. In previous studies, the PPS showed promise particularly in discriminating between individuals at clinical high risk for psychosis (CHR-P) and community controls (CC).
OBJECTIVES: This study aimed to (1) perform an external validation of the PPS mode…
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