Improved estimation of the risk of manic relapse by combining clinical and brain scan data

Introduction: Estimating the risk of manic relapse could help the psychiatrist individually adjust the treatment to the risk. Some authors have attempted to estimate this risk from baseline clinical data. Still, no studies have assessed whether the estimation could improve by adding structural magnetic resonance imaging (MRI) data. We aimed to evaluate it.Material and methods: We followed a cohort of 78 patients with a manic episode without mixed symptoms (bipolar type I or schizoaffective disorder) at 2-4-6-9-12-15-18 months and up to 10 years. Within a cross-validation scheme, we created and evaluated a Cox lasso model to estimate the risk of manic relapse using both clinical and MRI data.Results: The model successfully estimated the risk of manic relapse (Cox regression of the time to relapse as a function of the estimated risk: hazard ratio (HR) = 2.35, p = 0.027; area under the curve (AUC) = 0.65, expected calibration error (ECE) < 0.2). The most relevant variables included in the model were the diagnosis of schizoaffective disorder, poor impulse control, unusual thought content, and cerebellum volume decrease. The estimations were poorer when we used clinical or MRI data separately.Conclusion: Combining clinical and MRI data may improve the risk of manic relapse estimation after a manic episode. We provide a website that estimates the risk according to the model to facilitate replication by independent groups before translation to clinical settings.(c) 2023 The Author(s). Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Psiquiatna y Salud Mental (SEPSM). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)