{
  "abstract": "Early detection of individuals at clinical high risk for psychosis (CHR-P) improves access to preventive care. We developed and internally validated the E-DetectioN Tool for Emerging mental disoRders (ENTER), a multimodal digital screener designed to improve community identification of CHR-P compared with an established approach (PQ-16 cut-off). Participants aged 12-35 years from the UK and Italy completed the online ENTER screener, assessing attenuated psychotic symptoms, processing speed and environmental risk factors. Participants above the PQ-16 cut-off and a random subset below were assessed with the Comprehensive Assessment of At Risk Mental States (CAARMS). PQ-16 cut-off and ENTER models were developed using (penalised) logistic regression, random forest and extreme gradient boosting (XGBoost) within a repeated nested cross-validation framework with semi-supervised learning incorporating unlabelled data. Models were evaluated by discrimination, calibration and clinical utility. 2,522 participants completed the ENTER screener. 495 underwent CAARMS assessments. 124 (25.1%) met CHR-P criteria; 2,027 participants were not assessed with the CAARMS (unlabelled). ENTER showed improved discrimination (C=0.744, 95%CI: 0.697-0.790) compared to the PQ-16 cut-off (C=0.625, 95%CI: 0.570-0.682, p=0.003) and similar calibration (ENTER: slope=1.02, 95%CI: 0.78-1.32; PQ-16 cut-off: slope=0.39, 95%CI: 0.19-0.52, p=0.074). At a clinically relevant threshold, ENTER identified approximately 2 additional CHR-P individuals per 100 assessments compared with the PQ-16 cut-off. Compared with established PQ-16 cut-off pre-screening, ENTER showed higher performance for community identification of CHR-P individuals. Multimodal digital screening might support more informative community triage before specialist assessment. External validation and implementation studies are required to establish real-world clinical utility.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Psychiatry, University of Oxford, Oxford, UK; NIHR Oxford Health Biomedical Research Centre, Oxford, UK; OPEN Early Detection Service, Oxford Heal"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 25,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "D. Oliver"
    },
    {
      "name": "P. Fusar-Poli"
    },
    {
      "name": "G. Brunner"
    },
    {
      "name": "K. Haining"
    },
    {
      "name": "A. Estrade"
    },
    {
      "name": "M. Azis"
    },
    {
      "name": "B. Bianciardi"
    },
    {
      "name": "S. Cooper"
    },
    {
      "name": "S. Ramesh"
    },
    {
      "name": "P. Wallman"
    },
    {
      "name": "X. Liang"
    },
    {
      "name": "Y. Logeswaran"
    },
    {
      "name": "R. Stefanelli"
    },
    {
      "name": "S. Damiani"
    },
    {
      "name": "A. Melillo"
    },
    {
      "name": "U. Provenzani"
    },
    {
      "name": "P. McGuire"
    },
    {
      "name": "S. Brewster"
    },
    {
      "name": "S. Macdonald"
    },
    {
      "name": "P. D. C. San Vito"
    },
    {
      "name": "A. McConnachie"
    },
    {
      "name": "C. Haig"
    },
    {
      "name": "T. Spencer"
    },
    {
      "name": "K. Diederen"
    },
    {
      "name": "P. J. Uhlhaas"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0m427460e679r.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.05.26364756",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.05.26364756v1.full",
  "id": "0m427460e679r",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.05.26364756v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "psychiatry and clinical psychology"
    ],
    [
      "openalex",
      "2738|Schizophrenia research and treatment"
    ]
  ],
  "openalex": "W7221059734",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.05.26364756v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-05",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/0m427460e679r.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:26Z",
      "native_id": "10.64898/2026.10.05.26364756",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.05.26364756v2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:psychiatry and clinical psychology",
      "subfield": "psychiatry"
    }
  ],
  "title": "Refining E-detectioN Tools for Emerging mental disoRders (ENTER) to identify young people at clinical high risk for psychosis in the community: model development and internal validation",
  "title_text": "Refining E-detectioN Tools for Emerging mental disoRders (ENTER) to identify young people at clinical high risk for psychosis in the community: model development and internal validation",
  "type": "preprint",
  "updated_at": "2026-11-05T00:20:36Z",
  "url": "https://research.draconitic.com/paper/0m427460e679r",
  "venue": "medRxiv",
  "versions": []
}