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In this study, we looked at the additive predictive value of adding cognition, cortical structure information, or the neuroanatomical measure of “brain age gap” to a previously developed clinical prediction model for psychosis onset in individuals who are at ultra-high risk of psychosis. We used data from the PACE 400 study which is a well characterised cohort of Australian youth identified as UHR using the Comprehensive Assessment of At Risk Mental States followed for up to 18 years, containing clinical data (from N=416 participants), cognitive data (N=213), and MRI cortical parameters extracted using Freesurfer (N=231).

Our results showed that neuroimaging, brain age gap, and cognition added marginal predictive information to the previously developed clinical model (fraction of new information: neuroimaging 0-12%, brain age gap 7%, cognition 0-16%).

In summary, adding a second modality to a clinical risk model predicting the onset of a psychotic disorder in the PACE 400 cohort showed little improvement in fit of the model for long term prediction of transition to psychosis.