At risk or not at risk? A meta-analysis of the prognostic accuracy of psychometric interviews for psychosis prediction
At risk or not at risk? A meta-analysis of the prognostic accuracy of psychometric interviews for psychosis prediction
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DOI：
10.1002/wps.20250
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发表时间：
2015-10-01
期刊：
影响因子：
73.3
通讯作者：
Mcguire, Philip
中科院分区：
文献类型：
--
作者：
Fusar-Poli, Paolo;Cappucciati, Marco;Mcguire, Philip
准确检测精神病临床高危人群是有效预防干预的先决条件。一些心理测量访谈是可用的，但其预测的准确性是未知的。我们进行了一项预后准确性荟萃分析的心理测量访谈，用于检查转介到高风险服务。指数测试是一种既定的心理测量工具，用于识别受试者是否患有抑郁症（抑郁+和抑郁-）。参考指数是随时间的推移，精神病发作在这两个α +和α-受试者。数据用MIDAS（STATA 13）进行分析。计算曲线下面积（AUC）、受试者工作特征曲线总结、质量评估、似然比、Fagan列线图和概率修正图。纳入了11项独立研究，共有2，519名求助者，主要是成年受试者（A+：N= 1，359; B-：N= 1，160），涉及高风险服务。平均随访时间为38个月。AUC非常好（0.90; 95% CI：0.87-0.93），与预防医学中的其他测试相当，表明在涉及高风险服务的受试者中具有临床实用性。荟萃回归分析显示，抗精神病药物的暴露有影响，而仪器类型、年龄、性别、随访时间、样本量、质量评估、总样本中≥ 100%受试者的比例无影响。Fagan列线图显示一般非求助人群的阳性预测值较低（5.74%）。尽管明确需要进一步改善精神病的预测，这些研究结果支持使用心理测量预后访谈作为临床工具，用于在全球高风险服务中寻求帮助的受试者的指定预防。
An accurate detection of individuals at clinical high risk (CHR) for psychosis is a prerequisite for effective preventive interventions. Several psychometric interviews are available, but their prognostic accuracy is unknown. We conducted a prognostic accuracy meta-analysis of psychometric interviews used to examine referrals to high risk services. The index test was an established CHR psychometric instrument used to identify subjects with and without CHR (CHR+ and CHR-). The reference index was psychosis onset over time in both CHR+ and CHR- subjects. Data were analyzed with MIDAS (STATA13). Area under the curve (AUC), summary receiver operating characteristic curves, quality assessment, likelihood ratios, Fagan's nomogram and probability modified plots were computed. Eleven independent studies were included, with a total of 2,519 help-seeking, predominately adult subjects (CHR+: N=1,359; CHR-: N=1,160) referred to high risk services. The mean follow-up duration was 38 months. The AUC was excellent (0.90; 95% CI: 0.87-0.93), and comparable to other tests in preventive medicine, suggesting clinical utility in subjects referred to high risk services. Meta-regression analyses revealed an effect for exposure to anti-psychotics and no effects for type of instrument, age, gender, follow-up time, sample size, quality assessment, proportion of CHR+ subjects in the total sample. Fagan's nomogram indicated a low positive predictive value (5.74%) in the general non-help-seeking population. Albeit the clear need to further improve prediction of psychosis, these findings support the use of psychometric prognostic interviews for CHR as clinical tools for an indicated prevention in subjects seeking help at high risk services worldwide.