Identification of young people in the early stages of psychosis: Validation of a checklist for use in primary care
Identification of young people in the early stages of psychosis: Validation of a checklist for use in primary care
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DOI：
10.1016/j.psychres.2012.07.040
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发表时间：
2012-12-30
影响因子：
11.3
通讯作者：
Dunn, Graham
中科院分区：
文献类型：
--
作者：
French, Paul;Owens, Jane;Dunn, Graham
该研究旨在确定早期发现初级保健检查表（PCCL）的一致性效度；这是一个包含20个项目的工具，旨在帮助初级保健从业者识别处于精神病早期阶段的年轻人。英国各地的176名被转介到早期发现团队的年轻人的转诊医生完成了该检查表。通过将筛查结果与用于识别可能有患精神病风险的年轻人的标准化精神病评估（CAARMS）进行比较，确定了检查表的一致性效度。初步分析发现，最初构想的简单检查表具有极高的敏感性（96%），但特异性较差（10%）。随后的探索性分析促使开发了两个性能更好的模型，用于组合项目反应以预测CAARMS结果。第一个模型保留使用所有20个检查表项目，实现了89%的敏感性和60%的特异性。第二个模型保留了6个p值为0.2或更高的检查表项目，实现了88%的敏感性和47%的特异性。尽管最初的检查表作为一种筛查工具表现不佳，但与针对该人群的其他更长的筛查工具相比，这两个模型表现良好。这些工具并非用作诊断工具；而是被设计为初级保健和专科服务之间的桥梁，并基于初级保健从业者已有的技能和知识。考虑到本研究的局限性，建议在实践中继续评估这些工具的性能。（c）2012爱思唯尔爱尔兰有限公司。保留所有权利。
The study aims to establish the concordant validity of the Early Detection Primary Care Checklist (PCCL); a 20 item tool designed to help primary care practitioners identify young people in the early stages of psychosis. The checklist was completed by the referring practitioners of 176 young people referred to early detection teams across the UK. The concordant validity of the checklist was established by comparing screen results with a standardised psychiatric assessment for identifying young people who may be at a risk of developing psychosis (CAARMS). Preliminary analysis found that the simple checklist as originally conceived had excellent sensitivity (96%) but poor specificity (10%). Subsequent exploratory analysis led to the development of two better performing models for the combination of item responses to predict CAARMS outcomes. The first retained the use of all 20 checklist items and achieved sensitivity of 89% and specificity of 60%. The second retained six checklist items with p-values of 0.2 or above and achieved sensitivity of 88% and specificity of 47%. Although the initial checklist did not perform well as a screening tool the two models perform well in comparison to other, much longer, screening tools for this population. These tools are not intended as a diagnostic instrument; rather it has been designed as a bridge between primary care and specialist services and to build on the skills and knowledge already held by primary care practitioners. Following a consideration of the limitations of this study, the continued evaluation of the tools performance in practice is recommended. (c) 2012 Elsevier Ireland Ltd. All rights reserved.