Mapping the onset of psychosis: The comprehensive assessment of at-risk mental states
Mapping the onset of psychosis: The comprehensive assessment of at-risk mental states
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DOI：
10.1080/j.1440-1614.2005.01714.x
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发表时间：
2005-11-01
影响因子：
4.6
通讯作者：
Buckby, J
中科院分区：
文献类型：
--
作者：
Yung, AR;Yuen, HP;Buckby, J
目的：前瞻性地识别首次精神病发作的前驱症状创造了干预的机会，这可能延迟、改善甚至预防发病。需要有效的标准和可靠的方法来识别可能的前驱症状。本文介绍了一种工具，即高危精神状态综合评估（CAARMS），它是为此目的而设计的。它有两个功能：（i）评估被认为预示着首次发作精神病性障碍即将发生的精神病理学；（ii）确定个体是否符合首次精神病性障碍发病的超高风险（UHR）标准。本文描述了对CAARMS的初步评估。
方法：使用了几种方法来测试CAARMS。首先，分析了一组超高风险年轻人的CAARMS评分以及CAARMS评分与向精神病性障碍转变的风险之间的关联。其次，将超高风险组的CAARMS评分与对照组进行了比较。为了评估同时效度，将CAARMS定义的超高风险标准与现有的识别超高风险队列的标准进行了比较。为了评估预测效度，将CAARMS定义的超高风险标准应用于150名非精神病性求助者的样本，并确定了CAARMS阳性（即符合超高风险标准）组和CAARMS阴性（即不符合超高风险标准）组在6个月随访时精神病性障碍的发病率。通过使用成对的评定者来评估CAARMS的评定者间信度。
结果：超高风险组中较高的CAARMS评分与精神病性障碍的发病显著相关。对照组的CAARMS评分明显低于超高风险组。CAARMS评估的超高风险标准所确定的群体与现有方法所测量的标准相似。在非精神病性求助者样本中，与CAARMS阴性者相比，CAARMS阳性者患精神病性障碍的风险显著增加（相对风险为12.44（95%置信区间 = 1.5 - 103.41，p = 0.0025））。CAARMS具有良好到极好的信度。
结论：在这些初步研究中，CAARMS显示出良好到极好的同时效度、区分效度和预测效度以及极好的评定者间信度。CAARMS工具为监测亚阈值精神病性症状恶化为全阈值精神病性障碍提供了一个有用的平台。
Objective: Recognizing the prodrome of a first psychotic episode prospectively creates the opportunity of intervention, which could delay, ameliorate or even prevent onset. Valid criteria and a reliable methodology for identifying possible prodromes are needed. This paper describes an instrument, the Comprehensive Assessment of At-Risk Mental States (CAARMS), which has been designed for such a purpose. It has two functions: (i) to assess psychopathology thought to indicate imminent development of a first-episode psychotic disorder; and (ii) to determine if an individual meets criteria for being at ultra high risk (UHR) for onset of first psychotic disorder. This paper describes the pilot evaluation of the CAARMS.Method: Several methodologies were used to test the CAARMS. First, CAARMS scores in a group of UHR young people and the association between CAARMS scores and the risk of transition to psychotic disorder, were analysed. Second, CAARMS scores in a UHR group were compared to a control group. To assess concurrent validity, CAARMS-defined UHR criteria were compared to the existing criteria for identifying the UHR cohort. To assess predictive validity, the CAARMS-defined UHR criteria were applied to a sample of 150 non-psychotic help-seekers and rates of onset of psychotic disorder at 6-month follow-up determined for the CAARMS-positive (i.e. met UHR criteria) group and the CAARMS-negative (i.e. did not meet UHR criteria) group. The inter-rater reliability of the CAARMS was assessed by using pairs of raters.Results: High CAARMS score in the UHR group was significantly associated with onset of psychotic disorder. The control group had significantly lower CAARMS scores than the UHR group. The UHR criteria assessed by the CAARMS identified a similar group to the criteria measured by existing methodology. In the sample of non-psychotic help-seekers those who were CAARMS-positive were at significantly increased risk of onset of psychotic disorder compared to those who were CAARMS-negative (relative risk of 12.44 (95% Cl = 1.5-103.41, p = 0.0025)). The CAARMS had good to excellent reliability.Conclusions: In these preliminary investigations, the CAARMS displayed good to excellent concurrent, discriminant and predictive validity and excellent inter-rater reliability. The CAARMS instrument provides a useful platform for monitoring subthreshold psychotic symptoms for worsening into full-threshold psychotic disorder.