Self-Reported Psychotic-Like Experiences Are a Poor Estimate of Clinician-Rated Attenuated and Frank Delusions and Hallucinations
Self-Reported Psychotic-Like Experiences Are a Poor Estimate of Clinician-Rated Attenuated and Frank Delusions and Hallucinations
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DOI：
10.1159/000355554
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发表时间：
2014-01-01
期刊：
影响因子：
3.6
通讯作者：
Ruhrmann, Stephan
中科院分区：
文献类型：
--
作者：
Schultze-Lutter, Frauke;Renner, Fritz;Ruhrmann, Stephan
背景资料：美国精神病学协会的《精神疾病诊断与统计手册》第五版的正文中决定推迟引入减弱型精神病综合征的一个原因是担心减弱型精神病症状（APS）实际上可能是普通人群中青少年和年轻人的共同特征，而这些青少年和年轻人本身并没有精神病理学意义。这种担忧是基于一般人群中精神病样经历（PLEs）的高患病率报告以及PLEs是APS的良好估计的假设。虽然自我报告的PLEs的标准效度已经在临床医生评定的精神病症状方面进行了研究，发现不足，但有人认为PLEs实际上可能与精神病症状的轻度亚临床表现更具可比性，因此与APS更具可比性。本文是第一个具体研究这一假设。抽样和方法：样本包括123人寻求帮助的服务，精神病的早期检测，其中54人有危险的精神状态或精神病，55有非精神病性精神障碍和14没有全面的精神障碍。用Peters Delamination量表和修订的Launay-Slade幻觉量表评估PLEs，用前驱综合征结构化访谈评估精神病性症状和APS。结果如下：在任何PLE（98.4%的患者）和任何APS（40.7%）的存在之间的一致性水平刚刚超过机会（K = 0.022），APS的PLE标准有效性是不够的。即使考虑了额外的限定因素（高一致性或痛苦，专注和信念），PLEs（52.8%）仍然倾向于显著高估APS，一致性仅为公平（K = 0.340）。此外，对PLE患病率的群体效应最多为中度（Cramer's V
Background: One reason for the decision to delay the introduction of an Attenuated Psychosis Syndrome in the main text of the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders was the concern that attenuated psychotic symptoms (APS) might in fact be common features in adolescents and young adults from the general population of no psychopathological significance in themselves. This concern was based on reports of high prevalence rates of psychotic-like experiences (PLEs) in the general population and the assumption that PLEs are a good estimate of APS. Although the criterion validity of self-reported PLEs had already been studied with respect to clinician-rated psychotic symptoms and found insufficient, it had been argued that PLEs might in fact be more comparable with mild, subclinical expressions of psychotic symptoms and, therefore, with APS. The present paper is the first to specifically study this assumption. Sampling and Methods:The sample consisted of 123 persons seeking help at a service for the early detection of psychosis, of whom 54 had an at-risk mental state or psychosis, 55 had a nonpsychotic mental disorder and 14 had no full-blown mental disorder. PLEs were assessed with the Peters Delusion Inventory and the revised Launay-Slade Hallucination Scale, and psychotic symptoms and APS were assessed with the Structured Interview for Prodromal Syndromes. Results: At a level of agreement between the presence of any PLE (in 98.4% of patients) and any APS (in 40.7%) just exceeding chance (K = 0.022), the criterion validity of PLEs for APS was insufficient. Even if additional qualifiers (high agreement or distress, preoccupation and conviction) were considered, PLEs (in 52.8%) still tended to significantly overestimate APS, and agreement was only fair (K = 0.340). Furthermore, the group effect on PLE prevalence was, at most, moderate (Cramer's V