Severity of thought disorder predicts psychosis in persons at clinical high-risk.
Severity of thought disorder predicts psychosis in persons at clinical high-risk.
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DOI：
10.1016/j.schres.2015.09.008
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发表时间：
2015-12
影响因子：
4.5
通讯作者：
McGlashan TH
中科院分区：
文献类型：
--
作者：
Perkins DO;Jeffries CD;Cornblatt BA;Woods SW;Addington J;Bearden CE;Cadenhead KS;Cannon TD;Heinssen R;Mathalon DH;Seidman LJ;Tsuang MT;Walker EF;McGlashan TH
提高预测的准确性对于精神病的早期发现和预防至关重要。我们寻求一种症状严重程度分类器，以改善精神病风险预测。受试者来自北美前驱症状纵向研究的两个队列。所有受试者都符合精神病风险状态的标准。在Cohort-1(n=296)中，我们开发了一个分类器，其中包括精神病风险症状量表中的那些条目，这些条目最能区分转化为精神病的受试者和不转化的受试者，其表现最初通过Cohort-1中的随机测试进行验证。Cohort-2(n=592)作为独立测试集。我们编制了2项和4项分量表。两者都包括不同寻常的思想内容和猜疑；后者增加了概念的丰富性降低和集中/集中的困难。一致性指数(C-Index)是衡量人群区分度的指标，各队列之间的一致性指数相似(4项分量表队列2：0.71，95%CI=[0.64，0.77]，队列1：0.74，95%CI=[0.69，0.80]；2项分量表队列-2：0.68，95%CI=[0.3，0.76]，队列1：0.72，95%CI=[0.66-0.79])。在80%的队列-2受试者子集的742/1000随机选择中，4个条目的表现优于2个条目的子量表(p值=1.3E-55)。队列之间的子量表校正成比例(得分较高/生存率较低)，但队列1预测的绝对转换风险高于队列2，反映了两组2年转换率的差异(队列2：0.16，95%CI=[0.13，0.19]；队列-1：0.30，95%CI=[0.24，0.36])。异常思维内容的严重性、猜疑、概念丰富性降低、难以集中注意力/注意力都会导致精神病风险的预测。基于这些症状的量表可能在研究中有用，并假设进一步验证，最终应用于临床。
Improving predictive accuracy is of paramount importance for early detection and prevention of psychosis. We sought a symptom severity classifier that would improve psychosis risk prediction. Subjects were from two cohorts of the North American Prodrome Longitudinal Study. All subjects met Criteria of Psychosis-Risk States. In Cohort-1 (n=296) we developed a classifier that included those items of the Scale of Psychosis-Risk Symptoms that best distinguished subjects who converted to psychosis from nonconverters, with performance initially validated by randomization tests in Cohort-1. Cohort-2 (n=592) served as an independent test set. We derived 2-Item and 4-Item subscales. Both included unusual thought content and suspiciousness; the latter added reduced ideational richness and difficulties with focus/concentration. The Concordance Index (C-Index), a measure of discrimination, was similar for each subscale across cohorts (4-Item subscale Cohort-2: 0.71, 95%CI=[0.64,0.77], Cohort-1: 0.74, 95%CI=[0.69,0.80]; 2-Item subscale Cohort-2: 0.68, 95%CI=[0.3,0.76], Cohort-1: 0.72, 95%CI=[0.66-0.79]). The 4-Item performed better than the 2-Item subscale in 742/1000 random selections of 80% subsets of Cohort-2 subjects (p-value=1.3E-55). Subscale calibration between cohorts was proportional (higher scores/lower survival), but absolute conversion risk predicted from Cohort-1 was higher than that observed in Cohort-2, reflecting the cohorts’ differences in 2-year conversion rates (Cohort-2: 0.16, 95%CI=[0.13,0.19]; Cohort-1: 0.30, 95%CI=[0.24,0.36]). Severity of unusual thought content, suspiciousness, reduced ideational richness, and difficulty with focus/concentration informed psychosis risk prediction. Scales based on these symptoms may have utility in research and, assuming further validation, eventual clinical applications.