Prodromal Inventory for Negative Symptoms (PINS): A Development and Validation Study

项目摘要 阴性症状是精神分裂症的核心特征，被定义为丧失规范性动机和/或表达。 精神病理学的这一维度与疾病的其他方面不同，并且高度预测基于社区的不良功能结局。然而，对阴性症状的药理学和心理社会治疗已证明有效性有限。为了解决精神分裂症治疗中这一关键的未满足的需求，NIMH赞助了一个共识发展会议，以划定该领域的研究优先事项，并促进 治疗发展。这次会议的主要结论是，下一代阴性症状 应制定评级表，以解决现有工具在方法和概念上的局限性。 两个下一代临床评级量表产生于NIMH共识发展会议， 预期用于患有确定的精神病的成年人群。但 共识会议没有讨论针对超高风险青年（UHR）的评估发展， 发生精神病（即符合前驱综合征标准的青少年/年轻人）。鉴于负面的 这些症状高度预示着向可诊断精神病的转变，因此，提高我们检测UHR青年阴性症状的能力至关重要。现有的量表，旨在评估UHR青年的阴性症状有概念和方法上的局限性和量表设计的成年人诊断疾病不符合UHR人群的独特需求。需要专门设计用于评估UHR青年阴性症状的新量表，以准确绘制精神疾病轨迹，并确定何时，何地以及如何进行干预。目前的研究旨在将NIMH共识发展会议的规模发展目标扩展到UHR人群，方法是采用迭代的数据驱动方法来创建一种新的测量方法，即阴性症状前驱量表（PINS）。一个测试版的PINS的开发，显示出有前途的心理特性。将进行两项研究，以完善测试版，并根据最先进的统计方法，在3个正在进行的UHR研究项目的研究中心收集数据，得出最终量表。研究1将包括一个大的，有代表性的，和不同的样本UHR青年（n = 180）和评估测试版的心理测量特性。为了确定测试版应如何修改，将进行分析，以确定项目的选择，修改和保留，包括项目反应理论，验证性因素分析，项目水平分析，内部和站点之间的评分者信度，以及收敛和判别效度分析。在研究2中，修订后的量表的心理测量学特性将在UHR青年（n = 120）的样本进行评估，他们将被纵向跟踪。最终量表的分析将评估测量的稳定性，内部一致性，评分员间的可靠性，预测的过渡到可诊断的精神病，因素结构，收敛效度，和判别效度。这种迭代的、数据驱动的量表开发过程将为该领域提供下一代阴性症状量表，以满足UHR人群的独特评估需求。

Project Summary Negative symptoms are a core feature of schizophrenia defined as the loss of normative motivation and/or expression. This dimension of psychopathology is distinct from other aspects of the illness and highly predictive of poor community-based functional outcomes. However, pharmacological and psychosocial treatments for negative symptoms have demonstrated limited effectiveness. To address this critical unmet need in schizophrenia therapeutics, the NIMH sponsored a consensus development conference to delineate research priorities for the field and stimulate treatment development. The primary conclusion of this meeting was that next-generation negative symptom rating scales should be developed to address methodological and conceptual limitations of existing instruments. Two next-generation clinical rating scales resulted from the NIMH consensus development conference that were intended for use with adult populations presenting with established psychotic illnesses. However, the consensus conference did not discuss development of assessments specific to youth at ultra-high risk (UHR) for developing psychosis (i.e. adolescents/young adults meeting criteria for a prodromal syndrome). Given that negative symptoms are highly predictive of the transition to diagnosable psychotic illness, enhancing our ability to detect negative symptoms in UHR youth is paramount. Existing scales designed to assess negative symptoms in UHR youth have conceptual and methodological limitations and scales designed for adults with diagnosable illness do not meet the unique needs of the UHR population. New scales specifically designed to assess negative symptoms in UHR youth are needed to accurately chart mental illness trajectories and determine when, where, and how to intervene. The current study aims to extend the scale development aims of the NIMH consensus development conference to the UHR population by taking an iterative, data-driven approach to creating a new measure, the Prodromal Inventory for Negative Symptoms (PINS). A beta version of the PINS was developed that displayed promising psychometric properties. Two studies will be conducted to refine the beta version and arrive at a final scale based on state-of-the-art statistical methods, with data collected at 3 sites with ongoing UHR research programs. Study 1 will include a large, representative, and diverse sample of UHR youth (n = 180) and evaluate the psychometric properties of the beta version. To determine how the beta version should be revised, analyses will be conducted to determine item selection, modification, and retention, including Item Response Theory, confirmatory factor analysis, item-level analyses, within- and between-site inter-rater reliability, and analyses of convergent and discriminant validity. In study 2, psychometric properties of the revised scale will be evaluated in a sample of UHR youth (n = 120) who will be followed longitudinally. Analyses of the final scale will evaluate measurement stability, internal consistency, inter-rater reliability, prediction of the transition to diagnosable psychotic illness, factor structure, convergent validity, and discriminant validity. This iterative, data-driven scale development process will provide the field with a next-generation negative symptom scale that meets the unique assessment needs of the UHR population.