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一个核心特征，其定义是失去正常的动机和/或表达。 精神病理学的这一维度与疾病的其他方面截然不同，并高度预测基于社区的不良功能结果。然而，针对阴性症状的药物和心理社会治疗效果有限。为了解决精神分裂症治疗中未得到满足的这一关键需求，NIMH赞助了一次共识发展会议，以勾勒出该领域的研究重点并刺激 治疗的发展。这次会议的主要结论是，下一代阴性症状 应制定评级标准，以解决现有工具在方法和概念上的局限性。 NIMH共识发展会议产生了两个下一代临床评分标准 是为患有精神病的成年人群而设计的。然而， 协商一致会议没有讨论制定针对超高风险青年(UHR) 发展为精神病(即符合前驱症状标准的青少年/青壮年)。考虑到这一负面影响 症状是向可诊断精神疾病过渡的高度预测，提高我们在UHR青年中检测阴性症状的能力是至关重要的。现有的用于评估UHR青少年阴性症状的量表存在概念和方法上的局限性，为患有可诊断疾病的成年人设计的量表不能满足UHR人群的独特需求。需要专门为评估UHR青年的阴性症状而设计的新量表，以准确地绘制精神疾病的轨迹图，并确定何时、何地和如何干预。目前的研究旨在通过采用迭代的、数据驱动的方法创建一种新的衡量标准--阴性症状前兆清单(PIN)，将NIMH共识发展会议的规模发展目标扩展到UHR人群。这种别针的测试版被开发出来，显示出良好的心理测量学特性。将进行两项研究，以完善测试版，并基于最先进的统计方法得出最终量表，数据收集在3个地点，正在进行的UHR研究计划。研究1将包括大量、有代表性和多样化的UHR青年样本(n=180)，并评估测试版的心理测量学特性。为了确定测试版应该如何修订，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、站点内和站点间评分员之间的可靠性以及收敛和区分效度分析。在研究2中，修订后的量表的心理测量学特性将在UHR青年样本(n=120)中进行评估，并进行纵向跟踪。对最终量表的分析将评估测量的稳定性、内部一致性、评分者之间的可靠性、向可诊断的精神疾病过渡的预测、因素结构、收敛效度和区分效度。这一迭代的、数据驱动的量表开发过程将为实地提供新一代负面症状量表，以满足《世界人权宣言》人口的独特评估需求。

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.