Administrative Supplement - 3/3: Community Psychology Risk Screening: An Instrument Development Study

项目摘要/摘要 这项拟议的研究旨在开发一份简短、有效的筛查问卷，以确定有风险的个人 3个不同人口的大型社区集水区的非临床人群中的精神病。 这是一项必要的研究，因为目前针对高危精神病人群的筛查工具已经得到验证 仅在临床和/或治疗中寻求样本，这些样本不太可能超越这些专门的 设置。拟议的项目将管理3个知名的精神病风险筛查人员，以及症状- 基于(例如，抑郁、焦虑等)和基于风险因素的调查问卷(例如，大麻和其他 药物使用、严重精神障碍家族史、精神创伤史)给12,000名青少年/青壮年 在3个人口结构不同的地点(大费城、巴尔的摩和芝加哥)的当地社区 地区，包括邻近的农村/郊区地区)。根据三种精神病的既定分界值 筛查者，2,000名受试者被认为是风险较高的问卷(QHR；n=1,000)，而调查问卷的风险较低 (QLR；n=1,000)精神病(根据试点数据估计样本量和预期后续损失) 将被邀请完成半结构化访谈，以确定精神病的临床高风险(CHR)状态 基于对精神病风险综合征(SIPS)的结构化访谈，并评估当前/过去的主要 基于DSM-5(SCID-5)结构化临床访谈的精神障碍。SIPS精神病-风险 持续性综合征和DSM-5减弱阳性综合征(两者都用SIPS 5.6进行评估)也 将被收集，并将在补充分析中进行审查。基于初步数据和保守的 估计，我们预计186个QHR组将被认为是精神错乱的慢性阻塞性肺疾病。具体目标 具体如下：1)确定全国范围内弱化阳性精神病症状的常模和患病率 3个不同的社区集水区和2)开发一份筛查问卷，包括两者 基于症状和基于风险因素的问题，根据SIPS进行验证，以确定CHR的问题 社区中的精神病患者。这是美国第一项确定阈值以下精神病患者比率的研究 各种非求助样本的症状，这对于任何使用 精神障碍的次元治疗方法。此外，拟议的研究将制定一项重要的 筛选工具，将确定哪些人最需要通过结构化访谈进行后续跟进 在CHR研究或临床环境中，以确定精神病风险状态。根据调查结果，这个工具将是有价值的 那些患有精神障碍的人通常直到精神障碍发作后才寻求治疗， 而未经治疗的精神病持续时间与更严重的临床结果相关。建议数 这项研究有可能对精神障碍的早期发现和预防做出重大贡献。这个 在史无前例的新冠肺炎大流行之后，补充将有助于实现该项目的全面导入。

Project Summary/Abstract The proposed study aims to develop a brief, valid screening questionnaire to identify individuals at risk for psychosis in non-clinical populations across 3 large, community catchment areas with diverse populations. This is a needed study, as the current screening tools for at-risk psychotic populations have been validated only in clinical and/or treatment seeking samples, which are not likely to generalize beyond these specialized settings. The proposed project will administer 3 well-known psychosis risk screeners, as well as symptom- based (e.g., depression, anxiety, etc.) and risk-factor based questionnaires (e.g., cannabis and other substance use, a family history of major mental disorders, trauma history) to 12,000 adolescents/young adults in local communities across 3 demographically diverse sites (the greater Philadelphia, Baltimore, and Chicago areas, including neighboring rural/suburban areas). Based on established cut-off scores from the 3 psychosis screeners, 2,000 subjects deemed as questionnaire higher risk (QHR; n=1,000) and questionnaire lower risk (QLR; n=1,000) for psychosis (estimated sample sizes based on pilot data and anticipated loss to follow up) will be invited to complete semi-structured interviews to determine clinical high risk (CHR) for psychosis status based on the Structured Interview for Psychosis-Risk Syndromes (SIPS) and to assess current/past major mental disorders based on the Structured Clinical Interview for DSM-5 (SCID-5). The SIPS psychosis-risk persistence syndromes and the DSM-5 attenuated positive syndrome (both assessed with the SIPS 5.6) also will be collected and will be examined in supplementary analyses. Based on preliminary data and conservative estimates, we anticipate that 186 of the QHR group will be considered CHR for psychosis. The specific aims are as follows: 1) to determine norms and prevalence rates of attenuated positive psychotic symptoms across 3 diverse, community catchment areas and 2) to develop a screening questionnaire, inclusive of both symptom-based and risk factor-based questions, that is validated against the SIPS to identify those at CHR for psychosis in the community. This is the first study in the U.S. to determine the rate of subthreshold psychotic symptoms across diverse non-help seeking samples, which is essential for any investigation that uses dimensional approaches to psychotic disorders. Further, the proposed study will develop an essential screening tool that will identify which individuals have the greatest need of follow-up with structured interviews in CHR studies or clinical settings to determine psychosis-risk status. This tool is will be valuable given findings that those who develop psychotic disorders often do not seek treatment until after the onset of the disorder, and that duration of untreated psychosis is associated with more serious clinical outcomes. The proposed study has the potential for major contributions to the early detection and prevention of psychotic disorders. The supplement would help realize the full import of this project following the unprecedented COVID-19 pandemic.