IRT-based Self-report Screener for Prodromal Schizophrenia & Early Psychosis

描述（由申请人提供）：精神分裂症是美国最衰弱和最昂贵的精神疾病之一，在14-25岁的个体中发病率最高，每年造成的直接和间接费用超过627亿美元（Wu等人，2005年）。几项研究表明，早期识别和治疗可以延迟精神分裂症的发作并降低其严重程度，导致通常与精神分裂症发作相关的不可逆神经解剖学变化和认知缺陷的显著减少（McGlashan等人，2006; Piontkewitz等人，2009; Simon等人，2009）。2007年）。前驱期和早期精神病（PEP）研究和治疗进展的关键障碍是识别有转化为精神障碍风险的PEP个体。从所需的专业知识和给药时间来看，临床医生进行的PEP筛选评估既耗时又昂贵（Lindenmayer et al，2007）。建议的项目将通过编制适合14至25岁的公共部门精神健康门诊病人的简要文件和计算机化的自我报告PEP评估，促进PEP筛查和临床研究招募。为了实现这一点，我们将利用最先进的自我报告项目开发方法，这是PEP研究的新方法，即对50名PEP门诊患者进行认知访谈（CI），以及对1000名严重程度不同的门诊患者（包括无症状、PEP和精神障碍）的反应进行项目反应理论（IRT）分析。这些方法将减少人群特异性偏差，提高测量精度，从而提高预测有效性。我们将分别确定我们评估对SIPS和12个月SCID诊断结果的收敛性和预测性有效性，以及PQ-92对相同结果的预测有效性。新的PEP筛选器的计算机化版本将允许快速评分，临床和研究报告的生成，并与计算机化的结构化诊断评估，NetSCID的后续行动，当集成到我们现有的安全诊断门户网站。我们与高技能的顾问合作，包括三名NIMH北美前驱症状纵向研究（NAPLS）PI，两名来自NIMH首次精神分裂症发作后恢复（RAISE）临床试验的PI，一名代表美国以外最重要的超高风险（UHR）研究中心的研究人员，也是IRT的定量专家该项目可能对PEP的识别和治疗产生重大影响。它将通过增加自我报告筛查的预测有效性，从而改善临床试验招募，促进PEP研究。使用我们的仪器对门诊患者进行常规筛查，可以使更多的PEP个体获得NAPLS验证的干预措施，这可能会延迟或预防精神障碍的发作;从而改善精神病患者及其家人的生活; NIMH整体使命的重要组成部分。 公共卫生相关性：一旦开发出来，拟议的前驱期和早期精神病（PEP）评估（PEPS和PEPSS）将使研究人员和临床医生有可能使用多维自我报告工具来识别有转化为精神病性障碍风险的个体;从而促进PEP门诊患者的筛选和临床研究招募，这些患者可能受益于进一步的评估和可能纳入经验证的PEP治疗干预。因此，该项目很可能对精神病的识别、治疗和可能的预防以及有精神病风险和患有精神病的个人及其家人的生活产生重大影响;两个突出的 NIMH整体使命的组成部分。

DESCRIPTION (provided by applicant): Schizophrenia is one of the most debilitating and costly mental illnesses in the United States, with peak incidence in individuals aged 14-25 and causing annual direct and indirect costs of over $62.7 billion (Wu et al., 2005). Several studies suggest that early identification and treatment can delay onset and decrease the severity of schizophrenia, leading to a significant reduction in the irreversible neuroanatomical changes and cognitive deficits often associated with the onset of schizophrenia (McGlashan et al, 2006; Piontkewitz, et al, 2009; Simon et al., 2007). The critical barrier to advances in prodromal and early psychosis (PEP) research and treatment has been the identification of PEP individuals who are at risk of conversion to a psychotic disorder. Clinician-administered PEP screening assessments are time-consuming and costly, both in terms of required expertise and administration time (Lindenmayer et al, 2007). The proposed project will facilitate PEP screening and clinical research recruitment with the development of brief paper and computerized self-report PEP assessments that are appropriate for public sector mental health outpatients, 14-25 years of age. To accomplish this, we will utilize state-of-the art self- report item development methodology that is novel to PEP research, namely cognitive interviewing (CI) with 50 PEP outpatients as well as item response theory (IRT) analysis of responses from 1000 outpatients with varying levels of severity, including no symptoms, PEP, and a psychotic disorder. These methods will reduce population-specific biases and increase measurement precision and thereby, predictive validity. We will establish the convergent and predictive validit of our assessments against the SIPS and 12-month SCID-based diagnostic outcomes, respectively, as well as the predictive validity of the PQ-92 against the same outcomes. Computerized versions of the new PEP screeners will permit rapid scoring, clinical and research report generation, and follow-up with a computerized structured diagnostic assessment, the NetSCID, when integrated into our existing secure diagnostic Web portal. We have partnered with highly skilled consultants including three NIMH North American Prodrome Longitudinal Study (NAPLS) PIs, two PIs from the NIMH Recovery After an Initial Schizophrenia Episode (RAISE) clinical trial, a researcher representing the foremost ultra-high risk (UHR) research center outside the U.S., and a quantitative expert in IRT. This project is likely to have a substantial impact on the identification and treatment of PEP. It will facilitate PEP research by increasing the predictive validity of self-report screening thereby improving clinical trial recruitment. Routine screening of outpatients with our instruments may enable a greater number of PEP individuals to gain access to NAPLS-validated interventions, which may delay or prevent onset of a psychotic disorder; thereby serving to improve the lives of people suffering from psychosis and their families; prominent components of NIMH's overall mission. PUBLIC HEALTH RELEVANCE: Once developed, the proposed prodromal and early psychosis (PEP) assessments (the PEPS & PEPSS) will give researchers and clinicians the potential to use a multidimensional self-report instrument to identify individuals at risk of converting to a psychotic disorder; thereby, facilitating screening and clinical research recruitment of PEP outpatients who may benefit from further evaluation and possible inclusion in a validated PEP treatment intervention. As such, this project is likely to have a substantial impact on the identification, treatment, and possible prevention of psychosis as well as the lives of individuals at-risk for and suffering from psychotic disorders and their families; two prominent components of NIMH's overall mission.