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令人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成本超过627亿美元（Wu et al., 2005）。一些研究表明，早期识别和治疗可以延缓精神分裂症的发病并降低其严重程度，从而显著减少与精神分裂症发病相关的不可逆转的神经解剖学改变和认知缺陷（McGlashan et al., 2006; Piontkewitz, et al., 2009; Simon et al., 2007）。前驱和早期精神病（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管理时间来看，临床医生实施PEP筛查评估既耗时又昂贵（Lindenmayer et al, 2007）。拟议的项目将通过编制适合14-25岁公共部门精神健康门诊病人的简短纸张和电脑自我报告精神健康评估，促进精神健康筛查和临床研究招聘。为了实现这一目标，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门诊患者的认知访谈（CI）以及对1000名不同严重程度的门诊患者的反应进行项目反应理论（IRT）分析，包括无症状，PEP和精神障碍。这些方法将减少特定人群的偏差，提高测量精度，从而提高预测的有效性。我们将分别针对SIPS和基于scid的12个月诊断结果建立我们的评估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，生成临床和研究报告，并与计算机化的结构化诊断评估（NetSCID）进行跟踪，当集成到我们现有的安全诊断门户网站时。我们与高技能的顾问合作，包括三位NIMH北美前驱期纵向研究（NAPLS）的pi，两位来自NIMH初次精神分裂症发作后恢复（RAISE）临床试验的pi，一位代表美国以外最重要的超高风险（UHR）研究中心的研究员，以及一位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。它将通过提高自我报告筛选的预测有效性，从而改善临床试验招募，从而促进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个体获得经napls验证的干预措施，这可能会延迟或预防精神病的发作；从而改善精神病患者及其家属的生活；NIMH整体任务的重要组成部分。

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.