The resulting overall weight of similarities and differences between the two instruments on UHR identification is unknown. Psychometric diagnostic uncertainty questions validity of the UHR diagnostic interview, creating inconsistencies between clinicians or researchers and misunderstandings in patients [ 13 ]. Psychometric uncertainty may significantly impact the development of future large-scale UHR multicentre studies, by amplifying heterogeneity across individual sites. These concerns and speculations have never been tested empirically. Our second aim was to qualitatively investigate potential discrepancies and to link the severity and frequency of symptoms with equipercentile-linking tables. Our third aim was to develop a pragmatic algorithm to convert individual cases across the two instruments, to implement it in an automated conversion package CONVERT , and to validate it in an independent UHR sample.
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Gakus Also, the functional decline criterion i. However, their operationalization differs [ 10 ], with substantial changes over different versions of the instruments [ 10 ].
A software engineer JL then implemented the conversion algorithm in an automated package. First, the two instruments show similar psychometric parameters, such as excellent reliability properties overall IRR agreement for the SIPS 0. Post hoc analyses see eTable 3 confirmed an overall substantial agreement across the two instruments with the exception of the cell [2,5: Full details of the main diagnostic comparison are appended in Table 3.
To freely download the tool and the template. Qualitative analyses of discrepancies across the two instruments were also conducted, to better elucidate the impact of each specific cell on the overall results. This method is detailed in eMethod 2. The prevalence and bias adjusted kappa was 0. The pragmatic algorithm to convert individual cases across the SIPS 5. Indeed, the definition of case i. Table of Contents Alerts.
Interrater reliability of the original instruments has been investigated in even smaller samples [ 25 ]. The mean age was of Furthermore, we only included subjects who were directly assessed with both psychometric instruments during face-to-face interviews, excluding those caamrs declined the full assessment or who were unable to complete it.
However, type of recruitment strategies may have inflated the observed agreement and future studies should repeat these analyses in high-risk services adopting different outreach campaigns. These concerns and speculations have never been tested empirically. Gonen, Single Case Research: This is the first pilot study addressing comparability of the two psychometric instruments most frequently used to interview subjects seeking help from high-risk services for psychosis.
It is possible to speculate that the additional SIPS 5. The resulting overall weight of similarities and differences acarms the two instruments on UHR identification is unknown. The primary aim of the study was investigated by comparing the diagnostic outcomes i. These findings however may be influenced by the type of recruitment strategies adopted by the high-risk services.
Residual and qualitative analyses and equipercentile-linking tables provided additional comparability data. This algorithm has been implemented in the CONVERT tool, which has been made freely available for the use of future researchers and clinicians and externally validated in an independent sample.
Subjects are recruited from Seoul National University Hospital and other psychiatric clinics and public mental health centers or they can contact the clinic by telephone or an Internet homepage.
Of the subjects, 82 were females Differences remain between the characteristics of the basic population, the recruitment of patients, the follow-up, and the specific treatments psychosix [ 9 ]. External validation was performed in an independent sample assessed for suspicion of UHR symptoms at the Seoul Youth Clinic see eTable 5.
This study had limitations. Percent overall agreement, kappa, the McNemar-Bowker test, equipercentile methods, and residual analyses were used to investigate diagnostic outcomes and symptoms severity or frequency. The IRRs for each subscale were in the excellent range: Also, operationalization differences in APS onset criteria did not impact the overall consistency of the diagnostic interview for APS across the two instruments. Subscribe to Table of Contents Alerts.
The development of psychometric tools to prospectively identify subjects at ultra high clinical risk UHR hereafter of psychosis has allowed preventative screening [ 1 ], diagnosis [ 2 ], and interventions [ 3 ] to be feasible in psychiatry. To receive news and publication updates for Psychiatry Journal, enter your email address in the box below.
There was a problem providing the content you requested It may also paradoxically create additional biases because the most severe patients may be more likely to decline lengthy assessments. Finally, in a recent meta-analysis we specifically confirmed that, in help-seeking samples, the two instruments share similar excellent prognostic accuracy in ruling out psychosis risk, with no significant differences [ 26 ].
Third, our procedure involving a unique rater scoring both instruments in an uncontrolled order may have significantly inflated agreement across instruments. However, we also found some sources of disagreement, in particular, with respect to the diagnosis of BLIPS subjects.
Their diagnostic comparability is unknown. The results of the current investigation may be highly relevant to the field, as they may inform future multicentre studies as well as international consensus conferences aiming at standardizing the UHR diagnostic interview. The ROC area serves as a global measure of test performance and values in the range of 0. To elucidate this difference we conducted a qualitative analysis of the medical records of these 14 subjects.
CAARMS Comprehensive Assessment of At Risk Mental State
Such a substantial agreement is not completely surprising. We additionally estimated the prevalence and bias adjusted kappa PABAK [ 21 ] which adjusts the kappa for imbalances caused by differences in prevalence and bias [ 22 ]. Our third aim was to develop an automated algorithm to convert individual cases and to validate it in an external sample. Also, the functional decline criterion i.
CAARMS PSYCHOSIS PDF
Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States.