Camille Wilson

Psychosis risk screening in youth: A validation study of three self-report measures of attenuated psychosis symptoms

Brief self-report questionnaires that assess attenuated psychosis symptoms have the potential to quickly and effectively screen many people who may benefit from clinical monitoring or early intervention. The current study sought to examine and compare the criterion validities of attenuated symptoms screening tools with diagnoses obtained from the clinician-administered Structured Interview for Psychosis Risk Syndromes (SIPS). Three screening questionnaires (Prime Screen, Prodromal Questionnaire-Brief, and Youth Psychosis At-Risk Questionnaire-Brief) were administered just prior to the SIPS interview in a sample of adolescents and young adults seeking mental health services. Using thresholds recommended by instrument authors as well as empirically derived optimal thresholds, the sensitivity, specificity, positive predictive value, and overall accuracy of each self-report measure with regard to SIPS diagnosis were obtained. Screeners correlated highly with the SIPS and demonstrated equivalent overall efficiency in capturing psychosis risk status. All three screeners appear to be useful and valid assessment tools for attenuated symptoms, with each instrument demonstrating relative benefits. The validation of attenuated symptoms screening tools is an important step toward enabling early, wide-reaching identification of individuals on a course toward psychotic illness.

Convergent and discriminant validity of attenuated psychosis screening tools.

Brief self-report questionnaires that assess attenuated psychotic symptoms have the potential to screen many people who may benefit from clinical monitoring, further evaluation, or early intervention. The extent to which recently developed screening instruments demonstrate sound psychometric properties is an important issue toward the implementation of these measures in clinical practice. This study examines the convergent validity, discriminant validity, and test-retest reliability of four recently developed screening instruments. Screening instruments were included in an assessment battery and administered to a sample of 355 college students. Screening scores support the convergent and discriminant validity and the test-retest reliability of these measures.

Schizotypy, psychotic-like experiences and distress: an interaction model.

Psychotic-like experiences (PLEs) have been found to exist on a continuum in both general and clinical populations. Such experiences may characterize normal and abnormal variations in personality, as well as prodromal or high risk states for the development of psychotic disorders. High risk paradigms tend to emphasize distress and impairment associated with PLEs, yet the extent to which individuals find PLEs to be distressing likely depends on moderating factors. In particular, individuals high in trait schizotypy may differ in their appraisal and reaction to PLEs. The current study examines the relationship between schizotypy, PLEs, and distress associated with PLEs in a college sample. Participants (N=355) completed the Schizotypal Personality Questionnaire - Brief Version (SPQ-B), which assesses schizotypal traits, and the Prodromal Questionnaire - Brief Version (PQ-B), which assesses both PLEs and associated distress. Schizotypy was found to significantly moderate the association between PLEs and subjective distress. Individuals high in trait schizotypy reported more PLEs, yet less distress associated with PLEs, relative to individuals low in trait schizotypy. Implications for high-risk state assessment are discussed.

Impact of Family History in Persons With Dual Diagnosis

Objective: This study examined relationships among family history of alcohol, drug, and psychiatric problems and substance use severity, interpersonal relationships, and service use in individuals with dual diagnosis. Methods: Data were collected with the family history section of the Addiction Severity Index administered as part of three studies of individuals with dual disorders (N = 413). Participants were categorized into family history risk groups for each problem domain based on the number of first- and second-degree relatives with alcohol, drug, or psychiatric problems. Results: Rates of alcohol, drug, and psychiatric problems were high across family member categories and highest overall for siblings. More than two-thirds of the sample was categorized in the high-risk group in the alcohol problem domain, almost half of the sample was categorized as high-risk in the drug problem domain, and more than a third of the sample was categorized as high-risk in the psychiatric problem domain. Across problem domains, individuals in the high-risk group reported more relationship problems with parents and siblings and higher rates of lifetime emotional, physical, and sexual abuse than did those in the low- or moderate-risk groups. Conclusions: Family history of alcohol, drug, and psychiatric problems is associated with greater rates of poor family relationships and history of abuse. Assessment of these different forms of family history in multiple family members can aid treatment providers in identifying individuals with dual disorders who may benefit from trauma-informed care as part of their overall mental health and substance abuse treatment services.

Context matters: The impact of neighborhood crime and paranoid symptoms on psychosis risk assessment.

Psychosis risk assessment measures probe for paranoid thinking, persecutory ideas of reference, and suspiciousness as part of a psychosis risk construct. However, in some cases, these symptoms may reflect a normative, realistic, and even adaptive response to environmental stressors rather than psychopathology. Neighborhood characteristics, dangerousness for instance, are linked to levels of fear and suspiciousness that can be theoretically unrelated to psychosis. Despite this potential confound, psychosis-risk assessments do not explicitly evaluate neighborhood factors that might (adaptively) increase suspiciousness. In such cases, interviewers run the risk of misinterpreting adaptive suspiciousness as a psychosis-risk symptom. Ultimately, the degree to which neighborhood factors contribute to psychosis-risk assessment remains unclear. The current study examined the relation between neighborhood crime and suspiciousness as measured by the SIPS among predominantly African American help-seeking adolescents (N=57) living in various neighborhoods in Baltimore City. Uniform Crime Reports, including violent and property crime for Baltimore City, were used to calculate a proxy of neighborhood crime. This crime index correlated with SIPS suspiciousness (r(55)=.32, p=.02). Multiple regression analyses demonstrated that increased neighborhood crime significantly predicted suspiciousness over and above the influence of the other SIPS positive symptoms in predicting suspiciousness. Findings suggest that neighborhood crime may in some cases account for suspiciousness ascertained as part of a psychosis risk assessment, and therefore sensitivity to contextual factors is important when evaluating risk for psychosis.

The association between sleep dysfunction and psychosis-like experiences among college students

Sleep problems are prominent and pervasive clinical issues experienced by many people with psychotic disorders, often causing distress and functional impairment. Sleep problems are also related to psychosis-like experiences (PLE; non-diagnosable phenomenon such as transient perceptual disturbances, unusual thoughts, periodic suspiciousness) in epidemiological studies. Prior studies in this field have used brief measures that precluded the ability to test (1) whether risk for psychosis-like experiences are related to specific sub-types of sleep disturbance, and (2) whether sleep disturbance is specifically related to clinically significant (i.e., distressing) psychosis-like experiences. The current project examined the relation between specific sleep issues, and PLEs and distress associated with PLEs, in a college sample. Participants (N=420) completed the Prodromal Questionnaire-Brief (PQ-B), which assesses PLEs and associated distress, and the Iowa Sleep Disturbances Inventory - extended version (ISDI-E), which assesses thirteen separate disturbed sleep domains. Symptoms of fragmented sleep, sleep hallucinations, and night anxiety significantly correlated with PLEs, and several sleep domains were significantly associated with PLE-related distress.

Comparison of measures of functioning for use with treatment-seeking adolescents experiencing attenuated symptoms of psychosis

A growing body of research documents a relation between psychosis risk and functional impairment. Although a general picture of psychosis risk and impaired functioning is emerging, less is known about how different functional measures relate to specific psychosis‐risk symptoms.