Kristin Bussell

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.

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.

Self-Report Instruments for Clinical Monitoring of Psychosis Risk States.

OBJECTIVE Practice guidelines emphasize frequent clinical monitoring of patients at high risk for psychosis. No brief instrument assessing attenuated psychotic symptoms has been validated for this purpose. This study examined use of three self-report questionnaires, which were developed as psychosis risk screeners, for monitoring symptom severity in a naturalistic clinical sample of 54 adolescents. METHODS Self-report measures (Prime Screen-Revised, Prodromal Questionnaire-Brief Version [PQ-B], and Youth Psychosis At-Risk Questionnaire-Brief) and clinician assessments (Structured Interview for Psychosis Risk Syndromes) were administered to participants at baseline and six months. RESULTS Changes in self-report scores were moderately correlated with changes in clinician ratings. The PQ-B demonstrated slightly better agreement with changes in clinician ratings than the other two measures. CONCLUSIONS Questionnaires developed as psychosis risk screeners could be used for symptom monitoring. Further validation of tools to monitor attenuated symptoms will be a valuable step toward developing an evidence-based approach for treating high-risk youths.

The Family Value of Information, Community Support, and Experience Study: Rationale, Design, and Methods of a "Family-Centered" Research Study.

Abstract The Patient Protection and Affordable Care Act focuses on improving consumer engagement and patient-centered care. This article describes the design and rationale of a study targeting family engagement in pediatric mental health services. The study is a 90-day randomized trial of a telephone-delivered Family Navigator services versus usual care for parents of Medicaid-insured youth younger than 13 years with serious mental illness. Youth are identified through a pediatric antipsychotic medication preauthorization program. Family Navigators offer peer support to empower and engage parents in their childs recovery. Outcomes include parent report of empowerment, social support, satisfaction with child mental health services, and child functioning as well as claims-based measures of psychotherapy service utilization and antipsychotic medication dosage. The focus on “family-centered” care in this study is strongly supported by the active role of consumers in study design and implementation.

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.