Amos Andrew J
School of Medicine, University of Queensland, Queensland, Australia.
Prim Care Companion CNS Disord. 2014;16(1). doi: 10.4088/PCC.13r01586. Epub 2014 Feb 6.
The early intervention in psychosis literature has recently appropriated clinical terms with etiologic implications such as staging and pluripotent from the oncology literature without adopting the methodological rigor of oncology research. Oncology research maintains this rigor, among other methods, by examining the literature for evidence of bias and spin, which obscures negative trials. This study was designed to detect possible use of reporting bias and spin in the early intervention in psychosis literature.
Articles were selected from PubMed searches for early intervention in psychosis, duration of untreated psychosis, first-episode psychosis, ultra-high risk, and at risk mental state between January 1, 2000, and May 31, 2013.
38 RCT and quasi-experimental articles reporting results from early intervention in psychosis paradigms were selected for inclusion.
Articles were examined for evidence of inappropriate reporting of primary and secondary end points in the abstract (reporting bias) and presentation as positive despite negative primary end points (spin).
While only 13% of early intervention articles reported positive primary end points, abstracts implied that 76% of articles were positive. There was evidence of bias in 58% of articles and spin in 66% of articles.
There was a high prevalence of spin and bias in the early intervention in psychosis literature compared to previous findings in the oncological literature. The most common techniques were changing the primary end point or focusing on secondary end points when the primary end point was negative and reporting analyses using only a subset of the data. There appears to be a need for greater scrutiny of the early intervention in psychosis literature by editors, peer reviewers, and critical readers of the literature.
近期关于精神病早期干预的文献采用了一些具有病因学意义的临床术语，如分期和多能性，这些术语来自肿瘤学文献，但却未采用肿瘤学研究的严谨方法。肿瘤学研究通过检查文献中是否存在偏倚和歪曲证据来保持这种严谨性，而这些偏倚和歪曲会掩盖阴性试验结果。本研究旨在检测精神病早期干预文献中是否可能存在报告偏倚和歪曲情况。
从PubMed搜索中选取2000年1月1日至2013年5月31日期间关于精神病早期干预、未治疗精神病持续时间、首发精神病、超高风险和处于风险精神状态的文章。
选取38篇报告精神病早期干预范式结果的随机对照试验（RCT）和准实验性文章纳入研究。
检查文章摘要中主要和次要终点是否存在不当报告的证据（报告偏倚），以及尽管主要终点为阴性但仍呈现为阳性结果的情况（歪曲）。
虽然只有13%的早期干预文章报告主要终点为阳性，但摘要暗示76%的文章为阳性。58%的文章存在偏倚证据，66%的文章存在歪曲证据。
与肿瘤学文献先前的研究结果相比，精神病早期干预文献中存在很高比例的歪曲和偏倚情况。最常见的手法是在主要终点为阴性时改变主要终点或关注次要终点，并仅使用部分数据进行报告分析。编辑、同行评审人员和文献的批判性读者似乎有必要对精神病早期干预文献进行更严格的审查。
