Savill Mark, D'Ambrosio Jennifer, Cannon Tyrone D, Loewy Rachel L
Department of Psychiatry, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California.
Departments of Psychology and Psychiatry, Yale University, New Haven, Connecticut.
Early Interv Psychiatry. 2018 Feb;12(1):3-14. doi: 10.1111/eip.12446. Epub 2017 Aug 6.
Diagnosing individuals at ultra high risk (UHR) for psychosis can improve early access to treatment, and a two-stage model utilizing self-report screening followed by a clinical interview can be accurate and efficient. However, it is currently unclear which screening cut-offs to adopt with different populations.
A systematic review of diagnostic accuracy studies evaluating the Prodromal Questionnaire (PQ) as a preliminary screener for UHR and psychosis was conducted to examine screening effectiveness in different contexts. MedLine, PsycInfo, SCOPUS and ProQuest Dissertations and Abstracts databases were electronically searched, along with a review screen and citation search of key papers. Findings were summarized in a narrative synthesis.
In total, 14 diagnostic accuracy studies and 45 studies using the PQ as a screening tool for UHR and psychosis were included. In all settings, the 3 different versions of the PQ were all found to accurately identify UHR and full psychosis. Higher cut-off points were required in non-help-seeking samples, relative to general help-seeking populations, which in turn were higher than those needed in samples highly enriched with UHR participants.
The findings support the use of the PQ as a preliminary screening tool for UHR in different settings; however, higher thresholds in lower UHR-prevalence populations are necessary to minimize false positives. Including the distress criteria, rather than just number of symptoms, may improve screening effectiveness. Different thresholds may be appropriate in different contexts depending on the importance of sensitivity vs specificity. Protocol registration: CRD42016033004.
诊断处于精神病超高风险（UHR）的个体可改善早期治疗机会，采用自我报告筛查后进行临床访谈的两阶段模型既准确又高效。然而，目前尚不清楚针对不同人群应采用何种筛查临界值。
对评估前驱症状问卷（PQ）作为UHR和精神病初步筛查工具的诊断准确性研究进行系统综述，以检验其在不同背景下的筛查效果。通过电子检索MedLine、PsycInfo、SCOPUS和ProQuest学位论文与摘要数据库，同时对关键论文进行综述筛选和引文检索。研究结果以叙述性综述的形式进行总结。
总共纳入了14项诊断准确性研究以及45项将PQ用作UHR和精神病筛查工具的研究。在所有环境中，均发现PQ的3个不同版本都能准确识别UHR和完全型精神病。相对于一般寻求帮助的人群，在非寻求帮助的样本中需要更高的临界值，而后者又高于高度富集UHR参与者的样本所需的临界值。
研究结果支持将PQ用作不同环境中UHR的初步筛查工具；然而，在UHR患病率较低的人群中需要更高的阈值，以尽量减少假阳性。纳入痛苦标准而非仅症状数量，可能会提高筛查效果。根据敏感性与特异性的重要性，不同环境中可能适用不同的阈值。方案注册：CRD42016033004。
