Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China.
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Psychotic Disorders, Shanghai 200030, PR China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, PR China.
Schizophr Res. 2018 Dec;202:284-290. doi: 10.1016/j.schres.2018.06.026. Epub 2018 Jun 19.
Two-stage screening, involving a self-rating report, followed by a structured interview, has been proposed for identifying clinical high risk of psychosis (CHR) for nearly two decades. This study used PRIME Screen-Revised (PS-R) and Structured Interview for Prodromal Syndromes (SIPS) to investigate the predictive validity of the two-stage screening. Of 566 participants who completed two-stage screening in this study, 192 were PS-R(-) and 374 were PS-R(+). After being interviewed with SIPS, 112 were rated as CHR(+), 109 were diagnosed with psychosis, and the other 345 individuals were CHR(-). Those who were rated through SIPS as CHR(+) and CHR(-) were followed up within 2 years to observe their clinical outcome. Ninety one (81.3%) CHR(+) and 171 (49.6%) CHR(-) individuals completed the investigation at baseline and the two-year follow-up. The cumulative conversion rate to psychosis was 27.5% in CHR(+) group, but only 1.7% in CHR(-) group, with a significant difference between the two groups (log-rank test, χ2 = 30.07, p < 0.001). In terms of two-stage screening, PS-R(-)/CHR(-), PS-R(-)/CHR(+), and PS-R(+)/CHR(-) groups were viewed as expected negative (EN), and the PS-R(+)/CHR(+) group as expected positive (EP), and the sensitivity and specificity was 64.3% and 79.1%, respectively. Furthermore, Kaplan-Meyer survival analysis showed that EP group were more likely to convert to psychosis than EN group (log-rank test, χ2 = 16.702, p < 0.001). Two-stage screening indeed saves much time and alleviates the workload, but may exclude some target individuals. Optimizing self-report scale, and forming a nurse-doctor-interviewer coalition are likely to improve the use of self-rating report and structured interview.
两步筛查法，包括自评报告，接着是结构化访谈，已经被提议用于识别近二十年的精神病高危（CHR）。本研究使用 PRIME Screen-Revised (PS-R) 和 Prodromal Syndromes 结构化访谈 (SIPS) 来调查两步筛查的预测效度。在这项研究中，共有 566 名参与者完成了两步筛查，其中 192 名 PS-R(-)，374 名 PS-R(+)。在使用 SIPS 进行访谈后，112 名被评定为 CHR(+)，109 名被诊断为精神病，其余 345 名被评定为 CHR(-)。那些通过 SIPS 评定为 CHR(+)和 CHR(-)的人在两年内被跟踪观察他们的临床结果。91 名（81.3%）CHR(+)和 171 名（49.6%）CHR(-)的个体在基线和两年随访时完成了调查。CHR(+)组的精神病转化率为 27.5%，而 CHR(-)组仅为 1.7%，两组之间有显著差异（对数秩检验，χ2=30.07，p<0.001）。在两步筛查方面，PS-R(-)/CHR(-)、PS-R(-)/CHR(+)和 PS-R(+)/CHR(-)组被视为预期阴性（EN），PS-R(+)/CHR(+)组被视为预期阳性（EP），敏感性和特异性分别为 64.3%和 79.1%。此外，Kaplan-Meier 生存分析显示，EP 组比 EN 组更有可能转化为精神病（对数秩检验，χ2=16.702，p<0.001）。两步筛查确实节省了大量的时间和减轻了工作量，但可能排除了一些目标个体。优化自评量表，并形成护士-医生-访谈者联盟，可能会提高自评报告和结构化访谈的使用。
