Department of Psychiatry Research, The Zucker Hillside Hospital, New York, NY.
Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY.
Schizophr Bull. 2021 Apr 29;47(3):644-652. doi: 10.1093/schbul/sbaa168.
Time constraints limit the use of measurement-based approaches in research and routine clinical management of psychosis. Computerized adaptive testing (CAT) can reduce administration time, thus increasing measurement efficiency. This study aimed to develop and test the capacity of the CAT-Psychosis battery, both self-administered and rater-administered, to measure the severity of psychotic symptoms and discriminate psychosis from healthy controls.
An item bank was developed and calibrated. Two raters administered CAT-Psychosis for inter-rater reliability (IRR). Subjects rated themselves and were retested within 7 days for test-retest reliability. The Brief Psychiatric Rating Scale (BPRS) was administered for convergent validity and chart diagnosis, and the Structured Clinical Interview (SCID) was used to test psychosis discriminant validity.
Development and calibration study included 649 psychotic patients. Simulations revealed a correlation of r = .92 with the total 73-item bank score, using an average of 12 items. Validation study included 160 additional patients and 40 healthy controls. CAT-Psychosis showed convergent validity (clinician: r = 0.690; 95% confidence interval [95% CI]: 0.610-0.757; self-report: r = .690; 95% CI: 0.609-0.756), IRR (intraclass correlation coefficient [ICC] = 0.733; 95% CI: 0.611-0.828), and test-retest reliability (clinician ICC = 0.862; 95% CI: 0.767-0.922; self-report ICC = 0.815; 95%CI: 0.741-0.871). CAT-Psychosis could discriminate psychosis from healthy controls (clinician: area under the receiver operating characteristic curve [AUC] = 0.965, 95% CI: 0.945-0.984; self-report AUC = 0.850, 95% CI: 0.807-0.894). The median length of the clinician-administered assessment was 5 minutes (interquartile range [IQR]: 3:23-8:29 min) and 1 minute, 20 seconds (IQR: 0:57-2:09 min) for the self-report.
CAT-Psychosis can quickly and reliably assess the severity of psychosis and discriminate psychotic patients from healthy controls, creating an opportunity for frequent remote assessment and patient/population-level follow-up.
时间限制限制了基于测量的方法在精神病学研究和常规临床管理中的应用。计算机化自适应测试（CAT）可以减少管理时间，从而提高测量效率。本研究旨在开发和测试 CAT-精神病学电池的能力，无论是自我管理还是评估者管理，以测量精神病症状的严重程度，并将精神病与健康对照区分开来。
开发和校准了一个项目库。两名评估者对 CAT-精神病学进行了评估，以评估评估者间的可靠性（IRR）。被试者自我评估，并在 7 天内进行重测，以评估测试-重测的可靠性。简明精神病评定量表（BPRS）用于评估收敛效度和图表诊断，结构临床访谈（SCID）用于评估精神病学的判别效度。
发展和校准研究包括 649 名精神病患者。模拟显示，使用平均 12 个项目，与总 73 个项目库得分的相关性为 r =.92。验证研究包括 160 名额外的患者和 40 名健康对照者。CAT-精神病学表现出收敛效度（评估者：r = 0.690；95%置信区间[95%CI]：0.610-0.757；自我报告：r =.690；95%CI：0.609-0.756）、IRR（组内相关系数[ICC] = 0.733；95%CI：0.611-0.828）和测试-重测的可靠性（评估者 ICC = 0.862；95%CI：0.767-0.922；自我报告 ICC = 0.815；95%CI：0.741-0.871）。CAT-精神病学可以将精神病与健康对照者区分开来（评估者：受试者工作特征曲线下面积[AUC] = 0.965，95%CI：0.945-0.984；自我报告 AUC = 0.850，95%CI：0.807-0.894）。评估者管理的评估中位数长度为 5 分钟（四分位距[IQR]：3:23-8:29 分钟），自我报告的评估中位数长度为 1 分 20 秒（IQR：0:57-2:09 分钟）。
CAT-精神病学可以快速可靠地评估精神病的严重程度，并将精神病患者与健康对照者区分开来，为频繁的远程评估和患者/人群水平的随访创造了机会。
