Validation of the Korean version of the Eppendorf Schizophrenia Inventory as a screening measure to detect adolescents at ultra-high risk for psychosis

Validity of a smartphone application for self-monitoring psychiatric symptoms in patients with schizophrenia

Objective

Despite increasing research on digital technologies for psychiatric disorders, studies specifically examining self-monitoring of symptoms with smartphone applications by patients with schizophrenia remain limited. This study aims to evaluate the validity and reliability of self-monitoring psychiatric symptoms using a smartphone application among patients with schizophrenia at Mindlink, a community-based early intervention center.

Methods

Fifty-three young patients with schizophrenia spectrum disorders participated. They rated their psychiatric symptoms across five domains-delusions, hallucinations, anxiety, depression, and perceived stress-using an 11-point Likert scale at baseline, 1 week, 8 weeks, and 16 weeks. Test-retest reliability was assessed using intraclass correlation coefficients (ICCs) between baseline and 1-week ratings. Concurrent validity was determined by correlating app-based ratings with established self-report and clinician-administered scales, including the Eppendorf Schizophrenia Inventory, Hamilton Program for Schizophrenia Voices Questionnaire, Beck Depression Inventory, Generalized Anxiety Disorder-7, and Perceived Stress Scale. The accuracy of the app's depression rating was assessed using receiver operating characteristic (ROC) analysis.

Results

ICCs for test-retest reliability were high across all symptom domains, ranging from 0.741 to 0.876 (p < 0.001). Significant correlations were observed between app-based ratings and formal assessments at all time points. ROC analysis for single-item self-ratings using the app yielded an area under the curve of 0.829 (p = 0.002), indicating good accuracy.

Conclusion

This study demonstrates that self-monitoring of key symptoms and stress using a smartphone application is valid and reliable for patients with schizophrenia. These findings support the app's potential to enhance symptom management and enable early detection of relapse in this population.

Content validation using Aiken methodology through expert judgment of the first Spanish version of the Eppendorf Schizophrenia Inventory (ESI) in Peru: A brief qualitative report

BACKGROUND

The main objective of this study was the validation through the expert judgment of the first Spanish version of the Eppendorf Schizophrenia Inventory (ESI-Sp).

MATERIALS AND METHODS

A translation and cultural adaptation procedure as a first stage was carried out, which was evaluated by four psychiatrists with clinical experience. In a second stage, we recruited a group of clinical psychiatrists to evaluate the translated instrument by judging the items' clarity and relevance. Content validity was performed using the Aiken methodology (Aiken's V).

RESULTS

For the first stage, we did not find any items that needed alteration during translation and adaptation. Concerning the raters' stage, 30 clinical psychiatrists (47.07±13.62 years) completed the rating of the ESI-Sp. Of them, the majority worked in an institute (10/30; 33.33%) and had "15 or more" years of experience (12/30; 40.00%). The null hypothesis was rejected for all items and demonstrated the content validity of each item. Similar results were found for the factors of the ESI. Finally, the total Aiken's V for the ESI did not include the values of the null hypothesis in the confidence intervals (V=0.78; CI95 [0.70; 0.85]), demonstrating content validity.

CONCLUSIONS

ESI-Sp is a valid and representative instrument to determine subjective experiences in patients with a high risk of schizophrenia. The construct validation of the ESI-Sp is pending, which our research group will carry out after this first step.

Development of the Korea-Polyenvironmental Risk Score for Psychosis

OBJECTIVE

Comprehensive understanding of polyenvironmental risk factors for the development of psychosis is important. Based on a review of related evidence, we developed the Korea Polyenvironmental Risk Score (K-PERS) for psychosis. We investigated whether the K-PERS can differentiate patients with schizophrenia spectrum disorders (SSDs) from healthy controls (HCs).

METHODS

We reviewed existing tools for measuring polyenvironmental risk factors for psychosis, including the Maudsley Environmental Risk Score (ERS), polyenviromic risk score (PERS), and Psychosis Polyrisk Score (PPS). Using odds ratios and relative risks for Western studies and the "population proportion" (PP) of risk factors for Korean data, we developed the K-PERS, and compared the scores thereon between patients with SSDs and HCs. In addition, correlation was performed between the K-PERS and Positive and Negative Syndrome Scale (PANSS).

RESULTS

We first constructed the "K-PERS-I," comprising five factors based on the PPS, and then the "K-PERS-II" comprising six factors based on the ERS. The instruments accurately predicted participants' status (case vs. control). In addition, the K-PERS-I and -II scores exhibited significant negative correlations with the negative symptom factor score of the PANSS.

CONCLUSION

The K-PERS is the first comprehensive tool developed based on PP data obtained from Korean studies that measures polyenvironmental risk factors for psychosis. Using pilot data, the K-PERS predicted patient status (SSD vs. HC). Further research is warranted to examine the relationship of K-PERS scores with clinical outcomes of psychosis and schizophrenia.

Prevalence of Individuals at Clinical High-Risk of Psychosis in the General Population and Clinical Samples: Systematic Review and Meta-Analysis

(1) The consistency and magnitude of the prevalence of Clinical High-Risk for Psychosis (CHR-P) individuals are undetermined, limiting efficient detection of cases. We aimed to evaluate the prevalence of CHR-P individuals systematically assessed in the general population or clinical samples. (2) PRISMA/MOOSE-compliant (PROSPERO: CRD42020168672) meta-analysis of multiple databases until 21/01/21: a random-effects model meta-analysis, heterogeneity analysis, publication bias and quality assessment, sensitivity analysis—according to the gold-standard CHR-P and pre-screening instruments—leave-one-study-out analyses, and meta-regressions were conducted. (3) 35 studies were included, with 37,135 individuals tested and 1554 CHR-P individuals identified (median age = 19.3 years, Interquartile range (IQR) = 15.8–22.1; 52.2% females, IQR = 38.7–64.4). In the general population (k = 13, n = 26,835 individuals evaluated), the prevalence of the CHR-P state was 1.7% (95% Confidence Interval (CI) = 1.0–2.9%). In clinical samples (k = 22, n = 10,300 individuals evaluated), the prevalence of the CHR-P state was 19.2% (95% CI = 12.9–27.7%). Using a pre-screening instrument was associated with false negatives (5.6%, 95% CI = 2.2–13.3%) and a lower CHR-P prevalence (11.5%, 95% CI = 6.2–20.5%) compared to using CHR-P instruments only (28.5%, 95% CI = 23.0–34.7%, p = 0.003). (4) The prevalence of the CHR-P state is low in the general population and ten times higher in clinical samples. The prevalence of CHR-P may increase with a higher proportion of females in the general population and with a younger population in clinical samples. The CHR-P state may be unrecognized in routine clinical practice. These findings can refine detection and preventive strategies.

Screening for the at-risk mental state in educational settings: A systematic review

AIM

The at-risk mental state (ARMS) allows clinicians to identify individuals who have an increased risk of developing psychosis. At present, most screening for psychosis-risk is carried out within help-seeking populations; however, screening within educational settings may allow clinicians to identify individuals at-risk earlier and to increase the rate of detection. This review aimed to examine screening for the ARMS in educational settings, with the key questions: what screening tools have been used in educational settings, can screening in educational settings detect individuals with ARMS, what threshold scores in screening tools indicate a positive screen in educational settings, are there comorbid mental health conditions associated with the ARMS in educational settings?

METHODS

Searches were carried out in PsycINFO, MEDLINE, EMBASE, Scopus and Web of Science and reference lists of included articles searched. Results were summarized using narrative synthesis.

RESULTS

Nine papers were included for narrative synthesis. A variety of screening tools have been used when screening for the ARMS in educational settings. The majority of studies have been conducted in schools. The prevalence of the ARMS reported in ranges from 1% to 8%.

CONCLUSIONS

The ARMS indicates the presence of distressing symptoms for which intervention may be beneficial. Screening programmes within educational settings may allow outreach for prodromal symptoms at an earlier stage than clinical settings currently provided for.

Validation of the Korean Version of the 15-Item Community Assessment of Psychic Experiences in a College Population

OBJECTIVE

To investigate the reliability and validity of the Korean version of the Community Assessment of Psychic Experiences-15 item positive scale (CAPE-15) in college students.

METHODS

This study had two stages: initial screening with self-report questionnaires including the CAPE-15, and semi-structured interviews to investigate the instrument's diagnostic validity. The initial screening involved 1,749 college students. The modified Korean version of Prodromal Questionnaire-16 item (mKPQ-16) was also administered. The criteria for ultra-high risk (UHR) of psychosis in the Comprehensive Assessment of At-Risk Mental States (CAARMS) were the gold standard for diagnosis.

RESULTS

Twelve of the interviewed subjects met the CAARMS criteria for UHR of psychosis. The area under the receiver operating characteristic curve was highest (0.936) for the CAPE-15 distress score (p<0.001). The use of 6 as the cutoff for the CAPE-15 distress score resulted in the best balance of sensitivity (91.7%) and specificity (85.2%), with a favorable positive predictive value of 32.4%. The coefficients of correlation between the CAPE-15 and mKPQ-16 were significant.

CONCLUSION

The Korean version of the CAPE-15 is a good instrument for screening for psychosis risk in collegiate settings. The validation of this scale could contribute to the early identification of psychosis in the Korean community.

Four reasons why early detection centers for psychosis should be renamed and their treatment targets reconsidered: we should not catastrophize a future we can neither reliably predict nor change

Since the 1990s, facilities for individuals at putative risk for psychosis have mushroomed and within a very short time have become part of the standard psychiatric infrastructure in many countries. The idea of preventing a severe mental disorder before its exacerbation is laudable, and early data indeed strongly suggested that the sooner the intervention, the better the outcome. In this paper, the authors provide four reasons why they think that early detection or prodromal facilities should be renamed and their treatment targets reconsidered. First, the association between the duration of untreated psychosis and outcome is empirically established but has become increasingly weak over the years. Moreover, its applicability to those who are considered at risk remains elusive. Second, instruments designed to identify future psychosis are prone to many biases that are not yet sufficiently controlled. None of these instruments allows an even remotely precise prognosis. Third, the rate of transition to psychosis in at-risk patients is likely lower than initially thought, and evidence for the success of early intervention in preventing future psychosis is promising but still equivocal. Perhaps most importantly, the treatment is not hope-oriented. Patients are more or less told that schizophrenia is looming over them, which may stigmatize individuals who will never, in fact, develop psychosis. In addition self-stigma has been associated with suicidality and depression. The authors recommend that treatment of help-seeking individuals with mental problems but no established diagnosis should be need-based, and the risk of psychosis should be de-emphasized as it is only one of many possible outcomes, including full remission. Prodromal clinics should not be abolished but should be renamed and restructured. Such clinics exist, but the transformation process needs to be facilitated.

Validation of the Korean Version of the Prodromal Questionnaire-Brief Version in Non-Help-Seeking Individuals

OBJECTIVE

In this study, we examined the reliability and validity of the Korean version of the Prodromal Questionnaire-Brief (PQ-B), a self-report screening instrument for clinical high risk for psychosis (CHR).

METHODS

A total of 3,400 middle, high school and college students participated, and 261 subjects with a PQ-B total score ≥3 completed both the PQ-B and the Structured Interview for Prodromal Syndromes (SIPS). Receiver operating characteristic (ROC) curves were used to examine the psychometric properties of the PQ-B.

RESULTS

A cut-off of 7 for the PQ-B total score and a cut-off of 22 for the PQ-B distress score showed the best balance of sensitivity (72.2%, 77.8%) and specificity (71.4%, 75.0%).

CONCLUSION

The Korean version of the PQ-B showed good reliability and validity for predicting prodromal risk symptoms in the community population.

Validation of the Korean version of the 16-Item Prodromal Questionnaire in a Non-Help-Seeking College Population

OBJECTIVE

To examine the reliability and validity of the Korean version of the 16-item Prodromal Questionnaire (KPQ-16) in non-help-seeking university students.

METHODS

Among 2,246 university students participated in the initial screening, 257 subjects with KPQ-16 scores ≥4 were interviewed. The criteria for ultra-high risk (UHR) of psychosis of the Comprehensive Assessment of At-Risk Mental States (CAARMS) were the gold standard for diagnosis. An exploratory modified version of the questionnaire (mKPQ-16), to which three items from the Eppendorf Schizophrenia Inventory were added, was also used to compensate for items on thought and cognitive problems.

RESULTS

Seventeen subjects met the CAARMS criteria for UHR of psychosis. The area under the receiver operating characteristic curve (AUROC) was highest for the mKPQ-16 total score (AUROC=0.831, p<0.001). The use of cutoff total scores of 7 for the mKPQ-16 and 6 for the KPQ-16 resulted in the best balance of sensitivity (76.5% and 64.7%, respectively) and specificity (75.4% and 71.2%, respectively).

CONCLUSION

The Korean versions of the PQ-16 are good instruments for screening for psychosis risk in university students. This validation of a questionnaire version with a small number of items may make it feasible to screen large numbers of young adults in the community.

Applicability of the Chinese version of the 16-item Prodromal Questionnaire (CPQ-16) for identifying attenuated psychosis syndrome in a college population

AIM

The aim of this study was to examine the reliability, validity, sensitivity and specificity of the Chinese version of the 16-item Prodromal Questionnaire (CPQ-16) for identifying attenuated psychosis syndrome (APS) in a college population.

METHODS

The participants were recruited from a university. Five hundred seventy-nine students completed the CPQ-16 and the Symptom Checklist-90. One class (n = 79) was randomly selected to be retested with the CPQ-16 after 2 weeks. A randomly selected group of 49 individuals who tested positive and 50 individuals who tested negative were interviewed using the Structured Interview for Prodromal Syndromes (SIPS).

RESULTS

The internal consistency reliability was good (Cronbach's α = 0.72). The test-retest reliability was 0.88. The total score on the CPQ-16 was moderately to highly correlated with the total score on the Symptom Checklist-90 and all of the subscales (r = 0.39-0.67, P < 0.001). A cut-off CPQ-16 score of 9 was used to differentiate between those with a APS diagnosis on the SIPS versus those with no SIPS diagnoses; this cut-off value yielded 85% sensitivity, 87% specificity, a positive predictive value of 63% and a positive likelihood ratio of 6.69. The area under the ROC curve (AUC) was significant for the CPQ-16 total score (AUC = 0.93, SE = 0.026, 95% CI = 0.87-0.98, P < 0.001). Based on the proposed cut-off score, the CPQ-16 yielded a positive rate of 5.0% (29/579).

CONCLUSIONS

The CPQ-16, administered in a face-to-face interview, demonstrated high reliability and the ability to identify college students at risk for psychosis.

Reliability and Validity of an Interviewer-Administered Adaptation of the Youth Self-Report for Mental Health Screening of Vulnerable Young People in Ethiopia

OBJECTIVE

Evaluate the reliability and validity of the Youth Self-Report (YSR) as a screening tool for mental health problems among young people vulnerable to HIV in Ethiopia.

DESIGN

A cross-sectional assessment of young people currently receiving social services.

METHODS

Young people age 15-18 participated in a study where a translated and adapted version of the YSR was administered by trained nurses, followed by an assessment by Ethiopian psychiatrists. Internal reliability of YSR syndrome scales were assessed using Chronbach's alpha. Test-retest reliability was assessed through repeating the YSR one month later. To assess validity, analysis of the sensitivity and specificity of the YSR compared to the psychiatrist assessment was conducted.

RESULTS

Across the eight syndrome scales, the YSR best measured the diagnosis of anxiety/depression and social problems among young women, and attention problems among young men. Among individual YSR syndrome scales, internal reliability ranged from unacceptable (Chronback's alpha = 0.11, rule-breaking behavior among young women) to good (α≥0.71, anxiety/depression among young women). Anxiety/depression scores of ≥8.5 among young women also had good sensitivity (0.833) and specificity (0.754) to predict a true diagnosis. The YSR syndrome scales for social problems among young women and attention problems among young men also had fair consistency and validity measurements. Most YSR scores had significant positive correlations between baseline and post-one month administration. Measures of reliability and validity for most other YSR syndrome scales were fair to poor.

CONCLUSIONS

The adapted, personally administered, Amharic version of the YSR has sufficient reliability and validity in identifying young vulnerable women with anxiety/depression and/or social problems, and young men with attention problems; which were the most common mental health disorders observed by psychiatrists among the migrant populations in this study. Further assessment of the applicability of the YSR among vulnerable young people for less common disorders in Ethiopia is needed.

Screening tools for clinical high risk for psychosis

AIM

The purpose of this article was to review existing screening instruments that could be used to identify individuals who may be at increased risk for psychosis and to determine the suitability of these instruments.

METHODS

Medline (Ovid) and PubMed were searched for peer-reviewed articles published in English, which reported performance evaluation of screening instruments for symptoms of high risk for psychosis. The articles' titles, abstracts and, when necessary, full texts were read to filter them against the selection criteria. Citations within relevant articles were hand searched for other potentially eligible studies.

RESULTS

This selection strategy resulted in identifying 56 articles (including three articles available only in an abstract format) that reported performance evaluation of 17 screening instruments.

CONCLUSIONS

The sensitivity of these scales ranged from 67% to 100% and the specificity ranged from 39% to 100%. The positive predictive value was less precise with scores ranging from 24% to 100%, and the negative predictive value ranging from 58% to 100%. There were several scales that might be useful for screening for individuals who are at increased risk for developing psychosis; however, the majority of measures are underexplored with poor validation.

Psychosis risk screening: a systematic review

Despite the wealth of evidence linking duration of untreated psychosis to critical illness outcomes, most clinicians do not utilize any formal evaluation tools to identify attenuated or emerging psychotic symptoms. Given the costs associated with training and administration, interview-based assessments such as the Structured Interview for Psychosis Risk Syndromes (SIPS) are not likely to be widely adopted for clinical use. The ability to identify high-risk individuals through low-cost, brief methods is essential to the success of scalable prevention efforts. The aim of this article is to present a comprehensive review of the use of self-report forms as psychosis risk "screeners." A literature search revealed 34 investigations in which authors used a self-report questionnaire as a first-step screener in a clinical high-risk assessment protocol. Information about each screener, including reported psychometric data, is presented within the review. Psychosis risk screeners have been used in diverse samples with the goals of validating assessments, screening populations for clinical referral, recruiting samples of interest for research participation, and estimating symptom prevalence and severity. Screeners focusing on attenuated psychotic experiences appear to measure a reliable construct with variable prevalence in help-seeking and general population samples. Administration of screeners to help-seeking populations can identify enriched samples with substantially elevated likelihood of meeting CHR criteria and transitioning to psychosis over time. More research is needed, however, to establish reliable norms and screening thresholds, as score elevations indicating a likely high-risk respondent appear to be unreliable across populations and settings.

Psychotic-like experiences and their relationship to suicidal ideation in adolescents

Studies have suggested that psychotic-like experiences (PLEs) are associated with behavioral problems in adolescents. The aim of this study was to investigate relationships between domains of PLEs, suicidal ideation, and depression in a large community sample of adolescents. The sample consisted of 8096 Korean subjects (3184 boys and 4912 girls) aged 14 to 19 years. The level of PLEs, depression, and suicidal ideation were assessed by the Eppendorf schizophrenia inventory (ESI), Beck's depression inventory, and Beck's scale for suicidal ideation, respectively. Both the level of depression and suicidal ideation were significantly associated with PLEs. Among the four domains of the ESI, the deviant perception, ideas of reference, and auditory uncertainty were associated with the suicidal ideation. Additionally, subjects with more PLEs had significantly more suicidal ideation and depressive symptoms. PLEs in adolescents are associated with potential risk of suicide and depressive symptoms significantly mediated the association between suicidal ideation and PLEs. The presence of perceptual disturbances, ideas of reference, and depression may be regarded as warning signs for suicide-related behaviors.

Assessing psychotic-like symptoms using the BASC-2: adolescent, parent and teacher agreement

AIM

The aim of the current study was to investigate the psychometric properties of the BASC-2 (Behavior Assessment System for Children, Second Edition) Atypicality subscale in a sample of adolescents receiving mental health services.

METHODS

A large sample (n = 1916) of adolescents aged 12-20 years (median = 14.7 years) completed the BASC-2. A parent and teacher also completed the measure for each child. We analyzed internal consistency and interrater reliabilities for the Atypicality subscale, as well as the Depression and Hyperactivity subscales for comparison. Further analyses explored the influence of a participant's subscale scores, gender, and quality of relationships with adults on interrater agreement.

RESULTS

All subscales demonstrated good internal consistency; however, interrater agreement was low for all subscales. Gender, Atypicality subscale score, and self-reported quality of relationships with adults could not account for poor interrater agreement.

CONCLUSIONS

The Atypicality subscale has strong internal consistency across informants. Low interrater agreement for the Atypicality subscale, as well as other scales, however, presents a challenge when interpreting multi-informant scales.

[Prospective description of the course of psychopathological symptoms in schizophrenia: evaluation of the short form of the Eppendorf Schizophrenia Inventory]

BACKGROUND

The Eppendorf Schizophrenia Inventory (ESI-K) is a self-assessment procedure which can now be considered as the standard procedure in the diagnostics of schizophrenia. It has been evaluated in many studies and is widely used in research and clinical treatment. In contrast little is known about the psychometric characteristics of the short form of the ESI (ESI-K) which was designed in particular for prospective descriptive courses.

MATERIALS AND METHODS

The ESI-K was completed for 40 patients with schizophrenia undergoing complete inpatient psychiatric treatment together with the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions (CGI) form and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE). Of the patients 31 participated in a total of 4 measurements at 1-week intervals.

RESULTS

The reliability (Cronbachs α) of the ESI-K was high at all measurement time points and was comparable to the reliability of the standard version. The reliability of the PANSS was roughly the same level but that of the NOSIE was poor. The ESI-K correlated in particular with cognitive syndrome and the positive syndrome of the PANSS. All four instruments showed a decrease in scores over the observational time period which indicated a decline in the psychopathological symptoms.

CONCLUSIONS

The ESI-K is a valid time-saving procedure for documentation of the course of symptoms in patients with schizophrenia. It reflects clinically relevant aspects from the spectrum of psychotic symptoms.