O10.4. THE ROLE OF CONTEXTUAL FACTORS AND ASSESSMENT STRATEGIES IN THE ACCURATE SCREENING OF PSYCHOSIS-RISK SYMPTOMS

Abstract Background Falsely observing symptoms of psychosis risk in youth is a critical limitation to pluripotent prevention efforts. Factors including race, age, and measurement construction may affect the validity of semi-structured interviews and self-report screening tools designed to identify symptoms. Consideration of different constructs measured within a single screening tool, what a screening tool can offer beyond prediction of psychosis-like symptoms, and how to maximize efficiency may all influence the ability to effectively identify people who would benefit from services. Methods Help-seeking adolescents (N=134) ages 12–25 completed various screening tools for psychosis risk, and the Structured Interview for Psychosis-risk Syndromes (SIPS). The influence of race and age on screen scores and SIPS (CHR) symptoms were examined. We also evaluated alternatives to CHR symptom screening beyond conventional CHR screening tools. Results Higher Prime Screen scores increased the probability of clinician assessed symptoms among White participants, but not Black participants (interaction: b = -0.50 Wald χ2[1] = 4.63, p = .03, Exp[B] = 0.60), and younger participants were more likely to use the Prime Screen as a dichotomous (yes/no) screener relative to older participants, reducing screener efficacy (b = -0.04, Wald χ2[1] = 3.75, p = .05, Exp[B] = 0.96). Given discrepancies across groups, we attempted to expand screening strategies. First, to better understand the Prime Screen, factor analysis suggested two distinct factors that appear to measure different constructs. Additionally, an IRT model of several CHR screening tools suggested the value of an ultra-brief two-item measure. Finally, analyses of the BASC-2, a more comprehensive measure of behavior that includes, but is not limited to, psychosis risk items, also demonstrated accurate prediction of psychosis symptoms, as well as more pluripotent conceptualizations of symptoms. Discussion Results suggest that contextual or individual factors influence the accurate identification of individuals exhibiting psychosis-risk symptoms. Tailored approaches to screening based on an awareness of context, identity, setting, and preferences of clients are possible, and customizing assessment efforts accordingly may be useful for the accurate identification of a variety of people who might benefit from services.

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S27. EXAMINING DISCREPANCIES BETWEEN SELF-REPORT AND CLINICIAN-RATED ASSESSMENTS OF PSYCHOSIS RISK: DOES INTERNALIZED STIGMA MATTER?

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa031.093 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S41-S41

Author(s):

LeeAnn Shan ◽

Zachary B Millman ◽

Joseph DeLuca ◽

Mallory J Klaunig ◽

Pamela Rakhshan Rouhakhtar ◽

...

Keyword(s):

Mental Health ◽

High Risk ◽

Help Seeking ◽

Mental Health Problems ◽

Structured Interview ◽

Self Report ◽

Internalized Stigma ◽

Clinical High Risk ◽

Negative Stereotypes ◽

Psychosis Risk

Abstract Background Psychosis is one of the most highly stigmatized mental health conditions (Thornicroft et al., 2009). Compared to those with other mental health concerns, people diagnosed with schizophrenia spectrum disorders are more likely to be perceived by others as dangerous, violent, and unpredictable. As a result, they are often socially marginalized and discriminated against (Crisp et al., 2000; Martin et al., 2007). Individuals at clinical high risk (CHR) for psychosis may be at lower risk for experiencing public stigma, given that their symptoms are often less outwardly visible at this early stage of illness. However, evidence suggests that those at CHR experience high levels of self-stigma, as they may internalize negative stereotypes related to psychosis (Yang et al., 2010; Yang et al., 2015). Internalized stigma can negatively impact help-seeking behavior and has been associated with lower self-esteem and the underreporting of mental health symptoms (Corrigan, 2004; Corrigan, 2007; Saporito, Ryan, & Teachman, 2011; Rüsch, Angermeyer, & Corrigan, 2005). Despite these findings, no studies to-date have examined how internalized stigma may impact reporting of attenuated psychosis symptoms in the CHR population. The current study aims to examine whether discrepancies between self-report and clinician-rated measures of psychosis risk are associated with internalized stigma in a sample of help-seeking adolescents and young adults. We hypothesized that higher levels of self-stigma will predict inconsistencies between self-reported symptom severity and clinician-obtained diagnoses of psychosis risk. Methods Participants will include youth classified as either non-psychosis-related help-seeking controls or at clinical high risk (CHR) for psychosis, as determined by the Structured Interview for Psychosis-Risk Syndromes (SIPS; Miller et al., 2003). The SIPS is administered by trained raters and is currently considered the gold standard tool for diagnosing clinical high-risk syndromes (Thompson et al., 2018). In addition to SIPS diagnoses, psychosis risk will also be assessed using the Prime Screen – Revised (PS-R; Miller et al., 2004), a brief, 12-item self-report questionnaire designed to measure attenuated positive symptoms. Lastly, internalized stigma will be assessed using the Internalized Stigma of Mental Illness Inventory (ISMI; Ritsher, Otilingam, & Grajales, 2003), a 29-item self-report questionnaire designed to measure subjective experiences of stigma in adolescents (e.g., endorsement of negative stereotypes, social withdrawal and feelings of alienation due to mental health problems, etc.). Results Preliminary analyses demonstrate a significant interaction between Prime scores and internalized stigma in predicting SIPS diagnoses. Specifically, higher scores on the Prime were associated with increased odds of being diagnosed as CHR on the SIPS, but only for those participants who endorsed low and mean levels of stigma. For participants who endorsed high levels of stigma, there did not appear to be any relation between Prime scores and SIPS diagnoses. Discussion At the time of submission, participant recruitment is ongoing, and results and discussion will be presented on the final sample. Findings may inform efforts to improve detection and accurate diagnosis of psychosis risk syndromes in individuals at early stages of illness.

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Intimacy and Emotional Illness in the General Population

The Canadian Journal of Psychiatry ◽

10.1177/070674378102600306 ◽

1981 ◽

Vol 26 (3) ◽

pp. 167-172 ◽

Cited By ~ 35

Author(s):

Edward M. Waring ◽

Debbie Mcelrath ◽

Paul Mitchell ◽

Mary Ellen Derry

Keyword(s):

General Population ◽

Help Seeking ◽

Marital Adjustment ◽

Married Couples ◽

Structured Interview ◽

Self Report ◽

Marital Intimacy ◽

Emotional Illness ◽

Married Individuals

Ninety married couples in the general population received a structured interview to assess their level of intimacy. The couples also completed self-report questionnaires to assess non-psychotic emotional illness and marital adjustment. High levels of intimacy were associated with marital adjustment. Low ratings of marital intimacy were significantly associated with non-psychotic emotional illness and psychiatric help-seeking. These findings are discussed in relationship to recent studies which explore the role of lack of marital intimacy as a vulnerability fact or in the development of non-psychotic emotional illness. Implications for treatment of non-psychotic emotional illness in married individuals is briefly discussed.

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Understanding Intimate Partner Violence Perpetration Involving the Deaf Population

Journal of Interpersonal Violence ◽

10.1177/0886260520916265 ◽

2020 ◽

pp. 088626052091626

Author(s):

Jeanna M. Mastrocinque ◽

Catherine Cerulli ◽

Denise Thew ◽

Nancy P. Chin ◽

Robert Q Pollard

Keyword(s):

Intimate Partner Violence ◽

Hard Of Hearing ◽

Partner Violence ◽

Help Seeking ◽

Community Based Participatory Research ◽

Intimate Partner ◽

Screening Tools ◽

Structured Interviews ◽

Intergenerational Transmission Of Violence ◽

Ipv Perpetration

There has been an increase in intimate partner violence (IPV) research regarding the deaf population; however, no studies to date obtained data directly from members of the deaf population who disclose IPV perpetration. This community-based participatory research study explored the social context of IPV perpetration involving the deaf population through interviews with deaf or hard-of-hearing individuals who self-identified as perpetrating either physical or sexual abuse in an intimate relationship where at least one partner was deaf. Through semi-structured interviews using video relay, an interdisciplinary research team, which included deaf investigators, explored questions which included IPV triggers, types of IPV, weapon use, childhood victimization, and interactions with first responders and response systems (e.g., criminal justice, medical). The types of IPV abuse, resulting injuries, and systems used are discussed. The team collectively identified key elements of abuse and their relationships to each other through concept mapping of each interview. Through a method of constant comparison, we identified several themes: intergenerational transmission of violence, fund of information concerns, communication barriers with family and friends and resulting frustration, and help-seeking challenges. Many of these themes are specific to the deaf population, illustrating the need for continued research to understand IPV in diverse communities. Findings are compared with IPV trends in the general (hearing) population, and prompt concerns that universal IPV interventions may not effectively address the needs of the deaf population. Recommendations for diversifying screening efforts, modifying screening tools, and tailoring interventions to better address IPV involving deaf and hard-of-hearing populations are discussed.

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Views on Depression From Traditional Healing and Psychiatry Clinics in Uganda

Journal of Cross-Cultural Psychology ◽

10.1177/0022022116675424 ◽

2016 ◽

Vol 48 (2) ◽

pp. 243-261 ◽

Cited By ~ 3

Author(s):

Laura R. Johnson ◽

Eu Gene Chin ◽

Mayanja Kajumba ◽

Simon Kizito ◽

Paul Bangirana

Keyword(s):

Mental Health Professionals ◽

Help Seeking ◽

Traditional Healers ◽

Explanatory Models ◽

Traditional Healing ◽

Integrated System ◽

Self Report ◽

Herbal Remedies ◽

Structured Interviews ◽

Short Supply

In Uganda, depression is a growing concern, yet mental health professionals are in short supply, and help is often sought from traditional healers. To develop an integrated system of care, we must understand sociocultural aspects of depression including beliefs about help seeking and treatment. In a mixed methods study, we used semi-structured interviews and self-report measures to assess depressed patients ( N = 30) seeking treatment in traditional healing ( n = 15) and psychiatry clinics ( n = 15) near Kampala, Uganda. We assessed demographics, symptoms, treatment characteristics, and explanatory models (EMs) of depression (e.g., labeling the problem, cause, impact on life, best type of treatment). We predicted differences across treatment settings. To further explore EMs, we assessed differences in EMs of patients and their providers by interviewing patient–provider dyads ( n = 8 dyads). Patients in both settings were similar in demographics, symptoms, perceived cause, seriousness, and impact of depression. However, patients at traditional clinics were more likely to desire herbal remedies, while those in psychiatry clinics were more likely to desire modern medication. Patient–provider dyads also had different treatment beliefs, with patients desiring financial assistance, social support, and medication, and providers more likely to suggest counseling or advice. The study highlights the need to understand diverse beliefs and treatment trajectories in a multicultural context.

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Discordance between pediatric self‐report and parent proxy‐report symptom scores and creation of a dyad symptom screening tool (co‐SSPedi)

Cancer Medicine ◽

10.1002/cam4.3235 ◽

2020 ◽

Vol 9 (15) ◽

pp. 5526-5534 ◽

Cited By ~ 3

Author(s):

Deborah Tomlinson ◽

Erin Plenert ◽

Grace Dadzie ◽

Robyn Loves ◽

Sadie Cook ◽

...

Keyword(s):

Screening Tool ◽

Self Report ◽

Proxy Report ◽

Symptom Screening ◽

Parent Proxy Report ◽

Symptom Scores ◽

Report Symptom ◽

Parent Proxy

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Using the K-SADS psychosis screen to identify people with early psychosis or psychosis risk syndromes

Clinical Child Psychology and Psychiatry ◽

10.1177/1359104519846582 ◽

2019 ◽

Vol 24 (4) ◽

pp. 809-820

Author(s):

Thomas Tsuji ◽

Peter Phalen ◽

Pamela Rakhshan Rouhakhtar ◽

Zachary Millman ◽

Kristin Bussell ◽

...

Keyword(s):

Help Seeking ◽

Assessment Tool ◽

Structured Interview ◽

Early Psychosis ◽

Parent Reports ◽

Additional Information ◽

Child Reports ◽

Detailed Classification ◽

Psychosis Risk ◽

Staged Approach

Background: Current methods to identify people with psychosis risk involve administration of specialized tools such as the Structured Interview for Psychosis-Risk Syndromes (SIPS), but these methods have not been widely adopted. Validation of a more multipurpose assessment tool—such as the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS)—may increase the scope of identification efforts. Methods: We assessed the correspondence between SIPS-determined clinical high risk/early psychosis (CHR/early psychosis) status and K-SADS psychosis screen (child and parent reports and their combination) in a sample of 147 help-seeking individuals aged 12–25. Detailed classification results are reported. Results: Both the child and parent interviews on the K-SADS psychosis screen were strongly predictive of CHR/early psychosis status, although parent reports contributed no significant additional information beyond child reports. Across informants, the presence of either subthreshold hallucinations or subthreshold delusions was highly suggestive of CHR/early psychosis status as determined by SIPS interview (78% (child) and 74% (parent) accuracy). Conclusions: Subthreshold scores on the two-item K-SADS psychosis screen may be good indicators of the presence or absence of early signs of psychosis. The option of using a non-specialized assessment such as the K-SADS as a staged approach to assess for CHR/early psychosis status could increase rates of early psychosis screening and treatment.

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Finalising the administration of co-SSPedi, a dyad approach to symptom screening for paediatric patients receiving cancer treatments

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003169 ◽

2021 ◽

pp. bmjspcare-2021-003169

Author(s):

Deborah Tomlinson ◽

Tal Schechter ◽

Mark Mairs ◽

Robyn Loves ◽

Daniel Herman ◽

...

Keyword(s):

Screening Tool ◽

Self Report ◽

Verbal Instruction ◽

Cancer Treatments ◽

Hematopoietic Stem ◽

Patients With Cancer ◽

Symptom Screening ◽

Qualitative Feedback ◽

Report Symptom ◽

Parent Response

ObjectivesSymptom Screening in Pediatrics Tool (SSPedi) is a validated self-report symptom screening tool for patients with cancer 8–18 years of age. Co-SSPedi is a novel dyad approach in which both child and parent complete SSPedi together. The objective was to finalise the approach to co-SSPedi administration with instruction that is easy to understand, resulting in dyads completing co-SSPedi correctly.MethodWe enrolled child and parent dyads, who understood English and where children (4–18 years) had cancer or were hematopoietic stem cell transplantation recipients. We provided each dyad with instruction on how to complete co-SSPedi together. Mixed methods were used to determine how easy or hard the instruction was to understand. Two raters adjudicated if co-SSPedi was completed correctly. Dyads were enrolled in cohorts of 12 evenly divided by age (4–7, 8–10, 11–14 and 15–18 years).ResultsWe enrolled 5 cohorts of 12 dyads, resulting in 60 dyads. Following verbal instruction provided in the first cohort, we identified the need for written instruction emphasising children should wait for parent response prior to entering scores. The instruction was iteratively refined based on qualitative feedback until the fifth cohort, where all 12 dyads found the instruction easy to understand and completed co-SSPedi correctly.ConclusionsWe developed a standard approach to dyad symptom screening named co-SSPedi with instruction that is easy to understand, resulting in correct co-SSPedi completion. Future efforts should focus on co-SSPedi validation and understanding how co-SSPedi scores compare to self- or proxy-reported symptom reporting.

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Relationship between Nutritional Screening Tools and GLIM in Complicated IBD Requiring Surgery

Nutrients ◽

10.3390/nu13113899 ◽

2021 ◽

Vol 13 (11) ◽

pp. 3899

Author(s):

Camilla Fiorindi ◽

Gabriele Dragoni ◽

Stefano Scaringi ◽

Fabio Staderini ◽

Anita Nannoni ◽

...

Keyword(s):

Screening Tool ◽

Nutritional Assessment ◽

Elective Surgery ◽

Screening Tools ◽

Nutritional Risk ◽

Screening Tests ◽

Nutritional Screening ◽

Accurate Identification ◽

Nrs 2002 ◽

Low Sensitivity

Background: Accurate identification of malnutrition and preoperative nutritional care in Inflammatory Bowel Disease (IBD) surgery is mandatory. There is no validated nutritional screening tool for IBD patients. We developed a novel nutritional screening tool for IBD patients requiring surgery and compared it with other tools. Methods: we included 62 consecutive patients scheduled for elective surgery. The IBD Nutritional Screening tool (NS-IBD) was developed to screen patients for further comprehensive assessment. NRS-2002, MUST, MST, MIRT, SaskIBD-NR are compared with the new test. All screening tests were subsequently related to new GLIM criteria. Results: according to GLIM criteria, 25 (40%) IBD patients were malnourished (15 CD and 10 UC, 33% vs. 63%, p = 0.036). Stage 1 malnutrition was reported in ten patients, while stage 2 was detected in 15 patients. The comparison of each nutritional risk tool with GLIM criteria showed sensitivity of 0.52, 0.6, 0.6, 0.84, 0.84 and 0.92 for SASKIBD-NR, MUST, MST, NRS-2002, MIRT, and the new NS-IBD, respectively. Conclusions: in IBD, currently adopted nutritional screening tools are characterized by a low sensitivity when malnutrition diagnosis is performed with recent GLIM criteria. Our proposed tool to detect malnutrition performed the best in detecting patients that may require nutritional assessment and preoperative intervention.

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Discordance between family report and clinical assessment of suicide attempts: a prospective study from the emergency department

General Psychiatry ◽

10.1136/gpsych-2021-100576 ◽

2021 ◽

Vol 34 (6) ◽

pp. e100576

Author(s):

Yue Zheng ◽

Haiyin Zhang ◽

Qing Fan

Keyword(s):

Emergency Department ◽

Suicide Attempt ◽

Family Caregivers ◽

Clinical Assessment ◽

Suicide Risk ◽

Suicide Attempts ◽

Family Satisfaction ◽

Self Report ◽

Structured Interviews ◽

Accurate Identification

BackgroundDeveloping accurate identification methods for individuals with suicide attempts and providing them with follow-up care and supports can be a vital component of all comprehensive suicide prevention strategies. However, because of the difficulties concerning one’s intentions behind injurious behaviour, identifying suicide attempts is a challenge for families and clinicians.AimsThe aim of this study was to investigate the differences between family report and clinical assessment for suicide attempts in the emergency department (ED).MethodsA total of 148 patients with suspected suicide attempts (SSAs) and 148 family caregivers in the ED were enrolled. The suicide risk module of the Chinese version of the MINI International Neuropsychiatric Interview and the self-report measure were used to assess those with SSA’s suicidal behaviours. The Family Adaptability and Cohesion Evaluation Scales and semi-structured interviews were used to investigate the characteristics of suicide risk and demographics of patients with SSA, as well as the rate and influencing factors of omitted suicide attempts reported by family caregivers.ResultsThe underreporting rate for family reported suicide attempts in the ED was 69.0%. The suicide attempts group indicated lower mean scores on perceptions of family resources, adaptability and cohesion. Patients' suicide risk rating (OR =−1.81, 95% CI: −3.87 to −0.33, p=0.036), family satisfaction (OR =−1.11, 95% CI: −2.29 to −0.06, p=0.048), and caregiver’s age (OR =−1.68, 95% CI: −3.10 to −0.48, p=0.010) might be associated with underreporting by families. If patients committed suicide attempts through a falling injury or medication overdose, their families may have misreported the suicide attempt.ConclusionsThe discordance of suicide attempt records between family report and clinical assessment reveals the limitations of family self-reports when identifying suicide attempts. Interviews and observations, together with information from certain diagnoses, should be combined to accurately identify suicide attempters in the ED.

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Recency and intensification of positive symptoms enhance prediction of conversion to syndromal psychosis in clinical high-risk patients

Psychological Medicine ◽

10.1017/s0033291719003040 ◽

2019 ◽

pp. 1-9

Author(s):

Gary Brucato ◽

Michael B. First ◽

Gabriella A. Dishy ◽

Shana S. Samuel ◽

Qing Xu ◽

...

Keyword(s):

High Risk ◽

Help Seeking ◽

Structured Interview ◽

Positive Symptom ◽

First Episode ◽

Positive Symptoms ◽

Clinical High Risk ◽

Predictive Capacity ◽

Psychosis Risk ◽

Risk Patients

Abstract Background Early detection and intervention strategies in patients at clinical high-risk (CHR) for syndromal psychosis have the potential to contain the morbidity of schizophrenia and similar conditions. However, research criteria that have relied on severity and number of positive symptoms are limited in their specificity and risk high false-positive rates. Our objective was to examine the degree to which measures of recency of onset or intensification of positive symptoms [a.k.a., new or worsening (NOW) symptoms] contribute to predictive capacity. Methods We recruited 109 help-seeking individuals whose symptoms met criteria for the Progression Subtype of the Attenuated Positive Symptom Psychosis-Risk Syndrome defined by the Structured Interview for Psychosis-Risk Syndromes and followed every three months for two years or onset of syndromal psychosis. Results Forty-one (40.6%) of 101 participants meeting CHR criteria developed a syndromal psychotic disorder [mostly (80.5%) schizophrenia] with half converting within 142 days (interquartile range: 69–410 days). Patients with more NOW symptoms were more likely to convert (converters: 3.63 ± 0.89; non-converters: 2.90 ± 1.27; p = 0.001). Patients with stable attenuated positive symptoms were less likely to convert than those with NOW symptoms. New, but not worsening, symptoms, in isolation, also predicted conversion. Conclusions Results suggest that the severity and number of attenuated positive symptoms are less predictive of conversion to syndromal psychosis than the timing of their emergence and intensification. These findings also suggest that the earliest phase of psychotic illness involves a rapid, dynamic process, beginning before the syndromal first episode, with potentially substantial implications for CHR research and understanding the neurobiology of psychosis.

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