Are Screening Instruments Valid for Psychotic-Like Experiences? A Validation Study of Screening Questions for Psychotic-Like Experiences Using In-Depth Clinical Interview

Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
Schizophrenia Bulletin (Impact Factor: 8.45). 07/2009; 37(2):362-9. DOI: 10.1093/schbul/sbp057
Source: PubMed


Individuals who report psychotic-like experiences are at increased risk of future clinical psychotic disorder. They constitute a unique "high-risk" group for studying the developmental trajectory to schizophrenia and related illnesses. Previous research has used screening instruments to identify this high-risk group, but the validity of these instruments has not yet been established. We administered a screening questionnaire with 7 items designed to assess psychotic-like experiences to 334 adolescents aged 11-13 years. Detailed clinical interviews were subsequently carried out with a sample of these adolescents. We calculated sensitivity and specificity and positive predictive value (PPV) and negative predictive value (NPV) for each screening question for the specific symptom it enquired about and also in relation to any psychotic-like experience. The predictive power varied substantially between items, with the question on auditory hallucinations ("Have you ever heard voices or sounds that no one else can hear?") providing the best predictive power. For interview-verified auditory hallucinations specifically, this question had a PPV of 71.4% and an NPV of 90.4%. When assessed for its predictive power for any psychotic-like experience (including, but not limited to, auditory hallucinations), it provided a PPV of 100% and an NPV of 88.4%. Two further questions-relating to visual hallucinations and paranoid thoughts-also demonstrated good predictive power for psychotic-like experiences. Our results suggest that it may be possible to screen the general adolescent population for psychotic-like experiences with a high degree of accuracy using a short self-report questionnaire.

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    • "The nine items demonstrate good internal consistency among children aged 9–11 years (Laurens et al., 2007), and all items load on a single latent construct that is distinguishable from Psychopathology and psychotic symptoms 3 internalizing and externalizing psychopathology constructs (Laurens et al., 2012). A comparable, seven-item instrument used to screen paediatric community samples for PLEs has demonstrated good criterion validity between self-reported questionnaire items and clinician-rated psychotic symptoms on diagnostic interview (Kelleher, Harley, Murtagh, & Cannon, 2011). For the present study, a dichotomous variable was created to index PLE presence at follow-up assessment as the outcome variable for logistic regression analyses, defined as a " certainly true " rating on at least one of the nine PLE items. "
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    • "Although the scree plot suggested the single-factor solution, the unidimensionality of the PDI could not been confirmed by the confirmatory factor analysis (the asymptotically distribution free method) because of the small size of the study sample. What is more, specifying the prevalence of delusion-like experiences on the basis of the results of self-reports can distort these results and show higher values than real prevalence of delusion-like experiences [44, 45]. However, the results of previous studies show that scale scores on the basis of self-reports also allow to accurately calculate the risk of psychotic dis- orders [9, 15] and to predict the development of psychosis [27, 46, 47]. "

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    • "The items were validated by numerous groups (e.g. Kelleher et al., 2011; Polanczyk et al., 2010) and found to have good predictive validity for a diagnosis of schizophrenia during adulthood (Poulton et al., 2000). All items were originally in English and directly translated to Dutch for the current study. "
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