Prodromal Questionnaire Research Articles

Adolescent psychosis risk symptoms predicting persistent psychiatric service use: A 7-year follow-up study

BackgroundWe investigated whether psychosis risk symptoms predicted psychiatric service use using seven-year register follow-up data. MethodsOur sample included 715 adolescents aged 15–18, referred to psychiatric care for the first time. Psychosis risk symptoms were assessed with the Prodromal Questionnaire (PQ) at the beginning of the treatment. We assessed the power of the overall PQ as well as its positive, negative, general, and disorganized psychosis risk symptom factors in predicting prolonged service use. Baseline psychiatric diagnoses (grouped into 7 categories) were controlled for. Based on both inpatient and outpatient psychiatric treatment after baseline, adolescents were divided into three groups of brief, intermittent, and persistent service use. ResultsStronger symptoms on any PQ factor as well as the presence of a mood disorder predicted prolonged service use. All of the PQ factors remained significant predictors when adjusted for baseline mood disorder and multimorbidity. ConclusionsIn a prospective follow-up of a large sample using comprehensive mental health records, our findings indicate that assessing psychosis risk symptoms in clinical adolescent settings at the beginning of treatment could predict long-term need for care beyond diagnostic information. Our findings replicate the previous findings that positive psychosis risk symptoms are unspecific markers of severity of psychopathology. Also psychosis risk symptoms of the negative, disorganization, and general clusters are approximately as strongly associated with prolonged psychiatric service use in the upcoming years.

Translation and validation study of the prodromal questionnaire brief version into Indonesian language.

Psychosis is a mental disorder resulting in high disability impacts. Many studies show that early detection of prodromal symptoms may improve prognosis. Psychotic prodromal symptoms may mimic other mental health conditions such as depression, anxiety or learning difficulties. The aim of this study was to analyze validity, reliability, sensitivity and specificity of the Prodromal Questionnaire Brief Version (PQ-B) Indonesian version to detect psychotic prodromal symptoms. The PQ-B was translated into Indonesian then back-translated into English. Subjects included in this study were 50 children and adolescent psychiatric patients from Cipto Mangunkusumo National Hospital, aged 10-18 years old. Validity measurement was performed by comparing the total score and distress score of PQ-B with the categorical scale of Structured Interview for Prodromal Symptoms (SIPS) as the gold standard using Spearman correlation. Total scale and subscale reliability were examined using the Cronbach's Alpha. Analysis with Spearman correlation showed significant results of both PQ-B total score with diagnosis of SIPS (r = 0.374 and p = 0.007); and PQ-B distress score with diagnosis of SIPS (r = 0.400 and p = 0.004). Cronbach Alpha coefficient was equal to 0.853 for all scales. The sensitivity of the PQ-B in the Indonesian language is 70%, and the specificity is 72%, whereas, in the original language (English), the sensitivity and specificity is 88% and 68%. This study provides evidence of good validity, reliability, sensitivity, and specificity of PQ-B Indonesian language to detect prodromal symptoms of those who seek help in the psychiatric outpatient clinic.

The Italian Version of the Brief 21-Item Prodromal Questionnaire: Field Test, Psychometric Properties and Age-Sensitive Cut-Offs

Background: The Brief, 21-item version of the Prodromal Questionnaire (PQ-B) is a promising screener for psychosis-risk states that could be implemented in routine clinical practice. In this study, we assessed psychometric properties of the Italian version of the PQ-B (iPQ-B) in a sample of 243 help-seekers, aged 13–35 years. Sampling and Methods: After completing the iPQ-B, participants were assessed with the Comprehensive Assessment of At-Risk Mental States (CAARMS). Diagnostic accuracy (sensitivity, specificity, positive and negative predictive values [PPV and NPV], positive and negative likelihood ratios) and concurrent validity between PQ-B and CAARMS were determined using Cronbach’s alpha and Cohen’s kappa. We also tested the validity of the adopted PQ-B cut-offs through Receiver Operating Characteristic (ROC) curves plotted against CAARMS diagnoses and the predictive validity of the iPQ-B at 1-year follow-up. Results: The iPQ-B showed high internal consistency (Cronbach’s alpha = 0.868), acceptable diagnostic accuracy and concurrent validity (70% sensitivity, 67% specificity, 81% PPV, Cohen’s kappa = 0.335). ROC analyses pointed to threshold of ≥20 on the PQ-B total distress score as best cut-off. After 12 months of follow-up, 11% of participants who scored ≥4 on the PQ-B distressing item total score and did not meet CAARMS psychosis criteria at baseline, developed a psychotic disorder. Interestingly, age had significant negative correlations with iPQ-B scores and adolescents (aged < 18 years) showed higher iPQ-B scores than young adults. Conclusions: Overall, the psychometric properties of the iPQ-B were satisfactory. As iPQ-B scores appeared inversely associated to age, age-tailored cut-off scores are recommended for screening purposes in child-adolescent cohorts.

Using Online Screening in the General Population to Detect Participants at Clinical High-Risk for Psychosis.

IntroductionIdentification of participants at clinical high-risk (CHR) for the development of psychosis is an important objective of current preventive efforts in mental health research. However, the utility of using web-based screening approaches to detect CHR participants at the population level has not been investigated.MethodsWe tested a web-based screening approach to identify CHR individuals. Potential participants were invited to a website via e-mail invitations, flyers, and invitation letters involving both the general population and mental health services. Two thousand two hundred seventy-nine participants completed the 16-item version of the prodromal questionnaire (PQ-16) and a 9-item questionnaire of perceptual and cognitive aberrations (PCA) for the assessment of basic symptoms (BS) online. 52.3% of participants met a priori cut-off criteria for the PQ and 73.6% for PCA items online. One thousand seven hundred eighty-seven participants were invited for a clinical interview and n = 356 interviews were conducted (response rate: 19.9%) using the Comprehensive Assessment of At-Risk Mental State (CAARMS) and the Schizophrenia Proneness Interview, Adult Version (SPI-A). n = 101 CHR participants and n = 8 first-episode psychosis (FEP) were detected. ROC curve analysis revealed good to moderate sensitivity and specificity for predicting CHR status based on online results for both UHR and BS criteria (sensitivity/specificity: PQ-16 = 82%/46%; PCA = 94%/12%). Selection of a subset of 10 items from both PQ-16 and PCA lead to an improved of specificity of 57% while only marginally affecting sensitivity (81%). CHR participants were characterized by similar levels of functioning and neurocognitive deficits as clinically identified CHR groups.ConclusionThese data provide evidence for the possibility to identify CHR participants through population-based web screening. This could be an important strategy for early intervention and diagnosis of psychotic disorders.

Assessment of the Prodromal Questionnaire–Brief Child Version for Measurement of Self-reported Psychoticlike Experiences in Childhood

Childhood psychoticlike experiences (PLEs) are associated with greater odds of a diagnosis of a psychotic disorder during adulthood. However, no known, well-validated self-report tools have been designed to measure childhood PLEs. To examine the construct validity and psychometric properties of a measure of PLEs, the Prodromal Questionnaire-Brief Child Version (PQ-BC). This validation study used data from the first wave of the Adolescent Brain and Cognitive Development (ABCD) Study, a prospective longitudinal study aimed at assessing risk factors associated with adverse physical and mental health outcomes from ages 9 to 10 years into late adolescence and early adulthood. The population-based sample of 3984 children within the ABCD data set was recruited from 20 research sites across the United States. Data for this study were collected from June 1, 2016, through August 31, 2017. The PQ-BC Total and Distress scores were analyzed for measurement invariance across race/ethnicity and sex, their associations with measures of PLEs, and their associations with known correlates of PLEs, including internalizing and externalizing symptoms, neuropsychological test performance, and developmental milestones. The study analyses included 3984 participants (1885 girls [47.3%] and 2099 boys [52.7%]; mean [SE] age, 10.0 [0.01] years). The results demonstrated measurement invariance across race/ethnicity and sex. A family history of psychotic disorder was associated with higher mean (SE) PQ-BC Total (3.883 [0.352]; β = 0.061; 95% CI, 0.027-0.094) and Distress (10.210 [1.043]; β = 0.051; 95% CI, 0.018-0.084) scores, whereas a family history of depression or mania was not. Higher PQ-BC scores were associated with higher rates of child-rated internalizing symptoms (Total score: β range, 0.218 [95% CI, 0.189-0.246] to 0.273 [95% CI, 0.245-0.301]; Distress score: β range, 0.248 [95% CI, 0.220-0.277] to 0.310 [95% CI, 0.281-0.338]), neuropsychological test performance deficits such as working memory (Total score: β = -0.042 [95% CI, -0.077 to -0.008]; Distress score: β = -0.051 [95% CI, -0.086 to -0.017]), and motor and speech developmental milestone delays (Total score: β = 0.057 [95% CI, 0.026-0.086] for motor; β = 0.042 [95% CI, 0.010-0.073] for speech; Distress score: β = 0.048 [95% CI, 0.017-0.079] for motor; β = 0.049 [95% CI, 0.018-0.081] for speech). These results provide support for the construct validity and demonstrate adequate psychometric properties of a self-report instrument designed to measure childhood PLEs, providing evidence that the PQ-BC may be a useful measure of early risk for psychotic disorders. Furthermore, these data suggest that PLEs at school age are associated with many of the same familial, cognitive, and emotional factors associated with psychotic symptoms in older populations, consistent with the dimensionality of psychosis across the lifespan.

Increased plasticity of bodily self-experience in individuals who may carry latent liability for schizophrenia

Self-disturbances such as altered perception of one's own body boundary are central to the lived-in experience of schizophrenia. Bodily self-disturbances are also prevalent in healthy individuals who may carry latent liability for schizophrenia. Much of the research on self-disturbances rely on clinical interviews but these experiences are often difficult to verbalize, conceptualize and quantify. Furthermore, experimental evidence for plasticity of bodily self-experience in the schizophrenia-spectrum is scarce.We sought to quantify body boundary experience in healthy young adults who might be at an increased risk for schizophrenia with a multisensory paradigm known as the Pinocchio Illusion (PI) task that engenders the feeling that one's nose is changing, and has previously been used to demonstrate increased plasticity of bodily self-boundary in schizophrenia.62 college students participated in the PI task that assessed bodily self-disturbances, and a tactile discrimination task. We administered the Prodromal Questionnaire Brief (PQ-B) and the Schizotypal Personality Questionnaire (SPQ) to assess latent liability for schizophrenia. We found that PI was enhanced in individuals with elevated PQ-B scores but their tactile sensitivity was intact. PI was associated with the positive syndrome of schizotypy, but not with negative or disorganized factors. Increased PQ-B and SPQ scores were associated with loneliness. To conclude, these results highlight the importance of bodily self-disturbances in the broader context of the schizophrenia spectrum.

F212. Convergent and Divergent Validity of the Prodromal Questionnaire Negative Symptom Subscale

Negative symptoms are associated with risk for psychosis and poorer outcomes. The Prodromal Questionnaire (PQ) is a self-report questionnaire used to screen for prodromal and psychotic symptoms. However, the PQ-negative symptom subscale has not been examined for convergent or divergent validity.

F2. CHILDHOOD TRAUMA AND LACK OF CULTURAL IDENTITY AS RISK FACTORS OF ATTENUATED PSYCHOSIS SYMPTOMS AMONG AFRICAN AMERICAN YOUNG ADULTS

BackgroundSchizophrenia spectrum diagnosis is more commonly assigned to African Americans. Failing to understand and appropriately manage cultural differences will have significant mental health consequences for varied racial/ethnic groups in particular (Betancourt, Green, & Carrillo, 2002). The purpose of the present study was to examine risk factors of attenuated psychosis syndrome in a sample of African American young adults, specifically to investigate whether lack of ethnic identity and adverse childhood experiences (ACEs) put an individual at a higher risk of developing attenuated psychotic symptoms.Adverse Childhood Experiences (ACE) as Risk Factor of APS:The Comorbidity Survey (NCS) Part 2 data showed that the effects of neglect and sexual abuse, along with physical abuse similarly put a child at risk for psychosis. People who had suffered childhood adversity were 2.8 times more likely to develop psychosis than those who had not. Studies have also begun to look at gender differences in schizophrenia by way of ACEs.Lack of Ethnic Identity as Risk Factors of APS:The African worldview reflects psychological communal, spiritual, collective survival thrust as opposed to the European worldview of individualism and materialism. Cultural Misorientation (CM) represents that foreign psychological or psychopathological disposition in the African personality, which allows African Americans to unknowingly value and participate in European cultural indoctrination through the practice of European cultural values, rituals, and customs. The purpose of this study was to explore the roles that CM play on the overall presentation of attenuated psychotic symptoms, by way of ACE exposure.MethodsParticipants: Participants included 304 African American college students, 199 (65.46%) women and 105 (34.54%) men from a Historically Black College and University in the southeastern region of the United States. Participants were between 18 and 25 years of age.InstrumentsAdverse Childhood Experiences Scale measures the association of multiple types of abuse with different types of health outcomes. Prodromal Questionnaire- Brief (PQ-B) measures the presence of negative symptoms, perceptual abnormalities such as hallucinations, and unusual thought content like delusional ideas and paranoia. Cultural Misorientation - Short Form assesses the condition of cultural misorientation across 6 subscales-- materialism orientation, individualism orientation, alien-self orientation, anti-self orientation, self-destructive orientation, and integration orientation.ResultsThe Pearson correlation analysis indicated no significant relationship (r = -.073, p = .206) between ACE exposure and APS total scores on PQ-B. However, an unexpected negative significant relationship between childhood abuse exposures and symptom severity was observed (r = -.126*, p = .028), indicating that participants who reported more instances of childhood abuse tended to report less symptom severity. In addition, Cultural Misorientation (CM) was significantly positively correlated to PBQ total scores r = .194**, p = .001) and the severity of those symptoms (r = .171**, p = .003). CM materialism and individualism subscales mediated the relationship between childhood abuse and PQ-B total scores and symptom severity.DiscussionThis study provides support that some aspects of cultural misorientation can be detrimental to African Americans. Helping to reduce material and individualistic desires that have become detrimental should also be a central focus of implemented mental health programs.

S131. PERCEPTUAL ABNORMALITIES AND RELIGIOSITY IN ULTRA HIGH-RISK FOR PSYCHOSIS (UHR) INDIVIDUALS IN A LATIN AMERICAN POPULATIONAL SAMPLE RESULTS FROM THE SAO PAULO SSAPP COHORT

BackgroundIn the last decades, the ultra-high risk for psychosis (UHR) status has been studied to prevent people from developing full-blown psychosis. To better understand this condition, and to better predict conversion, the relationship between UHR and several biological and environmental markers have been assessed. Nevertheless, most UHR studies come from developed countries, constituting a gap in the literature regarding culture-related environmental factors. This study aims to study religiosity, a peculiar cultural constituent of Latin-American societies, in populational samples of UHR individuals and controls from the city of Sao Paulo, Brazil.MethodsThese are partial results from the cohort project SSAPP (Subclinical Symptoms and Prodromal Psychosis).Over 2500 individuals aged between 18 and 30 years were asked to participate in the research in a household survey. The Prodromal Questionnaire was used, a screening instrument for UHR constituted of 92 yes-or-no items divided into 4 domains; positive, negative, disorganization, and general symptoms. Those with 18 points or more in the positive subscale were asked to come to the Institute of Psychiatry to undergo blood testing, neuropsychological evaluation, to complete several self-filling questionnaires, and to undergo a clinical interview with an experienced psychiatrist with the SIPS (Structured Interview for Prodromal Syndromes). Functioning was assessed with the Global Assessment of Functioning (GAF), and religiosity was evaluated with the DUREL (Duke religiosity Index), which measures organizational and non-organizational religious activity, and intrinsic religiosity.Total sample for this study was constituted of 60 UHR individuals and 91 controls.The scores on the 5 positive symptoms items in the SIPS, the three religiosity dimensions, and the GAF were correlated, in controls and in UHR individuals.All variables had a non-normal distribution (Kruskal-Wallis p<0.001), so Spearman’s test was used. Generalized linear model was used between the resulting significantly associated variables.SPSS 23 for Mac was used for the analysis.ResultsLevel of organizational and non-organizational religious activity did not differ between samples, but controls had significantly higher levels of intrinsic religiosity than UHR individuals (p=0.04).None of the religiosity measures were related to positive symptom items for controls. For UHR individuals, P4 (perceptual abnormalities) was positively related to organizational religiosity (p=0.001).GAF was not related to any P item in controls, but they inversely correlated to P4 (perceptual abnormalities, p=0.033) and P5 (disorganized communication, p=0.031) in UHR individuals. GAF was not correlated to religiosity, neither in UHR nor in controls.Generalized linear model using P4 as dependent variable and GAF and Organizational religiosity as independent variable showed that organizational religiosity determined P4 score rather than GAF.DiscussionResults indicate that a higher score on perceptual abnormalities was related to a higher attendance in churches/temples in UHR individuals in our sample. Our study sheds light to an important aspect of Latin American cultures, namely the relationship between exceptional experiences and religion in lay people. In developing countries with a lack of mental health services churches might act as important gatekeepers for UHR individuals. Since an expected inverted correlation between GAF and religiosity was not found, we might hypothesize that religion might have been used to cope with subclinical symptoms. Longitudinal data would be required to test this hypothesis.

T203. ILLICIT DRUGS USE AND ULTRA-HIGH RISK (UHR) FOR PSYCHOSIS STATUS IN A LATIN-AMERICAN SAMPLE

BackgroundIn recent years, a number of investigations have evaluated the effect of cannabis use on the risk of presenting ultra-high risk for psychosis (UHR) status as well as its influences on transition rate, suggesting a dose-dependent interaction. On the other hand, the association between cocaine (snorted or smoked) - an increasing health issue in several countries worldwide - and the UHR state was not appropriately examined. Also, exposure to other psychotomimetic drugs, as amphetamines and lysergic acid diethylamide (LSD), has not been investigated yet. We sought to examine differences in the prevalence of drug use between UHR subjects and epidemiologic controls (EC).MethodsOver 2500 individuals from the city of São Paulo (Brazil), aged between 18 and 30 years old, were screened with the Prodromal Questionnaire. Subjects with scores higher than 18 points in the positive subscale were invited to be thoroughly assessed with the application of SIPS (Structured Interview for Psychosis-Risk Syndromes). Drug use (lifetime use, age of first use and more intense use) was assessed using South Westminster scale.Results100 individuals presented UHR state; other 110 were enrolled as EC. A subsample of 50 UHR subjects and 82 HC with data on drugs consumption were evaluated herein. UHR subjects history of lifetime drug use was: 19 (38%) cannabis; 5 (10%) snorted cocaine; 1 (2%) crack; 1 (2%) amphetamine; 2 (6.9%) LSD. EC history of lifetime drug use was: 20 (24.4%) cannabis; 6 (7.3%) snorted cocaine; 0 crack; 2 (2.4%) amphetamine; 1 (1.2%) LSD. No differences were observed for snorted cocaine (p=0.589), crack (p=0.379), amphetamine (p=1.0), or LSD (P=0.167). At a trend level, cannabis lifetime use (p=0.096) was more prevalent in the UHR group. Additional analyses showed that UHR subjects initiate cannabis use at earlier age than EC (p=0.006). In this group, 20% of subjects had used cannabis prior to 15 years of age, in comparison to 3.6% in the EC group.DiscussionOur results reinforce the view that cannabis use is linked to psychosis risk and that subjects at early age of exposure are at greatest risk. Nonetheless, studies with larger number of participants are warranted to confirm our findings, particularly on the lack of association between less frequently consumed drugs and the UHR for psychosis state.

T15. LONGITUDINAL ASSOCIATIONS BETWEEN CHILDHOOD SALIVARY CORTISOL LEVELS AND PRODROMAL SYMPTOMS IN LATE ADOLESCENCE: FINDINGS FROM A HIGH-RISK COHORT

BackgroundIndividuals with established psychosis are characterised by a distinct pattern of hypothalamic-pituitary-adrenal (HPA) axis dysfunctions which include both elevated daytime cortisol levels and a blunted cortisol awakening response (CAR). Whilst these patterns of dysfunction have also been observed among those at elevated risk for the disorder, longitudinal studies are scarce. As such, the relevance of these HPA axis abnormalities for the progression of psychopathology in high-risk populations is unknown. Utilising data from a well-characterised, longitudinal cohort of youth at elevated risk for schizophrenia and their typically-developing peers (The Child Health and Development Study), we aimed to investigate the extent to which HPA axis function determined in childhood is a significant predictor of putative prodromal status and psychopathology in late adolescence/early adulthood.MethodsThe sample comprised high-risk individuals who presented either multiple antecedents of schizophrenia (developmental delays, psychopathology, and psychotic-like experiences: ASz=21) or a family history of illness (FHx=13), and typically-developing youth with neither antecedents nor a family history (TD=36). Participants were recruited at age 9–12 years using a community screening method and assessed biennially throughout adolescence. At the age 11–14 years assessment phase, participants collected salivary cortisol samples in their home environment which were used to determine diurnal cortisol secretion and the CAR. At the age 17–21 years assessment phase, participants completed measures of prodromal symptoms (Prodromal Questionnaire: PQ), depression (Quick Inventory of Depressive Symptomatology questionnaire: QIDS), and anxiety (Social Interaction Anxiety Scale: SIAS). Established PQ thresholds were used to identify participants who met probable prodromal status. Logistic and linear regression analyses were used to examine the extent to which salivary cortisol measures at age 11–14 years predicted probable prodromal status and continuous psychopathology measures at 17–21 years, respectively.ResultsRelative to the TD group, ASz youth were characterised by higher depression (B=0.24, p=0.05) and disorganised symptoms (B=0.36, p=0.007) at 17–21 years whilst FHx youth obtained higher scores on the PQ general symptoms scale (B=0.24, p=0.048). Analyses performed in the total sample indicated that the CAR was negatively associated with depression symptoms (B=-0.28, p=0.006) and PQ negative symptoms (B=-0.30, p=0.004) at age 17–21 years. Positive associations were observed between diurnal cortisol and positive (B=0.41, p=0.02), disorganised (B=0.30, p=0.04), and general (B=0.29, p=0.03) PQ symptoms. Diurnal cortisol levels were also significantly associated with probable prodromal status at follow-up (OR=1.04, p=0.04). No significant interactions were observed between group status and salivary cortisol levels in any model. After adjustment for potential confounders (age, follow-up time, sex, BMI, and pubertal status), the CAR continued to show significant associations with both depression (p=0.006) and PQ negative symptoms (p=0.007) whilst only a statistical trend was observed for the relationship between diurnal cortisol levels and positive symptoms (p=0.055).DiscussionThe current study is the first to examine the extent to which HPA axis function can predict development of prodromal symptoms in a high-risk cohort. Our finding that more abnormal HPA axis function (i.e., a decreased CAR and higher diurnal cortisol) at age 11–14 years is associated with both prodromal and depression symptoms at age 17–21 has important implications for aetiological theories and for clinical practice.

F242. CHILDHOOD ADVERSITY AND PSYCHOTIC EXPERIENCES IN THE GENERAL POPULATION: WHAT IS THE PREDICTIVE ROLE OF RESILIENCE, COPING STYLE AND SOCIAL SUPPORT?

BackgroundA history of childhood adversity is known to be associated with psychotic disorder as well as subclinical psychotic-like experiences. This study aimed to examine the relationship between specific types of childhood adversity and psychotic-like experiences in a general population sample, and to determine the predictive role of psychological resilience, coping style and perceived social support.MethodsAn online survey was conducted with a US-based general population sample of 748 participants (aged 18 – 35 years) using Amazon’s Mechanical Turk (an online crowd-sourcing service). Participants completed the following validated measures: the Adverse Childhood Experiences Questionnaire (ACE-Q) as a measure of childhood adversities, the Prodromal Questionnaire (PQ-16) as a measure of psychotic experiences, the Brief Resilience Scale (BRS) measuring level of psychological resilience, the Brief COPE Scale as a measure of predominant coping style, the Multidimensional Scale of Perceived Social Support and the Neighbourhood Cohesion Scale. A series of backwards stepwise hierarchical regression analyses was employed to determine predictors of PQ-16 score.ResultsParticipants reported an average of 2.99 attenuated psychotic symptoms (from a total of 16 on the PQ-16), and an average of 2.77 childhood adversities (from a total of 10 on the ACE-Q). In the final regression model, which explained 33% of the variance in PQ-16 score, the specific types of childhood adversity which significantly predicted PQ-16 score were verbal abuse, sexual abuse and physical neglect. Level of resilience and coping via emotional support were significant negative predictive factors of PQ-16 score. The coping styles of self-distraction, denial, substance use, venting, religion and self-blame were significant positive predictors of PQ-16 score. Perceived social support and neighbourhood cohesion were not significant predictors.DiscussionThe results of this study add support to the relationship between history of childhood adversity and psychotic-like experiences in the general population. Our data suggest that a differential effect exists dependent on the specific type of adversity (the strongest observed effect was for physical neglect). These findings highlight the need for routine clinical enquiry regarding childhood trauma for patients experiencing attenuated psychotic symptoms. We also found that psychological resilience and coping style were important predictive factors in this relationship (whilst perceived social support and neighbourhood cohesion were not). These may represent possible avenues for psychosocial augmentative interventions in the early stages of the psychosis continuum.

S214. USING ONLINE-SCREENING TO DETECT PARTICIPANTS AT CLINICAL HIGH-RISK FOR PSYCHOSIS

BackgroundIdentification of participants at clinical high-risk (CHR) for the development of psychosis is an important objective of current preventive efforts in mental health research. However, the utility of using web-based screening approaches to detect CHR-participants at the population-level has not been investigated.MethodsWe tested a web-based screening approach to identify CHR-individuals. Potential participants were invited to a website via email-invitations, flyers and invitation letters involving both the general population and mental health services. 2121 participants completed the 16-item version of the prodromal questionnaire (PQ-16) and a 9-item questionnaire of perceptual and cognitive aberrations (PCA) for the assessment of Basic Symptoms (BS) online.Results54% of participants met a-priori cut-off criteria for the PQ and 72 % for PCA-items online. 969 participants were invited for a clinical interview and n = 277 interviews were conducted (response rate: 29%) using the Comprehensive Assessment of At-Risk Mental State (CAARMS) and the Schizophrenia Proneness Interview, Adult Version (SPI-A). N = 88 CHR-participants and n = 8 first-episode psychosis (FEP) were detected. ROC-curve analysis revealed good to moderate sensitivity and specificity for predicting CHR-status based on online-results for both UHR- and BS-criteria (Sensitivity/Specificity: PQ-16 = 76%/50.4%; PCA = 89%/19.7%). CHR-participants were characterized by similar levels of functioning and neurocognitive deficits as clinically identified CHR-groups.DiscussionThese data provide evidence for the possibility to identify CHR-participants through population-based web-screening. This could be an important strategy for early intervention and diagnosis of psychotic disorders.

The Italian version of the 16-item prodromal questionnaire (iPQ-16): Field-test and psychometric features

ObjectiveAmong current early screeners for psychosis-risk states, the Prodromal Questionnaire-16 items (PQ-16) is often used. We aimed to assess validity and reliability of the Italian version of the PQ-16 in a young adult help-seeking population. MethodsWe included 154 individuals aged 18–35years seeking help at the Reggio Emilia outpatient mental health services in a large semirural catchment area (550.000 inhabitants). Participants completed the Italian version of the PQ-16 (iPQ-16) and were subsequently evaluated with the Comprehensive Assessment of At-Risk Mental States (CAARMS). We examined diagnostic accuracy (i.e. specificity, sensitivity, negative and positive likelihood ratios, and negative and positive predictive values) and content, convergent, and concurrent validity between PQ-16 and CAARMS using Cronbach's alpha, Spearman's rho, and Cohen's kappa, respectively. We also tested the validity of the adopted PQ-16 cut-offs through Receiver Operating Characteristic (ROC) curves plotted against CAARMS diagnoses and the 1-year predictive validity of the PQ-16. ResultsThe iPQ-16 showed high internal consistency and acceptable diagnostic accuracy and concurrent validity. ROC analyses pointed to a cut-off score of ≥5 as best cut-off. After 12months of follow-up, 8.7% of participants with a PQ-16 symptom total score of ≥5 who were below the CAARMS psychosis threshold at the baseline, developed a psychotic disorder. ConclusionsPsychometric properties of the iPQ-16 were satisfactory.

The psychometric properties of the 16-item version of the Prodromal Questionnaire (PQ-16) as a screening instrument for perinatal psychosis.

Psychiatric illness can pose serious risks to pregnant and postpartum women and their infants. There is a need for screening tools that can identify women at risk for postpartum psychosis, the most dangerous perinatal psychiatric illness. This study used exploratory factor analysis (EFA) and Rasch item response theory (IRT) models to evaluate the psychometric properties and construct validity of the Spanish language version of the 16-item Prodromal Questionnaire (PQ-16) as a screening tool for psychosis in a population of pregnant Peruvian women. The EFA yielded a four-factor model, which accounted for 44% of the variance. Factor 1, representing "unstable sense of self," accounted for 22.1% of the total variance; factor 2, representing "ideas of reference/paranoia," for 8.4%; factor 3, representing "sensitivity to sensory experiences," accounted for 7.2%; and factor 4, possibly representing negative symptoms, accounted for 6.3%. Rasch IRT analysis found that all of the items fit the model. These findings support the construct validity of the PQ-16 in this pregnant Peruvian population. Also, further research is needed to establish definitive psychiatric diagnoses to determine the predictive power of the PQ-16 as a screening tool.

Screening for psychosis risk among help‐seeking adolescents: Application of the Italian version of the 16‐item prodromal questionnaire (iPQ‐16) in child and adolescent neuropsychiatry services

The 16-item Prodromal Questionnaire (PQ-16) is a versatile screen tool for routine screening of at-risk individuals. We wished to evaluate the psychometric properties of the Italian version of the PQ-16 (iPQ-16) in a sample of 72 help-seeking adolescents (age range 13-17 years) referred to child and adolescent neuropsychiatry services for diagnostic assessment. Participants who completed iPQ-16 were subsequently interviewed with the Comprehensive Assessment of At-Risk Mental States (CAARMS) to confirm the psychosis high risk state. We then examined the diagnostic accuracy (sensitivity, specificity, positive and negative predictive values [PPV e NPV]) and concurrent validity between iPQ-16 and CAARMS using Cronbach's alpha and Cohen's kappa. We also tested the validity of the adopted iPQ-16 cut-offs through Receiver Operating Characteristic (ROC) curves plotted against CAARMS diagnoses and the 1-year predictive validity of the iPQ-16. Overall, the psychometric properties of the iPQ-16 were satisfactory. The iPQ-16 showed high internal consistency (Cronbach's alpha = .827) and acceptable diagnostic accuracy (77% sensitivity, 72% PPV) and concurrent validity (Cohen's k = 0.309). ROC analyses pointed to iPQ-16 total distress score of ≥10 as best cut-off. The iPQ-16 is a reliable and valid instrument for routine screening of at-risk individuals in Italian neuropsychiatry services.

Clinician-rated and self-reported psychotic-like experiences in individuals accessing a specialist Youth Mental Health Service.

The prevalence of psychotic-like experiences (PLEs) was explored in a sample of 14- to 25-year-olds with non-psychotic mental health difficulties. Associations between PLEs, psychopathology, functioning, trauma history, and pathways to care were examined. Data were collected for 202 young people. Clinicians rated PLEs using the Primary Care Checklist (PCC) and functioning using Global Assessment Scales. Eighty-three young people completed self-report assessments of PLEs using the Prodromal Questionnaire (PQ-16) and measures of social anxiety, depression, trauma history, and pathways to care. There was a high prevalence of PLEs in the sample. The prevalence of PLEs was higher when young people self-rated their experiences. Endorsement frequencies for PLEs ranged from 3.5 to 24% on the PCC and 22 to 70% on the PQ-16. Higher scores on the PQ-16 were associated with more pathways into care and greater exposure to traumatic life events. PLEs are common in young people with non-psychotic mental health difficulties and may reflect increased severity and complexity of mental health difficulties. Routine screening and further assessment of PLEs are important in understanding and responding to such experiences. Screening should include self-rating of PLEs as well as clinician-rated scales. Clinical Implications Psychotic-like experiences are common in young people with severe non-psychotic mental health problems and should be routinely screened in mental health services. Psychotic-like experiences were found to be more prevalent when using a self-report screening tool compared to a clinician-rated measure. The presence of psychotic-like experiences may reflect more severe and complex mental health problems and may also cause delays in young people accessing the right kind of support. ;Limitations This study only assessed the presence or absence of psychotic-like experiences. Further studies should use more detailed assessments to understand more about the nature of such experiences and how they are appraised and responded to. This study is cross-sectional, and therefore, the direction of the relationships between psychotic-like experiences and depression, anxiety, functioning, and trauma cannot be specified. Longitudinal studies are needed to examine the impact of psychotic-like experiences on long-term outcomes.

The Early Psychosis Screener (EPS): Quantitative validation against the SIPS using machine learning

Machine learning techniques were used to identify highly informative early psychosis self-report items and to validate an early psychosis screener (EPS) against the Structured Interview for Psychosis-risk Syndromes (SIPS). The Prodromal Questionnaire–Brief Version (PQ-B) and 148 additional items were administered to 229 individuals being screened with the SIPS at 7 North American Prodrome Longitudinal Study sites and at Columbia University. Fifty individuals were found to have SIPS scores of 0, 1, or 2, making them clinically low risk (CLR) controls; 144 were classified as clinically high risk (CHR) (SIPS 3–5) and 35 were found to have first episode psychosis (FEP) (SIPS 6). Spectral clustering analysis, performed on 124 of the items, yielded two cohesive item groups, the first mostly related to psychosis and mania, the second mostly related to depression, anxiety, and social and general work/school functioning. Items within each group were sorted according to their usefulness in distinguishing between CLR and CHR individuals using the Minimum Redundancy Maximum Relevance procedure. A receiver operating characteristic area under the curve (AUC) analysis indicated that maximal differentiation of CLR and CHR participants was achieved with a 26-item solution (AUC=0.899±0.001). The EPS-26 outperformed the PQ-B (AUC=0.834±0.001). For screening purposes, the self-report EPS-26 appeared to differentiate individuals who are either CLR or CHR approximately as well as the clinician-administered SIPS. The EPS-26 may prove useful as a self-report screener and may lead to a decrease in the duration of untreated psychosis. A validation of the EPS-26 against actual conversion is underway.

Sleep quality, psychological symptoms, and psychotic-like experiences

Poor sleep quality has been repeatedly linked to the entire psychosis continuum, including psychotic-like experiences (PLEs); however, sleep dysfunction is a component of several other psychopathologies that have also been linked to increased risk for PLEs, including depression, anxiety, and post-traumatic stress disorder (PTSD). It has yet to be examined if PLEs are a significant risk factor for poor sleep quality or if this sleep dysfunction is better accounted for by comorbid psychopathology. In 2687 undergraduates, PLEs were evaluated using the positive items of the Prodromal Questionnaire. Symptoms of anxiety, depression, and PTSD were also assessed, as was sleep quality. Mediation analysis using PROCESS was conducted to determine if poor sleep quality associated with PLEs was in fact more associated with symptoms of other psychopathologies. Symptoms of depression and PTSD mediated the relationship between PLEs and sleep quality, though anxiety symptoms did not. These findings suggest that treating symptoms of depression and PTSD may improve multiple domains of psychotic illness.

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.