As the number of studies related to the early identification of and intervention in the schizophrenia prodrome continues to grow, it becomes increasingly critical to develop methods to diagnose this new clinical entity with validity. Furthermore, given the low incidence of patients and the need for multisite collaboration, diagnostic and symptom severity reliability is also crucial. This article provides further data on these psychometric parameters for the prodromal assessment instruments developed by the Prevention through Risk Identification, Management, and Education (PRIME) prodromal research team at Yale University: the Structured Interview for Prodromal Syndromes and the Scale of Prodromal Symptoms. It also presents data suggesting that excellent interrater reliability can be established for diagnosis in a day-and-a-half-long training workshop.

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Background-Neurocognitive functioning in schizophrenia has received considerable attention because of its robust prediction of functional outcome. Psychiatric symptoms, in particular negative symptoms, have also been shown to predict functional outcome, but have garnered much less attention. The high degree of intercorrelation among all of these variables leaves unclear whether neurocognition has a direct effect on functional outcome or whether that relationship to functional outcome is partially mediated by symptoms.Methods-A meta-analysis of 73 published English language studies (total n = 6519) was conducted to determine the magnitude of the relationship between neurocognition and symptoms, and between symptoms and functional outcome. A model was tested in which symptoms mediate the relationship between neurocognition and functional outcome. Functional outcome involved measures of social relationships, school and work functioning, and laboratory assessments of social skill.Results-Although negative symptoms were found to be significantly related to neurocognitive functioning (p < .01) positive symptoms were not (p = .97). The relationship was moderate for negative symptoms (r=−.24, n = 4757, 53 studies), but positive symptoms were not at all related to neurocogniton (r = .00, n= 1297, 25 studies). Negative symptoms were significantly correlated with Role of funding sourceThere was no funding source. ContributorsJoseph Ventura conceived the study design, data analysis plan, conducted literature searches, supervised the conduct of the study, and wrote the manuscript Dr. Hellemann conducted the data analysis and commented on all drafts of the manuscript. Ms. Thames performed literature searches, created tables, and commented on all drafts of the manuscript. Ms. Koeller conducted literature searches and organized study papers. Dr. Nuechterlein provided consultation of concepts we addressed and edited the final manuscript. All authors have contributed to and approved the final manuscript. Conflict of interestNone of the authors has a financial conflict of interest. Conclusions-Although neurocognition and negative symptoms are both predictors of functional outcome, negative symptoms might at least partially mediate the relationship between neurocognition and outcome. NIH Public Access