Utility of Washington Early Recognition Center Self-Report Screening Questionnaires in the Assessment of Patients with Schizophrenia and Bipolar Disorder

Abstract

Early identification and treatment are associated with improved outcomes in bipolar disorder (BPD) and schizophrenia (SCZ). Screening for the presence of these disorders usually involves time-intensive interviews that may not be practical in settings where mental health providers are limited. Thus, individuals at earlier stages of illness are often not identified. The Washington Early Recognition Center Affectivity and Psychosis (WERCAP) screen is a self-report questionnaire originally developed to identify clinical risk for developing bipolar or psychotic disorders. The goal of the current study was to investigate the utility of the WERCAP Screen and two complementary questionnaires, the WERC Stress Screen and the WERC Substance Screen, in identifying individuals with established SCZ or BPD. Participants consisted of 35 BPD and 34 SCZ patients, as well as 32 controls (CON), aged 18–30 years. Univariate analyses were used to test for score differences between groups. Logistic regression and receiver operating characteristic (ROC) curves were used to identify diagnostic predictors. Significant group differences were found for the psychosis section of the WERCAP (pWERCAP; p < 0.001), affective section of the WERCAP (aWERCAP; p = 0.001), and stress severity (p = 0.027). No significant group differences were found in the rates of substance use as measured by the WERC Substance Screen (p = 0.267). Only the aWERCAP and pWERCAP scores were useful predictors of diagnostic category. ROC curve analysis showed the optimal cut point on the aWERCAP to identify BPD among our participant groups was a score of >20 [area under the curve (AUC): 0.87; sensitivity: 0.91; specificity: 0.71], while that for the pWERCAP to identify SCZ was a score of >13 (AUC: 0.89; sensitivity: 0.88; specificity: 0.82). These results indicate that the WERCAP Screen may be useful in screening individuals for BPD and SCZ and that identifying stress and substance-use severity can be rapidly done using self-report questionnaires. Larger studies in undiagnosed individuals will be needed to test the WERCAP Screen’s ability to identify mania or psychosis in the community.

Regional cortical thinning in young adults with schizophrenia but not psychotic or non-psychotic bipolar I disorder

“…Considering that the period between symptom assessment and brain scanning varied across patients and were in some cases lengthy (median: 14 days; mean: 19 days), clinical symptoms during scanning may not be properly captured by our instruments. In the future, studying associations with clinical measures of chronic symptoms severity, such as the Washington Early Recognition Affectivity and Psychosis (WERCAP) Screen (Hsieh et al 2016 ; Mamah et al 2014 ), may be more accurate in uncovering brain-behavior relationships.…”

Personality Traits as Markers of Psychosis Risk in Kenya: Assessment of Temperament and Character

“…Assessment of psychosis was done using the psychotic section of the Washington Early Psychosis Center Affectivity and Psychosis Screen ( p WERCAP), 45 which provides a quantitative rating of psychosis severity in the past year, using item frequency of occurrence and effects on functioning. 44 , 47 , 48 CHR status was established as psychosis scores ≥30, based on a previous validation study. 47 Psychosis-risk ascertainment was also determined using the Structured Interview of Psychosis-Risk Syndromes (SIPS), 49 administered by 12 trained interviewers.…”

“…The WERC Stress Screen, a self-report questionnaire, was used to assess psychosocial stress severity. 47 , 48 …”

Screening for bipolar disorder with self-administered questionnaires: A critique of the concept and a call to stop publishing studies of their performance in psychiatric samples

“…However, this is not how researchers have derived cutoff scores on bipolar disorder screening scales. The developers of such instruments have recommended cutoff scores that optimize the level of agreement between the test and the diagnostic standard (Angst et al, 2005;Ghaemi et al, 2005;Hirschfeld et al, 2000;Hsieh, Godwin, & Mamah, 2016;Imamura, Kawakami, Naganuma, & Igarashi, 2015). The usual method of selecting a cutoff score has been to derive a receiver operating curve (ROC), which is a plot of the scale's sensitivity on the yaxis and 1-specificity on the x-axis.…”

“…This fundamental conceptual error in determining a cutoff score on bipolar disorder screening scales on the basis of optimal agreement with a diagnostic standard has continued in more recent studies. I reviewed 27 recently published studies that examined the performance of bipolar disorder screening scales across a range of scores (Bech, Christensen, Vinberg, Bech-Andersen, & Kessing, 2011;Boschloo et al, 2013;Chou et al, 2012;Cyprien et al, 2014;de Sousa Gurgel et al, 2012;Feng et al, 2016;Frey, Simpson, Wright, & Steiner, 2012;Gamma et al, 2013;Gan et al, 2012;Hsieh et al, 2016;Hu et al, 2012;Imamura et al, 2015;Kung et al, 2015;Leao & Del Porto, 2012;Lee et al, 2013Lee et al, , 2016Mosolov et al, 2014;Nallet et al, 2013;Pan & Yeh, 2015;Perugi et al, 2012;Poon, Chung, Tso, Chang, & Tang, 2012;Sasdelli et al, 2013;Smith et al, 2011;Waleeprakhon et al, 2014;Yang et al, 2014;Yang et al, 2011;Zaratiegui et al, 2011). Almost every study recommended a cutoff point on the screening scale that maximized or optimized the level of agreement with the diagnostic gold standard.…”