Youth-caregiver Agreement on Clinical High-risk Symptoms of Psychosis

Abstract

Early identification of individuals who will go on to develop schizophrenia is a difficult endeavor. The variety of symptoms experienced by clinical high-risk youth make it difficult to identify who will eventually develop schizophrenia in the future. Efforts are being made, therefore, to more accurately identify at-risk individuals and factors that predict conversion to psychosis. As in most assessments of children and adolescents, however, both youth and parental report of symptomatology and resulting dysfunction are important to assess. The goals of the current study were to assess the extent of cross-informant agreement on the Structured Interview for Prodromal Symptoms (SIPS), a widely-used tool employed to determine clinical high-risk status. A total of 84 youth-caregiver pairs participated. Youth and caregiver raters displayed moderate overall agreement on SIPS-rated symptoms. Both youth and caregiver ratings of youth symptomatology contributed significantly to predicting conversion to psychosis. In addition, youth age and quality of youth-caregiver relationships appear to be related to cross-informant symptom ratings. Despite differences on individual SIPS domains, the majority of dyads agreed on youth clinical high-risk status. Results highlight the potential clinical utility of using caregiver informants to determine youth psychosis risk.

Subthreshold Psychotic Symptoms in 22q11.2 Deletion Syndrome

“…A study looking at SIPS youth-caregiver agreement in a non-deleted population found similar results. 43 In our study, a significant proportion of psychosis-spectrum youths (17%) would not have been thus categorized based on caregiver report alone. Anecdotally, youths often acknowledged withholding information from their parents for fear of burdening them.…”

Expressed emotion (EE) in families of individuals at-risk of developing psychosis: A systematic review

“…Tsai et al (2015) found an effect of ethnicity and gender for criticism: Individuals with critical Latino fathers had more negative symptoms than non-Latino white fathers, albeit with a small sample size. Three studies found no association between symptoms, functioning and criticism (Meneghelli et al, 2011;Hamaie et al, 2016;Golembo-Smith et al, 2014). Meneghelli et al (2011) found that the individual"s gender, functioning and suicidal and self-harm behaviours had no impact on levels of EE.…”

“…The studies were conducted in America (n=9), Europe (n=5) and Asia (n=1), comprising cross sectional (n=8) and longitudinal (n=7) designs. Only two longitudinal studies compared EE at different time points (Golembo-Smith et al, 2014;O'Brien et al, 2015)…”

“…were used to assess EE that included interview measures rated by the researchers and completed with the caregiver (n=6), self-report questionnaire measures completed by either the caregiver (n=7) or the individual (n=6). Four studies included more than one measure of EE (Golembo-Smith et al, 2014;O'Brien et al, 2015;Schlosser et al, 2010;Tsai et al, 2015), of which three studies included subjective EE measures completed by both caregivers and individuals (Golembo-Smith et al, 2014;O'Brien et al, 2015;Schlosser et al, 2010).…”

“…Only one study (Tsai et al, 2015) A cross-sectional study found longer duration of untreated illness (DUI) in the ARMS population positively correlated with higher levels of EE (McFarlane and Cook, 2007). Two studies investigated EE over time (Golembo-Smith et al, 2014;O'Brien et al, 2015), neither commenting on initial rates nor change in high or low-EE. Furthermore, both studies included a two question self-report of perceived criticism, therefore not accounting for other EE components.…”