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Development and public release of a computerized adaptive (CAT) version of the Schizotypal Personality Questionnaire.

ABSTRACT: One of the most widely used measures of psychosis-related symptoms and characteristics is the 74-item Schizotypal Personality Questionnaire (SPQ). Using multidimensional Item Response Theory (bifactor 2-parameter model), we calibrated SPQ items in a sample of 375 youths aged 9-24 years and constructed a fully functional computerized adaptive form of the SPQ on an open-source platform for public use. To assess validity, we used the above parameters to simulate CAT sessions in a separate validation sample (N =?100) using three test-length-based stopping rules: 8 items, 16 items, and 32 items. Those scores were then compared to full-form and SPQ-Brief scores on their abilities to predict psychosis or clinical risk status. Areas under the receiver operating characteristic curves indicated mediocre predictive ability, but did not differ among any of the forms, even when only eight adaptive items were administered. The Youden index for the 16-item adaptive version was higher than that for the 22-item SPQ-Brief. Classification accuracy for the full SPQ was 73% compared to 66% for the both the SPQ-Brief and adaptive versions (average of three stopping rules). The SPQ-CAT shows promise as a much shorter but valid assessment of schizotypy which can save time with minimal loss of information.

SUBMITTER: Moore TM

PROVIDER: S-EPMC5911247 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Development and public release of a computerized adaptive (CAT) version of the Schizotypal Personality Questionnaire.

Moore Tyler M TM Calkins Monica E ME Reise Steven P SP Gur Ruben C RC Gur Raquel E RE

Psychiatry research 20180208

One of the most widely used measures of psychosis-related symptoms and characteristics is the 74-item Schizotypal Personality Questionnaire (SPQ). Using multidimensional Item Response Theory (bifactor 2-parameter model), we calibrated SPQ items in a sample of 375 youths aged 9-24 years and constructed a fully functional computerized adaptive form of the SPQ on an open-source platform for public use. To assess validity, we used the above parameters to simulate CAT sessions in a separate validatio ...[more]

PMID: 29625786

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Project description:Background and aimsThe focus of this paper is on the improvement of substance use disorder (SUD) screening and measurement. Using a multi-dimensional item response theory model, the bifactor model, we provide a psychometric harmonization between SUD, depression, anxiety, trauma, social isolation, functional impairment and risk-taking behavior symptom domains, providing a more balanced view of SUD. The aims are to (1) develop the item-bank, (2) calibrate the item-bank using a bifactor model that includes a primary dimension and symptom-specific subdomains, (3) administer using computerized adaptive testing (CAT) and (4) validate the CAT-SUD in Spanish and English in the United States and Spain.DesignItem bank construction, item calibration phase, CAT-SUD validation phase.SettingPrimary care, community clinics, emergency departments and patient-to-patient referrals in Spain (Barcelona and Madrid) and the United States (Boston and Los Angeles).Participants/casesCalibration phase: the CAT-SUD was developed via simulation from complete item responses in 513 participants. Validation phase: 297 participants received the Composite International Diagnostic Interview (CIDI) and the CAT-SUD.MeasurementsA total of 252 items from five subdomains: (1) SUD, (2) psychological disorders, (3) risky behavior, (4) functional impairment and (5) social support. CAT-SUD scale scores and CIDI SUD diagnosis.FindingsCalibration: the bifactor model provided excellent fit to the multi-dimensional item bank; 168 items had high loadings (> 0.4 with the majority > 0.6) on the primary SUD dimension. Using an average of 11 items (four to 26), which represents a 94% reduction in respondent burden (average administration time of approximately 2 minutes), we found a correlation of 0.91 with the 168-item scale (precision of 5 points on a 100-point scale).Validationstrong agreement was found between the primary CAT-SUD dimension estimate and the results of a structured clinical interview. There was a 20-fold increase in the likelihood of a CIDI SUD diagnosis across the range of the CAT-SUD (AUC = 0.85).ConclusionsWe have developed a new approach for the screening and measurement of SUD and related severity based on multi-dimensional item response theory. The bifactor model harmonized information from mental health, trauma, social support and traditional SUD items to provide a more complete characterization of SUD. The CAT-SUD is highly predictive of a current SUD diagnosis based on a structured clinical interview, and may be predictive of the development of SUD in the future.

Project description:ObjectiveImpaired cognition is a hallmark of schizophrenia spectrum disorders, including schizotypal personality disorder, and it is the best predictor of functional outcome. Cognitive remediation therapy has demonstrated efficacy for improving cognition, augmenting other rehabilitation efforts in schizophrenia, and effecting gains in real-world functioning. Pharmacological augmentation of cognitive remediation has been attempted, but the effects of augmentation on combined therapies, such as cognitive remediation and social skills training, have not been studied.MethodsTwenty-eight participants with schizotypal personality disorder enrolled in an 8-week, randomized, double-blind, placebo-controlled trial of guanfacine plus cognitive remediation and social skills training (15 guanfacine, 13 placebo). Cognition was assessed with the MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) Consensus Cognitive Battery (MCCB), social cognition with the Movie for the Assessment of Social Cognition (MASC), and functional capacity with the University of California San Diego Performance-Based Skills Assessment (UPSA).ResultsA statistically significant pre- versus posttreatment effect was observed for MCCB speed of processing, verbal learning, and visual learning and UPSA total score. A significant time-by-medication (guanfacine, placebo) interaction was observed for MCCB reasoning and problem solving and UPSA total score; the time-by-treatment interaction approached significance for MASC hypomentalizing errors.ConclusionsBoth guanfacine and cognitive remediation plus social skills training were well tolerated, with no side effects or dropouts. Participants treated with cognitive remediation, social skills training, and guanfacine demonstrated statistically significant improvements in reasoning and problem solving, as well as in functional capacity and possibly social cognition, compared with those treated with cognitive remediation, social skills training, and placebo. Cognitive remediation plus social skills training may be an appropriate intervention for individuals with schizotypal personality disorder, and guanfacine appears to be a promising pharmaceutical augmentation to this psychosocial intervention.

Project description:CONTEXT Unlike other areas of medicine, psychiatry is almost entirely dependent on patient report to assess the presence and severity of disease; therefore, it is particularly crucial that we find both more accurate and efficient means of obtaining that report. OBJECTIVE To develop a computerized adaptive test (CAT) for depression, called the Computerized Adaptive Test-Depression Inventory (CAT-DI), that decreases patient and clinician burden and increases measurement precision. DESIGN Case-control study. SETTING A psychiatric clinic and community mental health center. PARTICIPANTS A total of 1614 individuals with and without minor and major depression were recruited for study. MAIN OUTCOME MEASURES The focus of this study was the development of the CAT-DI. The 24-item Hamilton Rating Scale for Depression, Patient Health Questionnaire 9, and the Center for Epidemiologic Studies Depression Scale were used to study the convergent validity of the new measure, and the Structured Clinical Interview for DSM-IV was used to obtain diagnostic classifications of minor and major depressive disorder. RESULTS A mean of 12 items per study participant was required to achieve a 0.3 SE in the depression severity estimate and maintain a correlation of r = 0.95 with the total 389-item test score. Using empirically derived thresholds based on a mixture of normal distributions, we found a sensitivity of 0.92 and a specificity of 0.88 for the classification of major depressive disorder in a sample consisting of depressed patients and healthy controls. Correlations on the order of r = 0.8 were found with the other clinician and self-rating scale scores. The CAT-DI provided excellent discrimination throughout the entire depressive severity continuum (minor and major depression), whereas the traditional scales did so primarily at the extremes (eg, major depression). CONCLUSIONS Traditional measurement fixes the number of items administered and allows measurement uncertainty to vary. In contrast, a CAT fixes measurement uncertainty and allows the number of items to vary. The result is a significant reduction in the number of items needed to measure depression and increased precision of measurement.

Dataset Information

Development and public release of a computerized adaptive (CAT) version of the Schizotypal Personality Questionnaire.

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Development and public release of a computerized adaptive (CAT) version of the Schizotypal Personality Questionnaire.

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