The Complex Latent Structure of Attenuated Psychotic Symptoms: Hierarchical and Bifactor Models of SIPS Symptoms Replicated in Two Large Samples at Clinical High Risk for Psychosis.

IF 5.3 1区 医学 Q1 PSYCHIATRY
Henry R Cowan, Trevor F Williams, Vijay A Mittal, Jean Addington, Carrie E Bearden, Kristin S Cadenhead, Tyrone D Cannon, Barbara A Cornblatt, Matcheri Keshevan, Diana O Perkins, Daniel H Mathalon, William Stone, Scott W Woods, Elaine F Walker
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Abstract

Background and hypothesis: The Structured Interview for Psychosis-Risk Syndromes (SIPS) and other assessments of psychosis risk define clinical high risk for psychosis (CHR) by the presence of attenuated psychotic symptoms. Despite extensive research on attenuated psychotic symptoms, substantial questions remain about their internal psychometric structure and relationships to comorbid non-psychotic symptoms.

Study design: Hierarchical and bifactor models were developed for the SIPS in a large CHR sample (NAPLS-3, N = 787) and confirmed through preregistered replication in an independent sample (NAPLS-2, N = 1043). Criterion validity was tested through relationships with CHR status, comorbid symptoms/diagnoses, functional impairment, demographics, neurocognition, and conversion to psychotic disorders.

Study results: Most variance in SIPS items (75%-77%) was attributable to a general factor. Hierarchical and bifactor models included a general factor and five specific/lower-order factors (positive symptoms, eccentricity, avolition, lack of emotion, and deteriorated thought process). CHR participants were elevated on the general factor and the positive symptoms factor. The general factor was associated with depressive symptoms; functional impairment; and mood, anxiety, and schizotypal personality diagnoses. The general factor was the best predictor of psychotic disorders (d ≥ 0.50). Positive symptoms and eccentricity had specific effects on conversion outcomes. The deteriorated thought process was least meaningful/replicable.

Conclusions: Attenuated psychotic symptoms, measured by the SIPS, have a complex hierarchical structure with a strong general factor. The general factor relates to internalizing symptoms and functional impairment, emphasizing the roles of general psychopathological distress/impairment in psychosis risk. Shared symptom variance complicates the interpretation of raw symptom scores. Broad transdiagnostic assessment is warranted to model psychosis risk accurately.

减弱精神病症状的复杂潜伏结构:在两个精神病临床高风险大样本中复制的 SIPS 症状的层次模型和双因素模型。
背景与假设:精神病风险综合征结构化访谈(SIPS)和其他精神病风险评估方法是根据是否存在减轻的精神病性症状来定义精神病临床高风险(CHR)的。尽管对减轻的精神病性症状进行了广泛的研究,但对其内部心理测量结构以及与合并的非精神病性症状之间的关系仍存在大量疑问:研究设计:在一个大型 CHR 样本(NAPLS-3,样本数 = 787)中为 SIPS 建立了层次模型和双因素模型,并在一个独立样本(NAPLS-2,样本数 = 1043)中通过预先登记的复制进行了确认。研究结果表明,标准效度通过与 CHR 状态、合并症状/诊断、功能障碍、人口统计学、神经认知和精神病性障碍转换的关系进行了检验:SIPS项目中的大部分差异(75%-77%)可归因于一个一般因子。分层和双因子模型包括一个一般因子和五个特定/低阶因子(阳性症状、偏心、逃避、缺乏情感和思维过程恶化)。慢性阻塞性肺病患者的一般因子和积极症状因子均有所升高。一般因子与抑郁症状、功能障碍以及情绪、焦虑和分裂型人格诊断有关。一般因子是精神病性障碍的最佳预测因子(d ≥ 0.50)。阳性症状和偏心对转换结果有特定影响。思维过程恶化的意义/可重复性最小:由 SIPS 测定的减轻的精神病症状具有复杂的层次结构,其中有一个很强的一般因子。一般因子与内化症状和功能障碍有关,强调了一般精神病理困扰/障碍在精神病风险中的作用。共同的症状差异使原始症状评分的解释变得复杂。需要进行广泛的跨诊断评估,以准确建立精神病风险模型。
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来源期刊
Schizophrenia Bulletin
Schizophrenia Bulletin 医学-精神病学
CiteScore
11.40
自引率
6.10%
发文量
163
审稿时长
4-8 weeks
期刊介绍: Schizophrenia Bulletin seeks to review recent developments and empirically based hypotheses regarding the etiology and treatment of schizophrenia. We view the field as broad and deep, and will publish new knowledge ranging from the molecular basis to social and cultural factors. We will give new emphasis to translational reports which simultaneously highlight basic neurobiological mechanisms and clinical manifestations. Some of the Bulletin content is invited as special features or manuscripts organized as a theme by special guest editors. Most pages of the Bulletin are devoted to unsolicited manuscripts of high quality that report original data or where we can provide a special venue for a major study or workshop report. Supplement issues are sometimes provided for manuscripts reporting from a recent conference.
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