Instruments Developed by the McGlashan Group

Researchers at the Prevention through Risk Identification, Management, and Education (PRIME) Research Clinic of Yale University developed the Structured Interview for Prodromal Syndromes (SIPS) [161] and, to assess the severity of prodromal symptoms, the Scale of Prodromal Symptoms (SOPS) [162]. The SIPS is a diagnostic interview, the SOPS an associated severity scale. The aim of these instruments is to help to exclude current or previous psychosis, to diagnose one of three types of prodromal states and to assess the severity of prodromal symptoms. The following three prodromal states are distinguished: (a) recent psychotic symptoms of short duration (in particular BLIPS), (b) attenuated psychotic symptoms and (c) a combination of genetic risk and recent deterioration of functioning. The symptoms are rated on a six-point severity scale. The five psychotic symptoms (unusual thought content/delusional ideas; suspiciousness/ persecutory ideas; grandiosity; perceptual abnormalities/hallucinations; conceptual disorganization) denote a clear-cut psychotic state only at the highest severity, and stages 1 to 5 denote different degrees of prepsychotic severity. The six negative symptoms (social isolation or withdrawal; avolition; decreased expression of emotion; decreased experience of emotions and self; decreased ideational richness; deterioration in role functioning) as well as the four disorganization symptoms (odd behaviour or appearance; bizarre thinking; trouble with focus and attention; impairment in personal hygiene/social attentiveness) and the four general symptoms (sleep disturbance; dysphoric mood; motor disturbances; impaired tolerance to normal stress) are also rated on a six-point scale.

Results from a reliability and validity study are presented by Miller et al. [163]: inter-rater reliability as based on 18 patients (prodromal versus non-prodromal) was 93% (kappa: 0.81). As evidence for the prognostic power of the instruments the authors found that 6 out of 13 prodromal patients transited to psychosis within 6 months (46.2%) and seven (53.8%) within a year.

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