Diagnostic Reliability And Validity Of The Proposed Dsm-5 Attenuated Psychosis Syndrome

Presentation First Author: 
Scott Woods

Data on diagnostic reliability and validity in routine community practice are needed as part of evaluating the appropriateness of the proposed Attenuated Psychosis Syndrome (APS) diagnosis for DSM-5. Methods. In an ongoing locally-funded study, 34 patients referred for research evaluation for suspected APS and eleven non-expert, “community” clinicians participated. Community clinicians were recruited via the Connecticut Psychiatric Society email listserv. Patients underwent one (n=5) or two (n=29) independent clinical interviews (total 63 clinical interviews) from community clinicians and a “gold standard” research structured diagnostic interview, generally within a few days. Community clinicians received 30 minutes of training in the proposed DSM-5 APS diagnosis and then followed individual usual clinical practice in a 45-minute unstructured clinical diagnostic interview, recording a principal DSM-IV or APS diagnosis and any comorbid diagnoses. Intraclass kappa in the 0.2 to 0.4 range or higher was considered acceptable agreement. Results. APS was the principal diagnosis in 22 of 63 clinical interviews (35%). Clinical interviewers agreed with the gold standard on presence or absence of APS 70% of the time (intraclass kappa 0.34, 95% CI 0.09 to 0.60). Clinicians rarely selected APS in patients who did not meet research criteria (8%). Conclusions. When offered the opportunity, clinicians frequently elected to employ the proposed DSM-5 APS diagnosis as the principal diagnosis, suggesting some utility in the present referral population. Clinicians had relatively little difficulty distinguishing attenuated positive symptoms from the normal range, and overall agreement with the gold standard has been acceptable.

Conference Name: 
Presentation Date: 
January, 2013
Additional Authors: 
Scott Woods, Barbara Walsh, Thomas McGlashan
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