Schizophrenia Research 153 (2014) 251–253

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Letter to the Editor Reliability of telephone assessments of at-risk criteria of psychosis: A comparison to face-to-face interviews

Dear Editors, In the early detection of psychosis, two at-risk approaches are currently mainly followed (Fusar-Poli et al., 2013): (i) the ultra-high risk (UHR) criteria including attenuated psychotic symptoms (APS), transient psychotic symptoms (BLIPS), and a state–trait combination and (ii) the basic symptom (BS) criteria including cognitive–perceptive BSs (COPER) and cognitive disturbances (COGDIS). Both are assessed in clinical interviews with semistructured instruments such as the Structured Interview for Psychosis-Risk Syndromes (SIPS; McGlashan et al., 2010) or the Schizophrenia Proneness Instruments (SPI-A; SchultzeLutter et al., 2007; SPI-CY; Schultze-Lutter et al., 2012; Fux et al., 2013). However, in prospective longitudinal studies, particularly when spanning a larger time period, re-evaluations in face-to-face interviews (FFI) are sometimes impossible; then, telephone interviews (TI) are used as an alternative (Woods et al., 2009; Nelson et al., 2013). While the reliability of TI in comparison to FFI has already been shown for most mental disorders and problems (Rohde et al., 1997; Crippa et al., 2008; Hajebi et al., 2012), the reliability of TI for symptomatic at-risk criteria or exclusion/transition criteria (past or current psychosis) has not yet been shown. Therefore, we examined the reliability of TI in comparison with FFI in assessing current at-risk approaches and psychosis exclusion/transition criteria. Ninety-four psychiatric in- and outpatients oversampled for psychosis and at-risk status (27.6%) were assessed by two interviewers (clinical psychologists well trained in SIPS and SPI-A/SPI-CY) who were blind to each other's results and subjects' clinical statuses. The sequences of interview method and interviewer were varied, creating a balanced design with four starting conditions to control for sequential effects of both interviewer and method. One week was chosen as the lag time between interviews to reduce memory effects while avoiding discrepancies due to significant changes in psychopathology. A detailed description of assessments and statistical analysis can be obtained from the first author. Correspondence rates for agreement on presence of symptoms/ criteria were above the critical threshold for clinical usefulness of 75% in all cases (Table 1). Furthermore, sufficient agreement beyond chance of Cohen's kappa (κ) N 0.40 was found for all but three symptoms (O7, O14, and P5), in which κ was low despite good correspondence rates of N89% because of the infrequent occurrence (high prevalence index (PI) of N0.850). Consequently, the correspondence rate was regarded as the less biased measure of agreement between interview methods for these three symptoms. No systematic pattern of over- or under-report of symptoms/criteria was detected for either interview method. While no differences were found for criteria or SIPS items, two BSs showed significant differences, 0920-9964/$ – see front matter © 2014 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.schres.2014.01.025

but in opposite directions. C5 was reported significantly less frequently in FFI (McNemar's χ2 = 31.60, df = 1, p b 0.10), whereas an opposite result was observed for O13, which was reported significantly less frequently in TI (McNemar's χ2 = 30.77, df = 1, p b 0.10) (Table 1). For symptom severity, results were less favorable, especially for BSs whose severity rating completely relies on patient reports. Seven BSs and one SIPS item lay below the threshold of ICC N 0.40 (Table 1). However, no systematic significant effect in (dis)favor of a particular interview method was detected: While a significantly higher frequency was found for C5 in FFI (Wilcoxon z = −2.113, p b 0.10), the opposite was true for O13, for which frequency ratings were significantly higher when assessed via telephone (Wilcoxon z = −1.689, p b 0.10) (Table 1). Although TI of at-risk symptoms and criteria, including transition criteria, have been conducted in longitudinal studies on early detection of and intervention for psychosis (Woods et al., 2009; Nelson et al., 2013), to the best of our knowledge, this study is the first to examine the reliability of TI in comparison to FFI. Yet, results are somewhat limited by the only 30%-proportion of at-risk/psychosis patients and need replication in larger at-risk/psychosis samples. In accordance with earlier reports for the assessment of mental (Rohde et al., 1997) and psychotic disorders (Hajebi et al., 2012) with semistructured clinical interviews, our results support the use of TI as a reliable alternative to FFI in early detection research (e.g., at followups of persons who have moved away or are unwilling to come in for a personal interview) or in epidemiological studies. However, there was some indication that patients' information on severity of at-risk symptoms, particularly with regard to frequency, might generally not be fully reliable. Since frequency ratings completely rely on patients' responses to questions like “And how often did this happen during the past x months?” this result most likely reflects a recall effect, while no systematic effect of interview method was found. In summary, TI seem to be an acceptable interview method for assessing at-risk symptoms/criteria, their advantage being that they can be carried out from any location, both for research purposes and in clinical practice, and neither clinicians nor patients need to spend substantial amounts of time traveling. This is especially relevant for epidemiological or long-term studies when FFI are laborious. Role of funding source No funding was received in support of the presented study. Contributors CM, BGS, FSL and SK designed the study; CM and FSL managed the literature searches, undertook the statistical analyses, and wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript. Conflict of interest MSc Michel, Dr Schultze-Lutter, Dr Kupferschmid and MSc Siegwart declare that there are no conflicts of interest in relation to the subject of this study. Dr Schimmelmann has been a consultant and/or advisor to or has received honoraria from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, and Shire. Acknowledgment A detailed description of the sample, assessments and statistical analysis can be obtained from the first author.

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Table 1 Agreement between interview methods for at-risk criteria and symptoms and exclusion/transition criteria for past or present psychosis.

At-risk criteria and transition/exclusion criteria COPER COGDIS APS BLIPS Past or present psychosis

Ultra-high risk symptoms (score of 3 or higher on the SIPS) Unusual thought content/delusional ideas (P1) Suspiciousness/persecutory ideas (P2) Grandiose ideas (P3) Perceptual abnormalities/hallucinations (P4) Disorganized communication (P5) Bizarre thinking (D2)

Frequency in face-to-face interview

Correspondence rate (for symptom presence)

Kappa (κ)a (for symptom presence)

Prevalence index (PI)b

ICCa (for symptom frequency)

37.2% 16.0% 8.5% 1.1% 24.5%

38.3% 17.0% 5.3% 1.1% 25.5%

77.7% 89.4% 96.8% 100% 98.9%

0.570 0.652 0.753 1.000 0.972

0.245 0.660 0.862 0.979 0.500

8.5% 19.1% 14.9% 4.3% 14.8% 53.2% 9.6% 23.4% 16.0% 6.4% 12.8%

10.6% 11.7% 14.9% 4.3% 14.8% 54.3% 7.4% 19.1% 12.8% 5.3% 12.8%

92.5% 88.3% 89.4% 92.5% 89.4% 77.6% 91.5% 85.1% 86.2% 96.8% 87.2%

0.631 0.556c 0.580 0.216 0.580 0.551 0.454 0.557 0.439 0.710 0.427

0.798 0.691 0.702 0.904 0.702 0.074 0.830 0.574 0.713 0.882 0.745

−0.012 0.620d 0.410 0.935 0.796 0.350 0.276 0.598 0.306 0.593 0.340

18.1% 12.0% 7.4%

18.1% 19.6% 7.4%

89.4% 86.2% 89.4%

0.641 0.555e 0.228

0.638 0.670 0.862

0.370 0.460f 0.076

30.9% 33.0% 8.6% 36.2% 1.1% 13.8%

28.7% 28.7% 11.8% 40.4% 4.3% 14.9%

91.5% 87.2% 93.6% 93.6% 96.8% 90.4%

0.797 0.701 0.708 0.865 0.390 0.611

0.404 0.383 0.787 0.234 0.947 0.713

0.784 0.841 0.751 0.905 0.374 0.684

– – – – –

Note. ICC: intraclass correlation; COPER: cognitive–perceptive basic symptoms; note: calculated irrespective of onset criterion; COGDIS: cognitive disturbances; APS: attenuated psychotic symptoms; BLIPS: brief limited intermittent psychotic symptoms; SPI-A: Schizophrenia Proneness Instrument, Adult version; SPI-CY: Schizophrenia Proneness Instrument, Child and Youth version; and SIPS: Structured Interview for Psychosis-Risk Syndromes. a Evaluation guidelines for κ and ICC: 0.00–0.20 = slight, 0.21–0.40 = fair, 0.41–0.60 = moderate, 0.61–0.80 = substantial, and 0.81–1.00 = almost perfect agreement. b A high prevalence index represents a low prevalence rate, whereas a low prevalence index represents a high prevalence rate. c Reported significantly less frequently in face-to-face assessment (McNemar's test of symmetry: χ2 = 31.60, df = 1, p b 0.10). d Significantly higher in telephone assessment (z = −2.113, df = 1, p b 0.10). e Reported significantly less frequently in telephone assessment (McNemar's test of symmetry: χ2 = 30.77, df = 1, p b 0.10). f Significantly higher in face-to-face assessment (z = −1.689, df = 1, p b 0.10).

Letter to the Editor

Basic symptoms (score of 1 or higher on the SPI-A/SPI-CY) Inability to divide attention (B1) Disturbance of expressive speech (C5) Disturbances of abstract thinking (O3) Captivation of attention by details of the visual field (O7) Thought interference (C2) Thought blockages (C3) Disturbance of receptive speech (C4) Thought pressure (D3) Unstable ideas of reference (D4) Thought perseveration (O1) Decreased ability to discriminate between ideas and perception, fantasy and true memories (O2) Derealization (O8) Visual perception disturbances (O4) Acoustic perception disturbances (O5)

Frequency in telephone interview

Letter to the Editor

References Crippa, J.A., de Lima Osório, F., Del-Ben, C.M., Filho, A.S., da Silva Freitas, M.C., Loureiro, S.R., 2008. Comparability between telephone and face-to-face structured clinical interview for DSM-IV in assessing social anxiety disorder. Perspect. Psychiatr. Care 44 (4), 241–247. Fusar-Poli, P., Borgwardt, S., Bechdolf, A., Addington, J., Riecher-Rössler, A., SchultzeLutter, F., Keshavan, M., Wood, S., Ruhrmann, S., Seidman, L.J., Valmaggia, L., Cannon, T., Velthorst, E., De Haan, L., Cornblatt, B., Bonoldi, I., Birchwood, M., McGlashan, T., Carpenter, W., McGorry, P., Klosterkötter, J., McGuire, P., Yung, A., 2013. The psychosis high-risk state: a comprehensive state-of-the-art review. JAMA Psychiatry 70 (1), 107–120. Fux, L., Walger, P., Schimmelmann, B.G., Schultze-Lutter, F., 2013. The Schizophrenia Proneness Instrument, child and youth version (SPI-CY): practicability and discriminative validity. Schizophr. Res. 146 (1–3), 69–78. Hajebi, A., Motevalian, A., Amin-Esmaeili, M., Hefazi, M., Radgoodarzi, R., RahimiMovaghar, A., Sharifi, V., 2012. Telephone versus face-to-face administration of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, for diagnosis of psychotic disorders. Compr. Psychiatry 53 (5), 579–583. McGlashan, T.H., Walsh, B., Woods, S., 2010. The Psychosis-Risk Syndrome. Handbook for Diagnosis and Follow-up. Oxford University Press, New York. Nelson, B., Yuen, H.P., Wood, S.J., Linn, A., Spiliotacopoulos, D., Bruxner, A., Broussard, C., Simmons, M., Foley, D.L., Brewer, W.J., Francey, S.M., Amminger, P., Thompson, A., McGorry, P.D., Yung, A.R., 2013. Long-term follow-up of a group at ultra high risk (“prodromal”) for psychosis, the PACE 400 Study. JAMA Psychiatry 70 (8), 793–802. Rohde, P., Lewinsohn, P.M., Seeley, J.R., 1997. Comparability of telephone and face-to-face interviews in assessing axis I and II disorders. Am. J. Psychiatry 154 (11), 1593–1598. Schultze-Lutter, F., Addington, J., Ruhrmann, S., Klosterkötter, J., 2007. Schizophrenia Proneness Instrument, Adult Version (SPI-A). In: Fioriti, Giovanni (Ed.), s.l.r, Roma. Schultze-Lutter, F., Marshall, M., Koch, E., 2012. Schizophrenia Proneness Instrument, Child and Youth Version; Extended English Translation (SPI-CY EET). In: Fioriti, Giovanni (Ed.), s.l.r, Roma.

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Woods, S.W., Addington, J., Cadenhead, K.S., Cannon, T.D., Cornblatt, B.A., Heinssen, R., Perkins, D.O., Seidman, L.J., Tsuang, M.T., Walker, E.F., McGlashan, T.H., 2009. Validity of the prodromal risk syndrome for first psychosis: findings from the North American Prodrome Longitudinal Study. Schizophr. Bull. 35 (5), 894–908.

Chantal Michel⁎ Benno G. Schimmelmann Stephan Kupferschmid Marcel Siegwart Frauke Schultze-Lutter University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111 (Haus A), 3000 Bern 60, Switzerland ⁎ Corresponding author at: University Hospital of Child and Adolescent Psychiatry and Psychotherapy, Research Department, Bolligenstrasse 111, Haus A, 3000 Bern 60, Switzerland. Tel.: +41 31 932 8558; fax: +41 31 932 8569. E-mail addresses: [email protected] (C. Michel), [email protected] (B.G. Schimmelmann), [email protected], (S. Kupferschmid), [email protected], (M. Siegwart), [email protected] (F. Schultze-Lutter). 10 September 2013

Reliability of telephone assessments of at-risk criteria of psychosis: a comparison to face-to-face interviews.

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