User:Ongmianli/Portfolios/Schizophrenia

Demographic information

This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of schizophrenia they are likely to see in their clinical practice.

Setting	Reference	Base Rate	Demography	Diagnostic Method
Non-institutionalized civilians	Kessler et al., 1994	0.5%	48 contiguous US states	CIDI, SCID
Community sample	Rogers & Regier, 1991	1.3%	Urban settings in 5 states (MD, NC, CN, CA, MO)	DIS
Inmates with severe mental disorders	Dumais, Cote, & Lesage, 2010	23.5% incarcerated†, 69.7% hospitalized involuntarily†	All Federal Penitentiaries in Quebec-incarcerated and inmates currently hospitalized involuntarily	SCID
Patients presenting for inpatient and ambulatory services	Minsky et al., 2003	African-American (males – 19.1%, females – 11.3%) Latino (males – 9.4%, females – 6.2%) European-American (males – 9.9%, females – 6.1%) (Rates are for all psychotic disorders – authors note this was “mostly schizophrenia”)	New Jersey	BASIS-32
General population (community, inpatient, and outpatient)	Saha et al., 2005	0.7%	Global – 44 countries	Clinical interview
General population	Perala et al., 2007	0.87%	Finland	CIDI, SCID
County Mental Health Service Users	Folsom et al., 2002	54% - homeless individuals	San Diego County	Chart Diagnosis
Inpatient service	Brown, 2001	39% - non-homeless 8.4% - 65 years and up 17% - 19-64 years	Maryland	Psychiatrist Diagnosis
Insurance claimants in 2002	Wu, Shi, Birnbaum, Hudson, & Kessler, 2006	Medicaid – 1.66%, Uninsured – 1.02%, Medicare – 0.83%, Privately insured – 0.13%, Veterans (through VA) – 1.41%	USA (Note: Medicaid rate was calculated using California Medi-Cal rates as a proxy)	Physician diagnosis

• †Rates reflect schizophrenia spectrum disorders.
• Note: DIS = Diagnostic Interview Schedule, CIDI = Composite International Diagnostic Interview, SCID = Structured Diagnostic Interview for DSM, BASIC-32 = Behavior and Symptoms Identification Scale

Search terms: [Schizophrenia] AND [prevalence OR incidence], [Schizophrenia] AND [Prevalence] AND [Outpatient OR inpatient] in PsycINFO, Medline, and PubMed

Diagnosis

Recommended Diagnostic Interviews

• Structured Clinical Interview for DSM-IV (SCID); Located on Penn Lab, See Appendix 1 for schizophrenia modules

Recommended Screening Instruments

• PDSQ – available from Western Psychological Services www.wpspublish.com
• SIPS – available from PRIME clinic at Yale University, contact Dr. Barbara Walsh at 203-974-7052
• BSABS – available from http://www.amazon.co.uk/BSABS-Assessment-Commentary-References-Documentation/dp/3832271732 or publisher Shaker Verlag www.shaker.de

Areas Under the Curve (AUCs) and Likelihood Ratios for Potential Screening Measures for Specific Phobias

Screening Measure (Primary Reference)	AUC	LR+ (Score)	LR- (Score)	Citation	Clinical generalizability
Psychiatric Diagnostic Screening Questionnaire – PDSQ (Zimmerman & Mattia, 2001a)‡	.92 (N = 799)	2.7 (Subscale cutoff score = 1)	.33 (Subscale cutoff score = 1)	(Zimmerman & Sheeran, 2004)	Low – can distinguish psychotic disorders from non-psychotic disorders but cannot distinguish schizophrenia from other psychotic disorders (ex: MDD with psychosis)
Structured Interview for Prodromal Syndromes – SIPS (Miller et al., 1999)	Not given (N = 34)	3.5 (not given)	0 (not given)	(Miller et al., 2003)	Moderate – has some predictive validity (46% of those identified as prodromal by the SIPS developed schizophrenia psychosis within 6 mo.)
Bonn Scale for the Assessment of basic Symptoms – BSABS (Gross, 1989)• Cluster 1 = thought, language, perception, and motor disturbances Cluster 2 = impaired bodily sensations Cluster 3 = impaired tolerance to normal stress Cluster 4 = disorders of emotion and affect including impaired thought, energy, concentration, and memory Cluster 5 = increased emotional reactivity, impaired ability to maintain or initiate social contacts, and disturbances in nonverbal expression	(N = 160) C1 = 0.81 C2 = 0.50 C3 = 0.52 C4 = 0.57 C5 = 0.58	Overall = 2.4 (>=1) C1 = 3.1 C2 = 0.48 C3 = 0.97 C4 = 1.1 C5 = 1.4 (*)	Overall = 0.03 (>=1) C1 = 0.52 C2 = 1.0 C3 = 0.77 C4 = 0.5 C5 = 0.70 (*)	(Klosterkotter, Hellmich, Steinmeyer, Schultze-Lutter, 2001)	Moderate – has some predictive validity for individuals who are in the prodromal period or suspected to be in the prodromal period of schizophrenia overall, cluster 1 has best predictive accuracy and may be most useful
Symptom Severity Scale of the DSM5	0.85 (N=314)	3.53	0.35	Ritsner, Mar, Arbitman, & Grinshpoon (2013)	Medium: Schizophrenia versus all other psychotic disorders, but has not been studied in a variety of populations with schizophrenia as it is a relatively new measure.
Positive and Negative Syndrome Scale (PANSS) (Stanley, Flszbein, & Opfer, 1987)	0.91 (N=314)	N/A	N/A	Ritsner, Mar, Arbitman, & Grinshpoon (2013)	Note: 45 minute clinical interview. Requires training. Attached to appendix.
NIMH: Diagnostic Interview Schedule – Psychotic Symptoms Scale (Robins et al., 1981).	N/A	4.4	1.7	Eaton et al. (1991)	Note: Quick self-report interview that screens for psychotic symptoms. Should be followed up with more indepth diagnostic assessments.
Royal Park Multi- Diagnostic Instrument for Psychosis (RPMIP) (McGorry, Copolov, & Singh (1990).	0.78 (N=200)	0.8	1.625	McGorry, McKenzie, & Jackson (2000)	Note: Interview that requires training.
Schizotypal Personality Questionnaire (SPQ) and Survey of Attitudes and Experiences (SAE)	0.74 (N=339)	1.76	0.59	Venables & Raine (2015)	Note: Samples included young, predominantly female samples of nonclinical controls. Self-report measure, likelihood ratios are composite scores for three factors
UCSD performance-based skills assessment (UPSA) in predicting independence	0.74 (N=434)	2.03	0.47	Mausbach et al. (2008)	Note: Two cut-off scores were suggested for predicting independent living in this population. These data are based on the cut-off score of 75 (greater sensitivity)

• Note: ‡ Used the SCID administered by trained raters. • Used Present State Examination 9 and psychiatrist diagnosis. (*) Cutoff score for all clusters was 15% of symptoms in that cluster present (for cluster 1= 5/35 symptoms)

• “LR+” refers to the change in likelihood ratio associated with a positive test score, and “LR-” is the likelihood ratio for a low score. Likelihood ratios of 1 indicate that the test result did not change impressions at all. LRs larger than 10 or smaller than .10 are frequently clinically decisive; 5 or .20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation (Sackett et al., 2000).

Search terms: [schizophrenia] AND [sensitivity OR specificity] AND [differential diagnosis] AND [prodrome] in MedLine and PsycINFO

Treatment

Cognitive behavioral therapy to routine care has shown limited evidence of an average effect size on psychosis symptoms. However, individual CBT is not widely available in the US, and group CBT is likely more cost-efficient.

Process and Outcome Measures

Measure	Scale	Cut Scores*			Critical Change (Unstandardized Scores)
		A	B	C	95%	90%	SEdifference
Benchmarks Based on Published Norms for Samples with Schizophrenia
Positive and Negative Syndrome Scale (1987 Norms)	PANSS Positive Scale	6	n/a	n/a	8.8	7.4	4.5
	PANSS Negative Scale	8.8	n/a	n/a	7.0	5.9	3.6
	PANSS General Psychopathology Scale	18.8	n/a	n/a	9.5	8.0	4.8
Scale for the Assessment of Positive Symptoms (SAPS) and Negative Symptoms (SANS) (1991 Norms)	SAPS	-6.9	n/a	n/a	13.4	11.3	6.8
	SANS	0.6	n/a	n/a	13.9	11.7	7.1
Satisfaction with Life Scale (SWLS) (2007)	SWLS	5.8	36.4	22.1	7.3	6.2	3.7
Cogtest Battery Composite Score		34	70	55	9.9	8.3	5.0
Beck Depression Inventory		4	22	15	9	8	4.8
Overall Functioning: Global Assessment of Functioning (GAF)		26.8	81.6	54.8	8.3	7.0	4.2
Social Skills (Social Functioning Scale)		90.9	268.7	102.1	7.2	6.0	3.6

• “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean.

Search terms: [schizophrenia] AND [clinical significance OR outcomes OR change] AND [PANSS OR SWLS] in MedLine and PsycINFO

Note: Clinical significance may be limited for use in schizophrenia as the disorder is currently incurable and the extent to which a return to normal functioning may be less common. For this reason, some investigators have used methods other than those proposed by Jacobson and Truax (1991) to develop cut-off points (Jacobson et al. 1999).

• Example: Positive and Negative Syndrome Scale (PANSS) cut-off scores of 40, 45 and 50 have been mentioned for clinically significant change for schizophrenia patients in hospital settings (Schennach et al. 2015).

Local Resources

Schizophrenia Treatment and Evaluation Program (STEP): Outpatient clinic specializing in the diagnosis and treatment of:

1. Schizophrenia
2. Bipolar disorder
3. Depression
4. Other serious mental illnesses with psychotic symptoms

Physical address: Carr Mill Mall

200 N. Greensboro St., Suite C-6 Carrboro, NC 27510

Phone number: 919.962.4919

Website: https://www.med.unc.edu/psych/cecmh/patient-client-information/step-community-clinic

Outreach And Support Intervention Services (OASIS): Outpatient clinic specializing in the diagnosis and treatment of first episode psychosis and for individuals at risk for psychosis

Physical address: Carr Mill Mall

200 N. Greensboro St., Suite C-6 Carrboro, NC 27510

Phone number: 919.962.1401

Website: https://www.med.unc.edu/psych/cecmh/patient-client-information/oasis

Caramore Community: Structured support program for adults with mental illness

Physical address: 550 Smith Level Rd, Carrboro, NC 27510

Phone number: 919.967.3402

Website: http://www.caramore.org

The Farm at Penny Lane: Part of the UNC Center for Excellence in Community Mental Health that provides activities and groups for people with Severe Mental Illness, including:

1. Community Garden
2. Horticulture Therapy Program
3. UNC Paws: Dog-training Therapy Program

Main contacts:

• Michelle Morehouse, Farm Manager
  • Phone: michelle_morehouse@med.unc.edu
  • Email: 919-869-3419
• Thava Mahadevan, Director of the Farm, Director of Operations at the UNC Center of Excellence in Community Mental Health
  • Phone: thava@unc.edu
  • Email: 919-962-4919

National Alliance on Mental Illness (NAMI):

North Carolina site that provides support, education and advocacy for the families and friends of people with mental illnesses

Physical address: 309 W Millbrook Rd, Ste. 121, Raleigh, NC, NC 27609

Phone number: 919.788.0801

Website: http://naminc.org

Web-based Resources

Online Support Group for Family Members & Individuals with Schizophrenia

Website: http://www.schizophrenia.com/coping.html

Chatrooms for Individuals with Schizophrenia:

• http://www.schizophrenia-online.com/
• http://theircvillage.com/chat/

General Information about Schizophrenia: http://www.schizophrenia.com