Historically, two semi-structured interviews have most frequently been used to ascertain patients for clinical high risk for psychosis (CHR-P) and to rate their severity of illness over time. They are the Structured Interview for Psychosis-risk Syndromes (SIPS) and the Comprehensive Assessment of At-Risk Mental States (CAARMS). The National Institute of Mental Health (NIMH) spearheaded the effort to harmonize these two instruments. Harmonization was needed, despite identical attenuated positive symptom content and general overall similarity, because of six important differences in:
- Organization of attenuated positive symptom content into items
- Scaling of items
- Conceptualization of severity
- Quantifying symptom frequency
- Frank psychosis diagnosis criteria
- CHR-P syndrome criteria
These efforts led to the creation of a new instrument–the Positive SYmptoms and Diagnostic Criteria for the CAARMS Harmonized with the SIPS (PSYCHS). The PSYCHS harmonized the CAARMS and the SIPS for attenuated positive symptom ratings and for psychosis diagnostic criteria. In addition, it generates partly harmonized diagnostic criteria for both CAARMS and SIPS as well as derived severity scores for both CAARMS and SIPS.
The Accelerating Medicines Partnership (AMP®) SCZ observational study is using the PSYCHS for CHR-P ascertainment and attenuated positive symptom severity rating instead of individual SIPS or CAARMS assessment. When used in this way, studies can permit inclusion of participants who meet criteria for either CAARMS Ultra High Risk (UHR) or SIPS CHR-P Progression. In addition,sensitivity analyses in a data supplement can report whether findings differed by CAARMS vs. SIPS ascertainment or when employing CAARMS vs. SIPS severity ratings. This practice should facilitate comparing findings across studies and meta-analyses. A letter of intent to qualify the PSYCHS as a Clinical Outcomes Assessment Drug Development Tool has been accepted by the FDA (DDT-COA-000163).
Last Reviewed on November 21, 2023