scale of prodromal symptoms pdf

Prodding needed regularly. Prefers to spend time alone, although participates in social functions when required. b. Suspiciousness or paranoid thinking. Social apathy? (Does it bother you?) : K L M N O X Y c e f l n „ † ‡ ” ¿ ç û , - . While this additional information will not contribute to the diagnosis of a psychosis-risk syndrome, it will provide both a descriptive and quantitative estimate of the diversity and severity of psychosis-risk symptoms. The BPSS-R assesses the onset pattern, duration, severity, and frequency of 36 symptoms and signs that emerge or worsen prior to the first major depressive and/or first manic episode. ( Degree of interference with life: Do you ever act on this experience? Page 6 P. POSITIVE SYMPTOMS………………………………………………………… Page 7 P.1 Unusual Thought Content/Delusional Ideas…………………………………………. Baseline attenuated positive symptoms were rated in 42 putatively prodromal patients in the RAP program using the Scale of Prodromal Symptoms (SOPS). Overvalued beliefs. Unrealistic goals that may affect plans and functioning, but responsive to other’s concerns and limits.Compelling beliefs of superior intellect, attractiveness, power, or fame. The empirical factors of the SOPS showed similarities and notable differences compared with the existing SOPS structure. It is not necessary to meet every criterion in any one anchor to assign a particular rating. Does having the experience ever cause you to do anything differently? The Scale of Prodromal symptoms and the Structured Interview of Prodromal Symptoms Using the Australian criteria, the Yale group lead by McGlashan developed the SOPS embedded within a structured interview (The Structured Interview of Prodromal Symptoms [SIPS]).9181 Sinc9 e the defini-tion of prodromal states also includes the family his- The second test is whether the positive symptoms are more characteristic of a psychosis risk syndrome or of the co-occurring disorder. May provide noncontextual responses, or exhibit inappropriate affect. P.3 DESCRIPTION: GRANDIOSE IDEAS a. Do you feel as if you are unusually gifted in any particular area? Have you been doing worse in school or at work? ( Degree of interference with life: Do you ever act on this experience? Third party reports alone do not qualify. N. 1. severe anorexia or bulimia and some spontaneous vomiting or extensive laxative/diuretic/diet pill use, but without serious heart or kidney problems or severe dehydration and disorientation) A person with 1-2 of the 6 areas of disturbance in this category = rating 18-20 A person with 3-4 of the 6 areas of disturbance in this category = rating 14-17 A person with 5-6 of the 6 areas of disturbance in this category = rating 11-13IN PERSISTENT DANGER OF SEVERELY HURTING SELF OR OTHERS: 10 - 1Serious suicidal act with clear expectation of death (e.g. A rating in this range indicates a symptom severity that is at a psychosis-risk level of intensity. Anchors in each scale are intended to provide guidelines and examples of signs for every symptom observed. Do other people tell you that your ideas or beliefs are unusual or bizarre? Page 37 Global Assessment of Functioning: A Modified Scale…………. Anchors in each scale are intended to provide guidelines and examples of signs for every symptom observed. Even if these Positive Symptoms are present at a psychotic level of intensity (SOPS score = 6), a current psychotic syndrome can be ruled out if the POPS (B) criteria for sufficient frequency and duration or urgency are not met (See p. 1). Difficulty in abstract thinking. N NI Y (Record Qualifiers) QUALIFIERS: For all “Y” responses, record: ( Description-Onset-Duration-Frequency ( Degree of Distress: What is this experience like for you? Always? Louder or softer? Background: This study examines the ability of the Scale of Prodromal Symptoms (SOPS) to differentiate between negative and depression symptoms in a young help-seeking ultrahigh risk (UHR) group. (Does it bother you?) Expression of Emotion (p. 23) 0 1 2 3 4 5 6 N4. C.If Yes to A, did the symptoms occurr for at least one hour per day at an average frequency of four days per week over one month?If Yes to A and B or A and C, the subject meets criteria for current psychosis. N NI Y (Record Qualifiers) 2. May feel disconnected from body, from world, from time. N NI Y (Record Qualifiers) 2. Have you been put on probation or otherwise given notice due to poor performance? Some investigators may wish to obtain a full SOPS with all patients. ( Degree of interference with life: Do you ever act on this experience? c. Motor blockages (catatonia). What kinds of difficulty have you been having with your sleep? N NI Y (Record Qualifiers) QUALIFIERS: For all “Y” responses, record: ( Description-Onset-Duration-Frequency ( Degree of Distress: What is this experience like for you? Is this getting worse than it was before? Not responsive to structuring of the interview.Rating based on: For Symptoms Rated at Level 3 or HigherSymptom OnsetSymptom WorseningSymptom FrequencyBetter ExplainedRecord date when a positive symptom first reached at least a 3: ( “Ever since I can recall” ( Date of onset ___/___ Month/YearRecord most recent date when a positive symptom currently rated 3-6 experienced an increase by at least one rating point: Date of worsening ___/___ Month/YearCheck all that apply: ( e" 1 h / d , e" 4 d / w k ( e" s e v e r a l m i n u t e s / d , e" 1 x / m o ( e" 1 x / w k ( n o n e o f a b o v e S y m p t o m s a r e b e t t e r e x p l a i n e d b y a n o t h e r A x i s I o r I I d i s o r d e r . It ensued a new doctrine of hitherto neglected symptoms of schi spectrum, the BS, experiential and not - as negative symptoms and “prodromal and residual symptoms” of DSM - … ( Degree of Conviction/Meaning: How do you account for this experience? Do people ever seem to have difficulty understanding you? Do you ever feel that it could just be in your head? Experiences seem meaningful because they recur and will not go away. D I S O R G A N I Z E D C O M M U N I C A T I O N T h e f o l l o w i n g q u e s t i o n s p r o b e f o r t h o u g h t disorder and other difficulties in thinking as reflected in speech. It is not necessary to meet every criterion in any one anchor to assign a particular rating. Spends most time alone or with first-degree relatives.No friends. A score of “1” to “5” on one or more of scales P1-P5 indicates a Positive Symptoms that is at a non-psychotic level intensity. Do you ever think you see people, animals, or things, but then realize they N NI Y (Record Qualifiers) may not really be there? OCCUPATIONAL FUNCTIONING Negative Symptom Scale 0 Absent1 Questionably Present2 Mild3 Moderate4 Moderately Severe5 Severe 6 ExtremeMore than average effort and focus required to maintain usual level of performance at work, school.Difficulty in functioning at work or school that is becoming evident to others.Definite problems in accomplishing work tasks or a drop in Grade Point Average. Regrouping the symptoms based on the empirical symptom dimensions may improve the diagnostic validity of the SOPS. Are you superstitious? (2002). Feeling depersonalized, unreal or strange. Ƹ dğ ¤ $¤x a$gdùSÕ $„Z ]„Z a$gdùSÕ Æ Ÿ„Z ]„Z gdùSÕ _ ` a b c m n o p q ƒ „ † ¾ ú - f š à % GENERAL SYMPTOMS G. 1. N NI Y (Record Response) 2. Have you felt that things happening around you have a special meaning for just you? Both scales are listed below. Do you feel they have hostile or negative intentions? EXPERIENCE OF EMOTIONS AND SELF INQUIRY: 1. Has your mood affected your appetite? Page 7 P.2 Suspiciousness/Persecutory Ideas………………………..………………………….. Do you ever think that the world might not exist? The Functional Rating Scale Taskforce for pre-Huntington Disease (FuRST-pHD) is a multinational, multidisciplinary initiative with the goal of developing a data-driven, comprehensive, psychometrically sound, rating scale for assessing symptoms and functional ability in prodromal and early Huntington disease (HD) gene expansion carriers. N NI Y (Record Response) For all responses, record: description, onset, duration, and change over time. N g { è N NI Y (Record Qualifiers) 2. Sleeping problems. Positive Symptoms are rated on scales P1-P5 of the Scale of Psychosis-risk Symptoms (SOPS). collecting garbage, talking to self in public). QUALIFIERS Following each set of questions, a series of qualifiers is listed. Impaired Tolerance to Normal Stress (p. 34) 0 1 2 3 4 5 6 GAF (p. 37) Current _____ Highest in Past Year _____ Schizotypal Personality Disorder (p. 38) yes_______ no______ Family History of Psychotic Illness (p. 7) yes_______ no______ SUMMARY OF SIPS SYNDROME CRITERIA Rule out current and past psychosis: PRESENCE OF PSYCHOTIC SYNDROME (POPS) Psychotic SyndromeYesNoA.Are any of the SOPS P1-P5 Scales scored 6, or have they ever been?B.If Yes to A, are the symptoms seriously disorganizing or dangerous, or were they ever? DESCRIPTION: DYSPHORIC MOOD ALSO: a. UNUSUAL THOUGHT CONTENT/DELUSIONAL IDEAS The following questions are organized in sections and probe for both psychotic, delusional thinking and for non-psychotic, unusual thought content. For example: feelings of impending death during a panic attack are better explained by panic disorder than by a psychosis risk syndrome, feelings of personal worthlessness in a depressed patient are better explained by depression than by a psychosis risk syndrome, feelings of personal superiority in a patient with frank mania is better explained by the mania, and feelings of personal disintegration precipitated by stress and relieved by wrist-cutting in a borderline patient is better explained by the personality disorder. Do you have any hobbies, special interests or collections? Basis for ratings includes both interviewer observations and patient reports. Avolition (p. 22) 0 1 2 3 4 5 6 N3. ç Definition of the prodromal stage of psychosis. Do you think this is real? The SOPS is organized in four primary sections: (P.) Positive Symptoms, (N.) Negative Symptoms, (D.) Disorganized Symptoms, (G.) General Symptoms. 5. Appears preoccupied with and/or interactive with own thoughts. parent, full sibling, child)? Are you feeling emotionally flat? This article provides further data on these psychometric parameters for the prodromal assessment instruments developed by the Prevention through Risk Identification, Management, and Education (PRIME) prodromal research team at Yale University: the Structured Interview for Prodromal Syndromes and the Scale of Prodromal Symptoms. Does it affect your behavior? All boldface inquiries should be asked. Anchors in each scale are intended to provide guidelines and examples of signs for every symptom observed. Do you find that people have to push you to get things done? ( Degree of interference with life: Do you ever act on this experience? Confusing? e. Compulsive motor rituals. Relative prominence of the factors and symptom frequency support early identification strategies focusing on positive symptoms and distress. Thus, it is crucial to bettercharacterizethe prodromal symptoms preceding bipolar disorder onset. The SOPS final ratings are recorded on a summary sheet located at the end of the SIPS (See p. 40). Prodrome: The period directly before the onset of full-threshold or frank psychosis where noticeable changes occur (e.g. Loss of sense of self. __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ P.2 DESCRIPTION: SUSPICIOUSNESS/PERSECUTORY IDEAS a. Persecutory ideas of reference. Prodromal symptoms were determined using the McSweeney Acute and Prodromal Myocardial Infarction Symptom questionnaire. Page 27 D. Disorganization Symptoms……………………. DESCRIPTION: TROUBLE WITH FOCUS AND ATTENTION a. Difficulty keeping up with conversations. I feel uninterested in the things I used to enjoy. CURRENT SCHIZOTYPAL PERSONALITY DISORDER as indicated by five (or more) of the following: DSM IV - Schizotypal Personality Disorder Criteria - Rated based on responses to the interview.YesNoa. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, By continuing to browse this site, you agree to its use of cookies as described in our, I have read and accept the Wiley Online Library Terms and Conditions of Use. Psychosis seems to be a preformed pattern of response of the human brain. Difficult to awaken for appointments. A score of “6” on one or more of scales P1-P5 indicates that a Positive Symptom is at a “Severe and Psychotic” level of intensity and thus, the (A) criteria is met. Anchors in each scale are intended to provide guidelines and examples of signs for every symptom observed. Preliminary dimension reduction analyses suggested that psychosis-risk symptoms may deviate from the traditional symptom structure of schizophrenia, but findings have been inconsistent. A painting and a poem? Page 33 G.1 Sleep Disturbance………………………………………….……………………….. Preoccupying, distressing. N NI Y (Record Response) 2. Prodromal Questionnaire (PQ) and Structured Interview for Prodromal Syndromes (SIPS) have been used as a two-stage process for identifying subjects at clinical high risk (CHR) of psychosis. Uses simple words and sentence structure without many modifiers. Ruling out a current psychosis requires the questioning of and rating on the five Positive Symptom items outlined in the measure: Unusual Thought Content/Delusions, Suspiciousness, Grandiosity, Perceptual Abnormalities/Hallucinations, and Disorganized Speech. lian description of prodromal types, a diagnostic semi-structured interview, the Structured Interview for Prodromal Symptoms (SIPS), and a severity scale, the scale of Prodromal Symptoms (SOPS), have been designed to define, diagnose, and measure change systematically in individuals who may be in a pre-psy-chotic state (21). Methods: SOPS data of 77 help-seeking patients at UHR for psychosis were analyzed with an exploratory factor analysis. Disorganized Communication (p. 20) 0 1 2 3 4 5 6 Negative, Disorganized, General Symptom Scale 0 Absent1 Questionably Present2 Mild3 Moderate4 Moderately Severe5 Severe6 Extreme Negative Symptoms N1. MOTOR DISTURBANCES General Symptom Scale 0 Absent1 Questionably Present2 Mild3 Moderate4 Moderately Severe5 Severe 6 ExtremeAwkward.Reported or observed clumsiness.Poor coordination. Flat, constricted, diminished emotional responsiveness as characterized by a decrease in expression, modulation of feelings (e.g. Recurrent (yet unfounded) sense that people might be thinking or saying negative things about person..Thoughts of being the object of negative attention. Sudden pauses. It is not necessary to meet every criterion in any one anchor to assign a particular rating. Global assessment of functioning: A modified scale, Psychosomatics, 36, 267-275. the patient and the caregiver. Confused, muddled, racing or slowed down speech, using the wrong words, talking about things irrelevant to context or going off track. Page 18 N. NEGATIVE SYMPTOMS………………………………………………………….. an occasional argument with family members) A person with no symptoms or everyday problems = rating 88-90 A person with minimal symptoms or everyday problems = rating 84-87 A person with minimal symptoms and everyday problems = rating 81-83 SOME TRANSIENT SYMPTOMS: 80 - 71Mild symptoms are present, but they are transient and expectable reactions to psychosocial stressors (e.g. Rating based on: Symptom Onset (for symptoms rated at a level 3 or higher)Record date when the earliest symptom first occurred: ( Entire lifetime or “ever since I can remember” ( Cannot be determined ( Date of onset ________________/_______ Month Year N. 6. IMPAIRMENT IN PERSONAL HYGIENE Disorganization Symptom Scale 0 Absent1 Questionably Present2 Mild3 Moderate4 Moderately Severe5 Severe 6 ExtremeLow attention to personal hygiene, but still concerned with appearances.Low attention to personal hygiene and little concern with physical or social appearance, but still within bounds of convention and/or subculture.Indifference to conventional and/or subcultural conventions of dress and social cues.Neglect of social or subcultural norms of hygiene. Listening? very few or no friends, or avoids what friends s/he has) Serious impairment in relationships with family (e.g. Has anyone pointed out to you that you are less emotional or connected to people than you used to be? N NI Y (Record Response) 2. The sole exception is for schizotypal personality disorder: Positive symptoms that are worsening are always rated as NOT better explained by the disorder. There is some difficulty in directing sentences toward a goal. In medicine, a prodrome is an early sign or symptom (or set of signs and symptoms) that often indicates the onset of a disease before more diagnostically specific signs and symptoms develop. DISORGANIZED COMMUNICATION Severity Scale (circle one) 0 Absent1 Questionably Present2 Mild3 Moderate4 Moderately Severe5 Severe but Not Psychotic6 Severe and PsychoticOccasional word or phrase doesn’t make sense.Speech that is slightly vague, muddled, overelaborate or stereotyped.Incorrect words, irrelevant topics. N NI Y (Record Response) For all responses, record: description, onset, duration, and change over time. Preliminary dimension reduction analyses suggested that psychosis‐risk symptoms may deviate from the traditional symptom structure of schizophrenia, but findings have been inconsistent. Basis for ratings includes interviewer observations and patient reports. Vague, metaphorical overelaborate, stereotyped. Health-seeking behaviour and prehospital care were determined by questionnaires. Reading? What is it? Basis for ratings includes both interviewer observations and patient reports. Difficulty directing sentences toward a goal. b. N NI Y (Record Qualifiers) 6. 1 . The development of a new movement such as a nervous habit, stereotypes, characteristic ways of doing something, posture, or copying other peoples’ movements (echopraxia). Psychosis risk screening with the Prodromal Questionnaire — Brief Version (PQ-B) Rachel L. Loewya,⁎, Rahel Pearsona, Sophia Vinogradova,b, Carrie E. Beardenc,d, Tyrone D. Cannonc,d a Department of Psychiatry, University of California at San Francisco, San Francisco, CA, United States b San Francisco Department of Veteran's Affairs Medical Center, San Francisco, CA, United States P. 5. EXPERIENCE OF EMOTIONS AND SELF Negative Symptom Scale 0 Absent1 Questionably Present2 Mild3 Moderate4 Moderately Severe5 Severe 6 ExtremeFeeling distant from others. INTRODUCTION: We conduct an exploratory factor analysis with the Scale of Prodromal Symptoms (SOPS) items, to determine its psychometric characteristics and construct validity, as well as we analyze criterion or predictive validity of its clinical subscales in the conversion of high mental risk subjects from prodrome to psychosis in a 1 year follow-up period. Distracting, bothersome. Ƹ dğ ¤ $ a$ $ „À„°^„À`„°a$ $a$ – µ ¶ k r ¤ « × Ø ' ½ À õ ö ÷ ù ù ô â Ó Á Ó ± « ¡ � Ó Š ˆ ˆ N NI Y (Record Qualifiers) 2. It is not necessary to meet every criterion in any one anchor to assign a particular rating. The core symptoms of psychosis—delusions, hallucinations, and thought disorders—are not unique to the disorder traditionally called schizophrenia. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Do you seem to feel more sensitive to light or do things that you see ever N NI Y (Record Qualifiers) appear different in color, brightness or dullness; or have they changed in some other way? The symptoms of the psychosis prodrome and the symptoms of SPD are similar on a cross-sectional basis. Basis for ratings includes both interviewer observations and patient reports. Do you think this is real? The SOPS is used independently to determine the severity of the prodromal state once such a state has been diagnosed. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self Does the patient meet criteria for DSM IV - Schizotypal Personality Disorder? An apple and a banana? Include participation in special education programs. II. What has your mood been like recently? hùSÕ CJ( j hùSÕ UhùSÕ - : K L N P Q R S T U V W X Z [ \ ] ^ _ ı û û û î â Ø û û û û û û Î û û û û û û û û û û Inhuman? Please check your email for instructions on resetting your password. Have you felt that you are not in control of your own ideas or thoughts? Mistrustful. the study did not include criteria assessing prodromal symptoms or classifications. P. 4. e. Difficulty concentrating. Other? This study examines the ability of the Scale of Prodromal Symptoms (SOPS) to differentiate between negative and depression symptoms in a young help-seeking ultrahigh risk (UHR) group. The 16-item Version of the Prodromal Questionnaire (PQ-16) If TRUE: how much distress did you experience? Do you ever feel as if somehow thoughts are put into your head or taken away from you? After a rating is assigned, provide a brief description of the symptom(s) and the rationale for assigning the specific rating. Similarly, physical symptoms, including constipation, hyposmia and postural dizziness, have been described to appear years before memory loss in prodromal DLB [7]. Do familiar people or surroundings ever seem strange? being superstitious, belief in clairvoyance, uncommon religious beliefs). psychiatric symptoms, such as visual hallucinations, RBD, depression, anxiety and delirium, can be present very early and prior to the onset of memory impairment in DLB [6–8]. severe anorexia or bulimia with heart/kidney problems, or spontaneous vomiting WHENEVER food is ingested, or severe depression with out-of-control diabetes) A person with 1-2 of the 6 areas of disturbance in this category = rating 8-10 A person with 3-4 of the 6 areas of disturbance in this category = rating 4-7 A person with 5-6 of the 6 areas of disturbance in this category = rating 1-3Global Assessment of Functioning (cont’d) Adapted from: Hall, R. (1995). Current psychosis is defined by the presence of Positive Symptoms. Do you think this is real? Exaggerated self-opinion and unrealistic sense of superiority. b. 3+ G+ }Q Q Q Q Q Q Q $ „T ¶ :W ¬ £Q ± $ S+ k* š + S+ S+ £Q D D �' �' Û TR ™6 ™6 ™6 S+ D   �' $ �' }Q ™6 S+ }Q ™6 ™6 j O ¼ ä @ =Q �' ÿÿÿÿ °Êğ³=Ñ ÿÿÿÿ [- ÙP 2 iQ jR 0 šR Q 2 æW w6 " æW d =Q æW $ =Q , S+ S+ ™6 S+ S+ S+ S+ S+ £Q £Q ™6 S+ S+ S+ šR S+ S+ S+ S+ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ æW S+ S+ S+ S+ S+ S+ S+ S+ S+ Ì > No bathing and has developed an odor. (6). Questions that are not printed in boldface are optional and can be included for clarification or elaboration of positive responses. It is not necessary to meet every criterion in any one anchor to assign a particular rating. Do you ever feel as if your thoughts are being said out loud so that other people can hear them? There is no standard tool for measuring the symptoms of the bipolar prodrome, which has limited progress toward early identification. It is not necessary to meet every criterion in any one anchor to assign a particular rating. May avoid eye contact.Starting and maintaining conversation requires direct and sustained questioning by the interviewer. DSM IV - Schizotypal Personality Disorder: A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior. Does having the experience ever cause you to do anything differently? They occur at the early stages of various brain diseases, too. ACSs are the leading cause of death worldwide. Page 38 Schizotypal Personality Disorder Criteria……………………….. Severity of prodromal symptoms is rated using an ordinal scale, as follows: 0 = absent, 1 = mild, 2 = moderate, and 3 = severe. N NI Y (Record Qualifiers) If so, what are these ideas or beliefs? ( Degree of Conviction/Meaning: How do you account for this experience? Do you ever feel like you are being singled out or watched? Anchors in each scale are intended to provide guidelines and examples of signs for every symptom observed. N NI Y (Record Qualifiers) 3. Minimal interpersonal empathy. Impairment in the use of the abstract-symbolic mode of thinking, as evidenced by difficulty in classification, forming generalizations, and proceeding beyond concrete or egocentric thinking in problem-solving tasks; often utilizes a concrete mode. Do you ever feel people might be intending to harm you? G. 3. If you have this type of prodrome, you may have symptoms like APS, but they come and go. Mental events such as thought insertion/interference/withdrawal/broadcasting/ telepathy/external control/radio and TV messages. Under Better Explained, also rate for positive symptoms whether the symptom is better explained by an Axis I or Axis II disorder. Posturing. Prodromal Assessment with the Structured Interview for Prodromal Syndromes and the Scale of Prodromal Symptoms: Predictive Validity, Interrater Reliability, and Training to Reliability By Tandy J. Miller, Thomas H. McGlashan, Joanna L. Rosen, Kristen Cadenhead, Joseph Ventura, William McFarlane, Diana Perkins, Godfrey D. Pearlson and Scott W. Woods Have you been feeling more sensitive to sounds? Having difficulty falling asleep. Patients not meeting criteria for a past or current psychosis are evaluated on the Criteria of Psychosis-risk Syndromes (COPS) for the presence of one or more of the three psychosis-risk syndromes: Brief Intermittent Psychotic Syndrome, Attenuated Positive Symptom Syndrome, and Genetic Risk and Deterioration Syndrome. Have you ever found yourself feeling mistrustful or suspicious of other people? Ideas of reference (excluding delusions of reference) b. BIZARRE THINKING Disorganization Symptom Scale 0 Absent1 Questionably Present2 Mild3 Moderate4 Moderately Severe5 Severe 6 Extreme “Quirky” ideas that are easily abandoned.Unusual ideas, illogical or distorted thinking.Unusual ideas, illogical or distorted thoughts that are held as a belief or philosophical system within the realm of subcultural variation.Unusual ideas or illogical thinking that is embraced but which violates the boundary of most conventional religious or philosophical thoughts.Strange ideas that are difficult to understand.Thoughts that are fantastic, patently absurd, fragmented, and impossible to understand.Rating based on: Symptom Onset (for symptoms rated at a level 3 or higher)Record date when the earliest symptom first occurred: ( Entire lifetime or “ever since I can remember” ( Cannot be determined ( Date of onset ________________/_______ Month Year D. 3. unable to keep a job or stay in school, or failing school, or unable to care for family and house) Frequent problems with the law (e.g. Socially apathetic. Brief Intermittent Psychotic Symptom Psychosis-Risk SyndromeYesNo1.Are any of the SOPS P1-P5 Scales scored 6?2.If Yes to 1, have the symptoms reached a psychotic level of intensity in the past three months?3.If Yes to 1 and 2, are the symptoms currently present for at least several minutes per day at a frequency of at least once per month?4.Are all otherwise qualifying symptoms better explained by another DSM-IV disorder (Axis 1 or 2)?If 1-3 are Yes and 4 is No, the subject meets criteria for Brief Intermittent Psychotic Syndrome. Some superstitions beyond what might be expected by the average person but within cultural norms.Unanticipated mental events that are puzzling, unwilled, but not easily ignored. Second, the symptom must occur at the current intensity level at an average frequency of at least once per week in the past month. c. Trouble with short-term memory including holding conversation in memory. 2 . Do you ever hear unusual sounds like banging, clicking, hissing, clapping, ringing in your ears? G. 2. May exhibit some inappropriate behavior.Behavior or appearance, that is unconventional by most standards. This study describes (1) the prevalence and association of PS with patients’ baseline ACS-related acute symptoms of pain intensity and state anxiety and (2) the relationship of PS to co-morbidity. They are rated on the SOPS P2 Scale at the end of the queries. SLEEP DISTURBANCE INQUIRY: 1. D. 1. If a Positive Symptom also satisfies the (B) criterion, a current psychosis is defined. Do you think this is real? Affects functioning.Delusions of grandiosity with conviction (no doubt) at least intermittently Interferes persistently with thinking, feeling, social relations, or behavior.Rating based on: For Symptoms Rated at Level 3 or HigherSymptom OnsetSymptom WorseningSymptom FrequencyBetter ExplainedRecord date when a positive symptom first reached at least a 3: ( “Ever since I can recall” ( Date of onset ___/___ Month/YearRecord most recent date when a positive symptom currently rated 3-6 experienced an increase by at least one rating point: Date of worsening ___/___ Month/YearCheck all that apply: ( e" 1 h / d , e" 4 d / w k ( e" s e v e r a l m i n u t e s / d , e" 1 x / m o ( e" 1 x / w k ( n o n e o f a b o v e S y m p t o m s a r e b e t t e r e x p l a i n e d b y a n o t h e r A x i s I o r I I d i s o r d e r . Are you failing any classes or considering dropping out of school? Do you ever feel your eyes are playing tricks on you? (Does it bother you?) Record Response 3. May miss some abstract comments. Page 20 N.1 Social Anhedonia……………………………………………………………………. Anchors in each scale are intended to provide guidelines and examples of signs for every symptom observed. The duration of prodromal symptoms and psychotic symp-toms were 5.63±4.53 yr and 0.82±1.07 yr, respectively. RESULTS The mean age of the study population was 24.66±5.62 yr. Do you ever feel that it could just be in your head? ( Degree of Conviction/Meaning: How do you account for this experience? Diminished conversa-tional give and take.Correctly interprets most similarities and proverbs. Do you ever feel that it could just be in your head? It therefore might be useful for the prediction of the disorder, especially if it is further refined to select those items with particularly high prognostic accuracy. Do you find yourself feeling irritable a lot of the time? Brief intermittent psychosis prodromal syndrome (BIPS). It is not necessary to meet every criterion in any one anchor to assign a particular rating. Anchors in each scale are intended to provide guidelines and examples of signs for every symptom observed. Rate the current severity of the psychosis-risk symptoms I. When is the last time you went shopping for new clothes? Record Response What do you usually do with your free time? Basis for ratings includes both interviewer observations and patient reports. cant prodromal period.56 It appears as if the nonspecific symptoms and negative symptoms usually develop first and then attenuated positive symptoms.2 Although most individuals with schizophrenia have experienced a prodromal period, it is less clear how many of those who experience prodromal symptoms will subsequently develop a psychotic illness. Both scales are listed below. DYSPHORIC MOOD General Symptom Scale 0 Absent1 Questionably Present2 Mild3 Moderate4 Moderately Severe5 Severe 6 ExtremeFeeling “down” or edgy often.Occasional unstable and/or unpredictable periods of sad, bad, or dark feelings that may be a mixture of depression, irritability, or anxiety.Feelings like the “blues” or other anxieties or discontents have “settled in.”Recurrent periods of sadness, irritability, or depression.Persistent unpleasant mixtures of depression, irritability or anxiety. It is not necessary to meet every criterion in any one anchor to assign a particular rating. As such, its diagnosis is delayed, as other causes need to be ruled out first, and this needs to be carefully done to avoid any unnecessary stigma of such diseases [17] . N NI Y (Record Response) For all responses, record: description, onset, duration, and change over time. 2003;29(4):703-15. 3. SCALE OF PSYCHOSIS-RISK SYMPTOMS (SOPS) INSTRUCTIONS FOR USING THE RATING SCALES: The SOPS describes and rates psychosis-risk and other symptoms that have occurred in the past month (or since the last rating if more recently). III. Like a spectator in your own life? Unusual Thought Content/Delusional Ideas (p. 11) 0 1 2 3 4 5 6 P2. prodromal syndrome and psychotic syndrome diagnoses on the SIPS versus those with no SIPS diagnoses with 89% sensitivity, 58% specificity, and a positive Likelihood Ratio of 2.12. Yes___ No___ P. POSITIVE SYMPTOMS P. 1. They showed reasonable internal consistency and good convergence validity, and were not orthogonal. Preliminary dimension reduction analyses suggested that psychosis‐risk symptoms may deviate from the traditional symptom structure of schizophrenia, but findings have been inconsistent. N NI Y (Record Response) 7. Fourth, the diagnosis of psychotic disorders is by exclusion. Most psychotic episodes will be preceded by a prodromal period, however the nature and … Do you ever feel a loss of sense of self or feel disconnected from yourself or your life? Does having the experience ever cause you to do anything differently? Captures attention, frightening. The qualifier box is listed below: QUALIFIERS: For all “Y” responses, record: ( Description-Onset-Duration-Frequency ( Degree of Distress: What is this experience like for you? Does having the experience ever cause you to do anything differently? What do you do with them? Thus, prodromal symptoms are not deterministic from a prospective point of view, and considerable re-search is directed toward identifying which patients with prodromal symptoms will later develop schizophrenia. Have you had trouble remembering things? Have you felt more nervous, anxious lately? C h e c k o n e : ( L i k e l y ( N o t l i k e l y N . G.1. mild or lessened depression and/or mild insomnia) Some persistent difficulty in social, occupational, or school functioning (e.g. Decreased fluidity, spontaneity, and flexibility of thinking, as evidenced in repetitious, or simple thought content. temporarily falling behind in school or work) A person with EITHER mild symptom(s) OR mild impairment in social, work, or school functioning = rating 78-80 A person with mild impairment in more than 1 area of social, work, or school functioning = rating 74-77 A person with BOTH mild symptoms AND slight impairment in social, work, and school functioning = rating 71-73SOME PERSISTENT MILD SYMPTOMS: 70 - 61Mild symptoms are present that are NOT just expectable reactions to psychosocial stressors (e.g. Do you ever feel that you have to pay close attention to what's going on around you in order to feel safe? Data from the Scale of Prodromal Symptoms (SOPS) [Early Intervention in Psychotic Disorders, pp. Have you ever been depressed? Motor Disturbances (p. 33) 0 1 2 3 4 5 6 G4. Does having the experience ever cause you to do anything differently? Have you ever attempted suicide? Does having the experience ever cause you to do anything differently? They are rated on the SOPS P5 Scale. For those first-degree relatives who have a history of mental illness: Name of relativeName of problemSymptomsDurationTreatment history 3. (include time to bed, to sleep, and to awake, hours of sleep in a 24-hour period, difficulty falling asleep, early awakening, day/night reversal). b. Proverbs – “What does this saying mean?” A ball and an orange? SOMATIC DISTORTIONS, ILLUSIONS, HALLUCINATIONS INQUIRY: 1. AVOLITION Negative Symptom Scale 0 Absent1 Questionably Present2 Mild3 Moderate4 Moderately Severe5 Severe 6 ExtremeFocus on goal-directed activities but less than what would be considered average.Low drive or energy level. N NI Y (Record Qualifiers) 3. 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