Das Basler Interview für Psychosen (BIP): Struktur, Reliabilität und Validität

Zusammenfassung

Hintergrund: Obwohl in den letzten Jahren zahlreiche Instrumente entwickelt worden sind, um Psychoserisikopersonen und Psychoseersterkrankte zu identifizieren, gab es bisher keine geeigneten Instrumente, um solche Personen ausführlicher über ihren Krankheitsverlauf sowie die Risikofaktoren und frühen Indikatoren der Erkrankung zu befragen. Wir haben deshalb das Basler Interview für Psychosen (BIP) entwickelt. Ziel der vorliegenden Arbeit ist es, die Entwicklung und den Aufbau des BIP zu beschreiben sowie über seine psychometrischen Eigenschaften zu berichten.

Methoden: Das BIP ist ein halbstrukturiertes klinisches Anamneseinterview, das im Rahmen des Basler Projekts zur Früherkennung von Psychosen (FePsy) auf der Basis der wichtigsten in der Literatur beschriebenen Risikofaktoren und Indikatoren für Psychosen und unter Berücksichtigung schon existierender Fragebögen entwickelt wurde. Es gliedert sich in sechs Bereiche: 1. Soziale und körperliche Entwicklung/Familie, 2. Anzeichen und Symptome, 3. Vulnerabilität, 4. Hilfesucheverhalten, 5. Krankheitseinsicht, 6. Interviewereinschätzung. Um die Interrater-Reliabilität der Items der Abschnitte 2 und 3 zu bestimmen, wurden 20 Patienten von insgesamt 8 unterschiedlichen Ratern beurteilt. Die faktorielle Struktur des Abschnitts 2.3 „Prodromi und Symptome“ wurde in einer Stichprobe von 120 Psychoserisikopersonen und 77 Erstpsychosepatienten untersucht. Auf der Basis der gefundenen Faktorstruktur wurden neue Skalen gebildet und auf ihre Reliabilität und Validität untersucht.

Ergebnisse: Von 153 untersuchten Items der Abschnitte 2 und 3 wurden 150 (98 %) mit ausreichend hoher Übereinstimmung (Interrater-Reliabilität > 0,4) eingeschätzt. Die Items des Abschnitts 2.3 „Prodromi und Symptome“ konnten zu 5 Subskalen gruppiert werden. Die Subskalen wiesen überwiegend gute bis sehr gute interne Konsistenzen, Homogenitäten und diskriminante und konvergente Validitäten auf. Für die Subskalen „Positive psychotische Symptome“ und „Störungen des Denkens“ sowie den Gesamtscore konnte zudem eine prädiktive Validität nachgewiesen werden.

Diskussion: Mit dem BIP haben wir erstmals ein halbstrukturiertes klinisches Anamneseinterview konstruiert und validiert, das geeignet ist, Psychoserisikopatienten und Psychoseersterkrankte detailliert über Psychoserisikofaktoren und -indikatoren sowie den psychopathologischen Verlauf seit der Kindheit zu befragen. Wir konnten zeigen, dass das BIP hervorragende psychometrische Eigenschaften aufweist.

Abstract

Background: Although several instruments have been developed to identify patients with an at-risk mental state (ARMS) for psychosis and first episode of psychosis (FEP), up to now there were no instruments for a detailed assessment of risk factors and indicators of emerging psychosis and the temporal development of psychiatric symptoms over the whole life span in these patients. We therefore developed the Basle Interview for Psychosis (BIP). The aim of this study is to describe the development of the BIP and to report about its psychometric properties.

Methods: The BIP is a comprehensive semi-structured interview that was developed for the Basel early detection of psychoses (FePsy) study. Its items were derived from the most important risk factors and indicators of psychosis described in the literature and from several existing instruments. It contains the following six sections: 1) social and physical development and family, 2) signs and symptoms, 3) vulnerability, 4) help-seeking behavior, 5) illness insight, 6) evaluation of the interview. To estimate the inter-rater reliabilities of the items of sections 2 and 3, 20 interviews were conducted and rated by 8 well-trained raters. The factorial structure of the BIP section “signs and symptoms” was explored in a sample of 120 ARMS and 77 FEP patients. On the basis of the discovered factorial structure, we created new subscales and assessed their reliabilities and validities.

Results: Of the 153 studied items of sections 2 and 3, 150 (98 %) were rated with sufficiently high agreement (inter-rater reliability > 0.4). The items of section “signs and symptoms” could be grouped into 5 subscales with predominantly good to very good internal consistencies, homogeneities, and discriminant and convergent validities. Predictive validities could be demonstrated for the subscales “Positive Psychotic Symptoms”, “Disturbance of Thinking” and the total score.

Discussion: The BIP is the first interview for comprehensively assessing risk factors and indicators of emerging psychosis and the temporal development of psychiatric symptoms over the whole life span, which has been validated in ARMS and FEP patients. We could show that the BIP has excellent psychometric properties.

Schlüsselwörter

Klinisches Interview - Psychose - Schizophrenie - Früherkennung

Key words

clinical interview - psychosis - schizophrenia - early detection

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