Objective Time constraints limit the use of measurement-based approaches in research and routine clinical management of psychosis. Computerized adaptive testing (CAT) can reduce administration time, thus increasing measurement efficiency. This study aimed to develop and test the capacity of the CAT-Psychosis battery, both self-administered and rater-administered, to measure the severity of psychotic symptoms and discriminate psychosis from healthy controls. Methods An item bank was developed and calibrated. Two raters administered CAT-Psychosis for inter-rater reliability (IRR). Subjects rated themselves and were retested within 7 days for test-retest reliability. The Brief Psychiatric Rating Scale (BPRS) was administered for convergent validity and chart diagnosis, and the Structured Clinical Interview (SCID) was used to test psychosis discriminant validity. Results Development and calibration study included 649 psychotic patients. Simulations revealed a correlation of r = .92 with the total 73-item bank score, using an average of 12 items. Validation study included 160 additional patients and 40 healthy controls. CAT-Psychosis showed convergent validity (clinician: r = 0.690; 95% confidence interval [95% CI]: 0.610–0.757; self-report: r = .690; 95% CI: 0.609–0.756), IRR (intraclass correlation coefficient [ICC] = 0.733; 95% CI: 0.611–0.828), and test-retest reliability (clinician ICC = 0.862; 95% CI: 0.767–0.922; self-report ICC = 0.815; 95%CI: 0.741–0.871). CAT-Psychosis could discriminate psychosis from healthy controls (clinician: area under the receiver operating characteristic curve [AUC] = 0.965, 95% CI: 0.945–0.984; self-report AUC = 0.850, 95% CI: 0.807–0.894). The median length of the clinician-administered assessment was 5 minutes (interquartile range [IQR]: 3:23–8:29 min) and 1 minute, 20 seconds (IQR: 0:57–2:09 min) for the self-report. Conclusion CAT-Psychosis can quickly and reliably assess the severity of psychosis and discriminate psychotic patients from healthy controls, creating an opportunity for frequent remote assessment and patient/population-level follow-up.

This study showed that serum uric acid was lower in oral cancer patients compared with healthy volunteers and low serum uric acid was associated with increased risk of oral cancer development.

Background Medication nonadherence is prevalent in severe mental illness and is associated with multiple negative outcomes. Mobile technology and financial incentives show promise to improve medication adherence; however, studies in mental health, especially with oral medications, are lacking. Objective The aim of this paper is to assess the feasibility and effectiveness of offering financial incentives through a mobile app based on behavioral economics principles to improve medication adherence in severe mental illness. Methods A 10-week, single-arm longitudinal pilot study was conducted. Patients earned rewards in the context of app-based adherence incentives. The reward was split into biweekly payments made in increments of US $15, minus any US $2 per day penalties for missed check-ins. Time-varying effect modeling was used to summarize the patients’ response during the study. Results A total of 25 patients were enrolled in this pilot study, of which 72% (n=18) were female, and 48% (n=12) were of a White racial background. Median age was 24 (Q1-Q3: 20.5-30) years. Participants were more frequently diagnosed with schizophrenia and related disorders (n=9, 36%), followed by major depressive disorder (n=8, 32%). App engagement and medication adherence in the first 2 weeks were higher than in the last 8 weeks of the study. At study endpoint, app engagement remained high (n=24, Z=–3.17; P<.001), but medication adherence was not different from baseline (n=24, Z=–0.59; P=.28). Conclusions Financial incentives were effectively delivered using an app and led to high engagement throughout the study and a significantly increased medication adherence for 2 weeks. Leveraging behavioral economics and mobile health technology can increase medication adherence in the short term. Trial Registration ClinicalTrials.gov NCT04191876; https://clinicaltrials.gov/ct2/show/NCT04191876

Background Time constraints limit the use of measurement-based approaches in the routine clinical management of schizophrenia. Computerized Adaptive Testing (CAT) uses computational algorithms (item response theory - IRT) to match individual subjects with only the most relevant questions for them, reducing administration time and increasing measurement efficiency and scalability. This study aimed to test the psychometric properties of the newly developed CAT-Psychosis battery, both self-administered and rater-administered versions. Methods Patients rated themselves with the self-administered CAT-Psychosis which yields a current psychotic severity score. The CAT-Psychosis is based on a multidimensional extension of traditional IRT-based CAT that is suitable for complex traits and disorders such as psychosis. Two different raters independently conducted the rater-administered CAT-Psychosis to test inter-rater reliability (IRR). The Brief Psychiatric Rating Scale (BPRS) was administered to test convergent validity. Subjects were re-tested within 7 days to assess test-retest reliability. Generalized linear mixed models and Pearson product moment correlation coefficients were used to test for correlations between individual ratings and average CAT-Psychosis severity scores respectively and the BPRS. Intraclass correlation coefficients (ICCs) were used to test for reliability. Generalized linear and non-linear (logistic) mixed models were used to estimate diagnostic discrimination capacity (lifetime ratings) and to estimate diagnostic sensitivity, specificity and area under the ROC curve with 10-fold cross validation. Results 135 subjects with psychosis and 25 healthy controls were included in the study. Mean age of the sample was 33.1 years, standard deviation (SD)=12.2years; 62% were males. No significant differences were detected between groups (p=0.9064 and p=0.2684 respectively). Mean length of assessment was 7 minutes and 9 seconds (SD: 5:04min) for the clinician-administered version and 1 minute and 49 seconds (SD: 1:35min) for the self-administered version, averaging 11.4 and 12.6 questions each. Convergent validity against BPRS was moderate for both rater-administered (r=0.65 (0.55–0.73); Marginal Maximum Likelihood Estimation (MMLE)=0.052, Standard Error (SE)=0.005, p&lt;0.00001) and self-administered (r=0.66; MMLE=0.057, SE=0.005, p&lt;0.00001) versions. Clinician version’s IRR was strong (ICC=0.67 (Confidence Interval (CI): 0.51–0.80)), and test-retest reliability was strong for both self-report (ICC=0.83 (CI: 0.76–0.87) and clinician (ICC=0.87 (CI: 0.75–0.94) version. The CAT-Psychosis clinician version was able to discriminate psychosis vs. healthy controls (Area Under the ROC Curve (AUC)=0.96 (CI: 0.90–0.97)). CAT-Psychosis self-report yielded similar results (AUC= 0.85 (CI: 0.77–0.88)). Discussion CAT-Psychosis provides valid severity ratings that mirror BPRS total scores, even as a self-report, yielding a dramatic reduction in administration time, while maintaining reliable psychometric properties. Furthermore, CAT-Psychosis, both clinician and self-report versions, is able to reliably discriminate psychotic patients based on a lifetime diagnosis from healthy controls after a brief assessment of current symptomatology.