Identification of young people at "Ultra-High Risk" (UHR) of developing psychosis: Validation of the "Checklist per la valutazione dell'Esordio Psicotico" for use in primary care setting

Objective: The study aims to establish the concordant validity of the "Checklist per la valutazione dell'Esordio Psicotico" (CVEP) in an Italian help-seeking population. The CVEP is the Italian adaptation of the early detection Primary Care Checklist (PCCL), a 20 item tool specifically designed to assist primary care practitioners in identifying young people in the early stages of psychosis. Materials and Methods: The checklist was completed by the referring practitioners of 102 young people referred to the "Reggio Emilia At Risk Mental States" Project (ReARMS) in the Reggio Emilia Department of Mental Health and Addiction. The concordant validity of the CVEP was established by comparing screen results with the outcome of the Comprehensive Assessment of At Risk Mental States (CAARMS), a gold standard assessment for identifying young people who may be at risk of developing psychosis. Results: The simple checklist as originally conceived had excellent sensitivity (97.9%), but lower specificity (55.6%). Using only a CVEP total score of 20 or above as cut-off, the tool showed a substantial improvement in specificity (87%). Simple crosstabulations of the individual CVEP item scores against CAARMS outcome to identify the more discriminant items in terms of sensitivity and specificity were carried out. Conclusions: In comparison to other much longer screening tools, the CVEP performed well to identify young people in the early stages of psychosis. Therefore, the CVEP is well suited to optimize appropriate referrals to specialist services, building on the skill and knowledge already available in primary care settings.