Bipolar and Schizophrenia Disorders Accurately Predicted With WERCAP Sections

The Hand-Foot and Mucositic Symptom and Impact Questionnaire (HAMSIQ) may be a feasible instrument.
The Hand-Foot and Mucositic Symptom and Impact Questionnaire (HAMSIQ) may be a feasible instrument.
By using the Washington Early Recognition Center Affectivity and Psychosis (WERCAP) questionnaire, investigators accurately predicted bipolar disorder or schizophrenia in more than 85% of patients.

Both the affective and psychosis sections of an assessment typically used to identify clinical risk for bipolar disorder or schizophrenia appear to predict the early stages of either illness, found a new study.

On the self-report Washington Early Recognition Center Affectivity and Psychosis (WERCAP), initially designed to assess chronic or lifetime symptoms of bipolar disorder and schizophrenia, a score greater than 20 on the affective section and a score greater than 13 on the psychosis section appeared to predict the diagnosis of already identified patients.

Christina Hseih and her colleagues at St. Louis University School of Medicine in Missouri gave the WERCAP, the WERC Stress Screen and the WERC Substance Screen to 35 patients with bipolar disorder, 34 patients with schizophrenia, and 32 typical, healthy control participants, all ages 18 to 30. The participants had been recruited from clinic referrals, community flyers, and university websites.

A correct diagnosis was correctly predicted in 89.1% of participants using a combination of the WERCAP, Stress Screen and number of substances, but only the affective and psychosis WERCAP scores accurately predicted diagnosis categories. Overall, study authors accurately predicted 85.7% of bipolar patients, 88.2% of schizophrenia patients, and 93.8% of control participants.

The scores across the three groups revealed significant differences for stress severity on the WERC Stress Screen, and for both the psychosis and affective sections of the WERCAP. Significant differences across groups appeared for the WERC Substance Screen results. Only the WERCAP affective and psychosis sections, however, significantly predicted individuals’ diagnoses. 

Stress severity scores did not significantly differ between bipolar and schizophrenia groups or between schizophrenia and control groups. However, the Stress Screen “may be a useful tool for schools and clinics in monitoring at-risk individuals to prevent onset or relapse,” the authors noted, since “index manic and psychotic episodes are often preceded by an increase in stressful life events.”

Using a cutoff score of 20 on the WERCAP affective section had a sensitivity of 91% and a specificity of 71% for bipolar diagnosis; the psychosis WERCAP score did not significantly predict bipolar disorder. Similarly, the affective WERCAP score did not significantly predict schizophrenia, but a cutoff score of 13 on this section had a sensitivity of 88% and a specificity of 82% for schizophrenia.

The study was limited by its small sample size of already diagnosed patients and potentially by the significant differences between groups that appeared with gender and ethnicity. Although affective scores did not differ between males and females, males had statistically significant higher psychotic symptoms than did the females.

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Hsieh CJ, Godwin D, Mamah D. Utility of Washington Early Recognition Center Self-Report Screening Questionnaires in the Assessment of Patients with Schizophrenia and Bipolar Disorder. Front Psychiatry. 2016;7:149.