Screening for low prevalence disorders.
OBJECTIVE
To examine the epidemiologic theory of screening as it applies to low prevalence disorders, such as schizophrenia, in order to identify the tasks required for primary and secondary prevention.


METHODS
Review of principles of screening, computation of prevented fraction for varying sensitivities, specificities and prevalences of disease, and review of prevalence of schizophrenia in Australian general practice.


RESULTS
There is no currently available efficient method of screening for schizophrenia or for prodromal symptoms. From the genesis of disease to eventual outcome, the milestones that are passed in the case of schizophrenia are uncertain in their nature and the intervening time periods are of uncertain and possibly varying duration. The extent of false positives and negatives in low prevalence disorders is high unless the specificity is very high.


CONCLUSIONS
It may be feasible to screen for behaviours that are precursors to schizophrenia; however, screening depends upon the existence of a reliable screening instrument that can be shown to discriminate accurately between diseased and disease-free individuals. Development of a method for screening requires comparison against formal clinical assessment of both screen positives and screen negatives. For low prevalence disorders the predictive values may be low unless specificity is high.
O'Toole
B I
BI
Centre for General Practice Integration Studies, School of Community Medicine, University of New South Wales, Sydney, Australia. B.Otoole@unsw.edu.au
D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008403:Mass Screening; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control