For example, an ICC of 0.9 requires 111 patients compared with 200 patients if the ICC is 0.5 in order to achieve the same statistical power.80 The way that raters are trained and the manner in which reliability- is established varies. In fact, true interrater reliability is rarely established in multicenter clinical trials. Specifically, having Inhibitors,research,lifescience,medical prospective interviewers only rate videotaped assessments performed by an expert does

not establish the kind of reliability that is necessary. Even high ICCs with the expert rater do not in any way establish the ability of the rater to elicit the same symptoms when conducting an independent interview that he/she was able to rate when being fed the patient responses Inhibitors,research,lifescience,medical in an idealized training tape. Moreover, the method of rating even taped interviews is not usually standardized, so that it is not clear to what degree ratings occur completely independent in the classroom. In addition, a sufficient number of such assessments to establish statistical correlations is rarely done. Furthermore, even if reliability

was established for both the interview and the rating, rater drift needs to be countered by reassessing the reliability of the ratings periodically throughout the trial, as well as training Inhibitors,research,lifescience,medical new raters when there is staff turnover. Other methods of increasing precision of ratings include comparing similar SCR7 outcome dimensions across different assessment scales (ie, convergent validity) or checking rater-assessed outcomes against patient reported outcomes or against Inhibitors,research,lifescience,medical the evaluation of quality control by remote expert raters (ie, external consistency). In case of obvious inconsistencies, raters can then be approached and simply be given feedback or they can

be retrained. However, even though expert raters can be used to check or adjudicate site based ratings, they have to rely on the interviews that may be Inhibitors,research,lifescience,medical less than optimal in obtaining a full clinical picture. Research has shown that many assessments were deficient when site based interviews were audiotaped and randomly assessed by expert raters.81 Another method, particularly for multisite studies that has shown considerable promise to increase the reliability of ratings and reduce placebo response;82 includes the use of remote centralized expert raters who perform the assessments via live, two-way video. This method can be expensive and poses some logistical much challenges, but is in keeping with the desire to centralize and standardize assessments whenever possible, as has increasingly been done with cardiology, pathology, radiology, and laboratory tests in multicenter trials. Relapse prevention Relapse prevention in schizophrenia remains a major public problem. However, the number of studies focusing on relapse prevention/maintenance treatment is substantially smaller compared with acute phase trials.