Rules of Probability Let A and B be any events. 1, Addition Rule: P(AU B) = P(A) + P(B) ~ P(AN B) 2. Complement Rule: If A’ is the complement of A, then P(A’) = 1— P(A). 5.1 Conditional Probability Definition, The The conditional probability of A given B is defined as P(ANB) P(AIB) = Say whereP(B) #0. Example. The primary aim of a study by Carter et al. (AI) was to investigate the effect of the age at onset of bipolar disorder on the course of the illness. One of the variables investigated was family history of mood disorders, Table 3.4.1 shows the frequency of a family history of mood disorders in the two groups of interest (Early age at onset defined to be 18 years or younger and Later age at onset defined to be later than 18 years) TABLE 3.4.1 Frequency of Family History of Mood Disorder by Age Group among Bipolar Subjects Family History of Mood Disorders Early= 1816) Later > 19) Total Negative (4) 28 % 3 Bipolar disorder (6) 18 B a Unipolar ic) a “4 25 Unipolar and bipolar (O) 53 o a3 Total 1a m7 318, ‘Source: Tasha D. Carer, Emanuola Mundo, Sagar V. Parkh, and James L Kennedy, “Eady Age at Onset as a Rik Factor fr Poot Outcome of Bipolar Disorder,” Journal of Poyehate Research, 37 (2003, 297-303 Suppose we pick a person at random from this sample, What is the probability that this person will be 18 years old or younger? has no family history of mood disorder? has no family history of mood disorder, given that he/she is 18 years or younger? is older than 18 years old, given that he/she has a family history of bipolar disorder? is younger than 18 years old and has a family history of unipolar and bipolar disorder?6 Screening Tests and Diagnostic Criteria In the health sciences field a widely used application of probability laws and concepts is found in the evaluation of screening tests and diagnostic criteria. Of interest to clinicians is an enhanced ability to correctly predict the presence or absence of a particular disease from knowledge of test results (positive or negative) and/or the status of presenting symptoms (present or absent). In the consideration of screening tests, we must be aware of the fact that they are not always infal- ible. That is, a testing procedure may yield a false positive or a false negative Definition. 1. A false positive results when a test indicates a positive status when the true status is negative. 2. A false negative results when a test indicates a negative status when the true status is positive. ‘The following questions must be answered in order to evaluate the usefulness of test results and symptom status in determining whether or not a subject has some disease 1. Given that a subject has the disease, what is the probability of a positive test result (or the presence of a symptom)? 2, Given that a subject does not have the disease, what is the probability of a negative test result (or the absence of a symptom)? ‘that the n a positive screening test (or the presence of a symptom), what is the probability subject has the dise 4, Given a negative screening test result (or the absence of a symptom), what is the probability that the subject does not have the disease? Definition. Th (or presence of the symptom) given the presence of the disease. sensitivity of a test (or symptom) is the probability of a positive test result Definition. The specificity of a test (or symptom) is the probability of a negative test result (or absence of the symptom) given the absence of the disease. Definition. The predictive value positive of a screening test (or symptom) is the probability that a subject has the disease given that the subject has a positive screening test result (or has the symptom)Definition. The predictive value negative of a scrcening test (or symptom) is the probability that a subject does not have the disease, given that the subject has a negative screening test result (or does not have the symptom) Example. A medical research team wished to evaluate a proposed screening test for Alzheimer's disease ‘The test was given to a random sample of 450 patients with Alzheimer’s disease and an independent random sample of 500 patients without symptoms of the disease. The two samples were drawn from populations of subjects who were 65 years of age or older. The results are as follows: _Alsheimer’s Diagnosis Test Result Yes) Noi) “Total Pouive) 436 s “1 Negaive) 495 509 Toad 350 500950 In the context of this problem, 1. What is a false positive? 2. What is a false negative? 3, Compute the sensitivity of the test. 4, Compute the specificity of the test. 5. Suppose it is known that the rate of the disease in the general population is 11.3%. What is the predictive value positive of the test? What is the predictive value negative of the test?