A brief and rapid procedure to measure the intensity of depressive symptoms in Primary Care.

INTRODUCTION: Depression occupies a substantial part of medical visit attendance. However, medical practitioners have very little time so that a brief, quick and reliable procedure to evaluate the intensity of symptoms and their changes could be useful. Our objective has been to analyze the reliability of a self-applied Visual Analogue Scale (VAS) to measure symptom intensity in depressed patients within this context. MATERIAL AND METHODS: One hundred depressed outpatients (ICD-10) stated their clinical situation on a VAS. The psychiatrist evaluated them using a Global Clinical Impression (GGI) and Hamilton Depression Rating Scale (HDRS-17). RESULTS AND CONCLUSIONS: The patient's VAS showed high correlation with the HDRS-17 and with the GCI used by the psychiatrist (r = 0.63 and r=0.58; p=0.000). This suggests that the use of a VAS in Primary Care could be useful and reliable for these purposes within the medical contexts of those having little time availability. Key-words: Depression, primary care, medical patients, assessment, evaluation.

A study of the relationship between impulsiveness and obsessiveness in the general population. Inconsistency of the idea of the spectrum.

INTRODUCTION: The obsessivity and the impulsivity as personality traits have been object of few studies on the general population. The authors outline as objective to study if such features are co-existing constructs, as advocate some authors or the opposite extremes of a continuum as assert other. MATERIAL AND METHODS: They are studied the answers to a questionnaire on obsessive traits of the personality (MIRAP) and other referred to the impulsivity as trait, also, (ECIRYC) of a random sample of 418 subject extracted of the general population. They are applied multivariate statistic analysis technical (Factorial Analysis, Correspondence Analysis, and linear Regression Analysis) to establish the type of relationship that have the two studied personality traits. RESULTS: The total scores of the MIRAP and the ECIRYC are correlated of a manner statistically significant (r = .39; p< .01). The Correspondence Analysis of those total scores distributed in deciles and two linear Regression Analysis show, also, a direct relationship between both traits that it is statistically significant. The obsessivity and the impulsivity do not correlate with the principal factor of the opposite trait. All the factors of both traits are grouped mutually in a factor in a positive way, except the impulsive factor "haste" that makes it negatively with the obsessive factor "order". CONCLUSIONS: Our results indicate that the obsessivity and the impulsivity, as personality traits, they are constructs convergent and not opposite poles of a continuum. But, simultaneously, one of the five factors of each trait ("haste" and "order"), yes are behaved as opposite extremes of a continuum, within conceptual framework, wider, of the traits to those which belong.

A new validation of the Hamilton Rating Scale for Depression.

This paper investigates the reliability and validity of a Spanish version of the Hamilton Rating Scale for Depression (17-item version) which has good concurrent (r = 0.82) and content (average frequency = 62%) validity. Inter-rater reliability (r = 0.99), split-half reliability (r = 0.89) and alpha reliability (r = 0.72) are acceptable. A Factor Analysis identified five factors accounting for 56% of total variance.

Distinct quality of depressed mood: an attempt to develop an objective measure.

Since the time of Kraepelin, in continental Europe the sadness of depression has been considered to have a "distinct quality' basic to the diagnosis of pathological depression. This distinct quality has been interpreted by observers but patients have been noted to have difficulty verbalizing differences from normal sadness. The authors have used a discriminant analysis to study how patients define pathological sadness and as a result have developed a Pathological Sadness Index with a sensitivity of 0.94, a specificity of 0.96 and a total misclassification rate of 5% (kappa w = 0.90).

Measuring anankastic personality traits.

INTRODUCTION: The authors validate a 20 item scale designed to measure anankastic (obsessive) personality traits: the Mini-Inventory of Anankastic Personality Traits, 2nd version (MIAPT-2). MATERIAL AND METHODS: The answers of a sample of 418 subject of both genders obtained from the general population were used to analyze construct validity (factorial analysis), its alpha reliability and its internal consistency through the item/total correlations and the two halves test. An additional sample of 22 medical students was used to analyze the concurrent validity of the scale (external criterion: the Maudsley Obsessional-Compulsive Inventory) and the temporary reliability with the test-retest method. After this, the total scores of the instrument and the factorial scores were standardized and distributed into percentiles. RESULTS: The scale shows good concurrent validity (r = 0.67; p < 0.000) and construct validity (56 % of the total of the variance explained by the factorial analysis) as well as a good internal consistency through the item/total correlations (all p = 0.000) and two halves test (r = 0.71; p < 0.000; with the Spearman-Brown correction R= 0.83). The alpha reliability of the scale (alpha = 0.84), and the test-retest (r = 0.69; p < 0.000) are high. CONCLUSIONS: The validated MIAPT-2 shows good validity and reliability to evaluate anankastic personality traits. The authors include an appendix with the scale and the standardization of its total and factorial scores distributed into percentiles to be used in clinical and general population samples.

[The distinctive quality of depressed mood. VIII. A review of the concept and a proposal]. / La distinta cualidad del ánimo deprimido (y VIII). Revisión del concepto y una propuesta.

The authors have analyzed psychiatrists' problems for to measure reliably the sign "distinct quality" of depressed mood. They underline a semantic problem adding to difficulties to the diagnostic process. The authors propose methods for increase the reliability in detecting "distinct quality" and they propose also a new word for to replace the term "vital sadness": anelasticoendosthenia; from Greek an (absence), sthenos (strength), endon (inside), elastikós (driving out).

[Is there a surprise factor in the evaluation of suicide risk in depression?]. / Hay un factor sorpresa en la evaluación del riesgo suicida de las depresiones?

The suicidal risk evaluation seems to be difficult. The authors think that it could be created for a surprising factor identified with a low control of impulsiveness added to low levels of 5-hydroxyindoleacetic acid in cerebrospinal fluid.

[Prevalence of suicide in depression]. / La prevalencia del suicidio en las depresiones.

The authors have reviewed the literature on suicide in depressives. 47% of suicides are depressed. From 4% to 7% of depressives die by suicide and the life-time suicide morbidity risk is 9%.

[Suicide among psychiatric patients]. / El suicidio entre los pacientes psiquiátricos.

The authors have reviewed the literature on suicide in psychiatric patients. They are the group at highest risk and commit suicide some few months after discharge. This data suggests that psychiatrists have problems in evaluating the suicidal risk of their patients.

[Suicide risk after attempted suicide (its incidence and predictive evaluation]. / El riesgo suicida tras una tentativa suicida (su incidencia y evaluación predictiva).

The authors have revised the bibliography about predictive evaluation of suicide in attempted subject. It seems that the prediction is only possible determining the presence of a symptom: the hopelessness.

[The distinctive quality of depressed mood. III: Factorial structure of the pathologic sadness index]. / La distinta cualidad del ánimo deprimido. III: Estructura factorial del índice de tristeza patológica.

The authors report results of a factor analysis on a Pathological Sadness Index. The rate of total variance accounted (construct validity) is a 55% and two factors are found: distinct quality and rise-bodied.

[The distinctive quality of depressed mood . IV: The internal consistency of the index of pathologic sadness]. / La distinta cualidad del ánimo deprimido. IV: La consistencia interna del indice de tristeza patológica.

The authors research the reliability of the Pathological Sadness Index with the internal consistency method (Cronbach's alpha). Data show a good reliability.

[Endogenous and neurotic depression again. I. The distinctive quality as a unifying element for nuclear depressive symptomatology]. / Depresión endógena y neurótica otra vez. I: la distinta cualidad como elemento aglutinador de la sintomatología depresiva nuclear.

The authors analyse the Kiloh and Garside's (1963) and Carney's et al. (1965) data. They studied the influence of item distinct quality on core depressive symptoms. Deleting influence of this item the depressive syndrome lose its original cohesion. It suggests that the distinct quality could be the agglutinative component of the core depressive symptomatology.

[Identification of the actual experiencing of pain. Methodological basis for an evaluation]. / Identificación de la veracidad de la experiencia dolorosa. Base metodológica para una evaluación.

FUNDAMENTALS: The doctors don't have reliable instruments in order to detect the painful experience in a patient with intention of deceiving. The objective of this investigation is the development of an instrument that helps the doctors on that task. METHOD: The investigation is based on that the pain is not possible to evoke. A patient that doesn't feel pain, really, will introduce the modifications characteristic of all memory when requests you that he/she describe the pain that says feel. The will of deceit will also distort their description. A discriminant analysis will detect the difference between the description of a pain that is not present and another that yes it are, and between the sincere descriptions of the deceiving one. RESULTS: The descriptions of the pain carried out by two different samples of nursing students have been studied with a list of pair of antonym adjectives (Osgood's semantic differential). A subgroup of the first sample described a pain that they suffered in the same moment of description, and the other subgroup described a suffering pain some days before. In the other sample, a subgroup made a sincere description of their pain and other subgroup described the pain with will of deceiving the interviewer. The investigation has provided two discriminant models. A discriminant model differentiates between a present and another remembered pain (sensibility: 0.75; specificity: 0.85; kappa reliability: 0.60; p < 0.000000001; probability of success p: 89%). The other discriminant model differentiates between a description of a pain with will of deceiving and another pain described sincerely (sensibility: 0.94; specificity: 0.95; kappa reliability: 0.89; p < 0.000000001; probability of success p: 97%). CONCLUSIONS: The results of this investigation seem to demonstrate that it is possible to discriminate between the descriptions of real pains and the suspicious pains of not being real, and that also one is able to discriminate between pains described with will of deceit and pains described sincerely. These discriminant models allows to classify the description of the subjects in four groups: "liars", "sincere", "magnifiers", and "psychogenic". However, it is necessary still carry out more effort of investigation so that these results could be replied in patients that suffer pain.

[Construct validity and reliability of the Newcastle Endogeniety Index I]. / Validez de constructo y seguridad del indice de Endogeneidad Newcastle I.

The authors study the construct validity of the Newcastle's Endogeneity Index (NEI). They use the correlation matrix published originally by Carney et al (1965). The results show a high reliability of the NEI (alpha = 0.77). The Factorial Analysis shows two factors, not independent, that explain a 45% of the total obtained variance; it seem to indicate a drop construct validity of the NEI. The authors discuss the validity of the endogenous/neurotic classification of the depression because of the high agreement the NEI and the clinical criterion.

[Endogenous and neurotic depression again III: support for a sequence hypothesis]. / Depresión endógena y neurótica otra vez. III: Refuerzos para una hipotesis secuencial.

The sequential hypothesis about depression tells: "neurotic" and "endogenous" depression are not different diseases, but two different moments in the evolution of a unique disorder (initial and terminal, respectively). The authors use Kiloh and Garside's (1963) and Carney et al's (1965) data to support this hypothesis. The bibliographic data are analyzed in that way to show that biological correlates of endogeneity are the final pathway of an ontogenic evolution of biological modifications in depression less obvious in initial episodes ("neurotiforms") and more evident in subsequent episodes ("endogeniforms").

[Endogenous and neurotic depression again, II: is the separation of the two a methodologic artifact?]. / Depresión endógena y neurótica otra vez. II: Es un artefacto metodológico la separación entre ambas?

The authors study the Kiloh and Garside's (1963) and Carney's et al. (1965) data. They apply a Factorial Analysis without and with Varimax rotation. Only account a bipolar factor (endogenous/neurotic) the unrotated solutions, but not in rotated solutions. They discuss the validity of the classification endogenous/neurotic depression supported by a erroneus application of the Factorial Analysis method.

[The distinctive quality of depressed mood. I: Is it a myth or a reality? (a controlled study)]. / La distinta cualidad del ánimo deprimido. I: Mito o realidad? (un estudio controlado).

The authors have investigated the real existence of "distinct quality" of pathological sadness in depressed subjects. This paper, show a discriminant function that recognize the "distinct quality" with a 100% of cases correctly classified.

[The distinctive quality of depressed mood. II: Predictive value of a pathologic sadness index]. / La distinta cualidad del ánimo deprimido. II: Validez predictiva de un índice de tristeza patológica.

The authors develop a Pathological Sadness Index. It recognize between pathological and normal sadness with a sensitivity of 0.94, a specificity of 0.96, and 5% of misclassified cases. Its diagnostic reliability is kw = 0.90.