La escala de Edinburgo para la detección de cuadros depresivos en el postparto / The Edinburg`s scale for the detection of postnatal depression disorders

Este trabajo realiza la estandarización de la Edingurgh Postnatal Depression Scales. Se encuentra una buena capacidad de discriminar entre los "casos" y los "controles", con una elevada consistencia interna. Para el punto de corte sugerido por los autores originales de este instrumento, entre 12/13, se encuentra una sensibilidad del 71.43 por ciento , con una especificidad de 94.85 por ciento , un valor predictivo positivo de 80.00 por ciento y un eficiencia global de 89.60 por ciento Se discuten sus posibles usos

Diagnosis of DSM-III-R personality disorders by two structured interviews: patterns of comorbidity.

OBJECTIVE: The purpose of this study was to examine patterns of co-occurrence of axis II disorders in a group of consecutive patients evaluated with two contrasting structured interviews. METHOD: One hundred of 106 consecutive applicants for long-term, inpatient treatment of severe personality psychopathology were assessed, face-to-face, by psychiatrists using the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the Personality Disorder Examination (PDE). The percent of co-occurrence of pairs of disorders diagnosed by each structured interview separately was calculated, and significance levels were determined by using chi-square tests of independence. Finally, odds ratios were computed for the odds of each pair of disorders occurring together compared with the odds for the occurrence of each disorder alone. RESULTS: The two interview methods revealed different comorbidity patterns. Significant covariation was found for 29 pairs of disorders diagnosed with the PDE, compared with 12 pairs diagnosed with the SCID-II. Six pairs of disorders covaried significantly and were associated with odds ratios greater than 4: histrionic with borderline, histrionic with narcissistic, narcissistic with antisocial, narcissistic with passive-aggressive, avoidant with schizotypal, and avoidant with dependent. CONCLUSIONS: Substantial overlap occurred among personality disorders. In this group of patients, consistent patterns of comorbidity involving narcissistic, avoidant, and histrionic personality disorders suggest that categorical distinctions between them and certain other DSM-III-R personality disorders may be illusory. The question of which of two overlapping disorders is more valid, however, is left unanswered. For clinical purposes, a two-level diagnostic convention is proposed.

Volunteers for biomedical research. Recruitment and screening of normal controls.

We examined the process of accruing healthy control subjects for biomedical research on brain function. Of 1670 responders to newspaper advertising, 23.1% were uninterested when learning more about the studies, and 50.9% of those remaining were found by structured telephone screening to meet exclusionary criteria for having a history of psychiatric, neurologic, or medical disease that might affect brain function. Of 312 volunteers passing the telephone screening who came to an in-person evaluation by a physician and agreed to participate, 49.7% were found to meet exclusionary criteria, and only 157 were admitted to the study. This underscores the importance of attending to the issue of screening and assessment of "normal volunteers." Alternative strategies should be considered for enriching the pool.

Comparison of psychiatric screening tests in a general medical setting using ROC analysis.

Receiver operating characteristic (ROC) analysis was used to evaluate the usefulness of three self-administered screening instruments in helping primary care physicians detect anxiety and depressive disorders. This research was secondary to an investigation of hypochondriasis. The three tests were the Whitely Index (WI), the Somatosensory Amplification Scale (SAS), and the Somatic Symptom Inventory (SSI). Participating subjects were 75 patients seen in a general medical clinic and diagnosed as being free of hypochondriasis by DSM-III-R criteria. Psychiatric disorder was assessed with the Diagnostic Interview Schedule, version III-A. The three instruments delineated patients with depressive disorders versus no depressive disorders and patients with anxiety disorders versus no anxiety disorders. For depressive disorder, the areas under the curve (AUC) were 0.87, 0.75, and 0.82 for the WI, SAS, and SSI, respectively. For anxiety disorders the AUCs were 0.79, 0.76, and 0.74, respectively, for the three tests. Although the WI yielded slightly higher values, the areas under the ROC curves did not differ significantly among the three tests. Because of its relatively short length--13 items--it was concluded that the WI can be useful for screening primary care patients, both with respect to depressive and anxiety disorders.

[Application of schedule for affective disorders and schizophrenia research diagnostic criteria (SADS/RDC) in manic patients].

One hundred and nine clinically diagnosed manic patients were examined and re-diagnosed with SADS/RDC. The results of joint-test and test-retest showed that the reliabilities of the subscales of SADS were good enough for clinical use. The mania subscale score of SADS showed significant negative correlation with GAS score, but positive correlation with SI or BRMS. The results of joint-test and test-retest showed that the diagnosis of mania by the use of SADS/RDC were reliable. The concurrent validity between SADS/RDC and CMA-H was higher. This study indicated that SADA/RDC can be used satisfactorily in clinical practice.

[A contrast between the MMPI with the System Check List 90].

This study tested 131 patients with psychoses and contrasted the MMPI with the SCL-90. It was found that the nine groups of elemental symptoms in the SCL-90 was highly related with the corresponding symptoms in the MMPI. However, the relatively of groups in the two scales is different in the three diseases of schizophrenia, depression and neurosis. It was expressed that the three mental diseases possessed different psychopathologic characters. The result corresponded to clinical experience and also showed that SCL-90 was a self-rating scale with higher validity and spread of the scale was feasible.

Formulating a role for occupational therapy in child psychiatry: a clinical application.

Occupational therapy is in need of role clarification within the specialty of child psychiatry. The literature reveals that occupational therapy is often undelineated or unrecognized by child psychiatry, has limited efficacy research, and may be at risk for losing its practice with children hospitalized for psychiatric disturbances. This paper outlines steps for the formulation of a specialized role for occupational therapy within this specialty. The Model of Human Occupation (Kielhofner, 1985) is suggested as a basis for conceptualizing this role. A clinical study focused on the evaluation of adaptive functioning with use of the Vineland Adaptive Behavior Scales (Sparrow, Balla, & Cicchetti, 1984, 1985) is presented as an example of a way in which occupational therapy can provide assessment data valuable to the interdisciplinary clinical team. The role of occupational therapy in both short-term and long-term hospitalization of children with psychiatric disturbances is described.

Concurrent validity of the task-oriented assessment component of the Bay Area Functional Performance Evaluation with the American Association on Mental Deficiency Adaptive Behavior Scale.

This study was designed to test the concurrent validity of the revised Task-Oriented Assessment (TOA) component of the Bay Area Functional Performance Evaluation (BaFPE) (Bloomer & Williams, 1979) with Part 1 of the American Association on Mental Deficiency Adaptive Behavior Scale (ABS) (Nihira, Foster, Shellhaas, & Leland, 1969, 1974) and to develop a means of interpretation for the numeric scores on the TOA. Both measures were administered to 67 psychiatric inpatients within the first 14 days of admission. Low to moderate correlations were found between the TOA tasks and functional parameters and the ABS domains. Because the TOA shows low concurrent validity with the ABS, only limited interpretive descriptions for TOA scores could be developed.

[The development of depression inventory].

This paper describes the development of Depression Inventory (DI), its reliability, validity, and distributional value of DI score, using a sample of 329 currently depressed patients from 24 hospitals. Comparing to Hamilton Depression Scale (HDS), the correlation efficient between Hamilton Depression Scale and DI, and Beck Depression Inventory (BDI) is 0.608 and 0.536, respectively. The validity of DI is better than BDI. Item contents of DI are understood and rated easily for depressive patients. Four factors are derived from DI, those are alarm, agitation, somatic symptoms, and depression/retardation. Factor construction and items of DI are reasonable, and reflect the clinical features of depression, especially the alarm factor provides a parametric index for prevention and prediction of suicide.

[Social adjustment and psychiatric re-admission: a study using a self-rating scale]. / Adattamento sociale e riospedalizzazione psichiatrica: studio mediante una scala di autovalutazione (SAG).

The paper describes the results of a study on the relationship between the degree of social adjustment and re-admission of discharged psychiatric patients using the Italian version of the SAG (Self Assessment Guide). The validity of such a scale has been described in previous works. In this study, the test-retest assessment has proved the reliability of the scale. The test was administered to a sample of 51 patients during the first week of hospitalization, 26 of whom were followed up three months after discharge. A statistically significant improvement was observed, on the SAG score obtained during the follow-up, in patients (n = 16) who were not admitted to hospital in the 12 month period following discharge. This was unlike the case of those who required a new admission. The improvement concerned mainly the total score, the affectivity, the interpersonal functioning and aggressivity scales.

The Positive and Negative Syndrome Scale--Spanish adaptation.

The Positive and Negative Syndrome Scale (PANSS) consists of a formalized clinical interview and 30 operationally defined items for psychopathology assessment. We report here on the psychometric equivalence of a Spanish language adaptation (PANSS-S), developed to facilitate minority group, multinational, and cross-cultural studies on schizophrenia. Two bilingual psychiatrists simultaneously rated 57 psychiatric inpatients using the PANSS (N = 20), PANSS-S (N = 20), or both methods (N = 17). The PANSS-S demonstrated sound interrater reliabilities (r = .93 for positive and .74 for negative syndrome, p less than .001), which were similar to those from the current PANSS assessment and original standardization studies. In support of criterion-related validity, the means and variance of the two instruments were comparable, and significant cross-correlations were obtained for the principal scales (r = .92 for positive and .83 for negative syndrome, p less than .0001), component symptoms, and five additional psychopathology clusters. The results suggest that the PANSS-S has psychometric properties resembling those of the PANSS and may be used interchangeably in a Spanish-speaking population.

[Study of the quality of measurement by the Sickness Impact Profile. Assessment of the reliability of a method to determine the functional level of psychiatric patients]. / Undersøgelse af målekvalitet af Sickness Impact Profile. Vurdering af pålideligheden af en metode til bestemmelse af funktionsniveau, specielt med hensyn til psykiatriske patienter.

The Sickness Impact Profile (SIP) is a questionnaire method of assessing the functional level within 12 fields which together provide a generalized measurement of the level of health in agreement with the definition of health by WHO. In the present investigation, the method was employed for the first time occasion for 58 suitable psychiatric patients and the result of Rasch's item-analysis of the replies to the individual questions showed altogether scales of good measurement quality. A single question, however, appeared to be unsuitable. The item-analysis is a demanding measurement for the internal validity and homogeneity and it supplements foreign investigations of the criteria-related validity of SIP.

[Evaluation of the level of function before and after treatment at a psychiatric day-hospital. Are you better, or are you well]. / Vurdering af funktionsniveau før og efter behandling i psykiatrisk daghospital. "Fik du det bedre, eller fik du det godt?"

A pilot project was carried out to assess the effect of group therapy. This demonstrates the employment of a method of measuring general health, the Sickness Impact Profile. Employment of this method before and after the period of therapy could demonstrate significant improvement in relevant functional fields and development towards normalization of health in the 12 categories which describe this.

The diagnostic interview for narcissistic patients.

This report describes the content and development of a semistructured interview, the Diagnostic Interview for Narcissism. The interview evaluates 33 features of pathological narcissism covering five domains of function: grandiosity, interpersonal relations, reactiveness, affects and moods, and social and moral adaptation. Its utility is established by reliability studies and by developing a scoring system from a sample of 24 prototypic narcissistic patients who were compared with 58 others. Because narcissistic personality disorder is a widely used diagnosis whose inclusion in DSM-III-R was without reference to an empirical base, this instrument offers a method for doing much-needed research.

[Comparison between DSM III and CIM 9 in the data processing on computerized system. Study of 4000 records]. / Confrontation D.S.M. III et CIM 9 dans l'exploitation saisie sur système informatisé (1). Etude portant sur environ 4,000 dossiers.

The authors expose the results of a confrontation between ICD 9 and the D.S.M. III's classification published by APA. This work is the issue of a collected data system'use (S.D.P.A.) which is a basic tool for epidemiological programm, applied in military psychiatrics department (actually 18 services have got computer sets). It is evident that military structure (centralized dans homogeneous), and the size of the samples, are good conditions for psychiatric epidemiology. The authors recall the different stages and the difficulties on the field, for such a wide scale application. The use of two principal world-known classifications raise up unanticiped remarks: indeed, we consider the logical structure of D.S.M. III's axis I as better than ICD 9 classification. Meanwhile, the axis III, IV and V caused a disappointment, for both clinicians and programm's responsibles. In fact, there were some statistical biases and a little gain of informations. The former system (applied for 1976) was more efficient. Some hypothesis about that insufficient acceptability and reliability are proposed as also an important project for system's modifications from 1989.

Two mental status assessment methods: an evaluation.

Impairments in mental status following cataract extraction surgery appear to be a significant clinical problem in the elderly. Despite the prevalence and potential mortality and morbidity, these impairments are frequently undetected. The Mini-Mental State Examination and the Mental Status Questionnaire were evaluated in a population of elderly cataract surgery patients. Although either test can be used to evaluate mental status, the sensitivity and specificity of each must be validated with a larger, controlled sample. The Mental Status Questionnaire was easier to administer, did not appear to induce additional fatigue in patients, and the scores were unaffected by patients' motor and sensory deficits.

[The Cambridge Mental Disorders of the Elderly Examination. Validation of the Spanish adaptation]. / CAMDEX. Validación de la adaptación española.

A neurologist and a psychiatrist diagnosed independently, according to DSM-III-R and ICD-10 criteria, to 15 subjects with dementia, 15 with depression and 15 without any of two previous diagnostics. Later, a psychologist held an interview with them by means of the structured interview CAMDEX. The lump levels of agreement between clinical diagnostic and DSM-III-R diagnostic obtained through CAMDEX is of Kappa = 0.63. These levels are increased to one Kappa = 0.76 if we compare the clinical diagnostic with CAMDEX diagnostic according to the ICD-10. On the other hand, we value the outputs of some instruments that are included in the CAMDEX: Mini Examen Cognoscitivo, Mini-Mental State, CAMCOG, Organicity Scale, Blessed Scale and Depressión Scale.

[The Cambridge Mental Disorders of the Elderly Examination. Study of interobserver reliability]. / CAMDEX. Estudio de fiabilidad interexaminadores.

Three teams formed by psychologists with experience in the administration of structured interviews evaluated by the CAMDEX (The Cambridge Mental Disorders of the Elderly Examination) in a sample of 41 patients for the interrater reliability study. While a psychologist interview patient, the other one observes each patient. The CAMDEX were completed independently by each of the examiners. The results demonstrate an elevated level agreement both for the different scales (p less than 0.001) and for the different diagnostic criteria employed by the CAMDEX (kappa = 0.88 for the DSM-III-R and Kappa = 1 for the ICD-10).