Diagnostic Checklist Research Articles

Suicide attempts and clinical risk factors in patients with bipolar and unipolar affective disorders

BackgroundSuicide is an important clinical problem in psychiatric patients. The highest risk of suicide attempts is noted in affective disorders. ObjectiveThe aim of the study was to look for suicide risk factors among sociodemographic and clinical factors, family history and stressful life events in patients with diagnosis of unipolar and bipolar affective disorder (597 patients, 563 controls). MethodIn the study, the Structured Clinical Interview for DSM-IV Axis I Disorders and the Operational Criteria Diagnostic Checklist questionnaires, a questionnaire of family history, and a questionnaire of personality disorders and life events were used. ResultsIn the bipolar and unipolar affective disorders sample, we observed an association between suicidal attempts and the following: family history of psychiatric disorders, affective disorders and psychoactive substance abuse/dependence; inappropriate guilt in depression; chronic insomnia and early onset of unipolar disorder. The risk of suicide attempt differs in separate age brackets (it is greater in patients under 45 years old). No difference in family history of suicide and suicide attempts; marital status; offspring; living with family; psychotic symptoms and irritability; and coexistence of personality disorder, anxiety disorder or substance abuse/dependence with affective disorder was observed in the groups of patients with and without suicide attempt in lifetime history.

Acute care of pediatric patients with sickle cell disease: A simulation performance assessment

Sickle cell disease (SCD) is a rare disorder with cardinal features including hospitalization for vaso-occlusive pain episodes, acute pulmonary injury, and increased infection rates. For physician-trainees, learning optimal SCD management is challenging because of limited exposure to life threatening complications requiring timely interventions. To create, demonstrate reliability, and validate simulation-based, acute care SCD scenarios for physician-trainees, seven scenarios were derived from SCD patient cases. For each scenario, participants had 5 minutes to complete diagnostic and treatment interventions. Participants were divided into two groups based on clinical experience: interns or residents/fellows. Two raters scored performances using diagnostic and therapeutic checklists--indicating whether specific actions were performed and a global, 1 (poor) to 9 (excellent), rating. Scenario scores were calculated by averaging rater scores on each metric. Reliability was defined through uniformity in rater scoring and consistency of participant performance over scenarios. Validity was demonstrated by the performance gradient where the more experienced trainees outperform those early in training. Twenty-eight pediatric residents and hematology fellows took part in the study. Reliability for assessment scores overall was moderate. Performance on all but one scenario was moderately predictive of overall performance. Senior resident/fellows performed significantly better than interns. Positive associations existed between overall performance scores (P < 0.01) and months of postgraduate training (P < 0.01). Mannequin-based simulation is a novel method for teaching pediatric residents SCD-specific acute care skills. The assessment provided reliable and valid measures of trainees' performance. Further studies are needed to determine simulation's utility in education and evaluation.

Attention Deficit/Hyperactivity Disorder symptoms in Italian bipolar adult patients: A preliminary report

BackgroundIt has been recently suggested that bipolar disorder (BD) with comorbid ADHD represents a distinct clinical phenotype of BD. With the aim to assess the impact of ADHD symptoms, we investigated the prevalence, epidemiological and clinical features associated with such a comorbidity in a sample of adult BD patients. MethodsA total of 96 outpatients (aged 18–65 years) with BD were included. All patients were screened using the Adult ADHD Self-report Scale (ASRS) and the Diagnostic, Clinical and Therapeutic Checklist (DCTC), a semi-structured interview developed for systematic collection of familial, demographic, anamnestic and clinical informations and exploration of DSM-IV-TR diagnostic criteria for mood, anxiety, eating, impulse control and alcohol and substance use disorders. The DCTC also includes the Clinical Global Impression Bipolar scale (CGI-BP), the Global Assessment of Functioning scale (GAF) and the Sheehan Disability Scale (SDS). ResultsIn our sample, 19 (19.8%) out of 96 BD patients fulfilled ASRS criteria for current and lifetime (onset before 7 years of age) ADHD symptoms (ADHD+). Compared to BD probands without ADHD symptoms (ADHD−), ADHD+ patients showed higher rates of current mixed episode, and lower rates of mania. ADHD+ resulted in more severe mean scores on the CGI-BP mixed, depressive and global subscales. None of the ADHD+ patients were in remission of BD at the time of the evaluation, versus 24 (31.2%) of the ADHD− group. ADHD+ patients also reported higher rate of lifetime comorbidity with Substance Use Disorder (SUD) and Alcohol Abuse in comparison to ADHD− patients. In particular the different rate in substance abuse was related to cocaine and poly-drug abuse. The two groups did not report significant differences in functioning and social adjustment with the exception of familial adjustment that was more compromised in ADHD+ than in ADHD− patients. LimitationsRetrospective design and limited sample size. ConclusionsIn ADHD+ patients, BD is associated with higher rate of mixed states, more severe psychopathology and more impaired familial functioning as well as higher rates of comorbid substance, alcohol and poly-drug abuse compared to BD patients without adult ADHD. Our findings suggest that ADHD symptoms in adults may influence clinical presentation, course and prognosis of BD. Further prospective research is needed to confirm our findings and to explore treatment implications for the management of BD.

Spinal fusion for chronic low back pain: systematic review on the accuracy of tests for patient selection

Background contextSpinal fusion is a common but controversial treatment for chronic low back pain (LBP) with outcomes similar to those of programmed conservative care. To improve the results of fusion, tests for patient selection are used in clinical practice. PurposeTo determine the prognostic accuracy of tests for patient selection that are currently used in clinical practice to identify those patients with chronic LBP who will benefit from spinal fusion. Study designSystematic review of the literature. SampleStudies that compared the results of magnetic resonance imaging (MRI), provocative discography, facet joint blocks, orthosis immobilization, and temporary external fixation with the clinical outcome of patients who underwent spinal fusion for chronic LBP. Outcome measuresTo determine the prognostic accuracy of tests to predict the clinical outcome of spinal fusion in terms of sensitivity, specificity, and likelihood ratios (LRs). MethodsData sources PubMed (1966 to November 2010), EMBASE (1974 to November 2010), and reference lists were searched without restriction by language or publication status. Two reviewers independently selected studies for inclusion, extracted data for analysis, and assessed the risk of bias with the Quality Assessment of Diagnostic Accuracy Studies checklist, modified for prognostic studies. Discrepancies were resolved by consensus. ResultsTen studies met the eligibility criteria. Immobilization by an orthosis (median [range] positive LR, 1.10 [0.94–1.13] and negative LR, 0.92 [0.39–1.12]), provocative discography (median [range] positive LR, 1.18 [0.70–1.71] and negative LR, 0.74 [0.24–1.40]), and temporary external fixation (median [range] positive LR, 1.22 [1.02–1.74] and negative LR, 0.58 [0.15–0.94]) failed to show clinically useful prognostic accuracy. Statistical pooling was not feasible because of different test protocols, variability in outcome assessment, and heterogeneous patient populations. No studies reporting on facet joint blocks or MRI could satisfy the inclusion criteria. Obscure patient selection, high risk of verification bias, and outcome assessment with poorly validated instruments precluded strong conclusions for all tests. ConclusionsNo subset of patients with chronic LBP could be identified for whom spinal fusion is a predictable and effective treatment. Best evidence does not support the use of current tests for patient selection in clinical practice.

Taking Stock of Monitoring and Evaluation Arrangements in the Context of Poverty Reduction Strategy Papers: Evidence from 20 Aid‐Dependent Countries in Sub‐Saharan Africa

Shifts in thinking and practice concerning aid have posed serious challenges in monitoring and evaluation (M&amp;E) for both donors and recipients, but progress in reform remains slow. An important first step in any initiative involving M&amp;E capacity development is the diagnosis of the systems' current status. This article presents a diagnostic checklist that captures issues of M&amp;E policy: indicators, data collection and methodology; organisation; capacity‐building; participation of nongovernmental actors; and use. It applies it to a review of the PRSP M&amp;E arrangements of 20 aid‐dependent countries in sub‐Saharan Africa to demonstrate comparative strengths and weaknesses.

Use of a Second Generation Antipsychotic among Patients Diagnosed with Major Depressive Disorder in the United States

The purpose of the study was to discern the extent of the prescribing of a second generation atypical antipsychotic (SGA), either alone or in combination with an antidepressant, among patients diagnosed with major depressive disorder (MDD) in the US, and the influence of physician specialty on prescribing in 2007. Data from the 2007 US National Ambulatory Medical Care Survey (NAMCS) were extracted for (i) office-based physician-patient encounters (office-based visits; OBV) with an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code for MDD (296.2–296.36, 300.4, 311), and without an ICD-9-CM code(s) for co-morbid mental illness; and (ii) OBV with a diagnosis of MDD marked on the ‘diagnostic clinical checklist’ (DCC) of the NAMCS, and without an ICD-9-CM code(s) for co-morbid mental illness. Rates were calculated per 1000 OBV and per 1000 US population as of 1 July 2007. Statistical analyses were conducted using the Statistical Analysis System (SAS®; Cary, NC, USA) version 9.1.3. The quantitative methods employed addressed the complex survey sampling design of the US NAMCS. Descriptive statistics and logistic regression derived odds ratios (ORs) and 95% confidence intervals (CIs) are reported, as are rates per 1000 OBV and per 1000 US population. In 2007, there were (i) 28 457 078 OBVs with an ICD-9-CM code for MDD without co-morbid mental illness. Of these, 20 090 702 (70.6%) reported the prescribing of an antidepressant, 2420 885 (8.5%) OBVs reported the prescribing of an SGA (7.4% continued, 1.1% new) and 1 981 968 (7.0%) OBVs reported the prescribing of both an antidepressant and an SGA. The probability of prescribing an SGA increased when the physician specialty was psychiatry (OR 10.97; 95% CI 5.57, 21.58); and (ii) 74561367 OBVs with MDD marked on the DCC without co-morbid mental illness, 37 470 406 (50.3%) OBVs reported the prescribing of an antidepressant, 3 877 385 (5.2%) reported the prescribing of an SGA (4.5% continued, 0.8% new) and 2785941 (3.7%) reported the prescribing of both an antidepressant and an SGA. The probability of prescribing an SGA increased when the physician specialty was psychiatry (OR 10.63; 95% CI 6.68, 16.93). The rate of prescribing of both an antidepressant and an SGA was 2.2 per 1000 when the OBV had an ICD-9-CM code for MDD and 3.1 per 1000 when the OBV had MDD marked on the DCC. In 2007, for OBVs with either an ICD-9-CM code for MDD or MDD marked on the DCC, there was modest use of an SGA, and the probability of the prescribing of an SGA increased when the specialty of the physician was psychiatry.

Psychometric characteristics of the German adaptation of the Traumatic Experiences Checklist (TEC).

This study evaluated the psychometric properties of the German adaptation of the Traumatic Experiences Checklist (TEC), a comprehensive questionnaire for the assessment of adverse and potentially traumatic experiences in childhood and adult life. Participants were recruited from in- and outpatient units of 7 psychiatric services in Switzerland and Germany and from private practitioners of psychiatry and psychotherapy (N = 287). Participants were assessed by self-rating scales, diagnostic checklists, and diagnostic interviews. A subgroup of 67 participants recompleted the TEC 3 to 5 weeks following the first assessment. High correlations between TEC scores and Childhood Trauma Questionnaire scores confirmed criterion validity of the TEC. Construct validity was confirmed by the association of TEC scores with symptom scores of posttraumatic stress, dissociation, anxiety, and depression. The TEC showed high reliability (Cronbach's α = 0.85 to 0.94 for total scores, test-retest correlation = 0.94 to 0.95 for total scores). The psychometric properties of the German adaptation of the TEC are excellent. The TEC is useful to assess adverse and potentially traumatic experiences in clinical work and research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)

Assessment accuracy of core needle biopsy for hormone receptors in breast cancer: a meta-analysis

The concordance of hormone receptors (HR) status identified by core needle biopsy (CNB) compared with excisional biopsy (EB) has been widely reported, but results were extremely variable and underpowered. To derive a more precise estimation of assessment accuracy of CNB for HR in breast cancer, we conducted a meta-analysis of all eligible studies comparing concordance or disconcordance between CNB and EB for HR status. Eligible articles were identified by search of databases including PubMed, Web of Science, EMBASE, and Chinese Biomedical Literature database for the period up to November 2011, and the reference lists of identified studies, relevant reviews, meta-analyses, and abstracts from recent conference proceedings were reviewed as a augmented searching. Finally, a total of 21 articles involving 2,450 patients for estrogen receptor (ER) and 2,448 patients for progesterone receptor (PR) were included and analyzed in this analysis. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies checklist. The overall aggrement between CNB and EB were 92.8 % for ER (κ = 0.78) and 85.2 % for PR (κ = 0.66), indicating a good agreement in PR and a better result in ER. The pooled sensitivity and specificity were 97.3 % (95 % CI 96.0-98.2) and 82.0 % (95 % CI 68.2-90.6) for ER, and the corresponding values for PR were 92.3 % (95 % CI 88.2-95.1) and 76.5 % (95 % CI 64.6-85.3), respectively. The pooled positive likelihood ratios was 5.39 % (95 % CI 2.92-9.97) and the negative likelihood ratios was 0.03 % (95 % CI 0.02-0.05) for ER, the corresponding values for PR were 3.93 % (95 % CI 2.53-6.11) and 0.10 % (95 % CI 0.07-0.16), respectively. In summary, although a good agreement was observed between CNB and EB for both ER and PR, we still suggest that negative HR testing results should be interpreted with caution or repeated on EB.

Social phobia among Al Qadissya medical student: prevalence, Academic performance and response to different treatments

Background: Social phobia (SP) is an inappropriate anxiety; experienced in social situations in which the person feels observed by others and could be criticized by them so he/she attempts to avoid such situations.Objectives: This study aims to identify the prevalence of (SP) among the medical students, as well as the socio- demographic characters will be investigated.The effect of (SP) on the students that is; their academic performance and the response to different type of treatments.Methods: Three hundred eighty students of both genders were selected randomly from Al-Qadissia Medical College in Al- Diwania city. These students were interviewed using the International Diagnostic Checklist of ICD.10 Social Phobia. The academic performance of subjects meeting a diagnosis of (SP) was studied. Their response to selective serotonin reuptake inhibitor (Fluoxetine) and comprehensive cognitive behavioral therapy were evaluated.Results: The result showed that the prevalence of (SP) among the medical student is (12.6 %). female students had higher rates than males (17.4%, 7.9%) respectively. positive family history of any psychiatric disorder was found more in students having (SP) . Eating or speaking in public appeared to be the most common feared situations avoided by the diagnosed students. (SP) appeared to have no effect on the students academic performance. Both treatment (Fluoxetine, Comprehensive Cognitive Behavioral Therapy) had good response (48%, 52.8%) respectively.Conclusions: Significant differences are found between the rate of SP and different sexes. SP appeared to have no effect on the students academic performance. Both active treatments had good response; in addition they have nearly equal result.

6. Retrospective Comparison of DSM-IV Eating Disorder Diagnosis to Classification by Diagnostic Checklist for DSM-5 Feeding and Eating Disorders

To evaluate whether the proposed DSM-5 criteria for Feeding and Eating Disorders (ED) result in categorizing fewer adolescents with a nonspecific ED diagnosis (EDNOS), and to compare DSM-IV and DSM-5 diagnostic groups, the ‘Diagnostic Checklist for DSM-5 Feeding and Eating Disorders’(‘Checklist’)(developed and provided by B. Timothy Walsh, MD)was utilized and tested in patients with DSM-IV ED.

Drug-induced supersensitivity psychosis revisited: characteristics of relapse in treatment-compliant patients.

An association between abnormal involuntary movements and psychotic relapse was previously reported in a group of patients compliant with antipsychotic medication (Fallon and Dursun 2011). This was interpreted as the presence of an antipsychotic medication-induced supersensitivity psychosis. From the results of that study and the Chouinard diagnostic criteria for supersensitivity psychosis an abbreviated diagnostic checklist was developed to identify the phenomenon. In the present study the checklist was used on a larger sample of medication-compliant individuals experiencing a psychotic relapse. The checklist demonstrated its utility by identifying a cause of relapse in 70% (29/41) of patients. Furthermore, it identified the presence of supersensitivity psychosis in 39% (16/41) of patients. This study also replicated a number of findings from the previous paper supporting the idea that supersensitivity psychosis is one cause of relapse in psychosis. These results suggested that clinicians should exercise caution in prescribing and may have to augment treatment with other agents or switch to low dopamine-affinity antipsychotics.

Improving Safe Consumer Transfers in a Day Treatment Setting Using Training and Feedback

An intervention package that included employee training, supervisory feedback, and graphic feedback was developed to increase employees' safe patient-transfers at a day treatment center for adults with disabilities. The intervention was developed based on the center's results from a Performance Diagnostic Checklist (PDC), which focused on antecedents, equipment and processes, knowledge and skills, and consequences related to patient-transfers. A multiple baseline (MBL) across two lifts (pivot and trunk), with one lift (side) remaining in baseline was used to evaluate the effects of the treatment package on three lifts commonly used by three health-care workers. The results indicated a substantial increase in the overall safe performance of the three lifts. The mean increase for group safety performance following intervention was 34% and 29% over baseline measures for the two target transfers, and 28% over baseline measures for the nontargeted transfer. The implications of these findings suggest that in settings where patient transfers are frequent and injuries are likely to occur (e.g., hospitals, day treatment centers), safe lifting and transferring behaviors can improve with an efficient and cost-effective intervention.

The value of FDG positron emission tomography/computerised tomography (PET/CT) in pre-operative staging of colorectal cancer: a systematic review and economic evaluation.

The value of FDG positron emission tomography/computerised tomography (PET/CT) in pre-operative staging of colorectal cancer: a systematic review and economic evaluation.

Prevalence and psychopathological characteristics of depression in consecutive otorhinolaryngologic inpatients

BackgroundHigh prevalence of depression has been reported in otorhinolaryngologic patients (ORL). However, studies using a semi-structured interview to determine the prevalence of depression in ORL are lacking. Therefore the present study sought to determine the depression prevalence in ORL applying a semi-structured diagnostic interview and to further characterize the pathopsychological and demographic characteristics of depression in these patients.MethodsOne-hundred inpatients of the otorhinolaryngologic department of a German university hospital participated voluntarily (age M = 38.8 years, SD = 13.9; 38.0% female). Depression was assessed using a clinical interview in which the International Diagnostic Checklist for depression (IDCL) was applied. Patients completed the Brief Symptom Inventory (BSI) which constitutes three composite scores and nine symptom scales and the Beck Depression Inventory (BDI). Multivariate analyses of variance, correlations and effect sizes were conducted.ResultsA prevalence of depression of 21.0% was determined, 38.0% of the depressed patients were female. Depressed patients showed higher scores on the BSI-scales "interpersonal sensitivity", "depression", "anxiety", "phobic anxiety" and "psychoticism" with medium effect sizes.ConclusionsHigh prevalence of depression was found which is in accordance with results of prior studies. Depressed patients showed higher psychological distress as compared to non-depressed patients. The results call for carrying on in engaging in depression research and routine depression screening in ORL.

Diagnosing EAP writing ability using the Reduced Reparameterized Unified Model

Despite the increasing interest in and need for test information for use in instructional practice and student learning, there have been few attempts to systematically link a diagnostic approach to English for academic purposes (EAP) writing instruction and assessment. In response to this need for research, this study examined the extent to which the diagnostic information generated by the Reduced Reparameterized Unified Model (Reduced RUM; Hartz, Roussos, &amp; Stout, 2002) was a discriminant, accurate, and reliable method of determining student performance in EAP writing. Ten English as a second language (ESL) teachers assessed 480 Test of English as a Foreign Language™ Internet-based test (TOEFL® iBT ) independent essays using the Empirically-derived Descriptor-based Diagnostic (EDD) checklist, which consisted of 35 concrete, fine-grained descriptors. The resultant ratings were then analyzed using Arpeggio, the estimation software of the Reduced RUM. The findings showed that the skills diagnosis approach not only classified skill masters and non-masters accurately and reliably, but that it also had high discriminant function, with only a small number of students classified into flat profiles. However, concerns were raised with regard to the diagnostic power of some descriptors and the stability of one writing skill parameter (i.e., mechanics). The theoretical and pedagogical implications of the use of diagnostic assessment in EAP writing are discussed in this paper, as are suggestions for future research in applying psychometric diagnostic assessment models to performance assessment.

The Effect of Study Design Biases on the Diagnostic Accuracy of Magnetic Resonance Imaging for Detecting Silicone Breast Implant Ruptures: A Meta-Analysis

The U.S. Food and Drug Administration has recommended that all silicone breast implant recipients undergo serial screening to detect implant rupture with magnetic resonance imaging. The authors performed a systematic review and meta-analysis to examine the effect of study design biases on the estimation of magnetic resonance imaging diagnostic accuracy measures. Studies were identified using the MEDLINE, EMBASE, ISI Web of Science, and Cochrane library databases. Two reviewers independently screened potential studies for inclusion and extracted data. Study design biases were assessed using the Quality of Diagnostic Accuracy Studies tool and the Standards for Reporting of Diagnostic Accuracy Studies checklist. Meta-analyses estimated the influence of biases on diagnostic odds ratios. Among 1175 identified articles, 21 met the inclusion criteria. Most studies using magnetic resonance imaging (10 of 16) and ultrasound (10 of 13) examined symptomatic subjects. Magnetic resonance imaging studies evaluating symptomatic subjects had 14-fold higher diagnostic accuracy estimates compared with studies using an asymptomatic sample (relative diagnostic odds ratio, 13.8; 95 percent confidence interval, 1.83 to 104.6) and 2-fold higher diagnostic accuracy estimates compared with studies using a screening sample (relative diagnostic odds ratio, 1.89; 95 percent confidence interval, 0.05 to 75.7). Many of the published studies using magnetic resonance imaging or ultrasound to detect silicone breast implant rupture are flawed with methodologic biases. These methodologic shortcomings may result in overestimated magnetic resonance imaging diagnostic accuracy measures and should be interpreted with caution when applying the data to a screening population.

Multiscale assessment of treatment efficacy in adults with ADHD: A randomized placebo-controlled, multi-centre study with extended-release methylphenidate

Objectives. This trial was performed to test the efficacy and safety of an extended-release formulation of methylphenidate (MPH ER). Methods. A total of 162 adults with ADHD according to DSM-IV were treated for 8 weeks with either two daily individually body weight-adjusted doses of MPH ER up to 1 mg/kg per day (N = 84) or placebo (N = 78). The primary efficacy outcome was the Wender–Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) 8 weeks after randomization. Secondary efficacy measures were the ADHD Diagnostic Checklist (ADHD-DC), the Conners Adult Attention Deficit Disorder Scale (CAARS-S:L), the Clinical Global Impression (CGI) and the Sheehan Disability Scale (SDS). Results. At week 8 a significantly higher decline of the total WRAADDS score was found in the MPH ER group as compared to the placebo group (P = 0.0003). The rates of responders were 50% in the MPH ER and 18% in the placebo group (P < 0.0001). Furthermore, similar effects were observed for the secondary efficacy variable: ADHD-DC score (P = 0.004), CAARS-S:L score (P = 0.008) and the SDS score (P = 0.017). 50% of the MPH ER group and 24.4% of the placebo group were improved “much” or “very much” according to the CGI rating (P = 0.0001). MPH ER treatment was well tolerated. At week 2 also the mean heart rate was significantly higher in the MPH ER group as compared to the placebo group (P = 0.01). No differences between the study groups were observed regarding mean blood pressure at any visit. Conclusions. This clinical trial demonstrated statistically significant and clinical relevant effects of MPH ER in adults with ADHD for several self- and investigator-rated ADHD psychopathology and also functional efficacy measures.

Capsule endoscopy in Italy: An unbalanced review of the literature. Authors' response

The comments by Spada et al. (which are similar in style and content to the ones already made by the authors on the Italian Ministry of Health Web site) are based on misunderstandings and manipulations. The essence of systematic reviews is to sum up available knowledge and minimize bias. The latter is done by a priori stating study inclusion criteria both in the protocol and in the full HTA report (see Fig. 1, p. 299) and assessing methodological quality of included studies using an instrument which was specified in the protocol text and never changed (the Quality Assessment Diagnostic Accuracy Studies checklist or QUADAS). The purpose of inclusion criteria and bias minimization efforts is to ensure that what is included in a review is both relevant and contributes evidence weighted by its reliability to answer the study question (in our case the diagnostic performance of WCE in the small bowel). The high number of excluded studies is thus irrelevant, although it is a common feature of systematic reviews. What matters is what the included studies tell us.

The Validity and Reliability of the German Version of the Somatoform Dissociation Questionnaire (SDQ-20)

The present study investigated the validity of the German version of the Somatoform Dissociation Questionnaire (SDQ-20), a scale designed to measure somatoform dissociative symptoms. Somatoform dissociation involves physical manifestations of a dissociation of the personality and is considered a unique entity in the phenomenological spectrum of dissociation. The validity and reliability of the German version of the SDQ-20 was examined using a sample of 225 patients with (n = 39) and without dissociative disorders who were recruited from several in- and outpatient psychiatric clinics. Patients were assessed using structured diagnostic interviews; diagnostic checklists; and self-rating scales for dissociation, and posttraumatic stress. Patients with dissociative disorders reported significantly more (p < .001) somatoform dissociative symptoms than patients without dissociative disorders (criterion validity). Significant correlations (p < .001) were found between scores of somatoform dissociation, psychoform dissociation, posttraumatic stress symptoms, and traumatic childhood experiences (construct validity). Reliability was corroborated by a Cronbach's alpha coefficient of .91 and a test–retest correlation of .89. A component factor analysis suggested unidimensionality of the SDQ-20. In conclusion, the psychometric properties and cross-cultural validity of the German version of the SDQ-20 are excellent. Our results form the basis for the further study of somatoform dissociation in German-speaking populations.

Diagnosis of fetal alcohol spectrum disorders: a validity study of the fetal alcohol syndrome checklist

Fetal alcohol spectrum disorders (FASD) are a common cause of developmental disability, birth defects, and mortality. The performance characteristics of current diagnostic tools for FASD are not adequately reported. This study examines the performance characteristics of the Fetal Alcohol Syndrome Diagnostic Checklist (FASDC). In a population of 658 subjects from North Dakota, we used the FASDC score to examine the agreement between FASDC score, clinical diagnosis, and the Institute of Medicine criteria for FASD. All subjects were seen for evaluation in the genetic/dysmorphology clinics, which are funded by the state to provide genetic diagnostic services for residents of North Dakota. We compared the clinical diagnosis and the FASDC scores to determine the performance characteristics of the FASDC in the categorical diagnosis of fetal alcohol spectrum (FAS), other-FASD, and a group with No-FASD. Comparisons were made using univariate and logistic models of outcomes using both the presence and the absence of alcohol exposure or FASDC phenotype data. The FASDC performance characteristics for differentiation of the FAS group from non-FASD were excellent (accuracy 99%, sensitivity 99%, and specificity 99%). Logistic models for subjects with scores in the FASD range were differentiated with an accuracy of 82%, sensitivity 85%, and specificity 80% using the data on phenotype and exposure. We were able to delineate subjects with scores in the No-FASD range with an accuracy of 78%, sensitivity 64%, and specificity 81% without including the exposure and phenotype data by use of the other descriptive data (maternal characteristics, birth records, and demographic data) from the FASDC. All diagnostic tools should have performance characteristics assessed and available before adoption for use in clinical settings. The FASDC scores produce diagnostic groupings that approximate expert clinical judgment. The tool may be useful in other clinical settings for the diagnosis of FASD or as an FASD registry or research database.