Psychiatric Screening Instruments Research Articles

Neurological and cognitive impairment in COVID‐19: clinical characterization andepidemiological

AbstractBackgroundCOVID‐19 neurological manifestations were demonstrated during the pandemic, including cognitive impairment. Objectives: To determine the prevalence of cognitive and behavioral complaints (such as dementia, MCI or SCD) in a outpatient sample with recent SARS‐COV2 infection. Specific: Evaluate the association of cognitive impairment with the presence of the polymorphism found in the APOE gene and with respiratory diseaseMethodObservational, longitudinal, prospective clinical study. Inclusion criteria: patients with confirmed Covid‐19. Patients are evaluated in an outpatient clinic. They are evaluated through a standardized attendance record, with somatic and cognitive neurological assessment. Cognitive assessment involves the application of cognitive (ACER, MMSE and CDR), functional (Pfeffer) and psychiatric (GDS or Beck) screening instruments, in addition to subsequent extensive neuropsychological assessment. In addition, APOE polymorphism is analysed.ResultsTo date, 200 patients were evaluated. The average age is 46.5 years, with 65.4% female, 79.16% with 8 or more years of schooling, in addition to 57.5% of the sample with cognitive complaints.ConclusionsThe results so far in our study demonstrate that cognitive complaints are frequent in patients even in the chronic phase of the disease.

3.74 Validation of the Child Behavior Checklist and Achenbach Test Observation Form for Use With american indian Children in the Navajo Nation

There are virtually no psychiatric screening or diagnostic instruments validated for use with American Indian Children in the Navajo Nation, the largest American Indian reservation in the United Sates. In order to begin to remedy this problem, we completed a preliminary study examining the validity and reliability of the Child Behavior Checklist (CBCL) and the Achenbach System of Empirically Based Assessment (ASEBA) Test Observation Form (TOF) for American Indian children in the Navajo Nation. The CBCL is a parent report to screen for developmental psychopathology, whereas the TOF is a companion form, completed by trained assessors, to rate observed behaviors in 2- to 18-year-old children.

Validity and Reliability of the Iranian Rapid Assessment for Psychiatric Illness Screening Instrument (IRA-PISI) in Primary Health Care

Background: An estimated 25% to 30% of patients presenting to family physicians have psychiatric disorders (PDs). Accurate diagnosis of various PDs requires valid and well-designed screening tools and psychiatric interviews. There is no rapid and low-cost tool for PD screening in primary health care (PHC). Objectives: To determine the validity and psychometric properties of the Iranian Rapid Assessment for Psychiatric Illness Screening Instrument (IRA-PISI) in PHC. Methods: This psychometric study was performed among a convenience sample of 257 outpatients presenting to the first-line health services in Tabriz. Psychiatric interviews via DSM-5 were used as the gold standard. The validation process included the face validity (literature review and expert comments), content validity, estimating the best cutoff point, and measuring the sensitivity and specificity of the questionnaire compared to the psychiatric interview. Temporal and internal reliabilities were measured by test-retest and Cronbach's alpha coefficient, respectively. Results: The final questionnaire consisted of 14 items (with a score range of 14 to 70) after removing seven questions from the initial questionnaire (21 items) during the validation process. The sensitivity and specificity of the questionnaire compared to psychiatric interviews were 83.62% and 75.17%, respectively. The overall relevance and the best cutoff point (score) were 0.91% and 28, respectively. Interclass correlation coefficient (ICC) and Cronbach's alpha coefficient were 96% and 83%, respectively. The ICC of items/questions ranged from 89.3 to 100. Conclusions: The IRA-PISI has appropriate validity and reliability for screening common PDs among outpatients presenting to first-line healthcare providers.

Increased Incidence of Mental Disorders in Children with Cataract: Findings from a Population-based Study

To examine the incidence of mental disorders in children with cataract compared with children without cataract. Nationwide cohort study based on entries in comprehensive national databases. The incidence of mental disorders in children born between 2000 and 2017 diagnosed with cataract before 10 years of age (n=485) was compared with sex- and age-matched controls (n=4358). Analyses were corrected to somatic disease in the child and parental socioeconomic status and psychiatric morbidity. The study was conducted as 2 university hospitals in Denmark managing children 6 years of age our younger with cataract. The incidence of mental disorders was nearly doubled in children with cataract compared with controls (odds ratio [OR], 1.83; 95% CI, 1.28-3.63). The risk of anxiety disorders was quadrupled (OR, 4.10; 95% CI, 1.90-8.84) and the risk of developmental delay was doubled (OR, 2.66; 95% CI, 1.45-4.90). The risk of mental disorders was significantly higher in children diagnosed with cataract in the first 3 years of life compared with controls (OR, 2.36; 95% CI, 1.53-3.64), whereas those diagnosed with cataract later in childhood did not have an increased risk (OR, 1.24; 95% CI, 0.66-2.30). The risk of mental disorders, in particular anxiety and neurodevelopmental delay, is markedly increased in children with cataract and even more so in those diagnosed within the first 3 years of life. Psychiatric screening instruments may be integrated in the management of these children.

Psychiatric Comorbidities in Pediatric Epilepsy.

Psychiatric comorbidities are close to 5-times higher in children and youth with epilepsy (CYE) compared to general population. With epilepsy being one of the most common neurological disorders in children, we provide a timely review of psychiatric issues in CYE. A meta-analysis found a pooled prevalence of anxiety in 18.9% and depression in 13.5% of CYE. Attention deficit hyperactivity disorder (ADHD) is 2.5 to 5.5 times higher in CYE compared to healthy counterparts. Recent evidence highlights that behavioral adverse effects may lead to discontinuation of anti-epileptic drugs (AEDs) in more than 10% of CYE. Up to 70% CYE shows elevation in baseline psychological symptoms after AED initiation. Identifying psychiatric symptoms can be easily accomplished by the routine use of psychiatric screening instruments in CYE clinics, which is associated with improved health-related quality of life (HRQOL). Psychoeducation is a key component for any visit with CYE. There is some evidence of the effectiveness of behavioral psychological interventions for CYE. There are no therapeutic trials of psychotropics in CYE, but treatment recommendations based on the experience in adults with epilepsy and general population are applicable. Early diagnosis and management of psychiatric comorbidities leads to improvement in HRQOL of CYE. This requires routine screening and a multidisciplinary teamwork.

Adaptation and validation of a brief DSM-5 based psychiatric rating scale for childhood and adolescent mental health in Uganda: the Child and Adolescent Symptom Inventory-Progress Monitor (CASI-PM)

ABSTRACT We describe the process of locally adapting and validating the international psychiatric symptom screening instrument, the Child and Adolescent Symptom Inventory-Progress Monitor-parent version (CASI-PM-P) for use among youth in the sub-Saharan African setting of Uganda. To do this we used a methodology similar to that employed by the developers of this instrument. These analyses were undertaken among both a clinical sample (1,339 HIV positive children and adolescents attending HIV care services in central and south-western Uganda) and a standardised sample (consisting of 323 HIV negative children and adolescents attending government schools in central Uganda). Pearson’s correlations, Cronbach’s alpha and analyses of variance were used to assess the reliability and validity of the adapted instrument. On item selection, 18 (64%) of the 28 psychiatric symptom items in the derived instrument showed large to moderate item-to-total minus item correlations. There was concordance on 17 (61%) of the psychiatric symptom items between the original version of the CASI-PM-P and the Uganda version. The selected psychiatric variable items in the derived version of the CASI-PM-P showed stability across age groups (children and adolescents), time (baseline and 6 months) and samples (clinical sample and standardised sample). The instrument showed good construct validity. In conclusion, the 29-item CASI-PM-P can, therefore, be used in the sub-Saharan African setting to screen for and monitor the progress of psychiatric symptoms among youth. However, the selection of the specific variable items to constitute a local version of the CASI-PM-P should be guided by local adaptation and validation studies.

Comparison of psychiatric screening Instruments: GHQ-28, BSI and MMPI.

Background:Clinical interview comprises a method for of psychiatric disorders diagnosis. Given the cost, time, and expertise required for clinical assessment; alternative tools to accurately substitute clinical interviews are having high value. We conduct this study to compare the screening accuracy of GHQ-28, BSI, and MMPI.Materials and Methods:Considering a diagnostic value, this study was conducted on 983 students and 3 psychiatric screening tools; GHQ-28, BSI, and MMPI were completed by students. Among the whole participants, 237 students were interviewed by the clinical psychiatrists on the basis of DSM-IV-IR Criteria. Based on ANOVO and Chi-square, results compare was made. Kappa correlation -coefficient was calculated in a pairwise manner; eventually the diagnostic accuracy of each tool was determined by the means of ROC analysis.Results:The diversity of psychiatric disorders by GHQ-28, was about 39.1, on the basis of BST was 44.8% and 44% for MMPI. The sensitivity and specificity of GHQ-28 was 85.9% and 87.8% considering 21.5 as the cut-off point; respectively. Considering 41/5 as the cut-off point for the BSI test, sensitivity and specificity were 81.2% and 90.8%; respectively, and 88.2% and 91.4% for the MMPI test with the cut-off point of 63.5 compared to clinical interview, the MMPI test was associated with the greatest accurate staging, ranging about 90.3%.Conclusions:The results of this study according to clinical assessment reveal that GHQ-28, BSI, and MMPI psychiatric tools have high sensitivity and specificity and MMPI possessed the greatest efficiency compared to other evaluated tools.

The psychiatric assessment schedule for adults with developmental disability checklist: reliability and validity of Turkish version

ABSTRACTAim/background: There is a lack of psychometric instruments to measure psychopathology in people with intellectual disabilities (ID). This may lead to underdiagnosis of treatable psychiatric comorbidities in this population. Psychiatric assessment schedule for adults with developmental disabilities (PAS-ADD) Checklist was developed as a screening tool designed for lay people. The PAS-ADD Checklist was created in English and was later on validated for other languages, including French and German. There is no psychometric measure available in Turkish to screen for or detect psychiatric symptoms in adults with ID. The aim of the present study was to present a psychometric evidence of the Turkish language version of the PAS-ADD Checklist. This is the first study aiming to present and validate a psychiatric screening instrument for adults with ID in Turkey.Methods: The Turkish version was developed by translation and back translation. The checklist and a structured purpose-designed socio-demographic fo...

Mental health policies in South-East Asia and the public health role of screening instruments for depression.

The World Health Organization (WHO) South-East Asia Region, which contributes one quarter of the world's population, has a significant burden due to mental illnesses. Mental health has been a low priority in most countries of the region. Although most of these countries have national mental health policies, implementation at ground level remains a huge challenge. Many countries in the region lack mental health legislation that can safeguard the rights of people with mental illnesses, and governments have allocated low budgets for mental health services. It is imperative that concerned authorities work towards scaling up both financial and human resources for effective delivery of mental health services. Policymakers should facilitate training in the field of mental health and aim towards integrating mental health services with primary health care, to reduce the treatment gap. Steps should also be taken to develop a robust mental health information system that can provide baseline information and insight about existing mental health services and help in prioritization of the mental health needs of the individual countries. Although evidence-based management protocols such as the WHO Mental Health Gap Action Programme (mhGAP) guidelines facilitate training and scaling up of care in resource-limited countries, the identification of mental disorders like depression in such settings remains a challenge. Development and validation of brief psychiatric screening instruments should be prioritized to support such models of care. This paper illustrates an approach towards the development of a new culturally adapted instrument to identify depression that has scope for wider use in the WHO South-East Asia Region.

Clinimetric testing of the comprehensive cervical dystonia rating scale.

The aim of this study was to test the clinimetric properties of the Comprehensive Cervical Dystonia Rating Scale. This is a modular scale with modifications of the Toronto Western Spasmodic Torticollis Rating Scale (composed of three subscales assessing motor severity, disability, and pain) now referred to as the revised Toronto Western Spasmodic Torticollis Scale-2; a newly developed psychiatric screening instrument; and the Cervical Dystonia Impact Profile-58 as a quality of life measure. Ten dystonia experts rated subjects with cervical dystonia using the comprehensive scale. Clinimetric techniques assessed each module of the scale for reliability, item correlation, and factor structure. There were 208 cervical dystonia patients (73% women; age, 59 ± 10 years; duration, 15 ± 12 years). Internal consistency of the motor severity subscale was acceptable (Cronbach's alpha = 0.57). Item to total correlations showed that elimination of items with low correlations (<0.20) increased alpha to 0.71. Internal consistency estimates for the subscales for disability and pain were 0.88 and 0.95, respectively. The psychiatric screening scale had a Cronbach's alpha of 0.84 and satisfactory item to total correlations. When the subscales of the Toronto Western Spasmodic Torticollis Scale-2 were combined with the psychiatric screening scale, Cronbach's alpha was 0.88, and construct validity assessment demonstrated four rational factors: motor; disability; pain; and psychiatric disorders. The Cervical Dystonia Impact Profile-58 had an alpha of 0.98 and its construction was validated through a confirmatory factor analysis. The modules of the Comprehensive Cervical Dystonia Rating Scale are internally consistent with a logical factor structure.

A comparative study of variable selection methods in the context of developing psychiatric screening instruments

The development of screening instruments for psychiatric disorders involves item selection from a pool of items in existing questionnaires assessing clinical and behavioral phenotypes. A screening instrument should consist of only a few items and have good accuracy in classifying cases and non-cases. Variable/item selection methods such as Least Absolute Shrinkage and Selection Operator (LASSO), Elastic Net, Classification and Regression Tree, Random Forest, and the two-sample t-test can be used in such context. Unlike situations where variable selection methods are most commonly applied (e.g., ultra high-dimensional genetic or imaging data), psychiatric data usually have lower dimensions and are characterized by the following factors: correlations and possible interactions among predictors, unobservability of important variables (i.e., true variables not measured by available questionnaires), amount and pattern of missing values in the predictors, and prevalence of cases in the training data. We investigate how these factors affect the performance of several variable selection methods and compare them with respect to selection performance and prediction error rate via simulations. Our results demonstrated that: (1) for complete data, LASSO and Elastic Net outperformed other methods with respect to variable selection and future data prediction, and (2) for certain types of incomplete data, Random Forest induced bias in imputation, leading to incorrect ranking of variable importance. We propose the Imputed-LASSO combining Random Forest imputation and LASSO; this approach offsets the bias in Random Forest and offers a simple yet efficient item selection approach for missing data. As an illustration, we apply the methods to items from the standard Autism Diagnostic Interview-Revised version.

MEASURING DEPRESSION AND ANXIETY IN SUB-SAHARAN AFRICA

Despite being one of the leading causes of disability worldwide, fewer than 10% of depressed individuals in low-resource settings have access to treatment. Mounting evidence suggests that nonspecialist workers are capable of providing counseling and case management at the community level. They often use brief psychiatric screening instruments as clinical tools to identify cases and monitor symptoms over time. In order for such tools to be used in diverse settings, they must demonstrate adequate reliability and validity in addition to cross-cultural relevance. To be used to guide routine care they also need to be flexibly adapted and sensitive to change. The goal of this paper is to assess the cross-cultural validity of brief psychiatric screening instruments in sub-Saharan Africa, identify best practices, and discuss implications for clinical management and scale-up of mental health treatment in resource-poor settings. Systematic review of studies assessing the validity of screening instruments for depression, anxiety, and mental distress in sub-Saharan Africa using Medline and PsycINFO. Sixty-five studies from 16 countries assessing the validity of brief screening instruments for depression, anxiety, and/or mental distress. Despite evidence of underlying universality in the experience of depression and anxiety in sub-Saharan Africa, differences in the salience, manifestation, and expression of symptoms suggest the need for the local adaptation of instruments. Rapid ethnographic assessment has emerged as a promising, low-cost, and efficient strategy for doing so.

P01-461 - Adapting the SRQ for greek populations: a culturally-sensitive psychiatric screening instrument

IntroductionThere is a significant disagreement in the literature concerning the validity of psychiatric instruments in different cultures.The objective of the study was to develop a culturally sensitive psychiatric screening instrument valid for Greeks in Greece and all over the world.MethodsForward and back translation was used for the greek version of the instrument. The sample was divided into three groups:i) general population(69,4%);ii) people in non-psychiatric treatment(12,9%);iii) people in psychiatric treatment (11,7%).They were interviewed with the Self-Reporting Questionnaire (SRQ), modified to include SRQ-F culturally specific items and physicians also completed an encounter form about the presence of mental health symptoms in participants.ResultsThe study sample was composed of 631 Greek speaking adults, 502 females and 129 males, aged 18—67 (M = 30, SD = 11,5). Internal consistency for the overall score was very high (α = ,930). Item total correlations were between, 443 and, 692. Factor analysis revealed four factors accounting for the 54,22 of the total score variance. The factors were anxiety symptoms, depressed mood, somatic symptoms and psychotic symptoms. Content, construct, and criterion validity of each question led to 25 items. Independent t test revealed significant differences between psychiatric patients and control group in the total score (t = -17,795 p = ,0001), psychosis subscale (t = -12,622 p = ,0001) and somatic distress subscale (t = -17,712 p = ,0001).ConclusionsThe Greek SRQ was found to be a valid instrument which can be used in primary care to help general practitioners in the early recognition of mental illness.

S36-04 - Culturally sensitive assessment of depression from a psychometric perspective

A significant challenge in the culturally sensitive use of psychological and psychiatric instruments for depression is “bias”. Bias means that there is a lack of equivalence: Variation in the score is a result not of variation in the disorder or presence of the symptom in question but rather is due to “cultural factors”. Construct bias is perhaps the most complex of all, and is related to the very manner in which depression is understood. Psychological and psychiatric diagnostic and screening instruments delimit the very “nature” of depression, and fall prey to both false positives and false negatives when assessing individuals from cultures in which the experience and expression of depression is distinct from that found in the West. Equally complex are both method and item bias. In the former, the very method used—for example, a horizontal Likert-like scale—is responded to differentially across cultures, thus resulting in variance that is due not to variations in the presence of symptom but rather the manner of response. Item bias occurs when the item in question is understood in different ways in different cultures. Finally, there is concern about basic issues surround norms, cut-off scores and the like, in as much as the lack of equivalence indicates that results must be interpreted in accordance with population specific norms. Depression diagnostic and screening instruments and their items will be selectively reviewed to demonstrate the presence of bias, and concrete suggestions will be presented to achieve a more culturally sensitive assessment process.

Impact of maternal anxiety level on the childhood vaccination coverage

The mother's mental state as a risk factor for the children's vaccination status in developing countries has received little attention. The aim of this study was to determine the association between childhood vaccination coverage and maternal anxiety. A total of 195 consecutive infants and their mothers attending a tertiary teaching hospital, department of pediatric outpatient center between January 2008 and September 2009 were included in the study. One hundred five infants who have incomplete vaccination schedule (according to the National Immunization Schedule) were matched with 90 controls (fully vaccinated) and their mothers self-report measure of anxiety level using the State-Trait Anxiety Inventory (STAI), a psychiatric screening instrument. The chi-square test and the logistic regression were used in the statistical analysis. High maternal anxiety levels determined by STAI was associated with increased risk of incomplete vaccination status in infants (odds ratio 4.35, 95% confidence interval 1.87-8.79).This association remained significant after controlling for sociodemographic factors. High maternal anxiety scores may result in incomplete vaccination status in children younger than 3years.

Screening for mental disorders in residential aged care facilities

The International Psychogeriatric Association Task Force on Mental Health Services in Long-Term Care Facilities seeks to improve care of persons in residential aged care facilities (RACFs). As part of that effort the current authors have contributed an overview and discussion of the uses of brief screening instruments in RACFs. While no current guidelines on the use of screening instruments in nursing homes were found, relevant extant guidelines were consulted. The literature on measurement development, testing standards, psychometric considerations and the nursing home environment were consulted. Cognitive, psychiatric, behavioral, functional and omnibus screening instruments are described at a category level, along with specifics about their use in a RACF environment. Issues surrounding the selection, administration, interpretation and uses of screening instruments in RACFs are discussed. Issues of international interest (such as translation of measures) or clinical concern (e.g. impact of severe cognitive decline on assessment) are addressed. Practical points surrounding who can administer, score and interpret such screens, as well as their psychometric and clinical strengths more broadly, are articulated. Guidelines for use of screening instruments in the RACF environment are offered, together with broad recommendations concerning the appropriate use of brief screening instruments in RACFs. Directions for future research and policy directions are outlined, with particular reference to the international context.

Adapting the SRQ for Ethiopian Populations: A Culturally-Sensitive Psychiatric Screening Instrument

The objective of the study was to develop a culturally sensitive psychiatric screening instrument valid for Ethiopians in Ethiopia and Israel. The study sample was composed of 356 Amharic-speaking Ethiopians from Ethiopia and Israel, aged 18-55, divided into three groups: i) general population; ii) people in non-psychiatric treatment; iii) people in psychiatric treatment. They were interviewed with the Self-Reporting Questionnaire (SRQ), modified to include 10 culturally specific items, and the Brief Psychiatric Research Scale (BPRS) as a criterion of psychopathology. Physicians also completed an encounter form about the presence of mental health symptoms in participants. To make the questions more culturespecific, the translation of 12 items on the SRQ was changed. The content, construct, and criterion validity of each question were also examined, leading to the deletion of five items. The validity of the revised instrument (SRQ-F) was superior to that of the original instrument (SRQ). This study demonstrates the need for psychiatric screening instruments to be adapted to different cultures by incorporating meaningful translations and adding culturally specific items.

The relationship between psychiatric symptomatology and motivation of challenging behaviour: A preliminary study

In addition to explaining challenging behaviour by way of behaviour analytic, functional analyses, challenging behaviour is increasingly explained by way of psychiatric symptomatology. According to some researchers, the two approaches complement each other, as psychiatric symptomatology may form a motivational basis for the individual's response to more immediate environmental challenges, like deprivation and aversive conditions. The most common example may be that depressive mood may render task demands aversive. Consequently, the person may show escape-motivated challenging behaviour in the presence of demands. The question becomes whether, or to what extent, relationships between psychiatric symptomatologies and particular functions of challenging behaviour exist. In the present, preliminary study, PAS-ADD checklist, a psychiatric screening instrument, and motivation assessment scale (MAS) were employed in order to investigate this issue. The results show that symptomatologies are largely unrelated to particular behavioural functions. Practical implications are discussed.

Translation and cross-cultural adaptation of a mental health battery in an African setting.

Standardised measuring instruments are increasingly used in psychiatric research cross-culturally. These instruments are considered to be culturally equivalent when all forms of biases, or social norms specific to the culture of origin, have been removed. To describe the qualitative process of selection, translation and cultural adaptation of a mental health battery for use in a Xhosa-speaking community that is, as far as possible, 'culture-free' or equivalent. Informal discussions were held with key members in the community to determine what would be considered as appropriate for the community in respect of psychiatric screening instruments. Existing rating-scales for depression, alcohol abuse and posttraumatic stress disorder that would meet these criteria were identified and then translated from English into Xhosa. Cultural equivalence was achieved by combining methods of back-translation, committee consensus approach and decentering. Discussions during the committee consensus meetings were recorded and categorized into themes. Two themes emerged: (1) issues related to the attainment of semantic equivalence and (2) broader problems inherent in cross-cultural research. Issues related to individual questionnaires included the use of terms to describe emotional distress cross-culturally. Broader issues related to the translation process itself included the form of language to be used, time-frames, and the use of Likert-scales. It also demonstrated the problems inherent in the categorization of emotions. A method of combining a group approach, back-translation, and decentering was effective and efficient in this context for establishing content and semantic equivalence. Cross-cultural adaptation can never completely remove all forms of bias from a research instrument, but such limitations should be acknowledged and openly discussed, rather than hidden or ignored.

Primary care psychiatry: pertinent Arabian perspectives

There is substantive evidence of significant psychiatric morbidity among primary care patients, mainly in the form of anxiety and depressive disorders. A careful critical approach is essential for ensuring the cultural relevance, validity and reliability of the psychiatric screening instruments used to identify such morbidity. Most psychiatric morbidity among primary care patients passes undetected by the primary care practitioners. This will inevitably lead to unnecessary investigation and medication and the continuation of suffering for patients. Comorbidity and physical presentation in most instances contribute significantly to failure to detect psychiatric disorders. To deal with this problem of hidden psychiatric morbidity, carefully designed educational and training programmes need to be tailored to address the particular weaknesses and needs of primary care doctors.