Schedules For Clinical Assessment In Neuropsychiatry Research Articles

Psychiatrists' Ascertained Treatment Needs for Mental Disorders in a Population-Based Sample

Population-based studies of prevalence have been used to approximate the amount of need for treatment of mental disorders. This study aimed to estimate need for treatment of alcohol dependence, major depression, panic disorder, agoraphobia, and social phobia. Psychiatrists used the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) to assess individuals in a probability sample of the Baltimore Epidemiologic Catchment Area follow-up study for need for and use of mental health services. Population-based estimates were calculated with probability weights. The SCAN sample included 816 participants who were interviewed between 1993 and 1999. Prevalence of need for mental health services in the general population was 28.7%+/-2.7%. Among the disorders studied, the greatest need was for treatment of alcohol dependence; 90% of the SCAN sample who met criteria for this diagnosis, or 13.6%+/-1.9% of the population, needed treatment. In the general population, 10.5%+/-2.1% needed treatment for major depression; 5.2%+/-.9%, for social phobia; 5.2%+/-1.6%, for panic disorder; and 3.2%+/-.9%, for agoraphobia. The highest needs for specific treatment modalities were self-help groups for alcohol dependence, talk therapy for depression, behavior modification for social phobia and agoraphobia, and antidepressant medications for panic disorder. Overall, less than 33% of needs were met. Social phobia and alcohol dependence were the two disorders with the highest proportion of unmet need. Prevalence of mental disorders is only an approximation of the need for treatment. There is a substantial need for mental health services in the general population. Most individuals who would benefit from treatment are not receiving any type of mental health services.

Testing the self-medication hypothesis of depression and aggression in cannabis-dependent subjects

A self-medication hypothesis has been proposed to explain the association between cannabis use and psychiatric and behavioral problems. However, little is known about the reasons for use and reactions while intoxicated in cannabis users who suffer from depression or problems controlling violent behavior. We assessed 119 cannabis-dependent subjects using the Schedules of Clinical Assessment in Neuropsychiatry (SCAN), parts of the Addiction Severity Index (ASI), and questionnaires on reasons for cannabis use and reactions to cannabis use while intoxicated. Participants with lifetime depression and problems controlling violent behavior were compared to subjects without such problems. Validity of the groupings was corroborated by use of a psychiatric treatment register, previous use of psychotropic medication and convictions for violence. Subjects with lifetime depression used cannabis for the same reasons as others. While under the influence of cannabis, they more often experienced depression, sadness, anxiety and paranoia, and they were less likely to report happiness or euphoria. Participants reporting problems controlling violent behavior more often used cannabis to decrease aggression, decrease suspiciousness, and for relaxation; while intoxicated they more often reacted with aggression. Subjects with prior depression do not use cannabis as a mean of self-medication. They are more likely to experience specific increases of adverse symptoms while under the influence of cannabis, and are less likely to experience specific symptom relief. There is some evidence that cannabis is used as a means of self-medication for problems controlling aggression.

Neuropsychiatric consequences of traumatic brain injury: A comparison between two age groups

Background: Neurobehavioural symptoms and certain psychiatric disorders are common after a traumatic brain injury (TBI). Relatively few studies have investigated the effect of age upon these outcomes.Aim: Our aim was to compare the rates of neurobehavioural symptoms and psychiatric disorders between 18–65 year old and over 65 year old patients with TBI.Method: 120 adults aged 18 to 65 years and 45 adults over 65 years of age who were admitted to a hospital following a TBI were assessed for neurobehavioural symptoms and psychiatric disorders one year after the injury.Results: Our estimate suggested that a higher proportion of 18–65 year old patients (32%) had ICD-10 psychiatric disorders according to the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) interview compared with patients over 65 years of age (16%). Similarly, the ICD-10 depressive disorder was more common among the younger patients (16%) than the older group of patients (11%). None of these differences were statistically significant. However, a multiple regression analysis revealed that among other risk factors, a younger age was significantly associated with the presence of a psychiatric disorder. Also, a significantly higher rate of psychiatric caseness was detected among the younger age group using screening instruments such as the General Health Questionniare-28 (GHQ-28) (p < 0.01) and the Clinical Interview Schedule-Revised (CIS-R) (p < 0.01). The rates of individual neurobehavioural symptoms varied significantly between the two age groups. The most prevalent symptoms in 18–65 year olds were irritability (37%) and sleep problems (37%). In the older group of patients the most prevalent symptoms were poor memory (40%), dependence (38%) and slowness in thinking (33%).Conclusion: 18–65 year old patients are likely to be at a greater risk of psychiatric morbidity following TBI than over 65 year olds whereas neurobehavioural symptoms are prevalent in both age groups.

Prevalence of International Classification of Diseases, 10th Revision Common Mental Disorders in the Elderly in a Brazilian Community: The Bambui Health Ageing Study

Most community surveys of the mental health of older people have used fully structured interviews administered by lay interviewers. In this study of an older Brazilian population, the authors investigated the prevalence and correlates of common mental disorders with semistructured interviews administered by a psychiatrist. A two-phase population survey of 392 persons aged > or = 75 years were screened for depression and mental disorders using the General Health Questionnaire (GHQ-12) and Geriatric Depression Scale (GDS). Half of those scoring > or = 11 on GDS and > or = 4 on GHQ, and 20% of others, were evaluated in the second phase using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) to generate International Classification of Diseases, 10th Revision diagnoses. The prevalence of depressive episode was high (19.2%) with no effect of gender or age. Dysthymia is also prevalent (9.0%), but half of the cases were comorbid with depression. Anxiety and somatoform disorders were comparatively infrequent. Structured lay-administered interviews may underestimate the prevalence of mental disorders in older people. One month, rather than one year or lifetime, prevalence may be more appropriate for the oldest-old given patchy recall of distant experiences. The very strong association between mental disorders and poor self-reported global health underlines their impact on quality of life.

Parental alcoholism predicts suicidal behavior in adolescents and young adults with cannabis dependence

Little is known about the association between cannabis abuse/dependence, comorbid alcohol and substance use, depression, suicidal ideation and suicidal behavior. To establish the lifetime occurrence of depression, suicidal ideation and suicidal behavior in a group of very heavy cannabis users seeking treatment and to investigate the significance of a range of social, family and contextual factors with special emphasis on alcohol. 119 subjects recruited from 19 different substance treatment centers in Denmark. Structured questionnaires and assessment for psychiatric disorders using Schedules of Clinical Assessment in Neuropsychiatry (SCAN), and Beck Depression Inventory (BDI-II). Lifetime use and dependence of substances was established using parts of Addiction Severity Index (ASI), parts of Composite International Diagnostic Interview (CIDI) and Alcohol Use Disorders Identification Tests (AUDIT). Lifetime depression (46%), suicidal ideation (42%), and suicidal behavior (23%) were highly frequent. These problems were more common among females and related to adverse childhood experiences and parental alcoholism, while it could not be demonstrated that comorbid alcohol or other drug use increased the risk. Parental alcoholism remained significantly related to depression (p < .009), suicidal ideation (p < .001), and suicidal behavior (p < .03) after adjustment for a range of possible confounders using logistic regression. Physical abuse during childhood was associated with suicidal ideation (p < .01) and reporting an 'all in all bad childhood' was associated with suicidal behavior (p < .03) adjusting for the same control variables. Depression, suicidal ideation and suicidal behavior are common phenomena among heavy cannabis users predicted from factors related to childhood and parental alcoholism.

Symptoms and Syndromes of Bodily Distress: An Exploratory Study of 978 Internal Medical, Neurological, and Primary Care Patients

Physical complaints not attributable to verifiable, conventionally defined diseases, i.e., medically unexplained or functional somatic symptoms, are prevalent in all medical settings, but their classification is contested as numerous overlapping diagnoses and syndrome labels have been introduced. This study aims to determine whether functional somatic symptoms cluster into distinct syndromes and diagnostic entities. The 978 consecutively admitted patients from a neurological department (n = 120), a medical department (n = 157), and from primary care (n = 701) were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) diagnostic instrument. Patients complained of a median of five functional somatic symptoms; women of six, men of four (p < .0001). No single symptoms stood out as distinctive for patients with multiple symptoms. Principal component factor analysis identified a cardiopulmonary including autonomic (CP), a musculoskeletal (MS), and a gastrointestinal (GI) symptom group explaining 36.9% of the variance. Latent class analysis showed that the symptom groups are likely to materialize in the same patients, suggesting that they are different manifestations of a common latent phenomenon. Inclusion of a group of five additional general, unspecific symptoms in latent class analysis allowed construction of clinical diagnostic criteria for 'bodily distress disorder' dividing patients into three classes: nonbodily distress (n = 589), modest bodily distress (n = 329, prevalence 25.3%, men 20.4%, women 25.6%), and severe bodily distress (n = 60, prevalence 3.3%, men 1.2%, women 4.8%). The study suggests that bodily distress disorder as defined here may unite many of the functional somatic syndromes and some somatoform disorder diagnoses. Bodily distress may be triggered by stress rather than being distinct diseases of noncerebral pathology.

Using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1) as a diagnostic interview providing dimensional measures: Cross-national findings on the psychometric properties of psychopathology scales

Background The Schedules for Clinical Assessment in Neuropsychiatry (SCAN) is a set of clinical assessment instruments developed under the auspices of WHO. In contrast to other structured diagnostic interviews, SCAN also provides possibilities for dimensional assessment of psychopathology. This paper reports cross-national findings on the psychometric properties of psychopathology scales derived from SCAN 2.1. Methods Within a randomized controlled trial, SCAN 2.1 was used in Dresden (Germany), Michalovce (Slovak Republic), Prague (Czech Republic), and Wrocław (Poland). Forty-seven items from Part I of SCAN 2.1, identified as qualifying for constructing dimensional measures, were, on the one hand, grouped according to their allocation to five specific SCAN 2.1 sections. On the other hand, principal component analyses were used to group the items according to their statistical relationship. To estimate the reliability of the scales, Cronbach's α was computed. To assess factor similarity across sites, Tucker's congruence coefficients were calculated. To appraise concurrent validity, mean scale scores were compared across different diagnostic groups. Results Reliability was qualified as moderate to substantial for all generated scales. Factor-solutions differed across sites. Differences in mean scores supported the assumption that the scales might possess, in addition to face validity, concurrent validity. Conclusions This is the first cross-national study on the psychometric properties of psychopathology scales derived from SCAN 2.1, and findings are very encouraging concerning its use as a dimensional measure. However, further studies are needed to substantiate implementation of the scales established.

Outcome of prenatal depression and risk factors associated with persistence in the first postnatal year: Prospective study from Rawalpindi, Pakistan

BackgroundRates of prenatal and postnatal depression in developing countries are high. Prolonged depression during the postnatal period is associated with impaired infant growth and development. Little is known about the factors predicting the persistence of prenatal depression beyond the first few postnatal months. MethodsFrom a sample of 701 women in a rural sub-district of Pakistan, the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used to identify those with ICD-10 depressive disorder in the third trimester of pregnancy (n=160). Depressed women were re-assessed at 3, 6 and 12 months postnatal. Persistently depressed women (depressed at all time points) were compared with the remainder. Psychiatric symptoms, disability and life events were measured using the Self-Reporting Questionnaire (SRQ), Brief Disability Questionnaire (BDQ), and a modified Life Events Checklist. ResultsOf 129 mothers who completed follow-up, 73 (56%) were depressed at all points of assessment. These persistently depressed mothers had higher SRQ and BDQ scores prenatally and had experienced more life events in the year preceding the third pregnancy trimester than the mothers whose depressive disorder resolved (none received treatment). Persistent depression was significantly associated also with poverty, having 5 or more children, an uneducated husband and lack of a confidant or friend. On multivariate analysis, higher SRQ score and poverty during pregnancy predicted persistent depression. LimitationsThe sample was from one rural sub-district only. We did not assess the women for physical conditions such as anaemia and thyroid-deficiency. ConclusionWomen who are poor and have more psychological symptoms during pregnancy are more likely to remain depressed one year after giving birth. This study highlights the need for developing mechanisms of early identification and suitable psychosocial interventions to minimise the damaging effects of persistent postnatal depression in poor communities.

Is the GDS-30 better than the GHQ-12 for screening depression in elderly people in the community? The Bambui Health Aging Study (BHAS)

Two-phase diagnostic surveys are popular in psychiatric epidemiology. The Geriatric Depression Scale (GDS) and the General Health Questionnaire (GHQ) are commonly used to screen in older and younger populations, respectively. In Phase I, in this Brazilian population-based study, we screened 392 participants aged >or= 75 years. In Phase II, half of those scoring >or= 11 in the GDS and >or= 4 in the GHQ and 20% of others were selected for detailed evaluation with ICD-10 diagnoses assessed by the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) (n = 126). Internal consistencies were good for all scales. At the optimal cut-off points GDS-30 (14/15) yielded 73% sensitivity and 65% specificity, while classical GHQ (4/5), Likert (15/16) and c-GHQ (5/6) yielded 66-75% sensitivity and 57-62% specificity. Receiver operating characteristic (ROC) curve analysis against SCAN indicated only moderate screening potential [area under the ROC curve (AUROC): GDS = 0.76; classical GHQ = 0.74; Likert = 0.76; c-GHQ = 0.73], with no statistically significant differences. All measures were biased by disability and self-reported health. In this study, neither screen was sufficiently predictive of SCAN ICD-10 diagnosis to recommend their use in two-phase surveys. Despite its theoretical advantages, the GDS-30 performed no better than the GHQ-12, and was biased in similar ways.

Utilidad del cuestionario MALT (Münchner Alkoholismus Test) para el diagnóstico de alcoholismo en mujeres

Patients identified as risk drinkers usually fill a questionnaire in order to assess their alcohol dependence. In our setting, the Münchner Alkoholismus Test (MALT) has been recommended, but there are not enough data about its validity and accuracy, particularly in women. The aim of this study was to assess the psychometric properties of this test in a female population.414 woman were recruited in a Health Center and a Specialized Center for addiction treatment. MALT test and the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) semistructured interview (gold standard; DSM-IV and CIE-10 criteria) were performed to all patients. Internal consistence, criteria validity and the most diagnostic efficacy cut-off point (ROC curves) were assessed.The MALT average (standard deviation) score of the whole sample was 3.98 (9.48) points (95% confidence interval [CI], 3.07-4.90). Cronbach alpha was 0.939 (95% CI, 0.931-0.947). With a score of 4 or more points, the test had 100% (95% CI, 98.9-100) sensitivity and 95.4% (95% CI, 95.2-95.5) specificity.The MALT test has an excellent internal reliability and extremely good diagnostic accuracy. It is very useful to detect alcohol dependence in women. A cut-off of 4 or more points is proposed.

The effect of somatic symptom attribution on the prevalence rate of depression and anxiety among nursing home patients

The validity of diagnostic psychiatric instruments for depression and anxiety disorders may be compromised among patients with complex physical illness and disability. The objective of this study was to determine the effect on the prevalence rate of depression and anxiety in a nursing home population of attributing somatic symptoms of depression and anxiety to either somatic or psychiatric disorder. Symptoms of major depression (MD), generalized anxiety disorder (GAD) and panic disorder (PD) were measured using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Somatic symptoms of MD, GAD and PD were attributed to somatic causes when the interviewer was not sure about a psychiatric cause. To analyse the effect of this attribution on the prevalence rate of MD, GAD and PD, a sensitivity analysis was undertaken in which symptoms that were attributed to somatic causes were recoded as symptoms attributed to psychiatric disorder. Prevalence rates of MD, GAD and PD were calculated before and after recoding. The prevalence of MD after recoding rose from 7.5% to 8.1%. The prevalence of GAD did not change. The prevalence of PD rose from 1.5% to 1.8%. Attribution of somatic symptoms to either somatic or psychiatric disorder when the interviewer was not sure about a psychiatric cause of the somatic symptoms had only a very modest effect on the prevalence rate of major depression, generalized anxiety disorder and panic disorder in a nursing home population.

Prevalence and correlates of anxiety among nursing home patients

Background Very little is known about the prevalence and correlates of anxiety among nursing home patients. The current knowledge is predominantly based on information from population-based studies among elderly. Methods Prevalence of anxiety was measured with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) in a sample of 333 nursing home patients of somatic wards of 14 nursing homes in the Netherlands. Participants were over 55 years, had a MMSE-score > 14 and were able to communicate sufficiently. Information about demographic, health-related, psychosocial and care-related characteristics was collected in interviews with participants and from attending physicians and nursing home staff. Results The prevalence of anxiety disorders was 5.7%, of subthreshold anxiety disorders 4.2% and of anxiety symptoms 29.7%. Only health-related characteristics (MMSE-score > 23, depression, stroke) were significantly associated with anxiety disorders and subthreshold anxiety disorders. Demographic (> 6 years education), health-related (depression, impaired vision, pain) and psychosocial characteristics (a recent negative life event) were significantly associated with anxiety symptoms. No care-related characteristics were associated with anxiety. Limitations The study population is a selective one (> 55 years, MMSE > 15, able to communicate sufficiently). The data were collected cross-sectionally. Conclusions Anxiety disorders and anxiety symptoms occur frequently among nursing home patients and are mainly associated with health-related characteristics. Physicians should focus special attention on patients with depression or stroke.

Validation of the Spanish version of the SCOFF questionnaire for the screening of eating disorders in primary care

Objective To assess the performance of the Spanish version of a new screening tool (the SCOFF) for the detection of eating disorders (EDs) in primary care. Methods Design: validation study. The psychiatric interview Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used as the “gold standard.” Blinding was applied to administration of the SCOFF and the clinical interview. Setting: six primary health care centers in Zaragoza and Huesca, Spain. Participants: 203 female patients, between the ages of 15 and 53 years, with a probable diagnosis of ED. Main outcome measure: validity as assessed by sensitivity, specificity, positive predictive value and negative predictive value. In addition, test–retest reliability and the receiver operating characteristics (ROC) curve were calculated. Results The best threshold point in the Spanish version was 2+ positive answers, the same as that recommended in the original British study. This cutoff point provided 97.7% sensitivity and 94.4% specificity for the detection of EDs in primary care. For each specific ED, sensitivity and specificity with this threshold point were, respectively, the following: bulimia, 97.8% and 94.4%; anorexia, 93.1% and 94.4%; and ED not otherwise specified (EDNOS), 100% and 94.4%. Conclusions The Spanish version of the SCOFF questionnaire shows excellent psychometric properties for the early detection of EDs in primary settings.

Professional team's choices of intervention towards problems and needs of patients suffering from schizophrenia across six European countries

Objectives. – This article compares in a systematic way the team's intervention choices of professionals across seven European countries: France, Ireland, Italy, the Netherlands, Portugal and Spain towards problems and needs of patients with schizophrenia and relates this to the diversity of psychiatric systems. Methods. – The clinical and social status of 433 patients was assessed by means of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Needs for Care Assessment instrument (NFCAS) which was used to determine teams' intervention choices toward the NFCAS problems. Results. – There is no, or little, consensus across Europe on teams' intervention choices towards either the clinical or the social problems and needs of patients suffering from schizophrenic disorders. These comparisons outlined the cultural differences concerning the interventions that were proposed and should be taken into account when interpreting the number of needs and the need status since the need status relies heavily on the interventions proposed. The differences were not connected with the availability of resources; most of the comparisons show differences between centers as well as differences between groups of relatively similar resource countries.

A brief case-finding questionnaire for common mental disorders: the CMDQ

The aim of the study was to validate a new case-finding instrument for common mental disorders (CMDQ). A cross-sectional, stratified, two-phase study was carried out in 28 general practices in Aarhus County, Denmark. 1785 consecutive patients, 18-65 years old, consulting 38 GPs with a new health problem participated. Patients were screened before consultation using a one-page screening questionnaire including subscales for somatisation (SCL-SOM and Whiteley-7), anxiety (SCL-ANX4), depression (SCL-DEP6) and alcohol abuse (CAGE). A stratified subsample of 701 patients was interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview. We tested the external validity of the scales using the SCAN interview as gold standard. All data were analysed using appropriate weighted procedures to control for the two-phase sampling design and non-response bias. Estimates of sensitivity and specificity for relevant ICD-10 diagnoses at theoretical optimal cut-off points on subscales: Depressive disorder: 78/86 (SCL-DEP6); Alcohol abuse or dependence: 78/97 (CAGE); Severe anxiety disorder: 77/85 (SCL-ANX4); Somatisation disorder: 83/56 (SCL-SOM); and 75/52 (Whiteley-7); any mental disorder: 72/72 (SCL-8). At the theoretical optimal cut-off points the CMDQ demonstrated higher diagnostic accuracy than GPs on any diagnosis evaluated. The study results suggest that the CMDQ has excellent external validity for use as a diagnostic aid in primary care settings.

The Major Depression Inventory versus Schedules for Clinical Assessment in Neuropsychiatry in a population sample

This study examined the association between the Major Depression Inventory (MDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). A questionnaire including the MDI was sent out to an adult population and was completed by a total of 10,448 persons. Psychiatrists used SCAN and interviewed a subsample (n=1093). The specificity of the MDI was 0.22, the sensitivity 0.67 and Kappa 0.25 when Major Depression according to SCAN was considered as the index of validity, and with all depressive disorders the specificity was 0.44, the sensitivity 0.51 and Kappa 0.33. Higher educated persons and those with reported disability were less likely to be false negatives. The sensitivity and specificity for different cut-off scores when using the MDI total score were calculated. The result from this study suggests that, when MDI is used in population-based samples, cut-off scores rather than the algorithm for depression should be used. The optimal cut-off score must be chosen according to the aims of the study.

Mental illness and health care use: a study among new neurological patients

We investigated 198 new neurological patients to learn if mental illness had an impact on nonpsychiatric health care use. Mental illness was assessed in a two-phase design, including the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), providing ICD-10 diagnoses and two brief rating scales: the Symptom Check List (SCL-8) for anxiety and depression and the Whiteley-7 for somatization . The patients' use of health care was studied 5–10 years before and 18 months after the psychiatric assessment, using data from national patient registers. Mental illness was linked to data on health care use through weighted logistic regression. ICD-10 psychiatric disorders increased the risk of subsequent high use of nonpsychiatric hospital admissions — somatoform disorders with more than five times (OR=5.6; 95% CI=1.6–20.1) and anxiety/depression with almost four times (OR=3.7; 95% CI=1.1–12.0). There was also a trend, though less marked, linking mental illness to previous hospital use. Use of primary care was also markedly increased by mental disorders, however, only in patients entering the study as inpatients. In conclusion, neurological patients are at risk of being high users of health care if they have a mental illness, somatoform disorders being the most powerful risk factor. The results are consistent with the findings among internal medical patients.

Comorbidity of depression and anxiety in nursing home patients

To assess the occurrence and risk indicators of depression, anxiety, and comorbid anxiety and depression among nursing home patients and to determine whether depression and anxiety are best described in a dimensional or in a categorical classification system. DSM and subthreshold anxiety disorders, anxiety symptoms, major and minor depression and depressive symptoms were assessed in 333 nursing home patients of somatic wards of 14 nursing homes in the north west of the Netherlands with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Geriatric Depression Scale (GDS). Comorbidity was studied along a severity gradient. Logistic regression analyses were carried out to identify demographic, health-related, psychosocial and care-related correlates of anxiety and depression. The prevalence of pure depression (PD) was 17.1%, of pure anxiety (PA) 4.8%, and of comorbid anxiety and depression (CAD) 5.1%. Comorbidity increased dependent on severity of both anxiety and depression. Different patterns of risk indicators were demonstrated for PA, PD and CAD for the investigated baseline characteristics. Comorbidity of anxiety and depression is most prevalent in the more severe depressive and anxious nursing home patients. The gradual increase of comorbidity of anxiety and depression dependent on the levels of severity of depression and anxiety suggests that for nursing home patients a dimensional classification of depression and anxiety is more appropriate than a categorical one. The observed differences in patterns of risk indicators for PA, PD and CAD support a distinguishing of anxiety and depression. Future studies are needed to assess the effect of treatment of PA, PD and CAD in nursing home patients.

Diagnostic accuracy of the original 30-item and shortened versions of the Geriatric Depression Scale in nursing home patients

To determine the diagnostic accuracy of the 30-item and shortened versions of the Geriatric Depression Scale (GDS) in diagnosing depression in older nursing home patients. Three hundred and thirty-three older nursing home patients participated in a prospective cross-sectional study in the Netherlands. Sensitivity and specificity, positive and negative predictive values, and the area under the receiver operating curve (ROC) were assessed. Cronbach alphas were also calculated. Both major depression (MDD) and minor depression (MinD) according to the DSM-IV criteria, measured with the Schedules of Clinical Assessment in Neuropsychiatry (SCAN), were used as 'gold standard'. The cut-off point > or = 11 on the GDS-30 gave a sensitivity of 96.3% for MDD and 85.1% for MinD, with a specificity of 69.1%. The sensitivity of most of the shortened versions was sufficient, varying between 88.9% and 100% for MDD, and between 63.8% and 97.9% for MinD. With regard to the shortened versions, best sensitivity (96.3% and 78.7%) and specificity (69.5%) were found for the GDS-10 developed by D'Ath et al. (1994). The specificity rates for most of the shortened versions were found to be less satisfactory, varying between 18.9% and 74.1%. Sufficient internal consistency was found for the GDS-30, the GDS-15, the GDS-12 and the GDS-10, with Cronbach's alphas varying between 0.88 and 0.72. The GDS-30 was found to be a valid and reliable case-finding tool for both major and minor depression in nursing home patients with no cognitive impairment and in patients with mild to moderate cognitively impairment (MMSE > or = 15). The GDS-10 (D'Ath et al., 1994) appeared to be the best least time-consuming alternative for the nursing home setting.

Risk factors and the prevalence of neurosis and psychosis in ethnic groups in Great Britain

Our aim was to examine whether variations in the prevalence of neurosis and psychosis between ethnic minorities throughout Great Britain are explained by social disadvantage. A total of 10,108 adult householders throughout Great Britain were assessed in a two-stage survey with the Revised Clinical Interview Schedule (CIS-R) and Psychosis Screening Questionnaire (PSQ). Respondents with a positive PSQ or who received a diagnosis of, or treatment for, psychosis were examined by a psychiatrist using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Data on respondents' preferred ethnic group were collapsed into four groups: Whites, African-Caribbean or Africans, south Asians and other. Ethnic grouping was strongly associated with: unemployment; lone parent status; lower social class; low perceived social support; poverty (indicated by lack of car ownership) and having a primary social support group of less than three close others. All these associations applied to the group Africans and Afro-Caribbeans, but only some applied to the other groups. No ethnic group had significantly increased rates of neurosis. Only the African-Caribbean group were at significantly increased risk of a psychotic disorder (odds ratio 4.55; 95% CI: 1.13, 18.30). After adjustment for risk factors, the odds of psychosis were lower (odds ratio 2.97; 95% CI: 0.66, 13.36). The excess of psychosis in Africans and Afro-Caribbeans in Great Britain appears to be partly explained by socio-economic disadvantage, but larger studies are needed to confirm this.