Standardized Rating Instruments Research Articles

The Spanish adaptation of the Gilliam Autism Rating Scale-2: Translation and psychometric analysis

Autism is an increasingly prevalent developmental neurological condition that manifests in pervasive impairments in social interaction, communication, and stereotypic behavior and interests. Early identification leads to positive long-term outcomes. At present, all standardized rating instruments are written in English; therefore, the purpose of the present study was to adapt the Gilliam Autism Rating Scale-2 from English into Spanish using the state-of-the-art procedures described in the literature. The English instrument was translated into Spanish, back-translated into English, and then revised using an iterative process. The adapted instrument's psychometric qualities were substantiated. An alpha coefficient of .96 verified the adapted instrument's internal consistency. Results from test–retest comparisons verified the instrument's time stability. The instrument's discriminative validity was confirmed using analysis of variance; the autism group had significantly higher scores than did the other diagnostic groups. Factor analysis verified the construct validity as the items loaded into three clusters that corresponded to the defining characteristics of autism: social interaction, language, and stereotyped behaviors. This culturally and linguistically appropriate assessment tool could be an important instrument for autistic children with Spanish-speaking parents who would otherwise be disenfranchised in regards to early intervention services.

1600 – Establishment of a regional register for neurstimulation treatment in the western part of norway

Introduction Electroconvulsive therapy (ECT) is a highly effective treatment option mainly in severe depression. ECTs longterm effects on cognitive function are currently unknown, limiting its use. Transcranial magnet stimulation (TMS), is considered less effective than ECT in treatment of severe depression, but is without cognitive side effects. TMS is studied to a less degree than ECT. Objectives There is a need of large scale studies of effect, side effects and patients’ subjective experience of ECT and TMS. Aims Generate data to better predict which patients will benefit from ECT and TMS by establishing a regional register including all patients referred to ECT and TMS as part of an ordinary clinical treatment practice in the western part of Norway. Methods All patients referred to ECT and TMS in Bergen and Stavanger will be asked to participate in the study. There are no exclusion criteria. Demographics and course of illness factors will be recorded before start of ECT. Severity of the depressive disorder and treatment effects will be evaluated with a mix of self evaluation and clinician administrated standardized rating instruments. There will be a follow up at 6 months. Date from the described register will be merged with other relevant central Norwegian health registers. Results We expect the described regional register to offer an opportunity to determine predictors for effect, side effects and subjective satisfaction of the treatments. Conclusion This register is investigator initiated, with the aim to investigate which patient will benefit from ECT and TMS without serious side effects.

Quality improvement of forensic mental health evaluations and reports of youth in the Netherlands

Quality improvement of forensic mental health evaluations and reports is needed, but little information is available on how this can be attained, and relatively little conceptual analysis has been undertaken. The STAR, a standardized evaluation instrument of the quality of forensic mental health reports of youth, is developed on the basis of concept mapping to clarify the different perspectives on usability of these reports. Psychometric data are provided, demonstrating the reliability and supporting the validity of the STAR. The Dutch forensic context is described to better understand the development and psychometric properties of this standardized instrument. Quality improvement possibilities of forensic mental health evaluations and reports are discussed.

DEVELOPING EVALUATION INSTRUMENT FOR MATHEMATICS EDUCATIONAL SOFTWARE

The rapid increase and availability of mathematics software, either for classroom or individual learning activities, presents a challenge for teachers. It has been argued that many products are limited in quality. Some of the more commonly used software products have been criticized for poor content, activities which fail to address some learning issues, poor graphics presentation, inadequate documentation, and other technical problems. The challenge for schools is to ensure that the educational software used in classrooms is appropriate and effective in supporting intended outcomes and goals. This paper aimed to develop instrument for evaluating mathematics educational software in order to help teachers in selecting the appropriate software. The instrument considers the notion of educational including content, teaching and learning skill, interaction, and feedback and error correction; and technical aspects of educational software including design, clarity, assessment and documentation, cost and hardware and software interdependence. The instrument use a checklist approach, the easier and effective methods in assessing the quality of educational software, thus the user needs to put tick in each criteria. The criteria in this instrument are adapted and extended from standard evaluation instrument in several references. Keywords: mathematics educational software, educational aspect, technical aspect.

Insight in Chinese schizophrenia patients: a 12-month follow-up

This study aimed to assess insight in Chinese schizophrenia patients and to identify its relationship with socio-demographic and clinical factors, executive functions and quality of life (QOL). A cohort of 139 clinically stable schizophrenia patients was selected by consecutively screening patients diagnosed with schizophrenia who were attending the outpatient department of a university-affiliated psychiatric hospital in China. Participants' socio-demographic and clinical characteristics, including psychotic symptoms, depression and insight, as well as QOL and executive functions, were periodically assessed with standardized rating instruments. Patients received standard psychiatric care and were followed up for 1 year. Impaired insight was found to be common in stable Chinese schizophrenia patients (76.3%), with merely 5% showing improvement over the 1-year follow-up. Insight was inversely correlated with positive and negative symptoms at all but the 12-month assessment and with both the physical and mental components of QOL at baseline and the 12-month assessment. Insight was not associated with depressive symptoms or executive functions. Standard psychiatric care does not improve the level of insight in clinically stable Chinese schizophrenia outpatients, which warrants the introduction of specific therapeutic interventions that enhance insight.

The effect of adjunctive armodafinil on cognitive performance and psychopathology in antipsychotic-treated patients with schizophrenia/schizoaffective disorder: A randomized, double-blind, placebo-controlled trial

BackgroundThe efficacy, safety and tolerability of adjunctive armodafinil for cognitive performance, and negative and affective symptoms, were examined in 60 patients with schizophrenia or schizoaffective disorder. MethodThis was a 6-week, double-blind, placebo-controlled, fixed dose trial of armodafinil (150mg/d) augmentation in patients with clinically stable schizophrenia or schizoaffective disorder. Cognition, psychopathology, alertness/wakefulness and adverse effects were assessed with standardized rating instruments. The primary endpoint was performance on measures of attention/vigilance. ResultsPatients were randomly allocated to adjunctive armodafinil or placebo. There was a significant Drug×Time interaction effect for attention/vigilance, due to modest non-significant worsening in the armodafinil group and improvement in the armodafinil group [CPT-Pairs d′, F(1,40)=6.2, p=0.017]. However, it became non-significant after correction for multiple comparisons. There were no differences between armodafinil and placebo in other cognitive domains or psychopathology measures. However, armodafinil was associated with significant improvement in the Scale for the Assessment of Negative Symptoms (SANS) anhedonia–asociality [F(1,41)=4.1, p=0.05]. ConclusionsThere were no significant differences in neurocognitive measures between adjunctive armodafinil and placebo in this 6-week study. Armodafinil improved anhedonia–asociality, but not other negative symptom domains.

Association of insight with sociodemographic and clinical factors, quality of life, and cognition in Chinese patients with schizophrenia

Purpose The aims of this study were to assess insight in Chinese patients with schizophrenia and to identify its relationship with sociodemographic and clinical factors, cognition, and quality of life (QOL). Methods A cohort of 139 patients with clinically stable schizophrenia was selected by consecutively screening patients who had been diagnosed with schizophrenia and who were attending the outpatient department of a university-affiliated psychiatric hospital in China. Participants' sociodemographic and clinical characteristics, including psychotic and depressive symptoms and insight, as well as their social functioning, QOL, and flexibility of cognition, were assessed with standardized rating instruments. Results Thirty-three patients (23.7%) had good insight into their illness. In univariate analyses, poor insight was associated with the positive, negative, and general symptom scores of the Positive and Negative Syndrome Scale (PANSS), and with higher scores on the physical and mental components of QOL. In multivariate analysis, poor insight was independently associated with a higher negative symptom score on the PANSS, a shorter length of illness, and with a high score on the physical components of QOL. Conclusions Poor insight is common in patients with clinically stable schizophrenia. In this study, insight was not associated with basic sociodemographic characteristics or had it any associations with depression or the flexibility of cognitive processes.

Treatment of Sexual-Orientation Obsessions in Obsessive-Compulsive Disorder Using Exposure and Ritual Prevention

Presented is a case report of exposure and ritual prevention (EX/RP) therapy administered to a 51-year-old, White, heterosexual male with sexual-orientation obsessions in obsessive-compulsive disorder (OCD). The patient had been previously treated with pharmacotherapy, resulting in inadequate symptom reduction and unwanted side effects. OCD symptoms included anxiety about the possibility of becoming gay, mental reassurance, and avoidance of other men, which resulted in depressive symptoms and marital distress. The patient received 17 EX/RP sessions, administered twice per week. The effect of treatment was evaluated using standardized rating instruments and self-monitoring by the patient. OCD symptoms on the Yale-Brown Obsessive Compulsive Scale (YBOCS) fell from 24 at intake to 3 at posttreatment and to 4 at a 6-week follow-up, indicating minimal symptoms. Improvement also occurred in mood, quality of life, and social adjustment. Issues concerning the assessment and treatment of homosexuality-themed obsessions in OCD are highlighted and discussed.

Anxiety Disorders in Chinese Patients with Parkinson'S Disease

Anxiety disorders (AND1) commonly occur in patients with Parkinson's disease (PD) but their socio-demographic and clinical correlates have not yet been unequivocally determined. This study aimed to assess the frequency of ANDI and their correlates in Chinese PD patients. A cohort of 133 patients of PD were recruited from three neurology outpatient clinics. Participants' neurological, cognitive, and psychiatric status was assessed using standardized rating instruments. ANDI were diagnosed by qualified psychiatrists using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders--4th Edition (SCID-DSM IV). Thirty-six patients (27.1%) were diagnosed with some types of ANDI; Generalized Anxiety Disorder, Agoraphobia, and Social Phobia were the commonest subtypes of ANDI in PD (n = 11, 8.3%, in each of the three subtypes). Nine patients had more than one subtype of ANDI. In multivariate logistic regression, younger age of onset of PD [odds ratio (OR) = 2.654, 95% confident intervals (CI) = 1.120-6.289, p = 0.027), Geriatric Depression Scale score (OR = 1.179, 95% CI = 1.056-1.316, p = 0.003) and muscle cramps (> or = 1/week) (OR = 2.605, 95% CI = 1.098-6.184, p = 0.030) were independent correlates of ANDI. ANDI are common in Chinese PD patients. Younger age of onset of PD, severity of depressive symptoms, and muscle cramps may be independent correlates of ANDI suggesting that anxiety in PD has multifactorial origin.

The Clinical Ethics Credentialing Project: Preliminary Notes from a Pilot Project to Establish Quality Measures for Ethics Consultation

The Clinical Ethics Credentialing Project (CECP) was intiated in 2007 in response to the lack of uniform standards for both the training of clinical ethics consultants, and for evaluating their work as consultants. CECP participants, all practicing clinical ethics consultants, met monthly to apply a standard evaluation instrument, the "QI tool", to their consultation notes. This paper describes, from a qualitative perspective, how participants grappled with applying standards to their work. Although the process was marked by resistance and disagreement, it was also noteworthy for the sustained engagement by participants over the year of the project, and a high level of acceptance by its conclusion.

Socio-demographic and clinical determinants of quality of life in Chinese patients with schizophrenia: a prospective study

The aim of the study was to assess the changes in the quality of life (QOL) of Chinese schizophrenia patients and to identify their predictors over a 1-year follow-up. A cohort of 116 schizophrenia patients was recruited, and their socio-demographic and clinical characteristics including psychotic and depressive symptoms, drug-induced side effects, social functioning, and QOL were assessed with standardized rating instruments. The patients received standard psychiatric care and were followed up for 1 year. The psychotic and depressive symptoms, extrapyramidal side effects, and QOL domains of physical functioning, role limitations due to physical problems, social functioning, and role limitations due to emotional problems all improved significantly. Social functioning was a predictor of baseline QOL and change at 1-year follow-up. Routine clinical management was effective in improving schizophrenia patients' psychopathology and several domains of QOL. QOL was related to the level of social functioning and had only a weak association with socio-demographic factors.

Treatment of Co-Occurring Obsessive Compulsive Disorder and Social Phobia Through Exposure/Response Prevention and Cognitive Behavioral Therapy

We present a case report of exposure/response prevention and cognitive behavioral therapy for obsessive compulsive disorder (OCD) and social phobia in a 46-year-old man. The effects of both treatments were evaluated using standardized rating instruments and client self-monitoring. OCD and social phobia symptoms decreased with treatment, the man reported symptom relief, and results persisted post-treatment. Issues concerning treatment of co-occurring anxiety disorders are highlighted and discussed.

Striatal [ 11 C]dihydrotetrabenazine and [ 11 C]methylphenidate binding in Tourette syndrome

Tourette syndrome (TS) is a common neurodevelopmental disorder marked by tics and behavioral comorbidities. Clinical pharmacology suggests that dopaminergic signaling abnormalities are part of the pathophysiology of TS. Prior molecular imaging studies of nigrostriatal dopaminergic terminal markers report conflicting results. Our goal was to characterize the distribution of nigrostriatal dopaminergic terminals in subjects with TS. Thirty-three adult subjects with TS were studied with PET using [11C]dihydrotetrabenazine (DTBZ), a ligand for the type 2 vesicular monoamine transporter, and with [11C] methylphenidate (MP), a ligand for the plasmalemmal dopamine transporter. Subjects were characterized with standard rating instruments for tic severity, obsessive-compulsive behaviors, and attentional deficits. We found no differences between subjects with TS and control subjects in DTBZ and MP binding in any striatal region. There was no correlation between binding measures and clinical variables. Ventral striatal DTBZ and MP binding distributions in subjects with TS were normal. We found no evidence of increased striatal dopaminergic innervation in Tourette syndrome (TS). Discrepancy between our present results and those of other studies may be explained by heterogeneity of TS.

S26-03 The phenomenology of acute THC-psychosis

It has long been known that cannabis can elicit an acute psychotic reaction. Recent work shows that, of the 60 cannabinoid molecules in the plant, delta-9-tetrahydrocannibinol is responsible for the central effects of cannabis. Here we aimed to investigate, in more detail, the psychological effects of synthetic intravenous THC in healthy subjects. Over 2 experimental sessions, participants (N=22) were administered 2.5mg IV THC or placebo under randomised, double-blind conditions. Psychological reactions were assessed using standard rating instruments and a battery of cognitive tests was completed.Following THC, there was a significant increase in self-rated and observer-rated positive psychotic symptoms which were highly correlated (r=0.62, p=0.001).Phenomena centered on de-synchronisation of self-agency (ipseity disturbance) and hypersalience/paranoia. Participants also reported a significant increase in negative symptomatology under THC conditions, which was not explained by sedation. Finally, working memory/executive functioning was markedly and consistently impaired by THC.Here we provide further evidence that THC can elicit an acute psychotic reaction in a proportion of healthy subjects. Acute THC-psychosis elicits positive, negative and cognitive symptoms. Compared with other drug models THC recreates symptomatology across 3 major dimensions of schizophrenic psychosis without sedation/clouding of consciousness. Here we also present preliminary evidence that the molecule cannabidiol (CBD) inhibits THC-elicited positive symptoms. Current work in our laboratory is exploring the underlying mechanisms.

Development of a Standardized Tool for Intergenerational Programming: The Intergenerational Observation Scale

ABSTRACT Innovative intergenerational programs continue to grow in number and scope. The development of standardized evaluation instruments, however, lags behind, leaving many researchers and practitioners without tools to effectively assess their programs. Evaluation data often focus on outcomes without attention to the nature of the interactions between generations. Understanding the process of intergenerational contact is central to understanding its outcomes. We developed the Intergenerational Observation Scale to assess the social interactions and affect of young and old participants during intergenerational activities. Our three-step observer training process demonstrated good scale reliability. We present the process of developing the scale, achieving observer reliability, and next steps to continue exploring the scale's utility across intergenerational populations and settings.

Exposure to Child and Adolescent Psychiatry for Medical Students: Are There Optimal "Teaching Perspectives"?

The ability to develop quality medical student exposures in child and adolescent psychiatry is critical to the professional development of these future physicians and to the growth of recruitment efforts into the field. This study identifies teaching perspectives among child and adolescent psychiatry faculty to determine whether there are optimal perspectives that positively influence medical student satisfaction. Eighty-eight third- and fourth-year students at an allopathic U.S. medical school assessed teacher performance over a 1-year period using a standard internal teacher evaluation. Three experienced faculty members teaching the medical student seminars each completed a Teaching Perspective Inventory. The authors compared the different teaching perspectives with student satisfaction scores on the standard teacher evaluation instrument. All teachers had two dominant perspectives and one recessive perspective. Each teacher had a predominant developmental perspective but they differed in other dominant and recessive perspectives. The transmission perspective was associated with significantly less favorable scores on the standard teacher evaluation compared to the apprenticeship and nurturing perspective. The authors discuss the value of teaching perspective identification among child and adolescent psychiatry faculty for medical student education.

A comparison between former forensic and non-forensic patientsliving in psychiatric residential facilities: Anationalsurvey in Italy

Discharge from a psychiatric forensic institution is a critical moment for patients with severe mental disorders; often it leads to relocation to a non-forensic residential facility (RF) where treatment and support needs can be met. The present study used data from the Italian PROGRES project (aimed at studying the country's residential mental health care system) to investigate the characteristics of a large sample of patients formerly admitted to forensic mental hospitals (FMH) living in a psychiatric RF, and to compare them with RF patients never admitted to FMH. Structured interviews were conducted with the managers and staff of a representative sample of Italian RFs (n = 265); residents were also evaluated using standardized rating instruments. Among 2,962 surveyed residents, a total of 193 patients (6.5%) had previously been admitted to a FMH. The majority had a diagnosis of schizophrenia or a related disorder (n = 149, 78.0% of FMH patient vs. 1830, 66.8% of non-FMH patients). Overall, the symptom profile did not differentiate former forensic patients from residents who had never been admitted to an FMH. The rate of violent behaviour reported during stay in current residence was low and limited to a very small group of former FMH patients. The present study's main conclusion is that patients discharged from FMHs and selected as suitable for relocation to ordinary RFs are able to remain in this type of accommodation without posing a significant danger in terms of violent behaviour or threats.

Subjective quality of life in outpatients with schizophrenia in Hong Kong and Beijing: relationship to socio-demographic and clinical factors

This study compared the subjective quality of life (SQOL) in schizophrenia patients living with their families in Hong Kong (HK) and Beijing (BJ) and explored the relationship between SQOL and basic socio-demographic and clinical factors. Two hundred and sixty-four clinically stable outpatients with schizophrenia were randomly selected in HK and 258 counterparts matched according to age, sex, age at onset, and length of illness in BJ. SQOL and psychiatric status were assessed with standard rating instruments. There was no significant difference in any of SQOL domains between the two cohorts after controlling for potentially confounding variables. Positive, depressive and anxiety symptoms and drug-induced extrapyramidal side effects (EPS) were all significantly correlated with SQOL. Multiple regression analysis revealed that only depressive symptoms predicted all SQOL domains in both groups. Having removed depressive symptoms from the model, positive symptoms predicted all domains, anxiety predicted all but social domains, use of benzodiazepines (BZD) predicted all but physical domains, EPS predicted physical domain, and history of suicide predicted social domain in HK; anxiety predicted all domains, positive symptoms predicted all but physical domains, EPS, use of BZD and history of suicide all predicted physical domains, and length of illness predicted environmental domain in BJ. Despite considerable differences between the two sites in terms of health care delivery and the economic conditions of the subjects, SQOL did not differ between HK and BJ. The conclusion is in line with previous studies that suggested that patients' SQOL was independent of their living standard as long as it reached a certain minimum level. SQOL was more strongly related to the severity of depressive symptoms and had weak association with socio-demographic factors.

Schizophrenia with prominent catatonic features (‘catatonic schizophrenia’).II. Factor analysis of the catatonic syndrome

Previous factor analyses of catatonia have yielded conflicting results for several reasons including small and/or diagnostically heterogeneous samples and incomparability or lack of standardized assessment. This study examined the factor structure of catatonia in a large, diagnostically homogenous sample of patients with chronic schizophrenia using standardized rating instruments. A random sample of 225 Chinese inpatients diagnosed with schizophrenia according to DSM-IV criteria were selected from the long-stay wards of a psychiatric hospital. They were assessed with a battery of rating scales measuring psychopathology, extrapyramidal motor status, and level of functioning. Catatonia was rated using the Bush–Francis Catatonia Rating Scale. Factor analysis using principal component analysis and Varimax rotation with Kaiser normalization was performed. Four factors were identified with Eigenvalues of 3.27, 2.58, 2.28 and 1.88. The percentage of variance explained by each of the four factors was 15.9%, 12.0%, 11.8% and 10.2% respectively, and together they explained 49.9% of the total variance. Factor 1 loaded on “negative/withdrawn” phenomena, Factor 2 on “automatic” phenomena, Factor 3 on “repetitive/echo” phenomena and Factor 4 on “agitated/resistive” phenomena. In multivariate linear regression analysis negative symptoms and akinesia were associated with ‘negative’ catatonic symptoms, antipsychotic doses and atypical antipsychotics with ‘automatic’ symptoms, length of current admission, severity of psychopathology and younger age at onset with ‘repetitive’ symptoms and age, poor functioning and severity of psychopathology with ‘agitated’ catatonic symptom scores. The results support recent findings that four main factors underlie catatonic signs/symptoms in chronic schizophrenia.

Safety and Efficacy of Levetiracetam for Patients With Panic Disorder

To examine the safety and efficacy of the anticonvulsant levetiracetam in the treatment of patients with panic disorder. In an open-label, fixed-flexible dose study, 18 patients with panic disorder with or without agoraphobia (DSM-IV diagnostic criteria) were treated with levetiracetam for 12 weeks. Outcome was assessed with standard rating instruments (Clinical Global Impressions-Severity of Illness scale [CGI-S], Clinical Global Impressions-Improvement scale [CGI-I], and the 14-item Hamilton Rating Scale for Anxiety [HAM-A]) and by the number of panic attacks during the previous week. The study was conducted in 2 outpatient clinics in New York City from January 2004 through July 2005. Of the 13 patients completing the study, 11 were rated "very much" or "much" improved on the CGI-I. Panic attack frequency, anxiety (HAM-A), and global severity (CGI-S) ratings also demonstrated significant improvement (all p < .00). For most patients, clinical benefits were apparent after only 1 to 2 weeks of treatment. Levetiracetam was well tolerated with minimal side effects. Given its favorable pharmacokinetics, side effect profile, and, if confirmed, early onset of action and efficacy, levetiracetam might represent significant progress in the pharmacologic management of panic disorder.