Suitable Screening Instrument Research Articles

Evaluation of a new screening instrument for psychological distress in postacute rehabilitation in older person.

Although psychological distress has a negative impact on functional recovery, institutionalisation and mortality rates, there is typically no established procedure to screen for psychological distress in geriatric rehabilitation. The aim of the study was to evaluate a brief single-item Verbal Numerical Rating Scale (VNRS-PD) as a screening tool for psychological distress in multimorbid geriatric rehabilitation patients. In this cross-sectional study, N = 132 geriatric rehabilitation in-patients (M = 82years old; 70.5% female) completed a verbal numerical rating scale (VNRS-PD) on satisfaction with their mood as well as the Hospital Anxiety and Depression Scale (HADS) and the short-form of the Geriatric Depression Scale (GDS). Based on the questionnaire data, the rehabilitation patients were classified as high or low in psychopathology. Using receiver-operating characteristic (ROC) curve analysis, optimal cutoff scores of the VNRS-PD were calculated for each questionnaire to detect significant psychological distress. Between 28.8% (HADS ≥ 18) and 43.9% (GDS ≥ 6) of the sample had above-cutoff questionnaire scores. The area under the curve (AUC) of the VNRS-PD varied from 0.785 (95%-CI 0.709-0.861) (GDS ≥ 6) and 0.790 (95%-CI 0.716-0.864) (HADS ≥ 18) to 0.807 (95%-CI 0.734-0.880) (GDS ≥ 7). A score of ≤ 5 in the VNRS-PD proved to be the cutoff with an optimal trade-off between sensitivity (0.776-0.867) and specificity (0.638-0.703). The VNRS-PD may be a suitable screening instrument to detect patients with psychological distress in inpatient geriatric rehabilitation for and to initiate further diagnostics within a graduated psychodiagnostic scheme. This first step may help to identify older patients with psychological distress and mental disorders, to initiate targeted interventions. Further research is needed to replicate these findings in a larger sample.

Diagnostic Accuracy of the Drug Use Disorder Identification Test and Its Short Form, the DUDIT-C, in German Adolescent Psychiatric Patients.

BackgroundA common screening instrument for substance use disorders (SUDs) is the Drug Use Disorders Identification Test (DUDIT) which includes a short form regarding only drug consumption (DUDIT-C). We aim to assess if a German version of the DUDIT, adapted for adolescents, is a suitable screening instrument in a sample of adolescent psychiatric patients.MethodsN = 124 (54 female) German adolescent (M = 15.6 + 1.5 years) psychiatric patients completed the DUDIT and received a diagnostic interview (MINI-KID) assessing DSM-5 SUD criteria. A confirmatory factor analysis (CFA), receiver operating characteristic (ROC) curves, the area under the curve (AUC), and Youden’s Index were calculated.ResultsA two-factor model of the DUDIT shows the best model fit (CFI = 0.995, SRMR = 0.055, RMSEA = 0.059, WRMR = 0.603). The DUDIT as well as the DUDIT-C show high diagnostic accuracy, with AUC = 0.95 and AUC = 0.88, respectively. For the DUDIT a cut-off value of 8.5 was optimal (sensitivity = 0.93, specificity = 0.91, J = 0.84), while for the DUDIT-C the optimal cut-off value was at 1.5 (sensitivity = 0.86, specificity = 0.84, J = 0.70).ConclusionThis is the first psychometric evaluation of the DUDIT in German, adolescent psychiatric outpatients, using the DSM-5 diagnostic criteria. The DUDIT as well as the DUDIT-C are well suited for use in this population. Since in our sample only few patients presented with a mild or moderate SUD, our results need to be replicated in a sample of adolescents with mild SUD.

Validation of the 7-item Generalized Anxiety Disorder scale (GAD-7) as a screening tool for anxiety among pregnant Chinese women

BackgroundAnxiety is common during pregnancy. The 7-item Generalized Anxiety Disorder scale (GAD-7) is a self-rating scale for detecting anxiety and has been validated in various populations, but it has not been validated in pregnant Chinese women. The objective of this study was to validate the GAD-7 as a screening tool to detect anxiety during pregnancy among Chinese women. MethodsThe GAD-7 and the anxiety subscale of the Hospital Anxiety and Depression scale (HADS-A) were administered to 140 pregnant Chinese women to evaluate the Cronbach's alpha and the criterion-related validity. Additionally, a diagnostic study (n=170) was conducted by using the Mini International Neuropsychiatric Interview (MINI) as a gold standard to examine the screening performance of the GAD-7. We calculated the sensitivity, specificity, and area under the curve (AUC) by receiver operating characteristic (ROC) analysis. ResultsCronbach's alpha for the GAD-7 was 0.84. The Pearson correlation coefficient between GAD-7 and HADS-A scores was 0.66 (P<0.01). At the maximum Youden Index of 0.53, the optimal cutoff score for the GAD-7 among pregnant women was 7, and an AUC of 0.83, a sensitivity of 96.8%, and a specificity of 56.1% were obtained. LimitationThe majority of the participants were in the first trimester, and thus, the findings cannot be generalized to all pregnant women. ConclusionsThe GAD-7 is a suitable screening instrument for detecting antenatal anxiety in mainland China. Further validation is warranted in women in different trimesters of pregnancy.

A Practical and Validated Fall Risk Screening Instrument: A Systematic Review

Early detection of a high fall risk is important to start fall preventive interventions in time and to reduce fall risk among older people. Several fall risk screening instruments are available, however it is unclear which instrument is validated and most suitable for the primary care setting. This systematic review aims to identify the most suitable fall risk screening instrument(s) for the primary care setting (i.e. requires limited time, no expensive equipment and no additional space) with good prognostic ability to assess high fall risk among independently living older people. An extensive search was conducted in the databases PubMed, EMBASE CINAHL, Cochrane and PsycINFO. Twenty-six out of 2277 articles published between January 2000 and February 2019 were included. Six fall risk screening instruments were identified; TUG test, Gait Speed test, BBS, POMA, FR test, Fall History. Most articles reported AUCs ranging from 0.5-0.7 for all instruments. Sensitivity and specificity varied substantially across studies (e.g. TUG, sens.: 10-83.3%, spec.:37-96.6%). The results showed that none of the included screening instruments had sufficient (AUC>0.7) predictive performance (Šimundić, 2009). As suitability for the primary care setting prevails for now, Fall History appears to be the most suitable screening instrument. Compared to the other instruments, Fall History requires the least amount of time, no expensive equipment, no training, and no space (adjustments). Patient’s fall history together with a health care professional’s clinical judgment, might be a promising screening strategy for the primary care setting to identify high fall risk among older people.

Sensitivity and specificity of the Brazilian version of the Montreal Cognitive Assessment – Basic (MoCA-B) in chronic kidney disease

Cognitive impairment in chronic kidney disease (CKD) is commonly associated with neuropsychiatric disorders. As a complex pathology, at all stages of CKD patients need to have a good understanding of the need for drug and nutritional adherence. Cognitive screening is the starting point for detection of cognitive impairments. To determine the specificity and sensitivity of the Brazilian Portuguese version of the Montreal Cognitive Assessment - Basic (MoCA-B) for identification of cognitive impairment in the CKD population. This was a cross-sectional study with 163 CKD patients undergoing hemodialysis treatment. The Mini-Mental State Examination (MMSE) and MoCA-B were administered. The MoCA-B has reliable internal consistency (Cronbach's alpha = 0.74). A cutoff point of ≤ 21 points provides the best sensitivity and specificity for detection of cognitive impairment. The education variable had less impact on the total MoCA-B score than on the total MMSE score. The MoCA-B is a suitable screening instrument for evaluating the global cognition of hemodialysis patients. The results can help health professionals to conduct evaluations and plan clinical management.

Detection of malnutrition in geriatric trauma patients : Areassessment

Malnutrition in geriatric trauma patients is associated with an increased risk of complications and mortality and is therefore akey risk factor. The assessment of the affected patients plays an important role in improving the outcome of this growing patient group. In 2016 aquestionnaire was sent to 571 departments specialized in traumatology and orthopedics throughout Germany. The following were recorded: level of care, expertise in geriatric trauma, nutrition-based screening procedures and nutritional ward round procedures. The response rate was 57% (n = 325) and closely reflected the treatment reality in Germany with respect to the level of care (superregional, regional or local trauma center and those without special qualifications). In 14% (n = 45) the participants were German Society for Trauma Surgery(DGU)-certified centers for age-related traumatology, while afurther 5% (n = 15) were in the process of certification. The nutritional status was assessed in 56% (n = 181) of the clinics. Most frequently used was the body mass index (74%) followed by the mini nutritional assessment (30%), laboratory parameters (29%) and nutritional risk screening 2002 (19%). Some additional methods were specified. In approximately half of the departments nutritional ward rounds took place in regular wards (50%) and intensive care units (57%). The high response rate of this study seems to show the particular interest for malnutrition in geriatric trauma patients. This is reflected in an increase in the participating clinics compared to past surveys and also the more regularly performed assessment of nutritional status and implementation of nutritional visits. The establishment of suitable and time-effective screening instruments and their implementation are still achallenge.

Descriptive data in different paper-based cognitive assessments in elderly from the community Stratification by age and education.

ABSTRACTCognitive aging is dynamic and heterogeneous in elderly, thus adequate tools such as paper-based tests are relevant to describe the cognitive profile of this population.Objective:To describe different paper-based cognitive assessments tests in elderly people stratified by age and education.Methods:A cross-sectional study of 667 elderly (≥60 years) living in the community was conducted. Sociodemographic information was collected. Global cognition was assessed by the Addenbrooke's Cognitive Examination-Revised (ACE-R), Mini Addenbrooke’s Cognitive Examination (M-ACE) and Mini-Mental State Examination (MMSE). The data were analyzed using descriptive statistics, the t-test and Pearson’s Correlation Coefficient.Results:The findings showed a predominance of women (53.8%), mean age of 71.3 (±7.7) years and 3.6 (±3.5) years of education. The best global cognitive performance and cognitive domain assessment scores were found in the group with higher formal educational level. Each year of education was associated with an increase of up to 10% in scores on the M-ACE and MMSE and up to 11% in ACE-R scores. The mean values of the scores varied according to age, where the 60-69 years group had better scores than other age groups. The correlation matrix between the cognitive tests showed that near perfect correlations (r=1) were frequent in the subgroup with higher education.Conclusion:Younger elderly and those with higher educational level had greater global and domain scores. This study describes the scores of elderly for different strata of education and age. In practice, it is important to choose the most suitable screening instrument, considering the characteristics of the elderly.

An explanatory factor analysis of a brief self-report scale to detect neurocognitive impairment among HIV-positive men who have sex with men and transgender women in Peru

ABSTRACTNeurocognitive impairment (NCI) has been associated with poor clinical outcomes in various patient populations. This study used exploratory factor analysis (EFA) to examine the factor structure of the existing 95-item Neuropsychological Impairment Scale (NIS) to create a suitable NCI screening instrument for people living with HIV (PLH). In Lima, Peru, 313 HIV-positive men who have sex with men (MSM) and transgender women (TGW) prescribed antiretroviral therapy (ART) completed the NIS using computer-assisted self-interviews (CASI). The EFA used principal axis factoring and orthogonal varimax rotation, which resulted in 42 items with an 8-factor solution that explained 51.8% of the overall variance. The revised, 8-factor, Brief Inventory of Neurocognitive Impairment for Peru (BINI-P) showed a diverse set of factors with excellent to good reliability (i.e., F1 α = 0.92 to F8 α = 0.78). This EFA supports the use of the BINI-P to screen for NCI among Spanish-speaking, HIV-positive MSM and TGW. Future research should examine the effectiveness of the BINI-P in detecting NCI in clinical care settings and the impact of NCI on HIV health-related outcomes, including linkage and retention in care, ART adherence and HIV risk behaviors.

Potential Child Abuse Screening in Emergency Department; a Diagnostic Accuracy Study.

Designing a tool that can differentiate those at risk of child abuse with great diagnostic accuracy is of great interest. The present study was designed to evaluate the diagnostic accuracy of Escape instrument in triage of at risk cases of child abuse presenting to emergency department (ED). The present diagnostic accuracy study performed on 6120 of the children under 16 years old presented to ED during 3 years, using convenience sampling. Confirmation by the child abuse team (pediatrician, a social worker, and a forensic physician) was considered as the gold standard. Screening performance characteristics of Escape were calculated using STATA 21. 6120 children with the mean age of 2.19 ± 1.12 years were screened (52.7% girls). 137 children were suspected victims of child abuse. Based on child abuse team opinion, 35 (0.5%) children were confirmed victims of child abuse. Sensitivity, specificity, positive and negative likelihood ratio and positive and negative predictive values of this test with 95% CI were 100 (87.6 - 100), 98.3 (97.9 - 98.6), 25.5 (18.6 - 33.8), 100 (99.9 - 100), 0.34 (0.25 - 0.46), and 0 (0 - NAN), respectively. Area under the ROC curve was 99.2 (98.9 - 99.4). It seems that Escape is a suitable screening instrument for detection of at risk cases of child abuse presenting to ED. Based on the results of the present study, the accuracy of this screening tool is 99.2%, which is in the excellent range.

Clinical Heterogeneity in RUNX1-Associated Familial Myelodysplastic Syndrome - Report of Two Novel Pedigrees with Childhoodleukemia

RUNX1-associated familial leukemia is a rare hematologic malignancy. It is inherited in an autosomal dominant manner and mainly causes myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML). Since constitutional mutations in RUNX1 can lead to thrombocytopenia or dysfunctional platelets, the disease is termed familial platelet disorder with associated myeloid malignancies (FPDMM, MIM 601399). Here, we report two novel families with early onset MDS illustrating the variability of the disorder.The index patient (P1) of family 1 (Fig. 1A) was known to have asymptomatic thrombocytopenia (90 G/l) since his neonatal period. Platelet assays revealed impaired in vitro aggregation. Asymptomatic thrombocytopenia was also known in his younger sister, his mother and his maternal grandfather. A maternal uncle had died from leukemia at age 4. While P1 was treated with antibiotics for a middle ear infection, he developed petechiae and hematoma. He was found to have a platelet count of 11 G/l with a normal white blood count (WBC), hemoglobin concentration (Hb) and MCV. Bone marrow investigations led to the diagnosis of MDS with excess blasts (MDS-EB) with normal karyotype. Sequencing of RUNX1 identified a heterozygous truncating RUNX1 mutation in P1 that was also present in his mother: c.90_117dup; p.(Leu40AlafsX80). P1 underwent hematopoietic stem cell transplantation (HSCT) from a matched unrelated donor (MUD) following a preparative regimen consisting of busulfan, cyclophosphamide and melphalan (BuCyMel). He is alive and well 4 years post HSCT. Two years after his diagnosis, a 17-year-old maternal uncle of P1 (P2) was also diagnosed with MDS-EB with normal karyotype. Successively, the disorder progressed to AML and karyotyping showed a clonal derivative chromosome 7 due to an unbalanced translocation der(7)t(2;7)(p12;q21), and later on, a clonal evolution with trisomy 12. RUNX1 sequencing indicated that P2 also carries the familial RUNX1 mutation. Finally, the causative RUNX1 mutation was also identified in the younger sister and two further maternal uncles, all showing mild, asymptomatic thrombocytopenia without evidence of malignant transformation.In the second family (Fig. 1B), the male index patient (P3) had congenital, asymptomatic thrombocytopenia with subsequent platelet counts of 60-80 G/l. At age 3.5, platelet count declined over several months reaching values of 3-20 G/l. WBC, Hb and MCV were normal. The patient had recurrent nose bleeds and prolonged bleeding after cuts and blood drawing. Diagnostic bone marrow examination showed MDS-EB with normal karyotype. Since, thrombocytopenia was also known in P3’s mother, RUNX1 was sequenced and showed a typical heterozygous truncating mutation in P3 and his mother: c.415C>T; p.(Arg139X). The mutation was absent in P3’s brother. At age 16, a maternal aunt of P3 had died due to a cervical cancer. Her DNA was not available for testing. P3 received a MUD HSCT following a BuCyMel preparative regimen and is alive and well 2 years post HSCT.These two new pedigrees with germline RUNX1 mutation emphasize a few interesting points. For both index patients the history of familial thrombocytopenia had been known since birth, but genetic work-up was only initiated after the platelet count had rapidly decreased and bleeding had become obvious. At the time of genetic confirmation, MDS-EB had to be diagnosed despite normal values and blood morphology for white cells and red cells. Thus, decreasing platelet counts in patients with known RUNX1 germline mutations or long-standing thrombocytopenias of unknown cause should result in prompt bone marrow examination, even in the absence of other signs or symptoms suspicious of hematopoietic neoplasia. Furthermore, the platelet count might be a suitable screening instrument in surveillance of patients known to carry germline RUNX1 mutations. Although both index patients had been successfully transplanted following a standard myeloablative regimen, earlier diagnosis of MDS might have saved toxicity and late effects. With our current knowledge of myeloid neoplasms with germline predisposition and pre-existing platelet disorders, children with thrombocytopenia and a family history should have complete genetic work-up for currently known alterations. Consensus guidelines need to be developed by specialists in hematology/oncology, coagulation, general pediatrics and human genetics. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

The suitability of the Hospital Anxiety and Depression Scale, Distress Thermometer and other instruments to screen for psychiatric disorders in both lung cancer patients and their partners

BackgroundLung cancer patients and their partners report high rates of distress. Although distress is of importance, psychiatric disorders might be more important in terms of prognostic value and additional psychological treatment. This study examined the suitability of the Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), Beck Depression Inventory (BDI-II) and State subscale of State Trait Anxiety Inventory (STAI-S) to screen for psychiatric disorders in lung cancer patients and partners. MethodsA consecutive sample of lung cancer patients and partners completed the screening instruments. The Structured Clinical Interview DSM-IV (SCID-I) was used to diagnose psychiatric axis I disorders. ResultsIn 144 patients, overall ability of HADS total score (HADS-T) screening for patients with psychiatric disorders was good, whereas DT appeared less suitable. In 98 partners, the performance of HADS-T was good. Although no instrument was successful in identifying psychiatric disorders, HADS-T came closest with a fair performance in patients and partners. LimitationsSeveral patients and partners declined participation because they perceived participation as too distressing. As decliners possibly have the highest rates of disorders, our findings might underestimate the prevalence of psychiatric disorders. A low prevalence negatively affects the positive predictive value and complicates efficient screening for psychiatric disorders. ConclusionThe HADS-T appears to be a suitable screening instrument for ruling out those lung cancer patients and partners without a psychiatric disorder. Regarding identifying those with a psychiatric disorder, HADS-T should be used to refer both patients and partners for further diagnostics and treatment to a psychiatrist/psychologist.

The role of the CBCL in the assessment of autism spectrum disorders: An evaluation of symptom profiles and screening characteristics

BackgroundThe Child Behavior Checklist (CBCL) offers the possibility to obtain information about a large number of psychiatric and somatic symptoms in a short period of time. This study aimed to examine symptom profiles and the usefulness of the CBCL for screening purposes in ASD. MethodOur sample comprised 1800 children and adolescents aged 4–18 years (M=10.91, SD 3.34), who had been diagnosed with high-functioning ASD (n=130, IQ>70), ADHD (n=337), Internalizing Disorders (n=364) or other psychiatric disorders (n=969). ResultsIn line with previous research, children and adolescents with ASD showed a high prevalence of behavior problems, which was even higher in cases of comorbid ASD+ADHD. However, the sensitivity and specificity of the CBCL syndrome scales were low. ConclusionAlthough the CBCL is not a suitable screening instrument for the identification of ASD, high scores on the syndrome scales Social problems, Withdrawn, Thought problems and also Attention problems might be an indication for further and differential diagnostic procedures. Concerning the evaluation of co-occurring behavior problems in ASD the CBCL is of good utility − as part of a thorough assessment routine.

Validation of rapid suicidality screening in epilepsy using the NDDIE.

Standard mortality ratio for suicide in patients with epilepsy is three times higher than in the general population, and such a risk remains high even after adjusting for clinical and socioeconomic factors. It is thus important to have suitable screening instruments and to implement care pathways for suicide prevention in every epilepsy center. The aim of this study is to validate the use of the Neurological Disorder Depression Inventory for Epilepsy (NDDIE) as a suicidality-screening instrument. The study sample included adult patients with epilepsy assessed with the Mini International Neuropsychiatric Interview (MINI) and the NDDIE. A high suicidality risk according to the Suicidality Module of the MINI was considered the gold standard. Receiver operating characteristic analyses for NDDIE total and individual item scores were computed and subsequently compared using a nonparametric approach. The best possible cutoff was identified with the highest Youden index (J). Likelihood ratios were then computed, and specificity, sensitivity, positive, and negative predictive values calculated. The study sample consisted of 380 adult patients with epilepsy: 46.3% male; mean age was 39.4 ± 14.6; 76.7% had a diagnosis of focal epilepsy; mean age at onset of the epilepsy was 23.3 ± 17.5. According to the MINI, 74 patients (19.5%) fulfilled criteria for a major depressive episode and 19 (5%) presented a high suicidality risk. A score >2 (J = 0.751) for item 4 "I'd be better off dead" of the NDDIE displayed excellent psychometric properties with a good to excellent validity (area under the curve [AUC] 0.906; 95% confidence interval [CI] 0.820-0.992; p < 0.001), sensitivity 84.21% (95% CI 60.4-96.6), specificity 90.86% (95% CI 87.4-93.6), likelihood ratio+ 9.21 (95% CI 6.3-13.5), likelihood ratio- 0.17 (95% CI 0.06-0.50). Item 4 of the NDDIE has shown to be an excellent suicidality screening instrument allowing the development of further care pathways for suicide prevention in epilepsy centers.

Screening for cognitive dysfunction in Huntington's disease with the clock drawing test.

The aim of the study is to investigate the performance of the clock drawing test as a screening tool for cognitive impairment in Huntington's disease (HD) mutation carriers. The performance of the clock drawing test was assessed in 65 mutation carriers using the Shulman and the Freund scoring systems. The mini-mental state examination, the Symbol Digit Modalities Test, the Verbal Fluency Test, and the Stroop tests were used as comparisons for the evaluation of cognitive functioning. Correlations of the clock drawing test with various cognitive tests (convergent validity), neuropsychiatric characteristics (divergent validity) and clinical characteristics were analysed using the Spearman's rank correlation coefficient. Receiver-operator characteristic analyses were performed for the clock drawing test against both the mini-mental state examination and against a composite variable for executive cognitive functioning to assess optimal cut-off scores. Inter-rater reliability was high for both the Shulman and Freund scoring systems (ICC = 0.95 and ICC = 0.90 respectively). The clock drawing tests showed moderate to high correlations with the composite variable for executive cognitive functioning (mean ρ = 0.75) and weaker correlations with the mini-mental state examination (mean ρ = 0.62). Mean sensitivity of the clock drawing tests was 0.82 and mean specificity was 0.79, whereas the mean positive predictive value was 0.66 and the mean negative predictive value was 0.87. The clock drawing test is a suitable screening instrument for cognitive dysfunction in HD, because it was shown to be accurate, particularly so with respect to executive cognitive functioning, and is easy and quick to use. Copyright © 2016 John Wiley & Sons, Ltd.

Can the Montreal Cognitive Assessment Predict Discharge Destination in a Stroke Population in the Hospital?

To decide on an appropriate discharge destination for stroke survivors from hospital, factors such as activities of daily living and age are often taken into account as predictors. Cognition has been found to support the decision whether to send a patient home or to a dependent living situation. The Montreal Cognitive Assessment (MOCA) has been proven to be a suitable cognitive screening instrument in the acute phase after stroke. However, its predictive value in the determination of discharge destination is unknown. The aim of the present study was to examine whether cognitive functioning, as measured with the MOCA, in the acute phase after stroke could predict discharge destination. The study involved 211 patients with a first-ever cerebral stroke within the first week after stroke. Demographic and stroke-specific data, cognitive functioning (MOCA), and level of functional disability (Barthel Index [BI]) were collected. Multivariate logistic regression analyses were used to predict discharge destination (dependent versus independent living situation). Both age (B = -.05; P < .01) and BI score (B = .33; P < .001) were found to be significantly related to discharge destination with explained variance of 43%. Adding MOCA score as a predictor variable to the model resulted in a nonsignificant improvement of the model, explaining 44% of the variance. Cognitive functioning, as measured by a single screening instrument such as the MOCA, in the acute phase after stroke is not predictive for discharge destination.

G04 Screening For Cognitive Dysfunction In Huntington's Disease With The Clock Drawing Test

<h3>Background</h3> Deficits in executive cognitive functionering are common in Huntington’s disease (HD). <h3>Aims</h3> To investigate the performance of the clock drawing test (CDT) as a screening tool for cognitive impairment in pre-motor symptomatic and motor symptomatic HD mutation carriers. <h3>Methods</h3> In 65 HD mutation carriers participating in this study, the performance of the clock drawing test was assessed, using the Mini-Mental State Examination (MMSE), the Symbol Digit Modalities Test, the Verbal Fluency Test and the Stroop Colour-Word tests as comparisons for the evaluation of cognitive functioning. The CDT was rated according to two different schoring methods: Shulman and Freund scoring system. Interrater reliability was assessed and receiver operator characteristic (ROC) analyses were performed for the CDT against the MMSE and a composite variable for executive cognitive functioning (ExCog) to find optimal cut-off scores. Correlations of the CDT with various cognitive tests, and clinical and neuropsychiatric characteristics were analysed. <h3>Results</h3> Interrater reliability was high for both the Shulman and Freund scoring methods (ICC = 0.95 and ICC = 0.90, respectively). Using the MMSE and ExCog as criterion standard, the mean sensitivity of the CDT was 0.82 and the mean specificity 0.79. The CDT showed moderate to high correlations (mean r = 0.71) with the other cognitive tests, particularly so with the Stroop tests. Moderately strong correlations were found between the CDT and disease duration, Total Functional Capacity, and the total motor score of the Unified Huntington’s Disease Rating Scale. <h3>Conclusions</h3> The CDT is a suitable screening instrument for cognitive dysfunction in HD, since it was shown to be accurate, particularly so with respect to executive cognitive functioning, and is quick and easy to use.

Impact of axis-I comorbidity and suicidal behavior disorders on sensitivity and specificity of the Mood Disorder Questionnaire in complex depressed inpatients

ObjectiveThis study assessed the psychometric performance of the Mood Disorder Questionnaire (MDQ) and its modified MDQ7 version, to screen for bipolar disorders (BD) in depressive inpatients according to depression severity, number of current axis I psychiatric comorbidities and suicidal behavior disorders. MethodsDepressed adult inpatients (n=195) were consecutively enrolled. Psychiatric diagnoses were made using the standardized DSM-IV-TR structured interview MINI 5.0.0 and medical case notes. Depression severity was assessed with the Beck Depression Inventory and the Hamilton Depression Scale. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each MDQ version were evaluated in the whole sample and according to depression severity, current axis I psychiatric comorbidities and suicidal behavior. ResultsThe occurrence and the number of axis I disorders affected performance of both versions. Among depressed patients with two or more comorbidities, PPV and NPV of the MDQ were 65% and 80%, respectively, and they were respectively 56.2% and 87.9% with MDQ7.Current suicidal behavior disorders also dramatically reduced the PPV of MDQ (from 81.2% to 63.3%) and MDQ7 (from 72.2% to 52.6%) but the NPV remained above 80%.The performance of both versions of the MDQ tended to improve with the severity of depression. ConclusionThe MDQ is not a suitable screening instrument to diagnose BD in subjects with a complex major depressive episode and/or a current history of suicidal behavior. Nevertheless MDQ particularly in its modified version may be useful for ruling out the presence of BD among these complex patients.

Clock Drawing Test

Despite the wide use of clock drawing tests (CDTs) for screening cognitive impairment, their use in patients having Parkinson disease (PD) with dementia has not been systematically investigated until date. In this cross-sectional study, neurological and neuropsychiatric statuses of 1449 outpatients having PD with and without dementia were comprehensively assessed. The CDT revealed cognitive impairment in 42.7% of the 1383 patients whose drawings were available. Overall, CDT sensitivity and specificity were 70.7% and 68.9%, respectively. The positive and negative predictive values were 48.0% and 85.3%, respectively. In patients with depression, CDT specificity dropped significantly to 55.8% (71.3% in nondepressed patients, P < .001). Classification performance was not impacted by motor symptoms. The estimated classification performances and predictive values correspond to those reported previously for non-PD populations. Our results indicate that CDT is a suitable screening instrument in patients with PD, but test results from patients with depression warrant careful consideration.

Eliminate Noxious Agents Acting as Triggers

The authors deserve thanks for their profound exploration of this topic, which is so important in routine clinical practice (1). (Onsetting) dementia is a predisposing factor, and delirium is common in dementia (ICD F05.1). Often, undetected dementia is unmasked only by delirium. Identifying such patients in advance by using suitable screening instruments lowers the frequency of delirium drastically (2). It is important to mention that in patients with known dementia and plausible trigger factors, the diagnostic efforts should be kept in proportion: electroencephalogram and cerebrospinal fluid (CSF) analysis are not among the basic diagnostic tools. With regard to treatment it should be emphasized that the elimination of noxious substances acting as triggers is the first priority; these include numerous medications—and especially polypharmacy. The importance of environmental therapeutic factors (alleviating patients’ fears/anxiety, enable reorientation) should not be underestimated, since a lack of orientation and fear/anxiety lead to further escalation of the pathophysiological cascade of delirium via corresponding psychophysiological mechanisms (3). Long acting benzodiazepines should not be used to treat delirium in elderly patients because of the risk of gradual intoxication, with adverse effects including respiratory depression. Delirium usually does not last longer than hours to several days, but in some cases it may persists for weeks, including postoperatively. Durations of six months have been observed (4). The reversible character of the symptoms is then often overlooked and hospitals admit patients prematurely to nursing homes.

P.4.e.001 Screening for anxiety disorders in patients with coronary artery disease using self-rating scales

Anxiety is common during pregnancy. The 7-item Generalized Anxiety Disorder scale (GAD-7) is a self-rating scale for detecting anxiety and has been validated in various populations, but it has not been validated in pregnant Chinese women. The objective of this study was to validate the GAD-7 as a screening tool to detect anxiety during pregnancy among Chinese women.The GAD-7 and the anxiety subscale of the Hospital Anxiety and Depression scale (HADS-A) were administered to 140 pregnant Chinese women to evaluate the Cronbach's alpha and the criterion-related validity. Additionally, a diagnostic study (n=170) was conducted by using the Mini International Neuropsychiatric Interview (MINI) as a gold standard to examine the screening performance of the GAD-7. We calculated the sensitivity, specificity, and area under the curve (AUC) by receiver operating characteristic (ROC) analysis.Cronbach's alpha for the GAD-7 was 0.84. The Pearson correlation coefficient between GAD-7 and HADS-A scores was 0.66 (P<0.01). At the maximum Youden Index of 0.53, the optimal cutoff score for the GAD-7 among pregnant women was 7, and an AUC of 0.83, a sensitivity of 96.8%, and a specificity of 56.1% were obtained.The majority of the participants were in the first trimester, and thus, the findings cannot be generalized to all pregnant women.The GAD-7 is a suitable screening instrument for detecting antenatal anxiety in mainland China. Further validation is warranted in women in different trimesters of pregnancy.