Psychopathological rating scales for diagnostic use in adults with attention-deficit/hyperactivity disorder (ADHD)

The diagnosis of attention-deficit hyperactivity disorder (ADHD) in adults is a complex procedure which should include retrospective assessment of childhood ADHD symptoms either by patient recall or third party information, diagnostic criteria according to DSM-IV, current adult ADHD psychopathology including symptom severity and pervasiveness, functional impairment, quality of life and comorbidity. In order to obtain a systematic database for the diagnosis and evaluation of the course ADHD rating scales can be very useful. This article reviews rating instruments that have found general acceptance. The Wender-Utah Rating Scale (WURS) and the Childhood Symptoms Scale by Barkley and Murphy try to make a retrospective assessment of childhood ADHD symptoms. The Connors Adult ADHD Rating Scales (CAARS), the Current Symptoms Scales by Barkley and Murphy (CSS), the Adult Self Report Scale (ASRS) by Adler et al. and Kessler et al. or the Attention Deficit Hyperactivity Disorder--Self Report Scale (ADHD-SR by R?sler et al.) are self report rating scales focusing mainly on the DSM-IV criteria. The CAARS and the CSS have other report forms too. The Brown ADD Rating Scale (Brown ADD-RS) and the Attention Deficit Hyperactivity Disorder--Other Report Scale (ADHD-OR by R?sler et al.) are instruments for use by clinicians or significant others. Both self rating scales and observer report scales quantify the ADHD symptoms by use of a Likert scale mostly ranging from 0 to 3. This makes the instruments useful to follow the course of the disease quantitatively. Comprehensive diagnostic interviews not only evaluate diagnostic criteria, but also assess different psychopathological syndrome scores, functional disability measures, indices of pervasiveness and information about comorbid disorders. The most comprehensive procedures are the Brown ADD Diagnostic Form and the Adult Interview (AI) by Barkley and Murphy. An instrument of particular interest is the Wender Reimherr Interview (WRI) which follows a diagnostic algorithm different from DSM-IV. The interview contains only items delineated from adult psychopathology and not derived from symptoms originally designed for use in children. Other instruments focus on functional impairment, quality of life, comorbid disorders, gender effects and specific psychopathological models.     

Local perceptions of the mental health effects of the Rwandan genocide

The objectives of this study were to investigate how Rwandans perceive the mental health effects of the 1994 genocide, to investigate the local validity of western mental illness concepts, and (if these concepts were found to be valid) to provide data to adapt existing mental health assessment instruments for local use. We used three ethnographic methods to interview people in two rural areas in Rwanda: first, free listing provided a list of local terms for mental symptoms and disorders; second, key informant interviews then provided more detailed information about these disorders; and finally, pile sorts confirmed the relationships among symptoms and disorders that emerged from the other methods. We found that interviewees described the diagnostic symptoms of depression and posttraumatic stress disorder as results of the genocide and also described associated "local" symptoms not included in the established diagnostic criteria. They divided symptoms into a "mental trauma" syndrome that included the posttraumatic stress disorder symptoms and some depression and local symptoms, and a grief syndrome that included other depression and local symptoms. In the pile sorts, we focused on investigating mood disorders and confirmed that four of the locally described symptoms formed part of a local depression-like illness. The results suggest that depression occurs among this population and support the local content validity of depression assessment instruments, such as the Depression section of the Hopkins Symptom Checklist. Similar independent evidence of validity is missing from most cross-cultural surveys. Our work supports the need and feasibility for collecting this supporting evidence prior to conducting cross-cultural surveys using existing instruments.     

Assessment of eating disorders: review and recommendations for clinical use

Practitioners have come under increasing pressure to provide objective data on assessment and treatment outcome of clients. This article provides a brief summary of assessment of eating disorders for the practicing clinician, with an emphasis on well-validated assessment instruments. The critical domains that should be covered in a thorough assessment of eating disorders are reviewed, as are some shortcomings in the current assessment literature, and also discussed is which assessment instruments for the eating disorders are most useful in a clinical context. Using well-validated, standardized assessment instruments in all phases of the treatment process is a critical part of justifying a treatment plan and providing objective data on client progress and outcome.     

Symptômes négatifs de la schizophrénie : une revue des instruments d’évaluation

IntroductionNegative symptoms are a fundamental dimension of schizophrenia despite their limited role in the international diagnostic classification. Although a consensual definition seems to be attempted regarding the main negative dimensions (anhedonia, alogia, social withdrawal, blunted affect, avolition), several standardized assessment scales have been created.ObjectivesThe objective of this study was to identify a set of unidimensional instruments which allows an assessment of negative symptoms in schizophrenia and also to identify their general characteristics and the items included.MethodsInclusion criteria were: (a) the unidimensional assessment scales of negative symptoms of schizophrenia; (b) instruments in English (with French versions if possible); (c) all assessment instruments, the oldest and the most recent. The investigation ended in February 2013.ResultsTwelve unidimensional instruments were identified with only one of them based on a self-administered survey (MAP-SR). The number of items included is from 6 (SDS) to 25 (SANS). The fastest instrument is the HEN (5–10 min) and the longest is the SANS (30 min). The MASS needs an evaluation by another person (family or care-giver). Most instruments need to be handled and take place during a semi-structured or structured psychiatric interview. The SANS allows an assessment of the most important number of negative domains (11 domains). On the other side, we have the MAP-SR (3 domains). The most frequently evaluated domains are emotional blunting, alogia, social withdrawal, anhedonia and avolition. On the other side, we have mood and thought disorders. Only SDS allows to distinguish the primary and secondary negative symptoms.DiscussionThe oldest instruments (SANS, NSA-16, SDS) are more complicated to handle and to use. The SANS is the most complete instrument but there are more recent instruments which are easier to use and handle (BNSS, CAINS). Using a self-evaluation survey, MAP-SR is judicious as this type of evaluation is reliable. However, in this case, the assessment covers only a limited part of the negative symptoms.ConclusionDespite some progress in the definition, assessment and treatment of negative symptoms and despite new scales further instruments which are easy to use in clinical practice and integrating the patient's self-report are needed.     

Assessing the Risk of Australian Indigenous Sexual Offenders Reoffending: A Review of the Research Literature and Court Decisions

The assessment of offenders’ risk of reoffending, particularly sexual reoffending, is a core activity of forensic mental health practitioners. The purpose of these assessments is to reduce the risk of harm to the public, but they are controversial and become more contentious when Australian practitioners who want to undertake such assessments in an ethically responsible way must use reliable validated instruments, disclose the limitations of their assessment methods, instruments and data to judicial decision-makers and understand how decision-makers might use their reports. The purpose of this systematic literature review was to explore the practices of Australian practitioners and courts in respect of the assessment of Australian Indigenous male sexual offenders’ risk of reoffending. We could not identify an instrument that has been developed for the assessment of this population group. Australian courts differ in whether they admit and give weight to practitioners’ evidence and opinions based on data obtained with non-validated instruments. We could only identify three possible predictor variables with enough quantitative support to justify including them in an instrument that could be used to assess Indigenous sexual offenders. There is a need for research regarding the validity of the instruments that practitioners use.     

A Review of Scales to Measure Social Anxiety Disorder in Clinical and Epidemiological Studies

To advance research into social anxiety disorder (SAD) and provide efficacious treatments for individuals with SAD, researchers and clinicians must have effective assessment instruments for identifying the disorder in terms of its diagnostic criteria, symptoms, and the presence of specific maintaining factors. This review highlights the main lines of existing adult and youth research on scales that form part of diagnostic instruments that assess SAD, scales that measure social anxiety symptoms, and scales that measure theory-based psychological maintaining factors associated with SAD. The review also highlights methodological issues that impact on the use of the aforementioned scales. The continued refinement and comparative evaluation of measures for SAD, culminating in the ascertainment of optimal measures, will improve the assessment and identification of the disorder. Improved identification of the disorder will contribute to the advancement of SAD research and treatment.     

Informed consent and patient competence in the psychically ill. A review of empirical studies

In clinical practice, patients' self-determination has become more and more important. However, in psychiatry, the practice of informed consent encompasses several problems. In many cases the psychiatrist is faced with the issue of determining patients' competence. This paper gives an overview of empirical studies on competence assessment in psychiatry. In the course of some of these studies, test instruments were developed which allow objective and reliable assessment of different standards of competence. The applicability of these tests is discussed. We present empirical data on the relationship between competence and psychopathologic symptoms and cognitive factors. In recent empirical research, a shift from an initial skepticism of the applicability of informed consent in psychiatry towards a more differentiated approach and an interest in multidisciplinary research can be observed.     

The structure of negative symptoms within schizophrenia: implications for assessment

This review examines the structural validity of negative symptoms focusing on 2 questions: (1) Do negative symptoms represent a domain separate from other symptoms in schizophrenia? and (2) Within negative symptoms, is there a structure that suggests multidimensionality? Results from exploratory and confirmatory factor analytic studies are examined to address these questions. Across studies and symptom instruments, negative symptoms appear to consistently emerge as a factor separate from other dimensions of the illness in schizophrenia. Whether 2-, 3-, or 5-factor models are identified, negative symptoms consistently load on a factor separate from positive symptoms, affective symptoms of depression or anxiety, and symptoms of disorganization. Focusing on negative symptoms themselves, factor analytic findings suggest that this construct is multidimensional with at least 2 factors (involving diminished expression and anhedonia-asociality). Although these factors were replicable, serious limitations were noted in this literature. Thus, 2- (or even 3- or 5-) factor models of negative symptoms should not be considered definitive, but rather all converge to support the general conclusion of the multidimensionality of negative symptoms. The later findings indicate the importance of employing assessments that provide adequate coverage of the broad domain of negative symptoms. Importantly, caution is noted in the interpretability of findings based on existing instruments, and implications for future assessment are discussed.     

The factor structure of the CES-D in a sample of Rwandan genocide survivors

Background

Past research suggests that culture shapes the way psychopathology is experienced and expressed. Standard psychiatric assessment instruments may therefore not capture the same underlying constructs in different contexts. The present study investigated the factor structure of a standard depression scale in a sample of Rwandan genocide survivors.

Methods

One hundred ninety six Rwandan adults provided socio-demographic information and completed the Center for Epidemiological Studies-Depression scale (CES-D), one of the most widely used self-report instruments assessing depressive symptoms, as part of a larger study on well-being and mental health in Rwanda.

Results

A two-factor solution provided the best fit for these CES-D data. The first factor corresponded to general depressive symptoms (including depressed affect, somatic symptoms, and interpersonal concerns) and explained 37.20 % of the variance. The second factor included items assessing positive affect and explained 8.68 % of the variance.

Conclusions

The two-factor solution found in the present study deviates from the commonly reported four-factor structure, but is consistent with studies showing that depressed affect and somatic symptoms may not be experienced as distinct in certain non-Western and minority cultural groups.     

Daytime symptoms in primary insomnia: a prospective analysis using ecological momentary assessment

OBJECTIVES: To prospectively characterize and compare daytime symptoms in primary insomnia (PI) and good sleeper control (GSC) subjects using ecological momentary assessment; to examine relationships between daytime symptom factors, retrospective psychological and sleep reports, and concurrent sleep diary reports. METHODS: Subjects included 47 PI and 18 GSC. Retrospective self-reports of daytime and sleep symptoms were collected. Daytime symptoms and sleep diary information were then collected for 1 week on hand-held computers. The Daytime Insomnia Symptom Scale (DISS) consisted of 19 visual analog scales completed four times per day. Factors for the DISS were derived using functional principal components analysis. Nonparametric tests were used to contrast DISS, retrospective symptom ratings, and sleep diary results in PI and GSC subjects, and to examine relationships among them. RESULTS: Four principal components were identified for the DISS: Alert Cognition, Negative Mood, Positive Mood, and Sleepiness/Fatigue. PI scored significantly worse than GSC on all four factors (p<0.0003 for each). Among PI subjects DISS scales and retrospective psychological symptoms were related to each other in plausible ways. DISS factors were also related to self-report measures of sleep, whereas retrospective psychological symptom measures were not. CONCLUSIONS: Daytime symptom factors of alertness, positive and negative mood, and sleepiness/fatigue, collected with ecological momentary assessment, showed impairment in PI versus GSC. DISS factors showed stronger relationships to retrospective sleep symptoms and concurrent sleep diary reports than retrospective psychological symptoms. The diurnal pattern of symptoms may inform studies of the pathophysiology and treatment outcome of insomnia.     

Development of assessment toolkits for improving the diagnosis of the Lewy body dementias: feasibility study within the DIAMOND Lewy study

Objective

The Lewy body dementias (LBD, dementia with Lewy bodies and Parkinson's disease dementia) are the second most common cause of neurodegenerative dementia but remain under‐recognised, with long delays from initial assessment to diagnosis. Whilst validated instruments have been developed for key symptoms, there is no brief instrument for overall diagnostic assessment suitable for routine practice. We here report the development of such assessment toolkits.

Methods

We developed the LBD assessment toolkits in three stages. First, we conducted a systematic search for brief validated assessments for key symptoms and combined these into draft instruments. Second, we obtained feedback on acceptability and feasibility through two rounds of interviews with our patient and public involvement group. This led to modification of the toolkits. Finally, we piloted the toolkits in a feasibility study in routine dementia and Parkinson's disease services to produce final instruments suitable for routine clinical practice.

Results

Eleven clinicians, working in both dementia/memory assessment and Parkinson's disease/movement disorder services, consented to pilot the assessment toolkits and provide feedback on their feasibility. Clinicians worked in routine health service (not academic) settings and piloted the draft toolkits by integrating them into their regular clinical assessments. Feedback obtained informally, by written comments and through qualitative interviews led to modifications and production of final acceptable versions.

Conclusions

We were able to address an important need, the under‐diagnosis of LBD, by developing toolkits for improving the recognition and diagnosis of the LBD, which were acceptable to clinicians working in routine dementia and Parkinson's disease services. © 2016 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons, Ltd.     

Toward the Next Generation of Negative Symptom Assessments: The Collaboration to Advance Negative Symptom Assessment in Schizophrenia

Negative symptoms in schizophrenia are related to poor functional outcome, persistent over time, a source of burden for caregivers, and only minimally responsive to currently available medications. A major challenge to developing efficacious interventions concerns the valid and reliable assessment of negative symptoms. In a recent consensus statement on negative symptoms, a central recommendation was the need to develop new assessment approaches that address the limitations of existing instruments. In the current report, we summarize the background and rationale for the Collaboration to Advance Negative Symptom Assessment in Schizophrenia (CANSAS). The CANSAS project is an National Institute of Mental Health-funded multisite study that is constructing a next-generation negative symptom scale, the Clinical Assessment Interview for Negative Symptoms (CAINS). The CAINS is being developed within a data-driven iterative process that seeks to ensure the measure’s reliability, validity, and utility for both basic psychopathology and treatment development research.     

Assessment instruments used in the education and treatment of persons with autism: brief report of a survey of national service centers

Although assessment is a critical component in the education and treatment of persons who have autism, there is insufficient information about the types of assessment instruments that are used routinely by practitioners. This brief report describes a survey of national service centers to determine their use of standardized instruments and the purposes of their assessment practices. Data from centers representing 30 states revealed that (a) the number of assessment instruments endorsed by centers increased as centers adopted a "multidisciplinary" approach to education and treatment, (b) the largest proportion of instruments fell within intellectual, motor, and language/communication domains, and (c) instruments were used most frequently for diagnostic and curriculum design purposes. Agreement among practitioners on the selection of instruments occurred most frequently in the domains of projective, adaptive behavior, and family assessment. The implications from these findings for assessment practices in autism are discussed.     

Course of panic disorder during the early postpartum period: a prospective analysis

PURPOSE: Most of the studies about course of panic disorder (PD) after childbirth have a retrospective nature. The aim of the current study was to examine prospectively the clinical course of 13 pregnant women with a diagnosis of PD across pregnancy and the early postpartum period. METHOD: The diagnosis of PD was determined by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders in the third trimester of pregnancy. Within the same period, the Panic and Agoraphobia Scale was used to determine the severity of PD. The last assessment with both instruments was performed at 6 weeks postnatally. RESULTS: Of these 13 women, 6 (group 1) reported that PD developed during the 6th to the 28th week of their gestation, and the number of women who experienced PD symptoms before pregnancy (group 2) was 7. It was found that the severity of panic symptoms considerably decreased in the total sample, group 1, and group 2 from the basal levels to 6 weeks postnatally. CONCLUSION: Our study results suggest that pregnant women with PD may experience a marked improvement in PD symptoms in the early postpartum period.     

Differential results between self-report and interview-based ratings of risk symptoms of psychosis

Aim: Assessing potential risk of developing psychosis has gained growing attention in recent literature. The selection of suitable assessment methods is the central question for this research endeavour. Whereas prodromal detection instruments are mostly interview‐based instruments, there are short screening instruments for self‐report use. Methods: Difference in psychosis risk scores was tested between self‐report results and interview results, with risk symptoms of psychosis included in PROD screening instrument. Subjects were recruited by an early intervention team in Finland. Results: There was a significant difference between psychosis risk scores based on self‐report versus interview in a sample of adolescents (n = 87; P < 0.001). Conclusions: Results suggest that when using screening instruments, risk scores and risk status may vary by the method the information is collected. Checking self‐report results by an additional interview is recommended for both clinical and scientific uses.     

Convergent and discriminant validity of attenuated psychosis screening tools

Brief self-report questionnaires that assess attenuated psychotic symptoms have the potential to screen many people who may benefit from clinical monitoring, further evaluation, or early intervention. The extent to which recently developed screening instruments demonstrate sound psychometric properties is an important issue toward the implementation of these measures in clinical practice. This study examines the convergent validity, discriminant validity, and test-retest reliability of four recently developed screening instruments. Screening instruments were included in an assessment battery and administered to a sample of 355 college students. Screening scores support the convergent and discriminant validity and the test-retest reliability of these measures.     

Routine Outcomes Monitoring to Support Improving Care for Schizophrenia: Report from the VA Mental Health QUERI

In schizophrenia, treatments that improve outcomes have not been reliably disseminated. A major barrier to improving care has been a lack of routinely collected outcomes data that identify patients who are failing to improve or not receiving effective treatments. To support high quality care, the VA Mental Health QUERI used literature review, expert interviews, and a national panel process to increase consensus regarding outcomes monitoring instruments and strategies that support quality improvement. There was very good consensus in the domains of psychotic symptoms, side-effects, drugs and alcohol, depression, caregivers, vocational functioning, and community tenure. There are validated instruments and assessment strategies that are feasible for quality improvement in routine practice.     

Convergence of clinical staff ratings and research ratings to assess patients with schizophrenia in nursing homes

OBJECTIVE: A large number of older patients with serious mental illnesses, including schizophrenia, now reside in nursing homes or similar residences, yet little is known about assessments, services, or outcomes for these patients. The Minimum Data Set (MDS) is a mandatory assessment instrument for nursing care facilities, and although it has been well studied in the general nursing home population, little is known about its validity in assessing schizophrenia, which was the purpose of this study. METHODS: A group of 77 patients with schizophrenia had been recruited as part of a longitudinal study and were evaluated after their referral to nursing homes. Researchers compared ratings from the MDS with ratings of cognition and symptoms using instruments previously validated for the assessment of serious mental illness. RESULTS: The cognitive subscale of the MDS (MDS-COG) was not strongly correlated with the Mini-Mental State Examination and was generally uncorrelated with performance on neuropsychological tasks. Symptoms were underreported on the MDS and were not significantly associated with researchers' ratings. Moreover, the ratings from the MDS, unlike the researchers' ratings, were not predictive of functional status, revealing poor criterion validity. CONCLUSIONS: These findings suggest that the MDS is not a suitable rating instrument to evaluate the symptoms and functional characteristics of older patients with schizophrenia. Future work will be required to develop instruments that would allow nursing home staff to recognize and report symptoms, cognitive impairments, and functional characteristics of these patients, which are important first steps for improving treatment services.     

The Early Recognition Inventory ERIraos detects at risk mental states of psychosis with high sensitivity

The identification of patients carrying an increased risk of psychosis is one of the most important demands in schizophrenia research. Currently used diagnostic instruments mainly focus on either attenuated psychotic symptoms and brief limited intermittent psychotic symptoms or solely cognitive basic symptoms. The “Early Recognition Inventory based on IRAOS” (ERIraos) has been developed as a comprehensive assessment of both symptom groups within one scale. We compared the results obtained by ERIraos with an international standard instrument, the “Comprehensive Assessment of At Risk Mental States” (CAARMS) and applied both scales in a sample of 121 outpatients positively tested on a screening checklist for at risk mental states (ARMS). Subsamples were classified as first episode of psychosis, late ARMS with prevalent attenuated psychotic symptoms and/or brief limited intermittent psychotic symptoms, earlier stages of ARMS presenting cognitive basic symptoms as well as a vulnerability group, also differing regarding mean age and psychosocial functioning. Our results point to a higher sensitivity of ERIraos compared to scales that mainly focus on attenuated psychotic symptoms and brief limited intermittent psychotic symptoms. A detailed assessment of cognitive basic symptoms seems to be important in early detection, might be an important focus for therapeutic interventions in ARMS patients and might sustain attempts to alleviate cognitive dysfunction in schizophrenia.     

Assessment of depression in children and adolescents

Depression assessment instruments are valuable tools in the treatment of children and adolescents. Available instruments include diagnostic interviews, self-administered rating scales, and observer-rated scales. To select an appropriate instrument, the user must define the goal of the assessment and then identify instruments with the properties that match this goal. This article discusses how to choose an assessment instrument and gives an overview of currently available depression assessment instruments. Important considerations include how and by whom an instrument is administered, what kind of data are obtained by the instrument, and the validity and reliability of the instrument. Standardized instruments can greatly improve the assessment process, but the user must not overinterpret or misinterpret the results.