Study of functional rating scale for amyotrophic lateral sclerosis: revised ALSFRS(ALSFRS-R) Japanese version]

Amyotrophic lateral sclerosis(ALS) is progressive, degenerative, fatal disease of the motor neuron. No efficacious therapy is available to slow the progressive loss of function, but several new approaches including neurotrophic factors, antioxidants and glutamate antagonists, are currently being evaluated as potential therapies. Mortality, and/or time to tracheostomy, muscle strength and pulmonary function are used as primary endpoints in clinical trials for treatment of ALS. The effect of new therapies on the quality of patients' lives are also important, so we sought to develop a rating scale to measure it. The revised ALS Functional Rating Scale(ALSFRS-R), which has addition of items to ALSFRS to enhance the ability to assess respiratory symptoms, is an assessment determining the degree of impairment in ALS patients' abilities to function independently in activities of daily living. It consists of 12 items to evaluate bulbar function, motor function and respiratory function and each item is scored from 0(unable) to 4(normal). We translated the English score into Japanese one with minor modification considering the inter cultural difference. And we examined reliability of the translated scale. As a measure of reliability, the intraclass correlation coefficient(ICC) was evaluated for total score and the Kappa coefficient proposed by Cohen and Kraemer was calculated for each item. Moreover, we examined sensitivity to clinical change over time and carried out the factor analysis to analyze the factorial structure. The subjects were 27 ALS patients and each was scored twice for reliability or three times for sensitivity by 2 to 5 neurologists and if possible, nurses. The ICC for total score was 0.97(95% C. I.; 0.94-0.98). Extension of the Kappa coefficients were 0.48 to 1.00 for inter-rater reliability and the averaged Kappa coefficients were 0.63 to 1.00 for intra rater reliability, respectively. Concerning the factorial structure, the contribution of the first factor(the first principal component) were 53.5% principal factor solution. The factor loadings of items were 0.52-0.91 except "salivation" and this factor almost equal to the simple sum of all items was interpreted as the general degree of deterioration. The promax votation revealed the riginally supposed factor structure with 3 factors(groups of items): neuromuscuclar function, respiratory function and bulbar function. The rating scale correlated with Global clinical impression of change(GCIC) scored by neurologists and declined with time, indicating its sensitivity to change. On the bases of these results, ALSFRS-R(Japanese version) is considered to be highly reliable enough for clinical use.     

画钟测验的评分方法探讨

目的 编制和验证画钟测验(CDT)新的评分方法.方法 对188名健康中老年人、170例轻度认知障碍(MCI)患者和81例轻度阿尔茨海默病(AD)患者进行CDT等一系列神经心理测验.CDT 30分法包括先锚定12-3-6-9 4个点,称为"30分法-A",共4分;反映画钟结果的其余13项,称为"30分法-C",共26分,总分30分.38例被试者完成氙-CT(Xe-CT)检查,定量测量脑26个区域的局部血流量(rCBF).结果 CDT 30分法的14个项目分与总分的相关系数r=0.48～0.71,均有显著的相关性(P＜0.01)."30分法-C"与空间知觉和执行功能指标的相关性较大(r=0.58～0.64),而"30分法-A"与记忆指标的相关性较大(r=0.67)."30分法-A"≤2分,识别MCI的敏感性为70.6%,特异性为73.9%,"30分法-C"≤17分,识别MCI的敏感性为38.2%,识别轻度AD的敏感性为75.3%,特异性为75.9%.CDT与Xe-CT检测的rCBF的关系:"30分法-A"和"30分法-C"的回归方程中,入选的自变量分别为左额叶下区和右白质区.结论 "30分法"A和C两部分具有不同的意义,"30分法-C"可用于识别AD,而"30分法-A"有助于MCI的识别.     

Development of disaster mental health guidelines through the Delphi process in Japan

Background

The mental health community in Japan had started reviewing the country??s disaster mental health guidelines before the Great East Japan Earthquake, aiming to revise them based on evidence and experience accumulated in the last decade. Given the wealth of experience and knowledge acquired in the field by many Japanese mental health professionals, we decided to develop the guidelines through systematic consensus building and selected the Delphi method.

Methods

After a thorough literature review and focus group interviews, 96 items regarding disaster mental health were included in Delphi Round 1. Of 100 mental health professionals experienced in disaster response who were invited to participate, 97 agreed. The appropriateness of each statement was assessed by the participants using a Likert scale (1: extremely inappropriate, 9: very appropriate) and providing free comments in three rounds. Consensus by experts was defined as an average score of ??7 for which ??70% of participants assigned this score, and items reaching consensus were included in the final guidelines.

Results

Overall, of the 96 items (89 initially asked and 7 added items), 77 items were agreed on (46 items in Round 1, and 19 positive and 12 negative agreed on items in Round 2). In Round 2, three statements with which participants agreed most strongly were: 1) A protocol for emergency work structure and information flow should be prepared in normal times; 2) The mental health team should attend regular meetings on health and medicine to exchange information; and 3) Generally, it is recommended not to ask disaster survivors about psychological problems at the initial response but ask about their present worries and physical condition. Three statements with which the participants disagreed most strongly in this round were: 1) Individuals should be encouraged to provide detailed accounts of their experiences; 2) Individuals should be provided with education if they are interested in receiving it; and 3) Bad news should be withheld from distressed individuals for fear of causing more upset.

Conclusions

Most items which achieved agreement in Round 1 were statements described in previous guidelines or publications, or statements regarding the basic attitude of human service providers. The revised guidelines were thus developed based on the collective wisdom drawn from Japanese practitioners?? experience while also considering the similarities and differences from the international standards.     

Validation of the French version of a pleasure scale for children (The Pleasure Scale for Children, PSC, Kazdin, 1989) in 214 hospitalized children in pediatrics]

The aim of this study was to determine the metrological parameters of a french version of the Pleasure Scale for Children (PSC): 214 (121 males and 93 females) with a mean age of 8.69 years (sd: 1.95) ranging from 6 years to 12 years were included in the study. The children were inpatients presenting various somatic disorders. Statistical analysis: First a principal component analysis was done on the 39 items of the correlation matrix. Several guidelines were used to limit the number of factors (Kaiser criteria, Cattell scree test, Horn parallel analysis). Secondly the construct validity was studied using the alpha Cronbach coefficient and by calculing the Pearson correlation coefficient between each item and the total score. Thirdly the concurrent validity was determinated using two items of the Children Depression Rating Scale--Revised (CDRS-R) measuring pleasure (social withdrawal and enjoyment capacity). Fourthly the discriminant validity of the PSC was studied by comparing non depressive children (score lower than 30 to the CDRS-R) and depressive children (score higher than 30 to the CDRS-R). RESULTS: The principal component analysis showed a one factor solution with 33 items among the 39 having a higher than 0.3 saturation. The Cronbach alpha coefficient was 0.84. All the items correlated with the total score. The mean value was 0.37. The correlations between the total score of the scale and the CDRS-R enjoyment capacity and social withdrawal items were respectively -0.37 (p < 0.01) and -0.38 (p < 0.01). PSC score were significantly lower in depressive children (m = 86.96; sd = 8.33) than in non depressive children (m = 94.67; sd = 10) (t = 5.32; df = 212; p < 0.001).     

No predictors of antidepressant patient response to milnacipran were obtained using the three-factor structures of the Montgomery and Asberg Depression Rating Scale in Japanese patients with major depressive disorders

Aims:  Milnacipran, a new specific serotonin and norepinephrine re-uptake inhibitor, is as effective as tricyclic antidepressants. Symptomatological predictors of antidepressant response to milnacipran have not been studied until now.
Methods:  This study included 101 Japanese patients who fulfilled the DSM-IV criteria for the diagnosis of major depressive disorders and whose score on the Montgomery and Åsberg Depression Rating Scale (MADRS) was ≥21. Eighty-three patients were finally included. Patients with a pretreatment MADRS score ≥31 points were defined as severe ( n  = 28), and the rest as non-severe ( n  = 55). The three-factor model of MADRS was used for analysis; the first factor was defined by three items, the second factor was defined by four items and the third factor was defined by three items representing dysphoria, retardation, and vegetative symptoms, respectively. Milnacipran was administered twice daily for 6 weeks. The initial dose was 50 mg/day; after a week it was increased to 100 mg/day.
Results:  No significant difference was observed in the mean score of first factor, second factor and third factor at pretreatment time between responders and non-responders in both severe and non-severe patients.
Conclusions:  No predictor of antidepressant response to milnacipran was obtained using the three-factor structures of the MADRS in Japanese patients with major depressive disorders.     

Age and gender differences in the factor structure of the Center for Epidemiological Studies Depression Scale among Japanese working individuals

ObjectivesDepression is a serious mental illness with a high rate of prevalence. Depressive sympotomatology is heterogeneous and is expressed as a combination of emotional, physical, cognitive, and social symptoms. The objective of this study was to examine differences in the factor structure of the Center for Epidemiologic Studies Depression Scale (CES-D) among Japanese working individuals of differing age and gender using exploratory factor analysis (EFA).MethodsThis study examined the factor structure of the CES-D in a sample of 6696 Japanese working individuals aged 20 and older. To examine within-group differences in the structural characteristics of the CES-D, the participants were stratified by age subgroup.ResultsThe EFA with promax rotation identified three factors among the participants. These factors were labeled “depressed and negative complaints” (DEP), “somatic and apathetic complaints” (SOM), and “positive affect” (POS). Although the three factors were comparable for males in their 20–50s and females in their 20s and 30s, the content of these factors varied for other subgroups. For females in their 40s and 50s, items 15 and 19 (belonging to Radloff’s original interpersonal problem factor) constituted an independent factor. For all individuals in their 60s, items that were not included in the SOM and POS factors constituted new factors that were not observed for participants in their 20s–50s.ConclusionThese findings indicate that age and gender could affect the factor structure of the CES-D among Japanese working individuals. Psychosocial or biological factors might contribute to the age- and gender-related differences in the factor structure of the CES-D.     

Reliability, validity, and factor structure of the geriatric depression scale in Turkish elderly: are there different factor structures for different cultures?

The purpose of this study was to examine the Geriatric Depression Scale (GDS) translated into Turkish for its reliability, discriminant validity, and factor structure in a sample of 276 community-dwelling elderly and 30 patients with major depression. One item (Item 5) was discovered to have conceptual difficulty for Turkish elderly and was transformed to negative form. Item 2 was transformed to positive form to keep the number of positive and negative items equal to that in the original GDS. A reasonable time stability with 1-week interval (r: .74) and a high level of internal consistency (alpha=.91) were observed. Student's t test resulted in a significant discriminant validity for the scale total score. Factor study with principal component analysis and varimax rotation gave rise to a structure with seven factors. Results of the same analysis with two factors were found to be easier to interpret. The first factor was composed of 19 items reflecting "depressive affect and thought content." The other 11 items representing "decrease in motivation and cognitive functions" loaded in the second factor. In conclusion, the Turkish GDS was found to have reasonable time reliability, high internal consistency, and discriminant validity for Turkish elderly. Its two-factor structure can be used as an informative instrument for epidemiological studies, reflecting two main dimensions of depression in the elderly.     

Normal and obsessional jealousy: a study of a population of young adults.

BACKGROUND: Jealousy is a heterogenous emotion ranging from normality to pathology. Several problems still exist in the distinction between normal and pathological jealousy. AIM OF THE STUDY: With the present study, we aimed to contribute to the definition of the boundary between obsessional and normal jealousy by means of a specific self-report questionnaire developed by us. METHOD: The questionnaire called "Questionnaire on the Affective Relationships" (QAR) and consisting of 30 items, was administered to 400 university students of both sexes and to 14 outpatients affected by obsessive-compulsive disorder (OCD) whose main obsession was jealousy. The total scores and single items were analysed and compared. RESULTS: Two hundred and forty-five, approximately 61% of the questionnaires, were returned. The statistical analyses showed that patients with OCD had higher total scores than healthy subjects; in addition, it was possible to identify an intermediate group of subjects, corresponding to 10% of the total, who were concerned by jealousy thoughts around the partner, but at a lower degree than patients, and that we called "healthy jealous subjects" because they had no other psychopathological trait. Significant differences were also observed for single items in the three groups. CONCLUSIONS: Our study showed that 10% of a population of university students, albeit normal, have jealousy thoughts around the partner, as emerged by the specific questionnaire developed by us. This instrument permitted to clearly distinguish these subjects from patients with OCD and healthy subjects with no jealousy concern.     

Development of disaster mental health guidelines through the Delphi process

ABSTRACT: BACKGROUND: The mental health community in Japan had started reviewing the country's disaster mental health guidelines before the Great East Japan Earthquake, aiming to revise them based on evidence and experience accumulated in the last decade. Given the wealth of experience and knowledge acquired in the field by many Japanese mental health professionals, we decided to develop the guidelines through systematic consensus building and selected the Delphi method. METHODS: After a thorough literature review and focus group interviews, 96 items regarding disaster mental health were included in Delphi Round 1. Of 100 mental health professionals experienced in disaster response who were invited to participate, 97 agreed. The appropriateness of each statement was assessed by the participants using a Likert scale (1: extremely inappropriate, 9: very appropriate) and providing free comments in three rounds. Consensus by experts was defined as an average score of [greater than or equal to]7 for which [greater than or equal to]70% of participants assigned this score, and items reaching consensus were included in the final guidelines. RESULTS: Overall, of the 96 items (89 initially asked and 7 added items), 77 items were agreed on (46 items in Round 1, and 19 positive and 12 negative agreed on items in Round 2). In Round 2, three statements with which participants agreed most strongly were: 1) A protocol for emergency work structure and information flow should be prepared in normal times; 2) The mental health team should attend regular meetings on health and medicine to exchange information; and 3) Generally, it is recommended not to ask disaster survivors about psychological problems at the initial response but ask about their present worries and physical condition. Three statements with which the participants disagreed most strongly in this round were: 1) Individuals should be encouraged to provide detailed accounts of their experiences; 2) Individuals should be provided with education if they are interested in receiving it; and 3) Bad news should be withheld from distressed individuals for fear of causing more upset. CONCLUSIONS: Most items which achieved agreement in Round 1 were statements described in previous guidelines or publications, or statements regarding the basic attitude of human service providers. The revised guidelines were thus developed based on the collective wisdom drawn from Japanese practitioners' experience while also considering the similarities and differences from the international standards.     

Échelle d’attitudes à l’égard des personnes présentant un trouble de personnalité limite : structure factorielle et validation préliminaire

Objectives

Studies have shown that negative attitudes on the part of mental health professionals are often held toward people suffering from borderline personality disorder (BPD). These negative attitudes heighten the risk of stigmatization and rejection of these patients. Many publications have focused on the clinicians’ attitudes toward patients with personality disorders, and on the development of questionnaires meant to assess these attitudes. While some of these questionnaires have used semi-structured interviews in a qualitative framework, others have resorted to quantitative questionnaires. However, only one of these instruments has been developed with the specific purpose of evaluating the clinicians’ attitudes toward patients with BPD. The existing measures, developed in English, were validated among clinicians working outside Quebec. The present study exposes a factor analysis and preliminary validation of a French language instrument specifically designed to measure mental health professionals’ attitudes toward patients with BPD.

Method

A multidimensional and attitudinal model was chosen for the development of the scale. Twenty items were elaborated by Bouchard and grouped into four different scales: Negative attitudes (four items), Positive attitudes (five items), Caretaking necessity (five items), and False perceptions about BPD (six items). A total of 416 mental health professionals completed the questionnaire. Demographic data is available for 236 participants (178 women): mean age is 42, 1 year and 70% are university graduates.

Results

Preliminary factor analysis confirmed the existence of two main factors. The scales Positive attitudes and Negative attitude were grouped into factor 1, which was labelled Comfort when interacting with someone who has BPD. The items associated with the scales Caretaking necessity and False perceptions about BPD were grouped into factor 2, labelled Positives perceptions about BPD. The internal consistency indexes of the scale as well as the two distinct factors are satisfactory. Linear regressions were computed in order to assess whether sex, age, and level of education of participants are good predictors for the total score of the scale but the results are not significant; these variables are not good predictors for the total score of the scale.

Conclusion

Results constitute a first step toward the validation of a measure of the attitudes towards people with a diagnosis of BPD. The instrument could be also used to assess the effect of training workshops aimed to change mental health professionals’ attitudes toward this clinical population.