广泛性焦虑量表在颈椎病患者焦虑情绪评估的信度和效度研究

目的:探讨广泛性焦虑量表(GAD-7)在颈椎病患者焦虑情绪评估的信度和效度。方法:应用GAD-7及焦虑自评量表(SAS)对100例颈椎病患者进行筛查,同时进行美国《精神障碍诊断与统计手册》第4版(DSM-Ⅳ)临床定式访谈(SCID)评定。随机抽取30例患者在GAD-7测定1周后再次进行GAD-7评定。结果:GAD-7 Cronbach'sα系数为0.965;各条目与量表总分的相关系数为0.882~0.938,各条目间相关系数为0.718~0.887,相关有统计学意义(P均0.01)。1周后重测信度为0.952。GAD-7总分与SAS总分的Pearson相关系数为0.884(P0.01)。探索性因子分析显示该量表为1个因子结构,解释方差82.90%。以GAD-7≥10分为划界分,GAD-7灵敏度为94.23%,特异度为93.75%;与SCID评定的一致性Kappa值为0.880(u=18.345,P0.01)。结论:GAD-7应用于颈椎病患者焦虑情绪评估具有良好的信度和效度。     

长沙版蒙特利尔认知评估量表的信度、效度检测与血管性认知障碍理想划界分值

目的在湖南地区缺血性脑血管病人群中进行长沙版蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)的信度、效度检测并初步探索其筛查血管性认知障碍(vascular cognitive impairment,VCI)的理想划界分值。方法在长沙地区年龄≥40岁的159例缺血性脑血管病患者中进行长沙版MoCA、简易精神状态检查量表(mini-mental state examination,MMSE)、认知检测组合(包括中国修订韦氏成人智力量表中的计算、相似性、数字广度、木块图测验;中国修定韦氏记忆量表中的常识和定向、逻辑记忆、视觉再认;Stroop测试)及其他相关量表的评估。并于首次评估后的3～5周在随机选取的30例子样本中进行长沙版MoCA的复评。分别计算长沙版MoCA的内部一致性信度、重测信度、调查员信度、平行效度,并根据ROC曲线(receiver operator characteristic curve)分析探索其筛查VCI的理想划界分值。结果长沙版MoCA的克朗巴赫系数(Cronbach’sα)为0.846、重测信度为0.974、调查员信度为0.969;长沙版MoCA与MMSE及简式智商的Pearson相关系数分别为0.879及0.799;按照受教育年限≤6年者总分加1分,以26/27分作为诊断VCI的划界分(≤26分存在VCI),可得到最佳的灵敏度(90.0%)及特异度(70.9%)。以该划界分进行诊断的结果与临床专家组的认知诊断结果间的Kappa一致性系数为0.610。结论长沙版MoCA的信度、效度良好,适合在湖南地区缺血性脑血管病人群中进行VCI筛查;长沙版MoCA为一个适合中国大陆人群使用的中文版MoCA,有进一步向全国推广使用的潜力。     

广泛性焦虑量表在综合性医院的信度和效度研究

目的检验中文版广泛性焦虑量表（GAD-7）在综合性医院普通门诊患者中的信度与效度。方法 600名综合性医院普通门诊患者完成GAD-7、医院焦虑抑郁量表、汉密顿焦虑量表（HA-MA）的评定。随机抽取其中44名进行GAD-7重测;96名接受美国精神障碍诊断和统计手册第4版临床定式访谈（SCID）。计算GAD-7的信度系数、敏感度、特异度等。结果 GAD-7的Cronbach’α系数为0.898,重测信度系数为0.856。GAD-7与HADS总分及焦虑分量表分值和HAMA总分相关系数分别为0.663、0.822和0.841。在GAD-7分解值取10分时,灵敏度和特异度分别为86.2%和95.5%,Kappa值为0.825。结论中文版本GAD-7在综合性医院普通门诊患者应用中具有较好的信度和效度。     

谵妄评定方法修订及其信度、效度测试

目的 :研究适合国内临床使用的老年谵妄评定和辅助诊断量表。　方法 :对国际通用的谵妄评定方法 (confusionassessmentmethod ,CAM)进行修订 ,成为设有详细评分标准的谵妄评定方法中文修订版 (CAMChinesereversion ,CAM CR)。通过临床现场测试 ,对其信度、结构效度和诊断效度进行评定 ,建立因子量表。将CAM CR进行计算机网络编程 ,连接到门诊和病区的计算机终端。　结果 :应用CAM CR的一致性ICC值为 0 .91。因子分析结果提示谵妄有行为障碍、意识障碍和认知障碍 3个因子。应用2 2分作为谵妄的分界值时 ,敏感性为 0 .90 ,特异性为 0 .94 ,跨效度检验与临床符合率的Kappa值为 0 .83(P <0 .0 1)。　结论 :CAM CR具有满意的信度、结构效度和诊断效度 ,分别设置诊断分界值和筛查分界值 ,检查数据通过计算机网络进行处理。CAM CR临床使用方便 ,可以作为临床老年谵妄评定和辅助诊断的工具     

肌萎缩侧索硬化中医疗效评价量表(ALS-SSIT量表)的效能评价

目的:评价肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)中医疗效评价量表(ALS-SSIT量表)的可行性、信度、效度和灵敏度。方法:总结中医治疗ALS的经验以及征询专家建议,制定适用于评价中医治疗ALS疗效的量表(ALS-SSIT量表)。采用ALS-SSIT量表于入组当日以及随访6个月时,对160例接受中医治疗的ALS患者进行疗效评价,并以SF-36和ALSFRS-R量表作为参照,评估ALS-SSIT量表的可行性、信度、效度和灵敏度。结果:ALS-SSIT量表的接受率和完成率均高于99%,入组当日以及随访6个月时的重测信度分别为0.917和0.918,内容效度和灵敏度(总评分、各领域评分和各条目评分)均较高,与SF-36量表和ALSFRS-R量表之间存在线性相关性,能够较好地反映ALS患者病情的变化。结论:ALS-SSIT量表评价中医治疗ALS疗效的可行性、信度、效度和灵敏度均较好,适于临床推广应用。     

病人健康问卷抑郁量表(PHQ-9)在青少年中应用的信效度检验

目的检验病人健康问卷抑郁量表(PHQ-9)在青少年中应用的信度和效度。方法方便抽取河南省济源、新乡两地共3所中学,再以班级为单位采用整群抽样方法抽取初中一年级到高中三年级的14~18岁在校中学生471名进行PHQ-9测查,同时进行美国《精神障碍诊断与统计手册(第4版)》(DSM-IV)临床定式访谈(SCID)抑郁量表评定和贝克抑郁量表(BDI)评定。在样本中选取88人4周后完成PHQ-9重测。结果 PHQ-9总分的Cronbachα系数为0.85,条目间相关系数为0.289~0.560,各条目与PHQ-9总分相关系数为0.616~0.730,4周后重测信度为0.88。PHQ-9总分与BDI总分Pearson相关系数为0.77,主成分因子分析显示因子(躯体化-情感因子)突出。PHQ-9评估抑郁情绪的最佳划界分为10分,灵敏度为93.33%,特异度为96.83%;ROC曲线下面积(AUC)为0.984(95%CI 0.969~0.993)。结论 PHQ-9应用于青少年抑郁情绪评估中具有良好的信度与效度,10分为该量表的最佳诊断划界分。     

中文版心境障碍自知力量表信效度初步研究

目的:评价心境障碍自知力量表(mood disorders insight scale,MDIS)中文版的信度和效度。方法:131例符合美国精神障碍诊断与统计手册第4版心境障碍诊断标准的患者完成MDIS中文版测试,由精神科医师采用临床总体印象量表(CGI)和自知力视觉尺度量表评估其疾病严重程度和自知力;同时,家属也完成自知力视觉尺度量表。随机抽取50例患者间隔7 d后重测MDIS。计算量表Cronbach’sα系数和两次评分的相关系数,评价量表的内部一致性和1周重测信度;采用因子分析方法考评结构效度;通过MDIS评分与精神科医师及家属的自知力视觉尺度量表评分相关分析来考察效标效度;通过比较重度和轻中度疾病严重程度患者MDIS得分差异来考评实证效度。结果:1信度:MDIS量表总Cronbach’sα系数为0.81,1周重测信度系数为0.82;2效度:探索性因子分析显示MDIS符合两因子结构,贡献率达65.75%;验证性因子分析的拟合优度指数为0.900,赋范拟合指数为0.931,标准化残差均方根为0.064;3患者MDIS分值与精神科医师及家属自知力视觉尺度评分之间相关系数分别为0.74和0.59(P均0.05),与CGI评分相关系数为-0.87(P0.05)。轻中度与重度躁狂发作患者MDIS量表分值差异具有统计学意义(P0.05)。结论:MDIS中文版具有较好的信度和效度,可用于快速有效地评估心境障碍患者的自知力。     

民事诉讼行为能力评定量表信度与效度检验

目的检验自编民事诉讼行为能力评定量表(the capacity assessment scale of civil lawsuit,CASCL)的信度与效度。方法在司法鉴定机构,对评定民事诉讼行为能力的116例案例使用CASCL并采用盲法进行回顾性评分,并与司法精神病学专家出具的鉴定结果进行比较,以检验该量表的信度与效度。结果受试者工作特征曲线(receiver operator characteristic curve,ROC)分析结果示,量表取12分为划界分时,具有较高水平的灵敏度(0.808)、特异度(0.842)、阳性预测值(0.921)和阴性预测值(0.949)。CASCL所有条目Cronbach’sα系数为0.940;评分者信度组内相关系数(intraclass correlation coefficient,ICC)为0.938(P0.01);重测信度ICC为0.934(P0.01)。CASCL各条目与总分的Spearman关联系数为0.531~0.681(P0.01);因子分析结构效度,提取辨认能力、控制能力2个因子,其累积贡献率为75.3%;与鉴定结果进行一致性检验,Kappa值为0.864。结论CASCL具有较好的信度与效度,能较为准确地反映民事诉讼行为能力,对民事诉讼行为能力的评定和划分有无诉讼能力有较好的参考价值。     

15项重症肌无力生活质量量表汉语版在成人重症肌无力患者中的评估研究

目的拟对15项重症肌无力生活质量(MG-QOL15)量表汉语版在中国成人MG患者临床评估中的应用进行信度、效度和灵敏度的评估。方法纳入183例临床确诊的中国成人MG患者,所有患者均进行MG-QOL15、MG日常生活量表(ADL)、徒手肌力量表(MMT)和改良的美国重症肌无力基金会-疾病严重程度量表(MGFA-QMG)评分。采用SPSS19.0统计软件进行统计学分析,Cronbachα系数评价量表的内部一致性,用因子分析法评价量表的结构信度,用Spearman相关系数评价校标关联效度和量表之间的相关性。其中77例患者于6个月后进行随访,对前后量表评分分值进行Wilcoxon singal检验以验证灵敏度。结果 MG-QOL15量表的Cronbachα系数为0.911,提示该量表内部一致性好。MG-QOL15量表有3项公因子,累积方差值为64.883%,提示量表的结构效度良好。MG-QOL15量表与MG-QMG和MG-ADL的相关系数分别为0.540、0.638,均为中度相关。症状改善组的45例患者的MGQOL15量表ES值0.5,提示灵敏度较高。结论 MG-QOL15量表的内部一致性和结构信度良好,MG-QOL15量表与其他量表具有中度相关性;在病情改善的MG患者中,该量表的灵敏度较高,可有效用于中国成人MG患者的临床评估。     

PHQ-9在综合医院住院患者中信效度研究

目的检验病人健康问卷抑郁量表(PHQ-9)在综合医院住院患者中应用的信度和效度,探索PHQ-9在综合医院住院患者中快速筛查抑郁的可行性。方法方便抽取四川大学华西医院569名住院患者,在规定指导语下完成PHQ-9评定,采用随机数字表法随机抽取38名患者在完成初次评定2周后进行PHQ-9重测;以简明国际神经精神访谈(MINI)作为"金标准",评估中文版PHQ-9的效标效度,共139名患者接受MINI中文版访谈。结果 PHQ-9在本研究中的Cronbach'sα系数为0.839,各条目与总评分的相关系数r=0.484~0.724(P0.01),各条目间相关系数r=0.229~0.520(P0.01);两周后重测系数r=0.846(P0.01);因子分析获得3个公因子,分别为自我评价因子、情感因子和躯体化因子;最佳诊断划界分为8分,敏感度为92.6%,特异度为60.6%;PHQ-9的ROC曲线下面积为0.841(95%CI:0.777~0.905)。结论 PHQ-9应用于综合医院住院患者抑郁评估中具有良好的信效度,8分为该量表的最佳划界分。     

Test characteristics of the 15-item geriatric depression scale and Hamilton depression rating scale in Parkinson disease.

OBJECTIVE: The objective of this study was to compare the sensitivity, specificity, and diagnostic accuracy of the 15-item Geriatric Depression Scale (GDS-15) and the Hamilton Depression Rating Scale (HDRS) in patients with Parkinson disease (PD). METHOD: A convenience sample of 148 outpatients with idiopathic PD receiving specialty care completed the GDS-15 and were administered the HDRS and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID) depression module by a research psychiatrist or trained research assistant. Receiver-operating characteristic (ROC) curves were plotted for the GDS-15 and HDRS scores with a SCID diagnosis of a depressive disorder as the state variable. RESULTS: Thirty-two subjects (22%) were diagnosed with a depressive disorder. The discriminant validity of the GDS-15 and HDRS were both high (ROC area under the curve: 0.92 and 0.91, respectively), with greatest dichotomization for the GDS-15 at a cutoff of 4/5 (87% accuracy, 88% sensitivity, 85% specificity) and the HDRS at a cutoff of 9/10 (83% accuracy, 88% sensitivity, 78% specificity). CONCLUSIONS: The GDS-15 performs well as a screening instrument and in distinguishing depressed from nondepressed patients in PD. Its test characteristics are comparable to the HDRS. Because it is a brief instrument and can be self-administered, it is an excellent depression screening tool in this population.     

Reliability and validity of a Chinese version of the HADS for screening depression and anxiety in psycho-cardiological outpatients

Aim

The Hospital Anxiety and Depression Scale (HADS) has been used widely with cardiovascular patients. This study aims to examine the reliability and validity of a Chinese version of HADS among psycho-cardiological outpatients.

Methods

One hundred psycho-cardiological outpatients were asked to complete the Chinese version of HADS and were then interviewed according to the Mini International Neuropsychiatric Interview, Version 5 (MINI).

Results

According to the MINI, 38 outpatients were diagnosed with major depression and 15 outpatients were diagnosed with an anxiety disorder. Compared with the MINI diagnoses, the optimum cutoff value of the anxiety subscale (HADS-A) was six (6) with a sensitivity of 81.6%, specificity of 75.8%, positive predictive value (PPV) of 54.0% and negative predictive value (NPV) of 91.9%; at the optimum cutoff value of nine (9), the depression subscale (HADS-D) had a sensitivity of 80.0%, specificity of 92.9%, PPV of 52.2% and NPV of 96.1%. The Cronbach's alpha coefficients of the HADS-A and HADS-D subscales were 0.753 and 0.764, respectively. The areas under the ROC curves of the HADS-A and the HADS-D subscales, as compared to MINI diagnoses of anxiety and depression, were 0.81 (SE = 0.05, 95%CI: [0.73, 0.90]) and 0.86 (SE = 0.05, 95%CI: [0.77, 0.94]), respectively.

Conclusions

The HADS was found to be a reliable measurement tool for excluding depression and anxiety in psycho-cardiological outpatients.     

Time dependent validity in the diagnosis of brain death using transcranial Doppler sonography

OBJECTIVE: To evaluate the validity of transcranial Doppler (TCD) in confirming brain death from various pathological conditions. METHODS: An observational case-control study over a 2.5 year period, in which transcranial Doppler (TCD) examinations were done on 101 comatose patients for confirmation of brain death. Between October 2002 to May 2005, 44 clinically diagnosed brain death cases (29 male, 15 female; mean (SD) age, 46.5 (19.5) years; Glasgow Coma Scale (GCS) score, 3.0 (0.0)) and 57 controls (36 male, 21 female; age 48.1 (16.5) years; mean GCS, 4.9 (1.7)) were examined. Reverse diastolic flow, very small systolic spikes, or no signals were considered characteristic of cerebral circulatory arrest. RESULTS: The sensitivity and specificity of TCD examination of both the basilar artery and the middle cerebral arteries (MCAs) in confirming brain death were 77.2% and 100%, respectively. The sensitivity of TCD-diagnosed brain death increased with elapsed time. There was a trend for the basilar artery to have greater sensitivity (86.4% v 77.2%), higher positive predictive value (90.5% v 85.1%), and fewer false negatives (14% v 23.7%) than the MCAs for diagnosing brain death (all NS). The consistency of the basilar artery and the MCAs for diagnosing brain death was significant (kappa=0.877, p<0.001 and kappa=0.793, p<0.001, respectively). CONCLUSIONS: TCD can be a confirmatory tool for diagnosing brain death. The validity of TCD diagnosed brain death depends on the time lapse between brain death and the performance of TCD. TCD of both the basilar artery and the MCAs showed significant consistency in brain death diagnosis.     

The relation between the clinical subtypes of delirium and the urinary level of 6-SMT

Delirium is a common syndrome among hospitalized elderly patients. In humans, sleep and circadian rhythms are disturbed during delirium, and both are influenced by the hormone melatonin. This prompted us to investigate the relationship of the clinical subtypes of delirium: 1). hyperactive, 2). hypoactive, and 3). mixed, with melatonin, as reflected by a patient's urinary metabolite 6-SMT. Results support our hypothesis that urinary 6-SMT during delirium was higher in hypoactive and lower in hyperactive patients. Because this is the first time a biochemical parameter related to the clinical subtypes of delirium has been reported, further research on the link between melatonin and delirium is necessary.     

Reliability and validity of the Geriatric Depression Scale in depression in Parkinson's disease

The objective of this study was to investigate reliability and validity of the self rated 30 item Geriatric Depression Scale (GDS) in screening and diagnosis of depression in Parkinson's disease (PD). The study sample comprised 109 non-demented patients with PD admitted to the movement disorders outpatient unit. The reference diagnosis of depression was made according to DSM-IV criteria. Discriminant validity and internal consistency of the total scale were studied. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were calculated for different cutoff scores. Receiver operating characteristics (ROC) analysis was also carried out. The sample comprised 56 patients with and 53 without depression. In the discriminant validity analysis, the mean total GDS score of subjects with depression was significantly higher compared with those without depression. The Cronbach's alpha score was 0.92 and the split half correlation coefficient 0.91. The cutoff score of 13/14 provided the highest sum of sensitivity and specificity level. The sensitivity of this cutoff score was 0.78 and specificity 0.85, while PPV was 0.84 and NPV 0.79. The area under the curve value in the ROC analysis was 0.891. Sensitivity and specificity analysis showed that cutoff scores of 8/9 or 9/10 could be useful for screening and 14/15 or 15/16 for diagnostic purposes. This study showed that the 30 item GDS, with its high discriminant validity, internal consistency, and reasonably clear cutoff scores, could be a useful screening or diagnostic self rated depression scale in patients with PD.     

精神分裂症患者自我病耻感及其相关因素研究

目的:探讨精神分裂症患者自我病耻感及其相关因素。方法:采用精神疾病内在病耻感量表(ISMI)对384例精神分裂症患者进行评估,分析其与患者的人口学及临床资料的相关性。结果:80.2%患者有自我病耻感,7.3%为重度。女性患者歧视体验分(2.53±0.62)、价值否定分(2.34±0.47)明显高于男性患者(2.38±0.37,2.07±0.31;P0.01或P0.05);ISMI总分与受教育程度呈负相关(r=-0.186,P0.01);与年龄(r=0.164,P=0.003)、总病程(r=0.172,P=0.002)、发病次数(r=0.214,P0.001)、症状严重程度(r=0.257,P0.001)呈正相关。结论:精神分裂症患者普遍存在自我病耻感,与一定的社会人口学特征和临床因素相关;女性歧视体验、价值否定更严重。     

Investigating the construct validity of the SPAI-C: comparing the sensitivity and specificity of the SPAI-C and the SAS-A

Investigates the construct validity of the Social Phobia and Anxiety Inventory for Children (SPAI-C) by comparing its sensitivity and specificity with another self-report measure of social anxiety, the Social Anxiety Scale for Adolescents (SAS-A). Participants were 252 adolescents (124 males and 128 females) 13-17 years old. Adolescents completed the SPAI-C and the SAS-A and were interviewed using the Anxiety Disorders Interview Schedule for DSM-IV: Child Version (ADIS-IV:C). Parents were also interviewed and composite diagnoses were formed. Youth were classified as socially phobic or non-anxious based on these composite diagnoses. By comparing clinical cutoff scores with diagnostic group classification, the sensitivity and the specificity of the SPAI-C and SAS-A were compared. Results indicated that the SPAI-C was a more sensitive measure than the SAS-A (61.5% vs. 43.6%) providing evidence of the scale's construct validity. The two measures were similar with regard to specificity (82.7% for both). Implications of these results for assessment and research are discussed.     

Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV.

OBJECTIVE: To determine the validity of short Geriatric Depression Scale (GDS) versions for the detection of a major depressive episode according to ICD-10 criteria for research and DSM-IV. DESIGN: Cross-sectional evaluation of depressive symptoms in a sample of elderly subjects with short GDS versions. Different GDS cutoff points were used to estimate the sensitivity, specificity, positive predictive value and negative predictive value for the diagnosis of major depressive episode. Internal consistency of the scales was estimated with the Cronbach's alpha coefficient. SETTING: Mental Health Unit for the Elderly of 'Santa Casa' Medical School in S?o Paulo, Brazil. PARTICIPANTS: Sixty-four consecutive outpatients aged 60 or over who met criteria for depressive disorder (current or in remission). Subjects with severe sensory impairment, aphasia or Mini-Mental State score lower than 10 were excluded from the study. MEASUREMENTS: ICD-10 Checklist of Symptoms, GDS with 15, 10, 4 and 1 items, Montgomery-Asberg Depression Rating Scale (MADRS), ICD-10 diagnostic criteria for research and DSM-IV diagnostic criteria. RESULTS: The use of the cutoff point 4/5 for the GDS-15 produced sensitivity and specificity rates of 92.7% and 65.2% respectively, and positive and negative predictive values of 82.6% and 83.3% respectively when ICD-10 diagnostic criteria for major depressive episode were used as the 'gold standard'. Similarly, rates of 97.0%, 54.8%, 69.6% and 94.4% were found when DSM-IV was the comparing diagnostic criteria. Sensitivity, specificity and positive and negative predictive values for the cutoff point 6/7 were 80.5%, 78. 3%, 86.8% and 69.2% according to ICD-10, and 84.8%, 67.7%, 73.7% and 80.8% respectively according to DSM-IV. Intermediate values were found for the cutoff point 5/6. The best fit for GDS-10 was the cutoff point 4/5, which produced a sensitivity rate of 80.5%, specificity of 78.3%, positive predictive value of 86.8% and negative predictive value of 60.2% according to ICD-10 diagnosis of a major depressive episode. Similarly, rates of 84.8%, 67.7%, 73.7% and 80.8% were found when DSM-IV criteria for major depression were used. GDS-4 cutoff point of 2/3 was associated with a sensitivity rate of 80.5%, specificity of 78.3%, positive predictive value of 86. 8% and negative predictive value of 69.2% when compared to ICD-10. Again, rates of 84.8%, 67.7%, 73.7% and 80.8% respectively were found when the criteria used were based on DSM-IV. GDS-1 had low sensitivity (61.0% and 63.6% for ICD-10 and DSM-IV respectively) and negative predictive value (56.7% and 67.6% for ICD-10 and DSM-IV respectively), suggesting that this question is of limited clinical utility in screening for depression. GDS-15 (rho=0.82), GDS-10 (rho=0.82) and GDS-4 (rho=0.81) scores were highly correlated with subjects' scores on the MADRS. Reliability coefficients were 0.81 for GDS-15, 0.75 for GDS-10 and 0.41 for GDS-4. CONCLUSION: GDS-15, GDS-10 and GDS-4 are good screening instruments for major depression as defined by both the ICD-10 and DSM-IV. The shorter four- and one-item versions are of limited clinical value due to low reliability and failure to monitor the severity of the depressive episode. General practitioners may benefit from the systematic use of short GDS versions to increase detection rates of depression among the elderly. (c) 1999 John Wiley & Sons, Ltd.     

The Cambridge Cognitive Examination (CAMCOG): validation of the Hebrew version in elderly demented patients

BACKGROUND AND PURPOSE: The CAMCOG is the second most popular cognitive testing instrument in use by Israeli clinicians. The present study examines the reliability and validity of a Hebrew version of the CAMCOG in a group of dementia sufferers in a clinical setting. METHOD: Study participants included 36 dementia sufferers and 19 control non-demented, depressed elderly subjects, consecutive referrals to an outpatient psychogeriatric service and an 'open' ward of a psychiatric hospital. Operational clinical criteria for dementia and its subtypes and for the various forms of depression were used as the 'gold' standards. The CAMCOG was translated into Hebrew and then back to English. Seven items needed modifications for local usage. RESULTS: Interrater and test-retest scores calculated as exact agreement rates ranged from good to excellent for all items, although test-retest reliability scores were generally lower than interrater scores. Kappa statistics ranged from good to excellent for all but one item in the interrater scores and for two items in the test-retest scores. A strong convergent validity was found with the MMSE score (r=0.89, p<0.01). The 79/80 cutoff point provided moderate sensitivity (57.9%), excellent specificity (97.2%) and a strong predictive value (83.6%). CONCLUSION: The Hebrew version of the CAMCOG was found to be an appropriate instrument to discriminate between demented and non-demented depressed controls in a clinical setting. In light of the demographic, cultural and linguistic heterogeneity of the Israeli elderly population, further studies should examine the psychometric characteristics of the CAMCOG in a more varied sample and also using other cutoff points in order to establish if an increase in its discriminatory power is obtainable.     

歧视与病耻感量表(DISC)中文版在精神障碍患者中的信度和效度研究

目的:评估歧视与病耻感量表(DISC)在中国精神障碍患者中的信度和效度。方法:引进Thornicroft团队研发的DISC,按初译、回译等步骤形成DISC中文版,以242例精神障碍患者作为受访对象,验证量表的信度和效度。结果:DISC的Cronbach'α系数为0.70,分半信度为0.85,总分重测信度为0.83;DISC分量表1总分与精神疾病内在病耻感调查表(ISMI)歧视经历因子分呈正相关(r=0.417,P0.01),分量表2总分与ISMI社会退缩因子分呈正相关(r=0.332,P0.01);分量表2总分与自尊量表(SES)总分呈正相关(r=0.250,P0.01),分量表3总分与SES总分呈负相关(r=-0.187,P0.01);分量表4总分与社会支持评定量表(SSRS)客观支持分以及对支持的利用度分均呈正相关(r=0.177,0.170,P均0.01)。结论:DISC中文版具有较好的信度和效度,可作为评估精神障碍患者歧视与病耻感的临床工具。