精神分裂症认知功能评测量表与韦氏成人智力量表及韦氏记忆量表的相关性研究

目的对精神分裂症认知功能评测量表（SCoRS）、韦氏成人智力量表（WAIS—RC）和韦氏记忆量表（WMS）作相关分析并评估SCoRS在国内的适用性。方法对60例精神分裂症患者用SCoRS及wAIS—RC和wMS进行测评。结果相关分析显示SCoRS自评分、知情者评分、评定者评分各因子及总分与WAIS—RC评分的总智商、言语智商、操作在智商均呈显著相关性;SCoRS自评分、知情者评分、评定者评分各因子及总分与WMS评分的总记忆商数及10个分测验均呈显著相关性。结论SCoRS可以对精神分裂症患者的记忆及执行功能作出有力评估,能较好反映患者认知功能及生活功能状态,且简便易行,有较好适用性。     

Sex differences in performance over 7 years on the Wechsler Intelligence Scale for Children – Revised among adults with intellectual disability

Background The aim of this study was to explore changes related to sex differences on the Wechsler Intelligence Scale for Children – Revised (WISC‐R) subtest performance over a 7‐year interval in middle‐aged adults with intellectual disability (ID). Cognitive sex differences have been extensively studied in the general population, but there are few reports concerning individuals with ID. Sex differences are of current relevance to actively debated issues such as cognitive changes during menopause and risk for Alzheimer's disease. Given that hormonal effects on cognition have been observed in the general population, particularly in areas such as visuospatial processing, and individuals with Down's syndrome (DS) have been reported to be hormonally and reproductively atypical, we analysed our data to allow for the possibility of an aetiology‐specific profile of sex differences for these adults. Methods The WISC‐R subtests were administered in a longitudinal study, as part of a more comprehensive test battery, at least twice within 7 years. Participants were 18 females with ID without DS [age at first test time (time 1): mean = 40.5; IQ: mean = 59.3], 10 males with ID without DS (age at time 1: mean = 42.4; IQ: mean = 59.4), 21 females with DS (age at time 1: mean = 37.9; IQ: mean = 51.6), and 21 males with DS (age at time 1: mean = 40.3; IQ: mean = 54.3). All participants were in the mild to moderate range of ID and were displaying no changes suggestive of early dementia. Results Females, regardless of aetiology of ID, exhibited a robust superiority on the coding subtest, which parallels the widely reported difference among adults in the general population. Additionally, there was a decline in overall performance during the 7‐year study interval, particularly on the verbal subscale subtests, but there was no evidence of sex‐differentiated decline. There were also marginal sex by aetiology interactions on the object assembly and block design subtests, suggesting that males with unspecified ID might perform better than their female peers, but among adults with DS, females might do better than males. Conclusions This study supports the presence of cognitive sex differences in the population with ID as indicated by female superiority on the WISC‐R coding subtest. Extending this observation to adults with ID has implications for explanations of female advantage on this task, which now have to account for its presence among individuals with a broader range of intellectual capabilities, more atypical developmental histories and more varied genotypes than previously considered. Trends towards sex by aetiology interactions on the two visuoconstructive subtests, while marginal, were sufficient to warrant continued consideration of the idea of a distinct profile of sex differences for adults with DS and to justify looking at the effects of sex separately within different aetiologies of ID.     

Predicting children with pervasive developmental disorders using the Wechsler Intelligence Scale for Children-Third Edition

An original combination score (i.e. the sum of Vocabulary and Comprehension subtracted from the sum of Block Design and Digit Span) was created from the four Wechsler Intelligence Scale for Children–Third Edition (WISC-III) subtests identified by discriminant analysis on WISC-III data from 139/129 children with/without pervasive developmental disorders (PDD; mean, 8.3/8.1 years) and its utility examined for predicting PDD. Its best cut-off was 2/3, with sensitivity, specificity, positive and negative predictive values of 0.68, 0.61, 0.65 and 0.64, respectively. The score seems useful, so long as clinicians are aware of its limitations and use it only as a supplemental measure in PDD diagnosis.     

Parsimonious Estimation of the Wechsler Memory Scale,Fourth Edition Demographically Adjusted Index Scores: Immediate and Delayed Memory

The recent release of the Wechsler Memory Scale Fourth Edition contains many improvements from a theoretical and administration perspective, including demographic corrections using the Advanced Clinical Solutions. Although the administration time has been reduced from previous versions, a shortened version may be desirable in certain situations given practical time limitations in clinical practice. The current study evaluated two- and three-subtest estimations of demographically corrected Immediate and Delayed Memory index scores using both simple arithmetic prorating and regression models. All estimated values were significantly associated with observed index scores. Use of Lin's Concordance Correlation Coefficient as a measure of agreement showed a high degree of precision and virtually zero bias in the models, although the regression models showed a stronger association than prorated models. Regression-based models proved to be more accurate than prorated estimates with less dispersion around observed values, particularly when using three subtest regression models. Overall, the present research shows strong support for estimating demographically corrected index scores on the WMS-IV in clinical practice with an adequate performance using arithmetically prorated models and a stronger performance using regression models to predict index scores.     

Validity of brief intelligence tests for patients with Alzheimer's disease

The validity of two kinds of brief intelligence tests for patients with Alzheimer's disease (AD) was investigated. In study 1, five short forms of the Japanese Wechsler Adult Intelligence Scale-Revised (JWAIS-R) were administered to 102 AD patients. The results showed that the intra-class correlation coefficients (ICC) between IQ estimated with the short forms and those obtained by administration of the full JWAIS-R were satisfactory, ranging from 0.82 to 0.98, and that the abbreviated forms took a shorter time to execute. In study 2, the Raven's Coloured Progressive Matrices (RCPM) and the Mini-Mental State Examination (MMSE) were administered to 67 AD patients. The ICC between the IQ estimated with these tests and the full-scale IQ of the JWAIS-R were both acceptable at 0.57, and each test could be carried out in a very short time. It was concluded that these brief tests, particularly the WAIS-R short forms, are highly practical for quick measurement of intelligence in AD patients, although they have their respective limitations.     

Cognitive training for divergent thinking in schizophrenia: A pilot study

Individuals with schizophrenia demonstrate deficits in divergent thinking. This ability is indispensable for generating creative solutions and navigating the complexities of social interactions. In a pilot study, seventeen stable schizophrenia outpatients were randomly assigned to a training program for divergent thinking or a control program on convergent thinking. After eight weeks of training, participants in the divergent thinking program had significantly greater improvements on measures of idea fluency, negative symptoms, and interpersonal relations than did participants receiving the control program. These preliminary results suggest that interventions for divergent thinking in schizophrenia may lead to improvements in patients' social functioning.     

A comparison of reliability and construct validity between the original and revised versions of the Rosenberg Self-Esteem Scale

Objective

The Rosenberg Self-Esteem Scale (RSES) is a widely used instrument that has been tested for reliability and validity in many settings; however, some negative-worded items appear to have caused it to reveal low reliability in a number of studies. In this study, we revised one negative item that had previously (from the previous studies) produced the worst outcome in terms of the structure of the scale, then re-analyzed the new version for its reliability and construct validity, comparing it to the original version with respect to fit indices.

Methods

In total, 851 students from Chiang Mai University (mean age: 19.51±1.7, 57% of whom were female), participated in this study. Of these, 664 students completed the Thai version of the original RSES - containing five positively worded and five negatively worded items, while 187 students used the revised version containing six positively worded and four negatively worded items. Confirmatory factor analysis was applied, using a uni-dimensional model with method effects and a correlated uniqueness approach.

Results

The revised version showed the same level of reliability (good) as the original, but yielded a better model fit. The revised RSES demonstrated excellent fit statistics, with χ²=29.19 (df=19, n=187, p=0.063), GFI=0.970, TFI=0.969, NFI=0.964, CFI=0.987, SRMR=0.040 and RMSEA=0.054.

Conclusion

The revised version of the Thai RSES demonstrated an equivalent level of reliability but a better construct validity when compared to the original.     

A Meta-Analysis of the Neuropsychological Effects of Occupational Exposure to Manganese

Even though the veracity of children's claim of psychiatric symptoms has received increased attention in recent years, identification of noncredible neuropsychological symptoms in children has been virtually overlooked in clinical practice and research. A case is presented of a 9-year-old child involved in litigation regarding a head injury sustained when he was struck by a car. Neuropsychological evaluation revealed evidence of feigned cognitive symptoms; the child displayed noncredible performance on several specialized tests designed to discreetly assess effort and an atypical pattern of responses on standard cognitive measures, as well as discrepancies between neuropsychological scores and tests administered in school and the rehab setting. Results demonstrate that children as young as 9 years of age are capable of feigning cognitive impairment, which highlights the need for routine evaluation of effort, irrespective of the age of the patient.     

Standardization of the Korean Version of the Geriatric Depression Scale: Reliability, Validity, and Factor Structure

Objective

We developed a Revised Korean version of the Geriatric Depression Scale (GDS-KR) and examined its reliability, validity, and factor structures. We also estimated its optimal cutoff scores for major depressive disorder (MDD) and minor depressive disorder (MnDD) stratified by age and education.

Methods

The GDS-KR was administered to 888 subjects (61 MDD patients, 45 MnDD patients, and 782 normal elders). Its internal consistency and test-retest reliability were examined. Its concurrent validity was evaluated using Pearson correlation coefficients with the Korean version of the Center for Epidemiologic Studies Depression Scale (CES-D-K) and Hamilton Depression Rating Scale (HAM-D). The mean GDS-KR scores of the MDD patients, MnDD patients and normal elders were compared to evaluate its discriminant validity. To evaluate its construct validity, a principal component analysis with varimax rotation was performed. Receiver operator characteristic (ROC) curve analyses were performed to evaluate its diagnostic ability.

Results

Chronbach''s coefficient alpha for the GDS-KR was 0.90 and the test-retest reliability was 0.91 (p<0.01). The Pearson correlation coefficients of the GDS-KR scores with the CES-D-K and HAM-D scores were 0.63 (p<0.01) and 0.56 (p<0.01), respectively. The GDS-KR consisted of 5 factors. The optimal cut-off scores of the GDS-KR were 16/17 for MDD only and 15/16 for both MDD and MnDD. The optimal cutoff scores of the GDS-KR were higher in the less educated and younger subjects. The diagnostic accuracy for MDD of the GDS-KR was higher than that of the CES-D.

Conclusion

The GDS-KR was found to be a reliable and valid questionnaire for screening MDD and MnDD in late life.     

Symptom dimensions in recent-onset schizophrenia and mania: a principal components analysis of the 24-item Brief Psychiatric Rating Scale

Previous four- and five-factor solutions of the 18-item Brief Psychiatric Rating Scale (BPRS) suggested the possibility of an affective dimension in psychosis. A principal components analysis was used to analyze psychiatric symptom data rated on an expanded 24-item version of the BPRS. BPRS data were collected during a period of acute psychotic and affective illness with 114 young adult, recent-onset schizophrenia and schizoaffective patients and 27 bipolar manic patients. Principal components analyses of the 18-item and 24-item BPRS indicated a four-factor solution was the most interpretable. Principal components analysis of the 24-item BPRS produced a clear mania factor characterized by high loadings from items added to the 18-item BPRS, which included elevated mood, motor hyperactivity, and distractibility. This factor solution suggests that the 24-item BPRS allows for an expanded assessment of affective symptoms relating to a manic dimension. Potentially important symptoms that were added to the traditional 18-item version, namely suicidality, bizarre behavior, and self-neglect, also make clear contributions to other factors.     

Relationship between presurgical memory performance on the Wechsler Memory Scale-III and memory change following temporal resection for treatment of intractable epilepsy

Previous research demonstrated a relationship between preoperative memory measured by the Wechsler Memory Scale—Revised (WMS-R) and postsurgical memory change in patients who underwent left (LATL), but not right (RATL) anterior temporal lobectomy. The current study replicated previous efforts using the Wechsler Memory Scale–Third Edition (WMS-III) in a larger sample. The WMS-III was administered to 161 patients with medically intractable epilepsy prior to and 6 months following LATL or RATL. Correlations between presurgical memory on WMS-III indices and memory change following surgery were calculated for each group. Significant negative relationships were found between pre- and postsurgical memory scores in patients who underwent LATL on all WMS-III measures (r = −0.31 to −0.43). Significant negative correlations were observed in patients who underwent RATL only on visual memory measures (r = −0.24 to −0.44). Findings support previous conclusions using the WMS-R showing that patients who undergo LATL with higher presurgical memory ability are at greater risk for memory decline following temporal resection than patients with lower presurgical memory scores.     

Replication of factor structure of Wechsler Adult Intelligence Scale-III Chinese version in Chinese mainland non-clinical and schizophrenia samples

The aim of the present study was to evaluate the construct validity of the special four-factor structure of the Wechsler Adult Intelligence Scale (WAIS)-III Chinese version in a clinical sample of inpatients with schizophrenia as well as a sample of healthy adults. A sample of 114 inpatients with schizophrenia and a sample of 114 close-matched non-clinical adults on the Chinese mainland were studied with the measures of the WAIS-III Chinese version. Four competing hypothetical models of factors were tested for model fit and parsimony in both research samples, using maximum likelihood confirmatory factor analysis. Confirmatory factor analysis indicated that a four-factor model of Verbal Comprehension, Perceptual Organization, Working Memory, and Processing Speed best fit the data from both the schizophrenia sample and the healthy adult sample, and also fitted the data from both samples better than alternative models, which is similar to that reported by the developers and revisers of this scale. These empiric analyses and results support the construct validity of the WAIS-III Chinese version in patients with schizophrenia and healthy adults on the Chinese mainland.     

An Examination of the Wechsler Adult Intelligence Scales,Fourth Edition (WAIS-IV) in Individuals with Complicated Mild,Moderate and Severe Traumatic Brain Injury (TBI)

This study examined the clinical utility of the Wechsler Adult Intelligence Scales-Fourth Edition (WAIS-IV) in individuals with complicated mild, moderate or severe TBI. One hundred individuals with TBI (n = 35 complicated mild or moderate TBI; n = 65 severe TBI) and 100 control participants matched on key demographic variables from the WAIS-IV normative dataset completed the WAIS-IV. Univariate analyses indicated that participants with severe TBI had poorer performance than matched controls on all index scores and subtests (except Matrix Reasoning). Individuals with complicated mild/moderate TBI performed more poorly than controls on the Working Memory Index (WMI), Processing Speed Index (PSI), and Full Scale IQ (FSIQ), and on four subtests: the two processing speed subtests (SS, CD), two working memory subtests (AR, LN), and a perceptual reasoning subtest (BD). Participants with severe TBI had significantly lower scores than the complicated mild/moderate TBI on PSI, and on three subtests: the two processing speed subtests (SS and CD), and the new visual puzzles test. Effect sizes for index and subtest scores were generally small-to-moderate for the group with complicated mild/moderate and moderate-to-large for the group with severe TBI. PSI also showed good sensitivity and specificity for classifying individuals with severe TBI versus controls. Findings provide support for the clinical utility of the WAIS-IV in individuals with complicated mild, moderate, and severe TBI.     

Investigating the structure and invariance of the Wechsler Adult Intelligence Scales,Fourth Edition in a sample of adults with intellectual disabilities

Recent research has questioned whether the Wechsler Adult Intelligence Scales (WAIS) measure the same constructs for adults with intellectual disabilities as they do for the general population (MacLean et al., 2011). Using the special validity sample of the WAIS-IV (Wechsler, 2008b), the structure of the WAIS-IV was investigated using confirmatory factor analysis and tested for measurement invariance across a sample with intellectual disabilities and a control group matched in demographic characteristics. The instrument demonstrated strong factorial invariance when the standard subtests were used. When the standard and supplemental subtests were included in the model, the WAIS-IV four-factor structure provided a model of measurement for the Subtest Scores in the intellectual disability group, but the Perceptual Reasoning factor demonstrated differentiation into Fluid Reasoning and Visual-Spatial factors in the matched control group. In general, the research findings suggest that the four-factor structure of the WAIS-IV is invariant across the intellectual disability and matched control groups.     

More evidence on proneurocognitive effects of add-on mirtazapine in schizophrenia

Enhancement of neurocognition is essential in the treatment of schizophrenia. In our previously reported six-week Randomized Controlled Trial (RCT) mirtazapine added to conventional antipsychotics improved not only negative, but also positive symptoms and neurocognition in difficult-to-treat schizophrenia. The present study aimed to explore whether a prolonged exposure to mirtazapine could further improve neurocognition.Completers of the RCT who were able and willing to proceed to the extension phase received open label mirtazapine for an additional 6 weeks. During the extension phase, both groups (i.e., patients who previously received mirtazapine and those who received placebo) and the whole population showed improvement on a number of neurocognitive tests. Patients who shifted to open label mirtazapine from placebo achieved in the six following weeks similar results as their initially mirtazapine-treated counterparts did during their first 6 weeks of mirtazapine exposure. Middle-term mirtazapine treatment (12 weeks) demonstrated an advantage over short-term mirtazapine treatment (6 weeks) on Stroop Dots time and Trail Making Test, part B, number of mistakes (t = − 2.562, p = 0.035 and t = − 2.42, p = 0.043, correspondingly).Mirtazapine added to antipsychotics consistently shows desirable effects on neurocognition. Lengthy treatment seems worthwhile. Mirtazapine may become a safe and cost-saving neurocognitive enhancer in schizophrenia, yet more studies are needed.     

A comparison of measures for assessing the level and nature of intelligence in verbal children and adults with autism spectrum disorder

Previous work has suggested that the Raven's Progressive Matrices (RPM) are better suited for capturing the nature of intelligence for individuals with autism spectrum disorder (ASD) than the Wechsler scales. The RPM measures ‘fluid intelligence’, an area for which it has been argued that persons with ASD have a relative strength. Given that measures of intelligence are used for establishing clinical diagnoses, for making educational decisions, and for group-matching in research studies, continued examination of this contention is warranted. In the current study, verbal children with ASD performed moderately better on the RPM than on the Wechsler scales; children without ASD received higher percentile scores on the Wechsler than on the RPM. Adults with and without ASD received higher percentile scores on the Wechsler than the RPM. Results suggest that the RPM and Wechsler scales measure different aspects of cognitive abilities in verbal individuals with ASD. For the verbal children and adults with ASD in the current study, the RPM and Wechsler scales have unique contributions that must be considered in context when establishing a baseline of cognitive function. The results of this investigation highlight the importance of thoughtfully selecting appropriate measures of intelligence consistent with clinical, educational, and research purposes, especially for verbal children and adults with ASD.     

Development and validation of the Unified Multiple System Atrophy Rating Scale (UMSARS).

We aimed to develop and validate a novel rating scale for multiple system atrophy (Unified Multiple System Atrophy Rating Scale-UMSARS). The scale comprises the following components: Part I, historical, 12 items; Part II, motor examination, 14 items; Part III, autonomic examination; and Part IV, global disability scale. For validation purposes, 40 MSA patients were assessed in four centers by 4 raters per center (2 senior and 2 junior raters). The raters applied the UMSARS, as well as a range of other scales, including the Unified Parkinson's Disease Rating Scale (UPDRS) and the International Cooperative Ataxia Rating Scale (ICARS). Internal consistency was high for both UMSARS-I (Crohnbach's alpha = 0.84) and UMSARS-II (Crohnbach's alpha = 0.90) sections. The interrater reliability of most of the UMSARS-I and -II items as well as of total UMSARS-I and -II subscores was substantial (k(w) = 0.6-0.8) to excellent (k(w) > 0.8). UMSARS-II correlated well with UPDRS-III and ICARS (rs > 0.8). Depending on the degree of the patient's disability, completion of the entire UMSARS took 30 to 45 minutes. Based on our findings, the UMSARS appears to be a multidimensional, reliable, and valid scale for semiquantitative clinical assessments of MSA patients.     

Development and validation of a screening scale for depression in Korea: the Lee and Rhee Depression Scale

Objective

The aim of this study was to develop a culturally sensitive instrument that addressed how individuals express and experience depression to detect this disorder in Koreans. We also assessed the validity, reliability, and diagnostic utility of this scale (Lee and Rhee Depression Scale; LRDS).

Methods

The sample consisted of 3,697 normal adults selected from 12 administrative districts (Do) and 448 Korean patients diagnosed with depression using the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Reliability was calculated using Cronbach''s α. Construct validity, discriminant validity, and concurrent validity were also measured. Receiver-operator-characteristic (ROC) analysis was employed to evaluate diagnostic efficiency.

Results

The LRDS was found to be a reliable instrument (Cronbach''s α=0.95) consisting of six factors: negative thinking about the future, negative thinking about the self, worry and agitation, depressed mood, somatization, and loss of volition. Comparison of LRDS scores discriminated the group of patients with depression from the normal individuals in the control group. The measure showed good concurrent validity in that scores were significantly and strongly correlated with scores on established scales such as the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HAM-D), and the D scale of the Minnesota Multiphasic Personality Inventory-second edition (MMPI-2). Diagnostic efficiency was 77.7%, and the cut-off scores were 65 for males and 70 for females.

Conclusion

To our knowledge, this is the first study to develop a depression-screening scale on the basis of Korean patients'' complaints about the disorder. As a culturally sensitive tool, the LRDS will be useful in clinical and research settings in Korea.