A Validation of the Test of Memory Malingering in a Forensic Psychiatric Setting

The Test of Memory Malingering (TOMM) has not been adequately validated in a forensic psychiatric setting. Dissimulation of cognitive impairment, as assessed by the TOMM, was evaluated in a group of 25 forensic inpatients admitted for evaluation of Competency to Stand Trial (CST/MSO group), and hypothesized to be at higher risk for feigning cognitive impairment. A comparison group of 36 patients, who were either civilly committed or adjudicated Not Guilty by Reason of Insanity (CIVIL/NGRI group), were hypothesized to be less likely to feign cognitive impairment. Groups were comparable in age, education, premorbid intelligence, and psychiatric symptom severity. Significantly more CST/MSO patients (36%) scored below a recommended TOMM cutoff score relative to CIVIL/NGRI patients (6%). Findings indicate excellent specificity and modest sensitivity, and generally support the validity of the TOMM in a forensic psychiatric population. The utility of different cutoff scores and need for multiple indicators of effort are discussed.     

A validation of the test of memory malingering in a forensic psychiatric setting

The Test of Memory Malingering (TOMM) has not been adequately validated in a forensic psychiatric setting. Dissimulation of cognitive impairment, as assessed by the TOMM, was evaluated in a group of 25 forensic inpatients admitted for evaluation of Competency to Stand Trial (CST/MSO group), and hypothesized to be at higher risk for feigning cognitive impairment. A comparison group of 36 patients, who were either civilly committed or adjudicated Not Guilty by Reason of Insanity (CIVIL/NGRI group), were hypothesized to be less likely to feign cognitive impairment. Groups were comparable in age, education, premorbid intelligence, and psychiatric symptom severity. Significantly more CST/MSO patients (36%) scored below a recommended TOMM cutoff score relative to CIVIL/NGRI patients (6%). Findings indicate excellent specificity and modest sensitivity, and generally support the validity of the TOMM in a forensic psychiatric population. The utility of different cutoff scores and need for multiple indicators of effort are discussed.     

Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC)

Resilience may be viewed as a measure of stress coping ability and, as such, could be an important target of treatment in anxiety, depression, and stress reactions. We describe a new rating scale to assess resilience. The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale (0-4), with higher scores reflecting greater resilience. The scale was administered to subjects in the following groups: community sample, primary care outpatients, general psychiatric outpatients, clinical trial of generalized anxiety disorder, and two clinical trials of PTSD. The reliability, validity, and factor analytic structure of the scale were evaluated, and reference scores for study samples were calculated. Sensitivity to treatment effects was examined in subjects from the PTSD clinical trials. The scale demonstrated good psychometric properties and factor analysis yielded five factors. A repeated measures ANOVA showed that an increase in CD-RISC score was associated with greater improvement during treatment. Improvement in CD-RISC score was noted in proportion to overall clinical global improvement, with greatest increase noted in subjects with the highest global improvement and deterioration in CD-RISC score in those with minimal or no global improvement. The CD-RISC has sound psychometric properties and distinguishes between those with greater and lesser resilience. The scale demonstrates that resilience is modifiable and can improve with treatment, with greater improvement corresponding to higher levels of global improvement.     

Factor structure and convergent validity of the inventory of interpersonal problems in an inpatient setting

The Inventory of Interpersonal Problems (IIP32) is a self-report measure designed to be used in clinical settings to assess interpersonal difficulties. However, it has been exclusively used in either outpatient or non-clinical settings, and psychometric data concerning its use in inpatients are limited. The current study examined the factor structure and construct validity of the IIP-32, and ways to optimally use this measure with inpatients at a private hospital providing intensive treatment. The original eight-factor structure was a poor fit to the data, whereas a five-factor structure provided a somewhat better fit. Although the five factors (Nonassertive, Detached, Intrusive, Self-Sacrificing, and Socially Inhibited) demonstrated adequate internal consistency, reliability, and limited convergent validity, the IIP is ultimately useful insofar as it engages patients in collaborative self-awareness during intensive psychotherapeutically oriented treatment.     

Monitoring consumer satisfaction with inpatient service delivery: the Inpatient Evaluation of Service Questionnaire

OBJECTIVE: To report on the development, testing and psychometric properties of a brief consumer satisfaction measure for use with psychiatric inpatients. METHOD: Focus group discussions with inpatients were used to develop a pool of items related to satisfaction with hospital stay. A second cohort of 72 inpatients was invited to rate the 51 items that emerged for importance in contributing to satisfaction. Mean importance scores highlighted 20 items that were subsequently framed into neutrally worded statements. A draft questionnaire comprising these statements was introduced, on a trial basis, in a range of inpatient facilities. RESULTS: Factor analysis of 356 completed questionnaires yielded three factors comprising a staff-patient alliance; doctor/treatment issues; and an environmental component. Psychometric properties include good response variability and high internal consistency. CONCLUSIONS: The Inpatient Evaluation of Service Questionnaire addresses many of the shortcomings of existing satisfaction measures. It was developed through extensive consumer involvement, it is simply worded, easy to score and appears to perform well with acute and rehabilitation inpatients.     

Italian validation of MOAS and NOSIE: a useful package for psychiatric assessment and monitoring of aggressive behaviours

A validation of two rating scales is presented. We first translated the Modified Overt Aggression Scale (MOAS) and the Nurses' Observation Scale for In-patient Evaluation (NOSIE), which cover different aspects of psychopathology, into Italian. We then tested their validity and reliability in terms of inter-rater and internal consistency. For validity, both cases and controls were included: for the MOAS we compared patients who were aggressive (cases) to those who were presumably non-aggressive (controls). For the NOSIE, cases were acute inpatients and controls were subjects with expected stable behaviour. The Brief Psychiatric Rating Scale (BPRS) was also administered to cases in order to test convergent validity. Either the NOSIE and/or MOAS scales were administered to 358 psychiatric inpatients. A subset of these patients (131 for the MOAS and 226 for the NOSIE) was also used to test the inter-rater reliability. Both scales showed good psychometric properties. The correlation coefficients between raters were much higher than 0.75 (for the NOSIE) or 0.90 (for the MOAS), while the discriminant power between cases and controls was confirmed for both scales and good concordance with BPRS was observed. The NOSIE showed good internal consistency for all domains except neatness. In general the MOAS showed better results than the NOSIE for all psychometric properties, although both scales are suitable for monitoring the behaviour and aggression of acute ward inpatients.     

The diagnostic validity of the Athens Insomnia Scale

OBJECTIVE: To provide documentation for the diagnostic validity of the Athens Insomnia Scale (AIS), a self-assessment psychometric tool which has previously shown high consistency, reliability and external validity for the evaluation of the intensity of sleep difficulty. METHODS: The AIS was administered to a total of 299 subjects (105 primary insomniacs, 100 psychiatric outpatients, 44 psychiatric inpatients and 50 nonpatient controls) who were also assessed for the ICD-10 diagnosis of "nonorganic insomnia" blindly in terms of the AIS scores. RESULTS: 176 subjects were identified as insomniacs and 123 as noninsomniacs. Logistic regression of AIS total score against the ICD-10 diagnosis of insomnia demonstrated that a score of 6 is the optimum cutoff based on the balance between sensitivity and specificity. When diagnosing individuals with a score of 6 or higher as insomniacs, the scale presents with 93% sensitivity and 85% specificity (90% overall correct case identification). For this cutoff score, in the general population, the scale has a positive predictive value (PPV) of 41% and a negative predictive value (NPV) of 99%. For the same cutoff score, among unselected psychiatric patients, the PPV was found to be 86% and the NPV 92%. Other cutoff scores can be also considered, however, depending on the importance of avoiding false positive or false negative results; for example, for a cutoff score of 10, the PPV in the general population reaches about 90% without the NPV becoming lower than 94%. CONCLUSION: The AIS can be utilized in clinical practice and research, not only as an instrument to measure the intensity of sleep-related problems, but also as a screening tool in reliably establishing the diagnosis of insomnia.     

Utility of the Brief Symptom Inventory (BSI) in psychiatric outpatients with intellectual disabilities

Background Diagnostics and care for people with intellectual disabilities (ID) and psychiatric disorders need to be improved. This can be done by using assessment instruments to routinely measure the nature and severity of psychiatric symptoms. Up until now, in the Netherlands, assessment measures are seldom used in the psychiatric care for this population. The objective of the present paper is to evaluate the use of the Brief Symptom Inventory (BSI), a widely used standardised questionnaire in general psychiatry, in a well‐defined sample of people with borderline intellectual functioning or mild ID diagnosed with one or more psychiatric disorders. Methods A total of 224 psychiatric outpatients with either borderline intellectual functioning or mild ID participated in this study. All participants were new patients of Kristal, Centre for Psychiatry and Intellectual Disability in the Netherlands, in the period between 1 April 2008 and 1 October 2009. All participants were assessed by a multidisciplinary team, including a certified psychiatrist. Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV‐TR) criteria were applied. The mean total intelligence quotient was measured with the Wechsler Adult Intelligence Scale (WAIS‐III). The BSI was administered in an assisted fashion. Utility and psychometric properties of the BSI were investigated. Internal consistency coefficients (Cronbach's alphas) were computed. Bivariate correlations between the sub‐scales were computed to assess differentiation between the scales. Mean sub‐scale scores were compared between different DSM‐IV‐TR subgroups to investigate the discriminant abilities of the scales. A confirmatory factor analysis was conducted. Results The results suggest that the BSI is practically useful. Internal consistencies ranged from 0.70 to 0.96 and thus are considered good to adequate. Sub‐scale inter‐correlations showed there is a degree of differentiation between the sub‐scales. Discriminant validity was shown for the sub‐scales depression, anxiety and phobic anxiety. Confirmatory factor analysis showed that the underlying structure of the BSI could be described by the same nine‐factor model as reported in previous studies. Conclusions As a result of the psychometric properties illustrated, this study supports the use of the BSI as a screener for psychopathology and a general outcome measure in people with ID.     

The Psychometric Properties of the Colorado Symptom Index

The Colorado Symptom Index (CSI: Shern et al. 1994, Milbank Quart 72:123-148) is widely used in research as a self-report measure of psychiatric symptomatology, yet little information exists regarding the scale's psychometric properties. Additionally, the CSI has no cut-off score denoting the need for further psychiatric assessment. This study examined the CSI's psychometric properties and established a cut-off score. Analyses were based on 3,874 adult Florida Medicaid respondents. The CSI had excellent internal consistency (.92) and test-retest reliability (.71). Evidence of the CSI's validity was strong; CSI scores distinguished among individuals with and without mental health services needs and were significantly correlated with functioning. Results using a contrasting groups approach indicate that 30 is a reasonable "clinical" cut-off score. At this score, the CSI had respectable sensitivity (.76) and specificity (.68) and a ROC curve analysis suggests that the CSI is "fair to good" discriminator of individuals with psychiatric disabilities.     

Patients’ perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors

Purpose

The present study investigates perceived coercion in psychiatric inpatients under prescribed antipsychotic medication without a court order. The objective of this study was to investigate whether and to what extent involuntary and voluntary inpatients feel coerced to take their medication and which factors affect perceived coercion.

Methods

Voluntarily and involuntarily admitted patients (55 and 36, respectively) were interviewed about the extent of perceived coercion. In addition, socio-demographic and clinical data were collected. The Admission Experience Scale (aAES) was used to assess perceived coercion concerning medication. To measure insight into illness, attitude towards medication, and symptom severity, we used a questionnaire on insight into illness (FKE-10), the Drug Attitude Inventory (DAI-10), and the Brief Psychiatric Rating Scale (BPRS-24), respectively.

Results

Voluntarily treated patients experienced significantly less coercion when taking prescribed medication in inpatient settings than involuntarily treated patients. The experience of coercion was not related to socio-demographic or clinical variables nor to the BPRS-24 score, but to insight into illness and attitude towards medication. Patients who had experienced at least one coercive measure during the index hospital stay showed a higher level of perceived coercion.

Conclusion

Perceived coercion related to medication is dependent on insight into illness and experience of previous coercive interventions rather than on the severity of psychopathological symptoms. These findings are very similar to a previous study in a forensic psychiatric sample. Having experience of at least one coercive measure seems to be a decisive aspect of the extent of the patients’ perceived coercion.

     

Screening for Smoking in a General Hospital: Scale Validation,Indicators of Prevalence,and Comorbidity

PURPOSE: The study aims to conduct a psychometric study of the Fagerström Test for Nicotine Dependence (FTND) and to assess the prevalence, sociodemographic profile, and psychiatric comorbidities of smokers in a general hospital. DESIGN AND METHODS: Two hundred sixty‐four inpatients were elegible for inclusion in the study and assessed with Structured Clinical Interview for the DSM‐IV (Module E), Patient Health Questionnaire, Fast Alcohol Screening Test, and FTND. FINDINGS: The cut‐off note two of the FTND is the most adequate to identify tobacco abuse/dependence (sensibility: 0.59–0.76). The reliability was estimated to be 0.68–0.96. A 44% rate of tobacco abuser/dependent patients was detected, with a 28% rate of psychiatric comorbidity. PRACTICE IMPLICATIONS: Detection of the smoking habits at the time of hospitalization can be opportune, favoring the planning and the beginning of treatment.     

Elevated Blood Urea Nitrogen and Medical Outcome of Psychiatric Inpatients

Elevated blood urea nitrogen (BUN) is associated with increased severity of illness and mortality, but its predictive value has not been studied in patients admitted to free-standing psychiatric hospitals. To determine the clinical outcome of psychiatric inpatients with elevated BUN on admission and to create a quantitative method of using BUN for predicting deteriorations requiring transfers of psychiatric inpatients to a general hospital we conducted a retrospective cohort study of 939 adults consecutively admitted to a free-standing psychiatric hospital in 2010. Transfer to a general hospital was used as a proxy marker for poor medical outcome. The score Age (years) plus BUN (mg/dL) was used in sensitivity analyses to identify patients with medical deterioration in derivation (N = 523) and validation (N = 414) samples. Fifty-two (5.5 %) patients had admission azotemia (BUN >25 mg/dL). Medical deteriorations requiring emergency transfer to a general hospital occurred in 24 (46.2 %; 95 % confidence interval = 32.6–49.8 %) of azotemic patients and 112 (12.6 %; 95 % confidence interval = 10.4–14.8 %) of those with normal BUN (p < 0.0001). Age + BUN ≥90 identified 51 transferred patients and had positive and negative predictive values of 39.8 and 89.5 %, respectively, in the entire sample. We conclude that psychiatric inpatients with BUN >25 mg/dL or Age + BUN ≥90 are at risk for medical deterioration. Free-standing psychiatric hospitals should develop models of care requiring frequent, scheduled medical follow-up and enhanced monitoring for this vulnerable populations.     

Retrospective assessment of initial stroke severity with the NIH Stroke Scale

BACKGROUND AND PURPOSE: It is important to adjust stroke outcomes for differences in initial stroke severity. The NIH Stroke Scale (NIHSS) is a commonly used stroke severity measure but has been validated for retrospective scoring only in a subset of stroke clinical trial participants. The purpose of this research was to assess the validity and reliability of an algorithm for retrospective NIHSS scoring in a setting with usual chart documentation. METHODS: An algorithm for retrospective NIHSS scoring was developed with written history and physical admission notes. Missing physical examination data were scored as normal. One investigator prospectively scored the admission NIHSS in 32 consecutive stroke patients. Two raters retrospectively scored the NIHSS by applying the algorithm to photocopied admission notes. Linear regression was used to assess interrater reliability and agreement between prospective and retrospective NIHSS scores. The Wilcoxon signed rank test was used to assess systematic scoring bias. Weighted kappa statistics were calculated to assess the level of agreement of individual NIHSS items. RESULTS: Only 1 admission note was complete for all NIHSS elements. Interrater reliability was near perfect (r(2)=0.98, P<0. 001). Agreement between prospective and retrospective NIHSS score was also excellent (r(2)=0.94, P<0.001) and there was no systematic bias in retrospective scores. Agreement for individual items was moderate to high for all items except level of consciousness. CONCLUSIONS: Retrospective NIHSS scoring with the algorithm is reliable and unbiased even when physical examination elements are missing from the written record. Stroke research using retrospective review of charts or of administrative databases should adjust for differences in stroke severity using such an algorithm.     

Firearms risk management in psychiatric care

OBJECTIVE: This study sought to assess the effectiveness of a firearms risk management program. METHODS: A firearms risk management program, which included multidisciplinary assessment, treatment, and discharge planning, was developed and implemented among 46 civilly committed psychiatric inpatients at the Twin Valley Psychiatric System, a behavioral health organization of the Ohio Department of Mental Health. RESULTS: The research sample comprised mainly men who had personality disorders and histories of substance abuse and who had expressed an intent to use a firearm to commit suicide. On discharge, none of the patients had access to a firearm. Of the 16 patients who were hospitalized during the next 24 months, only five were noted to have threatened to harm themselves or others with a firearm or to have access to a firearm. CONCLUSIONS: Multidisciplinary and focused assessment, treatment, and discharge planning can be effective in neutralizing the risk of firearms use among psychiatric patients.     

Reliability and validity of the korean version of the childhood trauma questionnaire-short form for psychiatric outpatients

Objective

The Childhood Trauma Questionnaire (CTQ) is perhaps the most widely used and well-studied retrospective measure of childhood abuse or neglect. This study tested the initial reliability and validity of a Korean translation of the Childhood Trauma Questionnaire (CTQ-K) among non-psychotic psychiatric outpatients.

Methods

The CTQ-K was administered to a total of 163 non-psychotic psychiatric outpatients at a university-affiliated training hospital. Internal consistency, four-week test-retest reliability, and validity were calculated. A portion of the participants (n=65) also completed the Trauma Assessment Questionnaire (TAQ), the Impact of Events Scale-Revised, and the Dissociative Experiences Scale-Taxon.

Results

Four-week test-retest reliability was high (r=0.87) and internal consistency was good (Cronbach''s α=0.88). Each type of childhood trauma was significantly correlated with the corresponding subscale of the TAQ, thus confirming its concurrent validity. In addition, the CTQ-K total score was positively related to post-traumatic symptoms and pathological dissociation, demonstrating the convergent validity of the scale. The CTQ-K was also negatively correlated with the competence and safety subscale of the TAQ, confirming discriminant validity. Additionally, we confirmed the factorial validity by identifying a five-factor structure that explained 64% of the total variance.

Conclusion

Our study indicates that the CTQ-K is a measure of psychometric soundness that can be used to assess childhood abuse or neglect in Korean patients. It also supports the cross-cultural equivalence of the scale.     

Development of an antidepressant compliance questionnaire

OBJECTIVE: The development of the Antidepressant Compliance Questionnaire (ADCQ), assessing patients' attitudes and beliefs on depression and antidepressants. METHOD: A 51-item questionnaire was applied to 85 psychiatric out-patients with a DSM-IV diagnosis of major depressive disorder (MDD). This data set was used to assess psychometric properties of the ADCQ. The questionnaire was also applied to 272 primary care out-patients with MDD. RESULTS: A principal component analysis revealed four dimensions with good internal consistency and acceptable test-retest reliability: 'perceived doctor-patient relationship', 'preserved autonomy', 'positive beliefs on antidepressants' and 'partner agreement', resulting in a final questionnaire comprising 33-items. Responses were independent from depression severity and patient age. The response patterns of both psychiatric and primary care patients are provided and illustrate the many erroneous beliefs on antidepressants. CONCLUSION: The ADCQ has good psychometric properties; further investigation should investigate whether this questionnaire is predictive of patient compliance.     

Psychometrische Evaluation der deutschsprachigen Version der Barratt-Impulsiveness-Skala

BACKGROUND: Impulsive behavior is an important characteristic in a range of psychiatric disorders. A unanimous definition of impulsivity is still under discussion, but a questionnaire to measure it has been available for quite some time, i.e. the Barratt Impulsiveness Scale Version 11 (BIS11). However, it lacks adequate psychometric characterization for German speakers. MATERIALS AND METHODS: Control persons were recruited from the Munich city population. Patients with alcohol dependence, suicide attempts, and borderline personality disorders treated as inpatients at the Munich University Psychiatric Clinic were recruited. RESULTS: Confirmatory analysis of the originally suggested factor structure did not adequately represent the data in our sample. The BIS11 sum score, which showed adequate internal consistencies in all subgroups, significantly differentiated the extent of impulsivity between patients and control persons. CONCLUSIONS: Use of the BIS11 sum score in German-speaking regions can be recommended. This sum score shows adequate internal consistency and well differentiated the extent of impulsivity between different groups of patients with psychiatric diagnoses and control persons.     

Assessing Anomalous Perceptual Experiences in Nonpsychiatric Individuals and Outpatients with Psychosis in Taiwan: An Investigation Using the Cardiff Anomalous Perceptions Scale (CAPS)

The Cardiff anomalous perceptions scale (CAPS) has been recently designed for the assessment of anomalous perceptual experiences in the general population, and includes dimensions that measure distress, intrusiveness, and frequency. The purpose of this study was to assess the psychometric properties of a Taiwanese version of the CAPS. The English version of the CAPS was translated into Taiwanese (CAPS-T) and the latter was applied to this study. We administered the questionnaire to a consecutive sample of 192 participants with (n = 106; clinical group including schizophrenia and affective psychosis) or without psychotic disorders (n = 86; non-clinical group). In addition to the CAPS-T, the Taiwanese version of the brief psychiatric symptom rating scale (BSRS) measured the severity of the psychopathology. We also tested the psychometric properties of the CAPS-T including construct validity, internal consistency, test–retest reliability, and convergent and discriminative validity. Overall, the CAPS-T showed good construct validity, internal consistency, and stability over time and correlated significantly with the psychoticism subscale of the BSRS. As predicted, the mean differences in CAPS-T scores between participants with or without a psychotic disorder were significant. Convergent and discriminative validity were satisfactory. A score of 5 was found to the best threshold in discriminating between clinical and non-clinical samples. Our findings indicate that the Taiwanese version of the CAPS is a reliable and valid instrument to measure the multidimensionality of perceptual anomalies in general and appears to complement the clinical measures of psychosis proneness in Taiwan.     

The PEH. A questionnaire to assess acknowledgment of psychiatric illness.

The aim of this research project was to develop an instrument to measure acknowledgment and denial of illness in hospitalized psychiatric patients. The investigators developed a 23-item, 4-point self report scale, the Patient's Experience of Hospitalization (PEH), and collected validity data from a sample of inpatients. A total of 29 subjects completed the PEH, the Marlowe-Crowne Social Desirability Inventory (MCSD), the MMPI, and a Global Assessment Scale (GAS) report. The patients' psychotherapists also provided GAS scores. Kuder Richardson split-half reliability and point biserial correlations of 18 items were adequate. The PEH total score correlated significantly and positively with the difference between the GAS scores assigned to the patient by the patient and by the therapist, with the patient's self-report GAS score, with MCSD scores and with the MMPI L and K scales, considered to assess crude and subtle defensive denial. Correlations with MMPI clinical scales (symptom reports) were negative, further supporting the idea of the PEH as a measure of denial.     

综合医院住院患者的自测健康状况及影响因素分析

目的了解综合医院住院患者的自测健康状态及其影响因素。方法选择综合医院符合条件的住院患者，科室测评名额按其现有住院人数比例分配。由受过培训的专业人员对患者进行指导自评，患者躯体疾病的严重程度，由经治医生评定。结果综合医院住院患者的自测健康较低，不同性别、已未婚、有无职业、职业是否稳定及不同居住地之间存在显著差别，年龄、受教育程度和疾病严重性对自测结果影响明显，呈显著相关。经治医生对躯体疾病严重程度的评价与患者自测健康的结果是一致的。结论综合医院住院患者的健康状况不仅包括躯体健康，同时也包括心理和社会健康，关注患者的健康，要同时关注他的躯体、心理和社会健康一．