暴力危险性筛查量表中文版在精神分裂症患者中的信度与效度研究

目的：引入暴力危险性筛查量表（violenceriskscreening-10,V—RISK-10）,对V—RISK-10中文版在精神分裂症患者中的信度与效度进行检验。方法：对英文版V—RISK-10进行翻译和修订,以109例精神分裂症患者为评估对象,完成一般情况调查表、V—RISK-10中文版、卫生部危险性评估、修订版外显行为攻击量表（MOAS）的测评。其中14例患者由2位评估者独立评估V—RISK-10中文版,49例患者2周后重测V—RISK．10中文版。结果：V—RISK-10中文版9个条目的鉴别力良好,内部一致性系数0．833（P〈0．01）。评分者信度（斯皮尔曼等级相关系数：r=0．655—0．899）、重测信度（Kappa=0．536—1．000）较好（P〈0．ol或P〈0．05）。V—RISK．10中文版中7个条目得分与其综合评定建议分级（Kendal和谐系数为0．387～0．685）、危险性评估分级（Kendal和谐系数为0．319～0．618）、MOAS总分（皮尔逊相关系数：,=0,301～0．585）均显著正性相关（P均〈0．01）;关联效度理想。结论：V—RISK-10中文版在精神分裂症患者中的信度与关联效度良好。     

精神病患者刑事责任能力评定量表在司法精神病鉴定中的应用

目的:探讨精神病患者刑事责任能力评定量表(RSCRs)应用于司法精神病鉴定实践中的可能性。方法:对200例刑事责任能力鉴定案例进行RSCRS评分,对暴力犯罪案件增加暴力作案刑事责任能力评定量表(CRRSV)评定,并与专家鉴定意见进行比较。结果:全量表Cronbach'sα系数为0.944,Guttmann分半信度为0.890;除条目10、11,其余各条目之间及与总分相关性尚可(r0.400,P=0.000);专家评定意见中不同等级责任能力及相互之间差异有统计学意义(F=548.038,P=0.000);探索性因素分析提取4个因子,累积贡献率为78.612%,验证性因素分析提示模型拟合度比较理想;RSCRs等级划分结果与专家鉴定意见一致性高(Kappa=0.876,P=0.000)。在暴力犯罪案件中,RSCRs和CRRSV总分高度正相关,等级一致性高(Kappa=0.873,P=0.000);判别函数回代92.5%的样本划分正确。结论:RSCRs具有较好的信效度,可用于司法精神病鉴定中作为刑事责任能力评定及分级的参考工具。     

限定刑事责任能力的应用

目的：探讨限定刑事责任能力评定量表（DCRRS）在广州地区责任能力3级评定中的应用。方法：采用DCRRS回顾性评定刑事责任能力鉴定504例,进一步检验该量表的信效度及其和专家鉴定结论的一致性。结果：DCRRS的分半信度为0.90,各条目之间及其与总量表分之间的相关均有统计学意义（r=0.11-0.91,P〈0.05）。据DCRRS的参考划界分分组,无、限定和完全责任能力3组间及两两间总量表分的差异均具有统计学意义（P〈0.001）。DCRRS评定和专家鉴定两种责任能力分级方法的结果一致性较好（Kappa值=0.71,P〈0.001）,建立判别函数,回代的判别正确率分别为96.2%和86.7%。结论：DCRRS在广州地区使用的信效度良好,可推广用于责任能力3级评定的辅助参考。     

暴力行为刑事责任能力评定量表的初步研究

目的：初步探讨暴力行为刑事责任能力的量化。方法：对“暴力行为刑事责任能力评定量表（CRRSV）”作回顾性测试，分析其信度和效度。结果：CRRSV具有较好的内部一致性和稳定性。结构合理，其界限值所划分的不同法定能力等级与专家鉴定间也高度一致。结论：CRRSV值得在我国暴力行为刑事责任能力的鉴定中参考使用。并在实践中不断完善。     

暴力作案刑事责任能力的量化评定:Ⅰ.量表的编制

目的通过编制评定工具来探索对责任能力的客观量化评定。方法总结本中心16年来暴力作案责任能力的专家鉴定资料，并结合国内外有关的鉴定理论与实践报道，参考国外的类似评定工具编制出《暴力作案刑事责任能力评定量表》(CRRSV)；根据专家鉴定经验确定评分标准，并通过对近年来鉴定资料的试评来确定界限值，最后进行初步的信、效度检验。结果CRRSV条目与国内大多数研究报道的辨认、控制能力和责任能力法学(心理学)标准相关因素一致，同时也能反映医学要件对责任能力的影响，信度和效度良好，有操作性。结论CRRSV与医学标准相结合可能对于客观地评定暴力作案的责任能力具有参考价值。     

痴呆行为评定量表的信度和效度研究

目的 评价痴呆行为评定量表（BRSD）的信度和效度。方法 对51例老年精神科病房住院的痴呆和非痴呆患者,先由两名评定员用BRSD同时评定12名患者,再同时对所有病例评定BRSD和老年临床评定量表（SCAG）,一周后重测BRSD。对评定员之间的一致性,量表的分半相关,重测信度及平行效度进行分析。结果 BRSD的Cronbach‘s α系数为0．706,两评定员之间的一致性为0．834,BRSD重测总分相关系数γ为0．986。BRSD总分与SCAG的相关系数γ为0．787。结论 BRSD有较好的信度和效度。     

阿尔茨海默病病理行为评分表信度和效度

目的 :评定阿尔茨海默病 (AD)病理行为评分表 (BEHAVE- AD)的信度和效度。　方法 :8名医生对 6例痴呆病人进行联合测定。对 6 3例痴呆病人进行 BEHAVE- AD和简明精神病评定量表 (BPRS)评定 ,48小时后重复 BEHAVE- AD评定。　结果 :同质性信度系数 Cronbach'sα=0 .770 3。联合检测一致性系数 ICC=0 .95 95 ,重测一致性系数 r=0 .96 1,P均 <0 .0 1。与 BPRS评分相比 ,相关系数 r=0 .475 ,P<0 .0 1。根据医生总体评定结果 ,将病人分组 ,各组病人的量表评分有显著差异。　结论 :BEHAVE- AD中译本有较好的信度和效度 ,值得推广应用     

护士使用简易老年焦虑问卷筛查老年广泛性焦虑障碍的信效度

目的评价护士使用中文版简易老年焦虑问卷（Geriatric Anxiety Inventory—Short Form,GAI--SF）用于筛查老年焦虑时的信度和效度。方法某综合医院门诊就诊的老年人97名为研究对象,由护士进行GAI—SF问卷及汉密尔顿焦虑量表（Hamilton Anxiety Scale,HAMA）评定,并且由两名精神科主治医师根据ICD-10广泛性焦虑障碍诊断标准进行诊断性面谈。计算组内相关系数考察评定者抑制性,计算克朗巴赫-α系数评价问卷内部一致性;计算两次测量得分相关系数考评问卷的重测信度,采用主成分分析方法考评问卷结构效度;通过GAI—SF与HAMA的相关分析来考评问卷的效标效度;以临床标准为参考标准,根据ROC曲线下面积（Area Under Curve,AUC）来判断GAI—SF的区分效度以及划定问卷的划界分。结果（1）信度：GAI—SF问卷总分评定者组内相关系数为0．73,表明评定者一致性较好,总克朗巴赫-α系数为0．87,表明问卷内部一致性好。间隔15d两次测量问卷评分相关系数为0．78,说明问巷具有较好的重测信度。（2）效度：主成分分析结果显示,问卷的每个条目都在主因子上有较高的负荷值（0．501～0．670）,说明问卷结构效度良好;GAI—SF与HAMA之间的相关系数为r=0．60,P〈0．05,说明问卷具有较好的校标效度。以临床评估标准为参考在区分焦虑问题时界值分为≥3时灵敏度为70．4％,特异度为75．0％,AUC为0．73。结论GAI—SF中文译本具有较好的信度和效度,能够区分老年广泛性焦虑问题;可使用该问卷筛查社区老年广泛性焦虑障碍。     

Piers—Harris儿童自我意识量表用于河南农村儿童的信、效度检验

目的对Piers—Harris儿童自我意识量表（PHCSS）进行用于河南农村儿童的信、效度检验。方法在河南全省6个市的6个乡镇的中小学校中采样1760人,平均年龄（11．63±1．68）岁,由学生填写量表。同时对55例破坏性行为障碍患几（行为组）和59例焦虑、抑郁障碍患儿（焦抑组）进行该量表测评。结果Cronbach’Sd系数总量表为0．887,各维度为0．711～0．801;重测信度r为0．534～0．739,P〈0．01;内容效度中各项目与其维度分、各维度分与总分r=0．523～0．950,P〈0．01;区分效度中将常模儿童与行为组及焦抑组患儿量表评分进行比较,结果常模组在分量表及量表总分上得分均高,F=27．339～70．004,P〈0．01;该量表不能制定常模分。结论Piers—Harris儿童自我意识量表可用于河南农村儿童自我意识水平的评估,但不可用于筛查、诊断。     

中文版精神病人刑事责任能力评定量表的信度和效度研究

目的:探讨中文版《精神病人刑事责任能力评定量表》(中文版R-CRAS)的信度和效度。方法:国内12名不同省市的资深司法精神病学鉴定专家运用R-CRAS量表采用盲法对3例犯罪嫌疑人的辨认能力或者控制能力以及刑事责任能力的评定结果进行比较。结果:量表内部一致性系数(Cronbach'sα)r=0.846。12名评定者对全量表评定的一致性系数r=0.493,一致性最差的4个条目(第10、11、14、17题)占全量表的22.22%(r=0.099~0.294,P均0.05),提示这些条目与刑事责任能力评定或许没有必然联系。12名评定者36例次评定结果:部分、小部分、大部分、完全和无刑事责任能力的分别为7(19%)、2(6%)、8(22%)、15(42%)和4(11%)例次,提示评定者根据量表对刑事责任能力评定的结果明显不同。对于12名评定者的36例次的评分转换成等级资料,进行Friedman检验(χ2=208.824,df=17)和Kendall'W协同系数检验(Kendall'W系数=0.341,χ2=208.824,df=17),显著性均P=0.000,提示量表评分标准存在随意性。多维尺度分析发现,该量表条目按其相似性和差异性可以被划分为若干不同的范畴,仅以"辨认能力"和"控制能力"不能概括他们的特征。结论:中文版R-CRAS的设计欠合理,需进一步研究改进。     

加里福尼亚痴呆行为问卷的信度和效度检验

目的：检测加里福尼亚痴呆行为问卷（ＣＤＢＱ）的信度与效度。方法对６０例Ａｌｚｈｅｉｍｅｒ病（ＡＤ）患者进行测试,其中有４８例患者完成二倍照料者的联合评定。结果ＣＤＢＱ具有良好的内部一致性,Ｃｏｒｎｂａｃｈ’ｓα＝０．７８６３,ｐ〈０．０１,联合检测的一致性高,ＩＣＣ＝０．８５０８,Ｐ〈０．０１。与简明精神病量表（ＢＰＲＳ）评分相比,相关系数ｒ＝０．３６,Ｐ〈０．０１,平行效度较好。结论ＣＤＢＱ中译     

Interrater reliability of the assessment of DSM-IV Axis IV psychosocial stressors and environmental problems

The interrater reliability of the DSM-IV axis IV psychosocial stressors was investigated in a retrospective chart review study. The complete charts of 98 patients admitted to a specialized psychiatric ward were independently evaluated by three trained clinicians and rated on a questionnaire form comprising the presence and severity of the nine psychosocial stressors of DSM-IV axis IV (DSMSTR9; absent scored 0; mild, 1-3; moderate, 4-6; severe, 6-10). Chance-corrected intraclass correlations (ICC) were calculated for the interrater reliability of DSMSTR9 stressors. DSMSTR9 stressors exhibited sufficiently high levels of interrater reliability regarding presence (ICC = 0.560-0.943; p < 0.0005) and severity (ICC = 0.584-0.953; p < 0.0005) of stressors with slightly higher ICCs for severity assessments. Problems related to the social environment showed the lowest ICCs. According to the present results, the presence and severity of DSM-IV axis IV stressors can be scored sufficiently reliably even in retrospective studies. Including the assessment of presence and severity of DSM-IV axis IV psychosocial and environmental problems in future DSM versions, using a 4-point scale can therefore be recommended.     

A new measurement of activities of daily living for Thai elderly with dementia

BACKGROUND: Activities of daily living (ADL) vary across cultures, and measure of ADL needs to be specific to the population under study. We developed an ADL measure for Thai elderly with dementia and investigated the reliability and validity of this instrument. MATERIALS AND METHODS: Item construction was accomplished with a panel of neurologists and a rehabilitation medicine physician. One hundred eighty-one subjects were interviewed using the Thai ADL measure. Of this sample, one hundred fifty-nine had dementia according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. These data were analyzed for internal consistency; concurrent validity was determined by comparison with the Barthel Index, Functional Assessment Questionnaire (FAQ), Thai Mental State Exam (TMSE), and Clinical Dementia Rating (CDR) scale; and discriminant validity was determined by comparison with the Neuropsychiatric Inventory (NPI). Thirty subjects were tested to determine interrater and test-retest reliability. RESULTS: Thai ADL measure was composed of six basic ADL and seven instrumental ADL. It had high correlation with TMSE scores (r = -.69), CDR scores (r = .81), Barthel Index scores (r = -.80), and FAQ scores (r = .88), and moderate correlation with NPI scores (r = .46). The instrument had high test-retest reliability (intraclass correlation coefficient [ICC] = .92, .89) and high interrater reliability (ICC = .96, .93). CONCLUSION: The Thai ADL scale is easy to use and it has high reliability. It had high concurrent validity with previously published ADL scales. The methodology used to develop the Thai ADL scale can provide a model for creating culturally competent ADL scales.     

Long-term validity of biological markers of psychopathy and criminal recidivism: follow-up 6-8 years after forensic psychiatric investigation

This study is a follow-up investigation of a forensic psychiatric sub-population 6-8 years after forensic psychiatric evaluation. The aim was to examine the long-term validity of biological markers of psychopathy and antisocial behavior over time. Data on criminal records were obtained at follow-up from the National Council for Crime Prevention. Basic data included findings of psychiatric and psychological assessments, as well as values for serum triiodothyronine (T3) and free thyroxin (FT4), and platelet monoamine oxidase (MAO) activity, all obtained during the forensic psychiatric examination. Criminal recidivists at follow-up had higher serum T3 levels than non-recidivists, and much higher values than normal controls, while their levels of free T4 were lower. The T3 levels in criminal recidivists correlated to psychopathy- and aggression-related personality traits as measured by the Karolinska Scale of Personality. In violent recidivists, a remarkably high correlation was noted between T3 levels and Irritability and Detachment, traits that have previously been linked to the dopaminergic system. Stepwise multiple regression analyses confirmed the relationships of T3 levels and platelet MAO activity with personality traits in criminal recidivists. The predictive validity of biological markers of psychopathy, T3 and platelet MAO, measured during forensic psychiatric investigation, is stable over time. The results indicate chronic alterations of the hypothalamic-pituitary-thyroid axis in this group of subjects.     

Rating scales for dystonia in cerebral palsy: reliability and validity

Aim This study investigated the reliability and validity of the Barry–Albright Dystonia Scale (BADS), the Burke–Fahn–Marsden Movement Scale (BFMMS), and the Unified Dystonia Rating Scale (UDRS) in patients with bilateral dystonic cerebral palsy (CP). Method Three raters independently scored videotapes of 10 patients (five males, five females; mean age 13y 3mo, SD 5y 2mo, range 5–22y). One patient each was classified at levels I–IV in the Gross Motor Function Classification System and six patients were classified at level V. Reliability was measured by (1) intraclass correlation coefficient (ICC) for interrater reliability, (2) standard error of measurement (SEM) and smallest detectable difference (SDD), and (3) Cronbach’s alpha for internal consistency. Validity was assessed by Pearson’s correlations among the three scales used and by content analysis. Results Moderate to good interrater reliability was found for total scores of the three scales (ICC: BADS=0.87; BFMMS=0.86; UDRS=0.79). However, many subitems showed low reliability, in particular for the UDRS. SEM and SDD were respectively 6.36% and 17.72% for the BADS, 9.88% and 27.39% for the BFMMS, and 8.89% and 24.63% for the UDRS. High internal consistency was found. Pearson’s correlations were high. Content validity showed insufficient accordance with the new CP definition and classification. Interpretation Our results support the internal consistency and concurrent validity of the scales; however, taking into consideration the limitations in reliability, including the large SDD values and the content validity, further research on methods of assessment of dystonia is warranted.     

Criminal responsibility in sexual homicide perpetrators

OBJECTIVE: Evaluation of criteria for criminal responsibility, esp. in paraphilias and personality disorders. METHODS: We compared sexual murderers with diminished responsibility or not-guilty for reasons of insanity (n = 73) and those held fully responsible (n = 61) regarding psychiatric disorders, signs of severe paraphilias, level of personality structure (using Operationalized Psychodynamic Diagnostics) and offence related criteria. RESULTS: Sexual murderers found as diminished responsible or not-guilty, especially those detained in forensic psychiatric hospitals, showed more signs of a progressive sadistic development and lower levels of personality structure. Offence related criteria that are regarded as not supporting a diminished capacity plea (purposeful actions, long duration, complex, stepwise course of the offence) were found more frequent in those offenders that were detained in forensic hospitals. CONCLUSIONS: Signs for severity of paraphilias and personality disorders are useful in decisions about criminal responsibility. Criteria regarding purposeful course of action appear not to be adequate for the assessment of paraphilic sexual offenders.     

Casenote assessment of psychopathy in a high security hospital

INTRODUCTION: There is now a large amount of data demonstrating the internal reliability and construct validity of the Hare Psychopathy Checklist (PCL/PCL-R) when used in the assessment of psychopathy in male forensic populations. It has well-established psychometric properties when scored following a review of collateral information and a subsequent interview. However, its internal reliability and factor structure, when casenote information alone has been used, have not been examined outside North America. METHOD: A sample of 89 patients from a British high security hospital, with the legal classification of psychopathic disorder, was scored retrospectively on the PCL-R from their medical files only. The psychometric properties of the PCL-R were analysed. Results The PCL-R ratings showed a high level of internal reliability. The factor structure was very similar to that found in Hare's North American sample of forensic psychiatric patients. DISCUSSION: The findings support the application of the PCL-R, when scored using existing file data alone, to a British high security hospital population.