The role of high- and low-dose corticotropin tests in the diagnosis of secondary adrenal insufficiency

Mini Mental State Examination (MMSE), Brief Psychiatric Rating Scale (BPRS) and subscales of the BPRS were performed on 73 elderly inpatients (mean age: 67.9 years; standard deviation: 7.2; range: 60-89) diagnosed with DSM-III-R chronic schizophrenia. Forty of the subjects were men and 33 were women. A significant negative correlation was observed between MMSE and the age, factor negative, factor depressive, and total score of BPRS. We believe, however, that it is relatively sufficient to screen for demented illness of schizophrenics using MMSE when considering the age and the psychiatric symptoms (especially negative or depressive symptoms ). Forty-eight (66%) of the 73 patients were categorized as 'demented' by MMSE. These results suggest that the aged inpatients with schizophrenia in a hospital showed certain kinds of cognitive deficits (including senile dementia) more frequently than the general population.     

Increasing the reliability and validity of pain intensity measurement in chronic pain patients

This study examined the effects of increasing the number of assessments on the reliability and validity of measures of average pain intensity. Two hundred chronic pain patients completed 2 weeks of hourly pain ratings. A series of regression analyses were performed, and test-retest stability, internal consistency and validity coefficients were computed to address 4 questions. (1) Are chronic pain patients' reports of pain similar from one day to another? (2) What is the reliability and validity of a single rating of pain intensity when used as an indicant of average pain? (3) How many assessments (data points) are required to obtain estimates of average pain intensity with adequate to excellent psychometric properties? (4) How important is it to sample pain from different days? The results were consistent with predictions based on patients' self-reports of their pain and on psychometric theory. First, the majority of patients did not report similar levels of pain from one day to another, and average pain scores calculated from ratings obtained from a single day were less stable than those calculated from ratings obtained from multiple days. Also, and as expected, the results indicate that a single rating of pain intensity is not adequately reliable or valid as a measure of average pain. However, a composite pain intensity score calculated from an average of 12 ratings across 4 days demonstrated adequate reliability and excellent validity as a measure of the average pain in this sample of chronic pain patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Psychometric properties of the MMPI-2-RF Somatic Complaints (RC1) Scale.

The MMPI-2 Restructured Form (MMPI-2-RF; Tellegen & Ben-Porath, 2008) was designed to be psychometrically superior to its MMPI-2 counterpart. However, the test has yet to be extensively evaluated in diverse clinical settings. The purpose of this study was to examine the psychometric properties of the MMPI-2-RF Somatic Complaints (RC1) scale in a clinically relevant population. Participants were 399 patients diagnosed with either epilepsy or psychogenic nonepileptic seizures on the basis of video–electroencephalograph monitoring. The internal structure of the MMPI-2-RF was evaluated using taxometric, confirmatory factor analysis, and item response theory procedures. Data from 4 content-specific scales directly related to RC1 (Malaise, Gastrointestinal Complaints, Head Pain Complaints, and Neurological Complaints) indicated that the latent construct of somatization is a dimensional variable with a bifactor structure. However, consistent with the scale's construction, a unidimensional model also provided adequate fit. A 2-parameter logistic item response theory model better accounted for observed item responses than did 1- or 3-parameter models. Results suggest that the RC1 scale is most precise for T score estimates between 55 and 90. Overall, the scale appears to be well suited for the assessment of somatization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal factor structure of the Brief Psychiatric Rating Scale in schizophrenia.

The focus of this study was the invariance of the factor structure of the Brief Psychiatric Rating Scale (BPRS) over time. An initial sample of 193 individuals diagnosed with nonacute schizophrenia or schizoaffective disorder were administered the BPRS every 6 months over a 3-year period. Multiple-groups confirmatory factor analysis was used to fit the 4-factor oblique model of Mueser, Curran, and McHugo (1997) to both the 16-item and 18-item version of the BPRS. The results show that the model was configurally invariant over time, but it was more invariant for the 16-item version. The findings suggest that the factors, Thought Disturbance, Anergia, Affect, and Disorganized, as measured by the BPRS are distinct symptom constructs that endure over at least a 3-year period, but the strength of their interrelationships varies. Implications for interpretation of change in observed scores over time are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bifactor and item response theory analyses of interviewer report scales of cognitive impairment in schizophrenia.

A psychometric analysis of 2 interview-based measures of cognitive deficits was conducted: the 21-item Clinical Global Impression of Cognition in Schizophrenia (CGI-CogS; Ventura et al., 2008), and the 20-item Schizophrenia Cognition Rating Scale (SCoRS; Keefe et al., 2006), which were administered on 2 occasions to a sample of people with schizophrenia. Traditional psychometrics, bifactor analysis, and item response theory methods were used to explore item functioning and dimensionality and to compare instruments. Despite containing similar item content, responses to the CGI-CogS demonstrated superior psychometric properties (e.g., higher item intercorrelations, better spread of ratings across response categories) relative to the SCoRS. The authors argue that these differences arise mainly from the differential use of prompts and how the items are phrased and scored. Bifactor analysis demonstrated that although both measures capture a broad range of cognitive functioning (e.g., working memory, social cognition), the common variance on each is overwhelmingly explained by a single general factor. Item response theory analyses of the combined pool of 41 items showed that measurement precision is peaked in the mild to moderate range of cognitive impairment. Finally, simulated adaptive testing revealed that only about 10 to 12 items are necessary to achieve latent trait level estimates with reasonably small standard errors for most individuals. This suggests that these interview-based measures of cognitive deficits could be shortened without loss of measurement precision. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Developing outcome measures for ambulatory care--an application to asthma and diabetes

Increasing emphasis is now being placed on the assessment of patient outcomes, both in evaluating medical interventions and in quality assurance initiatives. Clinicians, purchasers, managers and researchers need outcome measures that are valid, reliable and responsive. This paper describes the theory and practice underlying the development of outcome measures for two chronic conditions, asthma and diabetes, for application in ambulatory settings. Existing generic and condition-specific health status and health-related quality-of-life measures were administered to almost 1300 patients. The psychometric properties of these measures were examined to identify those that were of adequate validity and reliability in these population groups. Step-wise regression procedures were then used to identify a core set of scales that best predicted patients' general health perceptions, which could be used in measuring general health outcomes for each of these groups. These core sets consist of up to 40 items, spanning physical function, energy and vitality, emotional well-being and condition-specific aspects of health such as symptom control. Further analysis is being carried out to assess the responsiveness to change of these core item sets.     

Psychometric properties of the French and English versions of the Social Phobia Inventory.

The Social Phobia Inventory (SPIN; Connor et al., 2000) is a self-report measure assessing fear, avoidance, and physiological symptoms associated with social anxiety. To date, the psychometric properties of this English-language measure have been examined primarily in individuals with social phobia. This study examined the psychometric properties of the English SPIN and a newly developed French version of the SPIN in nonclinical groups of undergraduate students. The SPIN, along with several other questionnaires, was completed by 202 English-speaking and 222 French-speaking participants in their respective languages from three different universities. A subset of participants completed the questionnaire a second time approximately one month later to assess test-retest reliability. The SPIN total score exhibited excellent internal consistency and test-retest reliability, as well as strong convergent and divergent validity in both English and French. A revised confirmatory factor analysis suggested the three-factor model of the SPIN was a good fit in French and English; however, the psychometric properties of the fear, avoidance, and physiology subscales were not as strong as those of the total score of the SPIN. The excellent psychometric properties of the English and French SPIN total score support the use of this measure not only in clinical populations, but now also in a nonclinical student sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of shame, guilt, and the negative reaction in brief dynamic psychotherapy.

Developed the Therapy Shame and Guilt Scale (TSGS) to test the hypothesis that patients' degree of shame and guilt would be significant predictors of therapy outcome. 35 patients (aged 20–80 yrs) with neurotic and/or character disorders received 16 weekly sessions of psychodynamically oriented psychotherapy. Two judges' ratings of Sessions 1, 5, 8, and 14 on the TSGS demonstrated that patient levels of shame and (especially) guilt were associated with therapeutic outcome. The TSGS was a better predictor of outcome than the Vanderbilt Negative Indicators Scale (VNIS), whose major point of overlap with the TSGS was the VNIS item of self-rejection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adjuvant whole body acupuncture in depression. A placebo-controlled study with standardized mianserin therapy

This article reports on the process undertaken to adapt the U.S. version of the SF-36 to an Australian setting. In addition, the results of psychometric testing, using the International Quality of Life Assessment (IQOLA) Project process and standards, is also reported. The adaptation process involved a number of steps including: a series of forward and backward translations; ratings of the difficulty of translating the SF-36 and the quality of the resulting translation. To assess the psychometric properties of the Australian form, a random sample of people residing in the Hunter region of New South Wales, Australia, were invited to complete the SF-36 with 855 respondents consenting to complete the measure. Principal components analyses supported the assumption of two factors underlying the measure with the percentage of variance explained by these factors ranging from between 0.66 and 0.77. Demonstrable internal consistency (both item and scale) and test-retest reliability were also found.     

Relation of psychopathology and bilingualism to kinesic aspects of interview behavior in schizophrenia.

As part of a larger study conducted by the 2nd author and his associates, 10 bilingual Spanish-American schizophrenic patients were interviewed in both their native and 2nd languages. The patients were also administered the WAIS Verbal subtest and the Brief Psychiatric Rating Scale (BPRS). Hand-movement behavior observed during the videotaped interviews was scored and related to ratings of psychopathology derived from the BPRS. Results show that discrete symptom clusters were meaningfully related to various types of hand-movement behavior during the nondominant-language interview. These patterns of correlations provide support for the assumption than kinesic behavior is related to cognitive processing dysfunctions and language encoding stress in this patient population. Findings are discussed in terms of the function of kinesic behavior in modulating such stresses. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perennial mystery of poor agreement among criteria for psychotherapy outcome.

Discusses S. Garfield, R. Prager, and A. Bergin's (see pa, vol. 47:issue 5) finding of little relationship among criteria and most change on global ratings of improvement which they believe are the most biased. Values of the global improvement ratings are discussed. Patient and therapist (and supervisor) have intimate knowledge of the specific areas needing change; many other measures are nonspecific or insensitive to change, and since therapeutic gains may be small, intercorrelations among criteria may be limited. Some of the statistics are questioned: raw gain scores are of questionable value; the relative importance of changes on the "other measures" is unclear; and considering the unreliability of single item ratings, the amount of the interrelationship among different criteria is not to be dismissed as slight. Furthermore, rotation of their factor matrix showed patient, therapist, and supervisor ratings of change loading the same factor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonverbal interaction of patients and therapists during psychiatric interviews.

Videotaped interviews of 50 psychiatric inpatients and 25 control Ss with 5 psychiatrists and analyzed the nonverbal behavior, which was coded and recorded every 10 sec for 2 5-min segments per interview. After the interview the therapists rated the Ss on the Brief Psychiatric Rating Scale (BPRS). Results show that the psychiatric patients held their legs symmetrically, groomed themselves, shifted posture, and frowned more than the control Ss did, and smiled and looked toward the therapist less. Nonverbal behavior of patients varied according to BPRS factor scores: Withdrawal was positively associated with turning the head away and negatively associated with smiling. Thought Disorder was positively correlated with grooming. Anxiety–Depression was associated with holding the head even and with hand tapping; and Mania was correlated with sitting upright and smiling. In interviews with patients vs controls, therapists' behavior differed in head orientation, smiling, hand tapping, and foot movements. It also differed according to the patients' ratings on the BPRS. Results are discussed in terms of affiliative–conflict theory and the construct of the therapeutic role. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Decision support of clinical laboratory test by object-oriented data base

There is growing interest in the role of the nitric oxide (NO) pathway in idiopathic psychotic disorders such as schizophrenia. In this preliminary study, we examined the therapeutic efficacy of methylene blue (MB), a "downstream" inhibitor of one of NO's actions, administered orally as an adjuvant to conventional neuroleptic medications. Specifically, MB blocks NO's activation of soluble guanylyl cyclase. MB has previously been reported to have therapeutic effects in the treatment of psychosis and mania. Preclinical data also suggest that MB might possess antipsychotic potential. Participants in the current study were eight patients with schizophrenia who had incomplete responses to conventional antipsychotics (as evidenced by a Brief Psychiatric Rating Scale [BPRS] total score of 35 or more). These patients completed a 4-week open-label study with a 1 week "off", 2 week "on", and one final week "off" design. Measures of treatment efficacy were the BPRS, Schedule for the Assessment of Negative Symptoms, and Clinical Global Improvement Scale administered weekly. Final scores for each outcome measure item were based on the consensus of at least two trained raters present during each rating interview. A statistically significant, albeit modest, decrease in the severity of psychopathology was observed while the subjects were taking MB, and psychopathology significantly worsened when MB was discontinued. The results suggest a need for further study with MB or perhaps other NO-dependent guanylyl cyclase-inhibiting medications.     

Voice quality in depression.

32 depressed patients were interviewed daily throughout their hospitalization. Spectrum analyses of the patients' speech were compared with mood ratings made by the 2 clinicians who jointly conducted the interviews. Using a stepwise multiple regression with cross-validation for each patient, predictions of the mood ratings from the voice spectra correlated significantly (1% level) with the ratings for 25 of the 32 patients. These cross-validation correlations were largest for those patients who showed considerable change in their mood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validation de l'échelle d'évaluation des traits antisociaux.

This study is testing the psychometric properties of the French version of the Antisocial Process Screening Device (APSD, Frick & Hare, 2001). Reliability and validity of the scales (impulsivity/conduct problems, callous/unemotional), as well as the total scale are tested on a sample of 306 children (mean age: 9.9 years) receiving special education services because of behaviour problems. Results indicate psychometric properties consistent with the English version (Frick, O'Brien, Wooton & McBurnett, 1994), as well as some differences. Test-retest reliability, internal consistency, confirmatory factor analysis, and validity (convergent, predictive) are acceptable. Further use of the French version of the APSD is warranted for research purposes but interpretation must remain cautious in the absence of a population based sample used in the validation process. Studies on the factors associated with the precocity and the stability of antisocial traits are recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An optimality score for the neurologic examination of the term newborn

We describe the application of a revised version of the Dubowitz neurologic examination of the newborn in 224 low-risk, term newborn infants. The method has been updated by eliminating less useful items and including new items evaluating general movements and patterns of distribution of tone. An optimality score is included to make the evaluation more quantitative and for comparison with sequential examinations with neurophysiologic and imaging findings. The score is based on the distribution of the scores for each item in the population of low-risk term infants. We defined not only the most common pattern for each item but also the variability of the findings by using 10th and 5th centiles. Because most of the items assessing tone and the Moro reflex varied with gestational age between 37 and 42 weeks, the changes were incorporated in the scoring system. The total optimality score was the sum of the optimality scores of individual items. Although the association of 4 or more deviant scores was found in less than 10% of our infants, deviant results on 1 or 2 single items could be observed in a third of this normal population, suggesting that isolated deviant signs have little diagnostic value. In contrast, an abnormal distribution of tone patterns, which we have commonly observed in infants with brain lesions, was not found in this cohort.     

UCLA Loneliness Scale (Version 3): reliability, validity, and factor structure

In this article I evaluated the psychometric properties of the UCLA Loneliness Scale (Version 3). Using data from prior studies of college students, nurses, teachers, and the elderly, analyses of the reliability, validity, and factor structure of this new version of the UCLA Loneliness Scale were conducted. Results indicated that the measure was highly reliable, both in terms of internal consistency (coefficient alpha ranging from .89 to .94) and test-retest reliability over a 1-year period (r = .73). Convergent validity for the scale was indicated by significant correlations with other measures of loneliness. Construct validity was supported by significant relations with measures of the adequacy of the individual's interpersonal relationships, and by correlations between loneliness and measures of health and well-being. Confirmatory factor analyses indicated that a model incorporating a global bipolar loneliness factor along with two method factor reflecting direction of item wording provided a very good fit to the data across samples. Implications of these results for future measurement research on loneliness are discussed.