Recognition and classification of seizures in infants

PURPOSE: We wished to assess the reliability of the International League Against Epilepsy (ILAE) seizure classification system applied to infantile seizures and to test a proposed new classification. METHODS: We first analyzed 39 seizures in 20 infants (aged 1-26 months) recorded with simultaneous closed-circuit television and EEG (CCTV/EEG). EEGs and videotapes of all seizures were independently analyzed by two epileptologists blinded to clinical histories. Videotapes of each seizure were reviewed without simultaneous EEG (phase 1), and printouts of ictal EEGs were assessed without behavioral correlates (phase II). The observers classified seizures according to ILAE criteria. Interrater agreement was assessed by the kappa statistic. RESULTS: Agreement on EEG features (phase II) was moderate (= 0.54) in identifying focal ictal onsets and substantial (= 0.79) in identifying generalized onsets. In contrast, analysis of videotapes showed substantial disagreement between observers in terms of classifying seizures as partial or generalized. Therefore, agreement between observers for partial was slight (= 0.14) and fair for generalized seizures (= 0.26). Similarly, conclusions of the observers as compared with those of a consensus panel were divergent for both partial (= 0.18) and generalized seizures (= 0.30). We therefore developed an alternative classification scheme and retested interrater agreement in a review of 50 seizures in 25 other infants. With this classification scheme, there was substantial agreement between observers (= 0.72). CONCLUSIONS: With clinical observations and interictal EEGs, seizures in infants cannot be reliably classified by current ILAE criteria. In contrast, a proposed new classification scheme based solely on semiology showed substantial reliability.     

A standardized interviewing technique for evaluating postgraduate training applicants

In an effort to streamline the personal interview and to reduce the influence of subjectivity inpreparation of ranking lists for postgraduate year-one applicants, a standardized interview was constructed for use in evaluating condidates for admission to a training program in internal medicine. The interview was conducted in a uniformly structured manner by 14 interviewers of 260 applicants. Each applicant received an interview score which correlated well with the final decision of the Intern Selection Committee. For each interviewer various measures of performance were obtained which allowed a classification into "hard" versus "easy" interviewer and indicated the comparability of each interview's evaluations with the final decisions. Thus, the standardized interview resulted in quantifiable data in the form of uniform evaluations of applicants and interviewers.     

Personality disorders in patients with eating disorders: a controlled study

A group of 24 eating-disordered female subjects (10 anorexia nervosa--AN--and 14 bulimia nervosa--BN--patients) were interviewed, using a semistructured interview for DSM-III-R Axis-II Personality Disorders (SCID-II). A group of 54 subjects without eating disorder acted as a control group. A high rate of personality disorder (PD) diagnoses occurred in eating disordered subjects (AN and BN patients), with a high prevalence of borderline, dependent, and self-defeating PD. Avoidant and obsessive-compulsive PD were more common in AN patients, whereas BN was associated with histrionic PD. Findings have implications for the assessment and diagnosis of eating-disordered patients and for treatment planning.     

Verbal reinforcement and interviewer bias.

The relative effectiveness of the responses "Good" and "Mmhmm" as a reinforcer was ascertained by an experiment taking the form of an attitude survey conducted by telephone. The interviewer asked questions concerning the Harvard philosophy of General Education, revealing a bias for or against the philosophy by his reactions to the answers of the interviewees. 10 Ss were assigned at random to each of 4 experimental groups. For 2 groups the reinforcement was "Mmhmm," pronounced after pro General Education answers for one group, and after anti answers for the other. For the remaining 2 groups, the reinforcement was "Good." "Good" proved to bias the results obtained while "Mm-hmm" did not. Replication produced similar results, which were compared with those obtained by other experiments, and the implications for the clinical and opinion interview were discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mixed-mode data collection: Telephone and personal interviewing.

Examined the utility of a mixed-mode telephone interview/personal interview method of data collection in a study of voting in union representation elections. The sample of 1,239 employees in 31 different elections was heterogeneous with respect to age, education level, sex, race, wage rate, and urban–rural background. Ss who could not be contacted by telephone or who refused to participate in a telephone interview were interviewed in person. The utility of the mixed-mode method was evaluated with respect to (a) response rate (92%), (b) cost (saved $10,746 in interviewer wages alone), and (c) quality. On most indices, the quality of the data collected in person and by telephone was similar. Respondents interviewed by telephone were more likely than those interviewed in person to refuse to disclose their vote and less likely to report unlawful campaign practices. Implications for the internal validity and generalizability of the voting study are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of standardized assessment in occupational therapy: the BaFPE-R as an example

Before 1970, most assessments administered by occupational therapists were informal and nonstandardized. Since the 1970s, the use of scientifically sound instruments has increased. One such standardized assessment, the Bay Area Functional Performance Evaluation (BaFPE), was developed to measure the functional performance of psychiatric clients. This study was designed to explore the use of a revised version of BaFPE as an example of standardized assessment in occupational therapy. The BaFPE was selected as an example of an assessment extensively used in psychiatric occupational therapy practice. A qualitative study that used in-depth semistructured interviews was conducted with a convenience sample of occupational therapists. The occupational therapists who were interviewed described and explained making several adaptations and modifications to the recommended administration and scoring of the BaFPE. An analysis of the interview data suggested that standardized assessments are valued as indicators of professional status. However, the interview responses also suggested that the demands of test standardization were incongruent with the values that guide occupational therapy practice. The findings of this study suggest that the future development and use of standardized instruments should be consistent with the values of the profession. In particular, assessments that recognize the diverse nature and needs of individual clients are required.     

Female Wistar-Kyoto and SHR/y rats have the same genotype but different patterns of expression of renin and angiotensinogen genes

BACKGROUND: Prevalence estimates vary 2750-fold among the 20 studies of essential tremor (ET). It is not clear how the choice of diagnostic criteria affects research results. OBJECTIVE: To determine the impact of alternative sets of diagnostic criteria on the diagnosis of ET. METHODS: As part of the Washington Heights-Inwood Genetic Study of ET (WHIGET), a population-based study of ET, 285 subjects who include 36 case subjects with probable or definite ET, 34 case subjects with possible ET, and 215 normal subjects were interviewed and examined. All diagnoses in WHIGET were assigned by 2 neurologists. Ten of the 20 published prevalence studies of ET provided diagnostic criteria for ET. Criteria differed in terms of requirements for the distribution, duration, and severity of tremor. These 10 sets of criteria were then each separately applied to the subjects in the WHIGET cohort to determine their impact on the diagnosis of ET. RESULTS: Depending on which diagnostic criteria were applied to the WHIGET cohort, the proportion of WHIGET case subjects with definite or probable ET who would have been diagnosed as having ET was as low as 14% and the proportion of WHIGET normal subjects who would have been diagnosed as having ET was as high as 51%. Diagnostic criteria that included a positive family history of ET or a lengthy duration of tremor would have classified many WHIGET case subjects with ET as normal, whereas criteria that did not specify a minimal tremor severity would have classified many WHIGET normal subjects as having ET. CONCLUSIONS: Alternative sets of diagnostic criteria for ET greatly impact on the diagnosis of ET. For population-based studies, information on tremor type and severity rather than family history should be included in diagnostic criteria.     

Differential impairment as an indicator of sex bias in DSM-IV criteria for four personality disorders.

The aim of the present study was to investigate the possibility of sex bias in the diagnostic criteria for borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders. A clinical sample of 668 individuals was evaluated for personality disorder criteria using a semistructured interview, and areas of functional impairment were assessed with both self-report and semistructured interview. The authors used a regression model of bias to identify bias as differences in slopes or intercepts between men and women in the relationship between each diagnostic criterion and level of impairment. The results suggest that most of the diagnostic criteria examined do not seem to display sex bias. However, those criteria that displayed evidence of bias came largely from the borderline diagnosis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of depressive symptoms early in the course of schizophrenia

OBJECTIVE: The rate of depressive symptoms early in the course of schizophrenia was determined. METHOD: Seventy subjects with recent-onset schizophrenia were followed for 5 years by using semistructured interview instruments. The initial assessment included ratings of each criterion A symptom of a DSM-III-R major depressive episode. The rates of symptoms experienced with at least moderate severity were calculated, and an algorithm based on DSM identified subjects meeting the criteria for a major depressive episode. RESULTS: Four symptoms were present to at least a moderate degree in a majority of subjects, while no symptom was present in fewer than 12% of subjects. More than one-third of the subjects met the algorithmic criteria for a major depressive episode at the time of intake. CONCLUSIONS: Depressive symptoms are common early in the course of schizophrenia. This finding is consistent with other recent data and has potential implications for current diagnostic and treatment practices.     

Specialized memory consultation. Value and evaluation after 2 years of functioning

Disorders of memory are a frequent cause of consultation and are observed in dementias, in some depressive syndromes and in normal ageing. The specialized memory consultation is based on two successive examinations: one by a neurologist, the other by a psychologist, using standardized batteries of tests. In 100 consecutive subjects, 3 main groups of about 20 to 30 individuals each could be identified: dementia syndromes, psychiatric disorders and age-related disorders of memory. The remaining subjects had various diseases. In subjects with memory complaints a psychometric evaluation performed by a team of specialists seems to be the only means of refining the diagnosis enough for a personalized management. In addition, the specialized consultation team acquires the knowledge that will help it, in the future, to lay down the bases of medical prevention of pathological cerebral ageing.     

Long-term socioeconomic outcome following surgical intervention in the treatment of refractory epilepsy in childhood and adolescence

Surgical treatment of refractory epilepsy in childhood and adolescence has been shown to be effective in reducing the seizure frequency. This paper examines the question: "Does this result in a better socioeconomic outcome in later years?" Patients who underwent a surgical procedure for the treatment of their medically refractory epilepsy at our hospital, had more than 2-years' follow-up, and were less than 18 years old at time of survey were included. From a retrospective chart review, age at onset and at surgery, duration of seizures prior to surgery, years of follow-up, type of surgery, and neurological status were obtained. From a telephone survey, seizure frequency after surgery, marital, financial and driving status, level of education, and employment status were ascertained. Sixty-four patients in our epileptic surgical series meet entry criteria. Significantly higher levels of education, employment status and independence were found in patients with a class I Engel outcome compared to other Engel outcomes.     

Chronic widespread pain in the community: the influence of psychological symptoms and mental disorder on healthcare seeking behavior

OBJECTIVE: To determine whether psychological symptoms and mental disorder are an intrinsic part of the chronic widespread pain syndrome or whether they have been observed in clinic attenders primarily because of their influence on the decision to seek a medical consultation. METHODS: A population survey of 1953 subjects was conducted in the Greater Manchester area of the United Kingdom. The survey included a postal questionnaire, and in a subgroup of respondents with high levels of distress, the presence of mental disorder was assessed by a semistructured standardized interview. Subjects with chronic widespread pain were classified according to whether they had sought a medical consultation for the reported pain ("consulters") or not ("nonconsulters"). RESULTS: In all, 252 subjects (13%) satisfied American College of Rheumatology criteria for chronic widespread pain, and of these 72% reported having consulted a general practitioner about this pain. There was a clear difference in levels of psychological distress, measured by the General Health Questionnaire (GHQ), between consulters, nonconsulters, and those with no pain. Consulters did not differ from nonconsulters in terms of levels of fatigue, social dysfunction, or number of somatic symptoms reported. Although consulters (among whom one in 4 had a mental disorder) were more likely to have a mental disorder than subjects without pain [OR = 4.9, 95% CI (2.6, 9.5)] the increase in risk comparing consulters to nonconsulters [OR = 2.1, 95% CI (0.7, 5.9)] and nonconsulters to subjects without pain [OR = 1.4, 95% CI (0.7, 2.6)] was not significant. CONCLUSION: The results suggest that psychological distress is associated with chronic widespread pain in addition to any effect on whether consultation is sought for symptoms. The finding that one-quarter of consulters to primary care with chronic widespread pain have a mental disorder should alert primary care physicians and rheumatologists to screen for mental disorder in this group.     

Semiological seizure classification

We propose an epileptic seizure classification based exclusively on ictal semiology. In this semiological seizure classification (SSC), seizures are classified as follows: a. Auras are ictal manifestations having sensory, psychosensory, and experiential symptoms. b. Autonomic seizures are seizures in which the main ictal manifestations are objectively documented autonomic alterations. c. "Dialeptic" seizures have as their main ictal manifestations an alteration of consciousness that is independent of ictal EEG manifestations. The new term "dialeptic" seizure has been coined to differentiate this concept from absence seizures (dialeptic seizures with a generalized ictal EEG) and complex partial seizures (dialeptic seizures with a focal ictal EEG). d. Motor seizures are characterized mainly by motor symptoms and are subclassified as simple or complex. Simple motor seizures are characterized by simple, unnatural movements that can be elicited by electrical stimulation of the primary and supplementary motor area (myoclonic, tonic, clonic and tonic-clonic, versive). Complex motor seizures are characterized by complex motor movements that resemble natural movements but that occur in an inappropriate setting ("automatisms"). e. Special seizures include seizures characterized by "negative" features (atonic, astatic, hypomotor, akinetic, and aphasic seizures). The SSC identifies in detail the somatotopic distribution of the ictal semiology as well as the seizure evolution. The advantages of a pure SSC, as opposed to the current classification of the International League Against Epilepsy (ILAE), which is actually a classification of electroclinical syndromes, are discussed.     

Randomized trial of brief motivational treatments for pathological gamblers: More is not necessarily better.

The efficacy of brief treatments for media-recruited pathological gamblers was tested in a randomized clinical trial design (N = 314). Two self-directed motivational interventions were compared with a 6-week waiting list control and a workbook only control. Brief motivational treatment involved a telephone motivational interview and a mailed self-help workbook. Brief motivational booster treatment involved a telephone motivational interview, a workbook, and 6 booster telephone calls over a 9-month period. Primary outcomes were gambling frequency and dollar losses. As hypothesized, brief and brief booster treatment participants reported less gambling at 6 weeks than those assigned to the control groups. Brief and brief booster treatment participants gambled significantly less often over the first 6 months of the follow-up than workbook only participants. However, the workbook only participants were as likely to have significantly reduced their losses over the year and to have not met criteria for pathological gambling. Contrary to the hypothesis, participants in the brief booster treatment group showed no greater improvement than brief treatment participants. These results provide further support for the value of brief motivational treatments for pathological gambling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cannabis use, abuse, and dependence in a population-based sample of female twins

OBJECTIVE: The rate of cannabis use by women has been increasing in recent decades. This study examined the etiology of cannabis use and abuse among women and the possible role of genetic risk factors. METHOD: Unselected individual twins (N=1,934) from female-female pairs ascertained through a population-based registry, including both members of 485 monozygotic pairs and of 335 dizygotic pairs, were interviewed by telephone to assess lifetime cannabis use, heavy use, abuse, and dependence as defined by DSM-IV criteria. Biometric model fitting was performed with the Mx computer package. RESULTS: The prevalences of lifetime cannabis use, heavy use, abuse, and dependence were 47.9%, 6.7%, 7.2%, and 2.2%, respectively. Model fitting suggested that twins' resemblance for liability to cannabis use was due to both genetic and familial-environmental factors, while twins' resemblance for heavy cannabis use and abuse and symptoms of dependence resulted solely from genetic factors, with heritabilities ranging from 62% to 79%. The frequency of adolescent social contact between co-twins, which was greater among monozygotic than among dizygotic twins, predicted the twins' resemblance in cannabis use. However, further analyses suggested that the heritability of cannabis use was at most modestly inflated by such social factors. CONCLUSIONS: In women, genetic risk factors have a moderate impact on the probability of ever using cannabis and a strong impact on the liability to heavy use, abuse, and, probably, dependence. By contrast, the family and social environment substantially influences risk of ever using cannabis but plays little role in the probability of developing heavy cannabis use or abuse.     

Complexity of adult verbal behavior in a dyadic situation with retarded children.

The purpose of the study was to observe the verbal behavior of young normal adults assembled with retarded children characterized in advance as either high (H) or low (L) with a standardized language test. Each adult was asked to "interview" 1 child at a time for ? hr. 6 adults interviewed 4 different H children and the 6 other adults interviewed 4 different L children. A measure of the child's verbal output during the interview confirmed usefulness of the language test to classify children in advance. Adults assembled with L children had a significantly lower average type-token ratio than those assembled with H children. Measures of the complexity and number of adult questions did not show any significant differences between H and L children. Possible implications of adult reactions to retarded children were briefly discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trusting problem gamblers: Reliability and validity of self-reported gambling behavior.

The retest reliability and validity of self-reported gambling behavior were assessed in 2 samples of problem gamblers. Days gambled and money spent gambling over a 6-month timeframe were reliable over a 2- to 3-week retest period using the timeline follow-back interview procedure (N=35; intraclass correlation coefficients [ICCs] ranged from .61 to .98). Gamblers did, however, report significantly more gambling at the 2nd interview. Agreement with collaterals was fair to good overall (ICCs ranged from .46 to .65) with no clear pattern of either over- or underreporting by gamblers. Spouses did not show greater agreement with gamblers compared with nonspouses, and greater agreement was not found for collaterals who were more versus less confident in their reports. The results are generally supportive of the use of self-reported gambling in studies of problem gamblers, assessed face to face and by telephone, although suggestions for further research are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancement of the value of hip questionnaires by telephone follow-up evaluation

Errors, omissions, false understanding, and contradictory answers can compromise the use of questionnaires to generate follow-up data. To assess the utility of and effort involved in adding routinely a telephone interview to clarify the questionnaire, a study of total hip arthroplasty patients was carried out. Thirty-six patients with 37 primary and 13 revision total hip arthroplasties filled out a standardized questionnaire (which asks a number of demographic questions as well as questions that allow calculation of the Medical Outcome Studies [MOS] 36-Item Short-form Health Survey [SF-36], Western Ontario MacMaster Arthritis Center [WOMAC] osteoarthritis index, and Harris hip score) prior to returning for routine follow-up evaluation a minimum of 1 year after surgery. Two hundred thirty-two of a possible 4,350 responses (5.3%) were missing, contradictory, or answered with two or more answers on the questionnaire. Only eight such defects occurred following the telephone interview by a skilled orthopaedic surgeon, representing a significant reduction in these defects (P < .005). The average time of the telephone call was 2.8 minutes (range, 1-12 minutes), and the average number of attempts to contact the patient was 1.4 (range, 1-6). All questionnaire data and questionnaire data plus telephone data were compared with data obtained from a subsequent face-to-face interview by a different skilled orthopaedic surgeon who was blinded to the data from both the questionnaire and the telephone interview. It is demonstrated that a telephone call to follow up a standardized, self-administered questionnaire is a very effective way to augment the quality and quantity of questionnaire responses.     

Test-retest stability of interaction patterns during interviews conducted one week apart.

Using a standardized psychiatric interview, a single examiner interviewed 20 patients in test-retest interviews 7 days apart. Interaction was measured with Chapple's interaction chronograph. Interaction patterns are stable over the test period, and "can be predictably modified… by planned changes in the interviewer's behavior." (PsycINFO Database Record (c) 2010 APA, all rights reserved)