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The development of an observer-scale for measuring social dysfunction and aggression.

Scales for measuring aggressive cognitions and behaviour have mainly been administered by nursing-staff or been self-ratings. During recent years we have made an attempt to construct an observer-scale for aggression analogous to the Hamilton scale for depression. The Social Dysfunction and Aggression Scale (SDAS) consists of 9 items (SDAS-9) covering outward aggression and 2 items (SDAS-2) covering inward aggression. The inter-observer reliability of the SDAS has been found adequate in terms of intra-class coefficients. In a pilot study on 82 inpatients from different centres in Denmark and Sweden the SDAS was compared to three-item scales for outward and inward aggression and to a global scale for outward aggression. The results showed that the SDAS-9 correlated positively with the other outward observer-scales, and the SDAS-2 with the other inward scale. A divergent validity was seen between the outward and inward scales, indicating that it is necessary to measure both dimensions. Preliminary ranks-according-to-frequency scores showed the following order of the nine outward items: irritability, dysphoric mood, social disturbances, nondirected verbal aggressiveness, negativism, directed verbal aggressiveness, physical violence towards staff, physical violence towards things, and physical violence towards persons other than staff.

Aggression↗

Validity and reliability of the Minimum Data Set Depression Rating Scale (MDSDRS) for older adults in nursing homes.

OBJECTIVE: this research examined the psychometric properties of the Minimum Data Set Depression Rating Scale for use among older adults living in nursing homes. METHODS: interviews with 145 older adults in three nursing homes were conducted to complete the Hamilton Depression Rating Scale and the Geriatric Depression Scale. Information relevant to completing the Minimum Data Set Depression Rating Scale was gathered from the Minimum Data Set. RESULTS: the Minimum Data Set Depression Rating Scale did not perform well when validated against the Hamilton Depression Rating Scale and the Geriatric Depression Scale. Minimum Data Set Depression Rating Scale cut-off levels of > or =2 and > or =3 were associated with relatively low total score correlations and sensitivity rates, but acceptable specificity. CONCLUSIONS: findings suggest that the Minimum Data Set Depression Rating Scale may be of limited clinical value to identify depression among older adults living in nursing homes.

Aged↗

Validation of two anxiety scales in a university primary care clinic.

Psychometric scales for the assessment of anxiety disorders have not been validated in primary care settings. We undertook a study to validate two brief, self-administered anxiety scales, Sheehan's Patient-Rated Anxiety Scale and Beck's Cognition Checklist, in a university primary care clinic. The two scales were compared with a diagnostic standard, the Structured Clinical Interview for the revised third edition of the Diagnostic and Statistical Manual (SCID). Of 87 randomly selected patients, 25 had an anxiety disorder by the SCID. Anxious patients scored statistically higher on both scales than nonanxious persons on both the Beck and Sheehan scales. Based on receiver operating characteristics curve analysis, we found that these two scales correctly classified 72% to 77% of anxious patients. Of the two scales, the Sheehan scale performed better, with a specificity of 94% and positive predictive value of 75%. Our results suggest that these instruments may be useful in the assessment of the anxiety disorders in medical populations.

Academic Medical Centers↗

Child mania rating scale: development, reliability, and validity.

OBJECTIVE: To develop a reliable and valid parent-report screening instrument for mania, based on DSM-IVsymptoms. METHOD: A 21-item Child Mania Rating Scale-Parent version (CMRS-P) was completed by parents of 150 children (42.3% female) ages 10.3 +/- 2.9 years (healthy controls = 50; bipolar disorder = 50; attention-deficit/hyperactivity disorder [ADHD] = 50). The Washington University Schedule for Affective Disorders and Schizophrenia was used to determine DSM-IV diagnosis. The Young Mania Rating Scale, Schedule for Affective Disorders and Schizophrenia Mania Rating Scale, Child Behavior Checklist, and Child Depression Inventory were completed to estimate the construct validity of the measure. RESULTS: Exploratory and confirmatory factor analysis of the CMRS-P indicated that the scale was unidimensional. The internal consistency and retest reliability were both 0.96. Convergence of the CMRS-P with the Washington University Schedule for Affective Disorders and Schizophrenia mania module, the Schedule for Affective Disorders and Schizophrenia Mania Rating Scale, and the Young Mania Rating Scale was excellent (.78-.83). The scale did not correlate as strongly with the Conners parent-rated ADHD scale, the Child Behavior Checklist -Attention Problems and Aggressive Behavior subscales, or the child self-report Child Depression Inventory (.29-.51). Criterion validity was demonstrated in analysis of receiver operating characteristics curves, which showed excellent sensitivity and specificity in differentiating children with mania from either healthy controls or children with ADHD (areas under the curve of.91 to.96). CONCLUSION: The CMRS-P is a promising parent-report scale that can be used in screening for pediatric mania.

Adolescent↗

Staging the severity of dementia: comparison of clinical (CDR, DSM-III-R), functional (ADL, IADL) and cognitive (MMSE) scales.

The Helsinki Aging Study is based on a random sample of 795 subjects aged 75 years (N = 274), 80 years (N = 266) and 85 years (N = 255). Ninety-three demented patients were found. All were assessed for severity of dementia by Clinical Dementia Rating (CDR) scale by a general practitioner and according to the DSM-III-R criteria by a neurologist. The Mini-Mental State Examination (MMSE) was carried out by a community nurse and the Index of ADL and the IADL-scale by a close informant. The correlation of the severity of dementia between the DSM-III-R criteria and the CDR scale was moderate. The overall agreement was 64.5% and the Kappa index 0.56. The CDR scale tended to put patients in milder categories than the DSM-III-R criteria. The correlation between the clinical scales and categorized MMSE was moderate to fair. The overall agreement between MMSE and DSM-III-R criteria was 64% (Kappa 0.44) and between MMSE and CDR scale 55% (Kappa 0.33%). The dispersion of the functional scales (ADL, IADL) was much greater indicating that there were also other factors influencing the functional capacity than the degree of dementia. Different methods in staging dementia give different results thus influencing for instance the results of epidemiological studies. Functional scales are needed in clinical practice in addition to the assessment of the severity of dementia. The CDR scale is useful in assessing the need for support services.

Activities of Daily Living↗

Reliability and validity of the Newcastle Scales in relation to ICD-9-classification.

The assessment of endogenous depression by means of the Newcastle Scales (1965, 1971) has been validated by their correlation with biological findings in many previous studies. However, reliability and cross validation studies are lacking for these scales. We found the reliability of the Newcastle Scales to be sufficient or at least moderate in a sample of 70 inpatients with major depression. In order to cross validate both scales, the clinical classification according to ICD-9 and the assessment of the Newcastle Scales have been performed independently in a sample of 112 inpatients with Major Depressive Disorder (RDC). The rate of agreement between clinical diagnosis and classification according to the Newcastle Scales of endogenous depression is only fair. However, a modification of the diagnostic algorithm applied to the items of the Newcastle Scales I (1965) improves the rate of agreement considerably. The Newcastle Scale I turned out to represent a heterogenous concept without sufficient transferability. Modifications of both scales are proposed.

Adult↗

Rating scales for mood disorders: applicability, consistency and construct validity.

Rating scales for mood disorders have been reviewed with special reference to their consistency, applicability, and validity. Diagnostic scales with a biometric reference to antidepressants have been developed on the basis of the Newcastle Scales. This Diagnostic Melancholia Scale (DMS) includes two dimensions, one measuring endogenous depression, and one measuring reactive depression. These dimensions were found not to be mutually exclusive as 30% of the depressed patients scored high on both dimensions. Scales measuring outcomes of treatment were subdivided into (a) scales measuring disability of clinical depression (melancholia), anxiety, and mania, (b) scales measuring distress as a construct of side-effects during treatment, and (c) scales measuring discomfort or quality of life. Disability, distress and discomfort should be separately validated as they reflect different aspects of outcome of treatment. Self-rating scales have their main applicability in the measurement of discomfort.

Anxiety Disorders↗

External correlates of the MMPI-2 content component scales in mental health inpatients.

External correlates of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Content Component Scales were identified using an inpatient sample of 544 adults. The Brief Psychiatric Rating Scale (BPRS) and Symptom Checklist 90-Revised (SCL-90-R) produced correlates of the Content Component Scales, demonstrating external validity with clinician-rated and self-report scales. Relationships between MMPI-2 Content Component Scales and patient hospital chart variables were also examined. Results demonstrated cross-criterion validity in that most MMPI-2 Content Component Scales correlated with appropriate BPRS dimensions, SCL-90-R items, and other patient variables. Discriminant validity of the Content Component Scales was also demonstrated. In addition, the finding that similar patterns of correlates are produced when the component scales are correlated with a self-report measure, as well as clinician ratings and medical chart variables, provides converging lines of evidence supporting the construct validity of the Content Component Scales.

Adult↗

The effect of scale form choice on psychometric properties of patient satisfaction measurement.

One hundred and fifty nine subjects responded to one of three differently labeled 5-point scale forms of patient satisfaction measurement: Likert-type scale form (1 = Strongly Agree, 5 = Strongly Disagree); Mixed scale form (1 = Very Satisfied, 5 = Very Dissatisfied); and Expectational scale form (1 = More Than I Expected, 5 = Less Than I Expected). A well-known patient satisfaction instrument developed by Ware and colleagues (Ware, Snyder, and Wright, 1976) was utilized to manipulate the scale form effect. The psychometric properties of each scale form was analyzed. The findings indicated generally comparable satisfaction data generated by each scale form as well as comparable measures of reliability. The Likert-type scale form has shown advantage in reducing leniency (relatively high satisfaction scores) over the mixed and expectational scale forms.

Adult↗

Reliability and validity of a Portuguese version of the Young Mania Rating Scale.

The reliability and validity of a Portuguese version of the Young Mania Rating Scale were evaluated. The original scale was translated into and adapted to Portuguese by the authors. Definitions of clinical manifestations, a semi-structured anchored interview and more explicit rating criteria were added to the scale. Fifty-five adult subjects, aged 18 to 60 years, with a diagnosis of Current Manic Episode according to DSM-III-R criteria were assessed using the Young Mania Rating Scale as well as the Brief Psychiatric Rating Scale in two sessions held at intervals from 7 to 10 days. Good reliability ratings were obtained, with intra-class correlation coefficient of 0.97 for total scores, and levels of agreement above 0.80 (P < 0.001) for all individual items. Internal consistency analysis resulted in an alpha = 0.67 for the scale as a whole, and an alpha = 0.72 for each standardized item (P < 0.001). For the concurrent validity, a correlation of 0.78 was obtained by the Pearson coefficient between the total scores of the Young Mania Rating Scale and Brief Psychiatric Rating Scale. The results are similar to those reported for the English version, indicating that the Portuguese version of the scale constitutes a reliable and valid instrument for the assessment of manic patients.

Adolescent↗

[Reliability and validity of the Cornell Scale for Depression in Dementia in an elderly Turkish population].

OBJECTIVE: The reliability and validity of the Cornell Scale for Depression in Dementia were investigated in a Turkish population over 60 years of age. METHOD: Forty-six male and 34 female demented elderly people classified as demented according to DSM-IV criteria were included in the study. The Structured Clinical Interview for DSM-IV Clinical Version (SCID-I) was completed for all subjects to establish the diagnosis of major depression. The Cornell Scale for Depression in Dementia (CSDD), Geriatric Depression Scale (GDS), Mini Mental State Examination (MMSE) and Global Deterioration Scale (GDS) were used. RESULTS: A high test-retest correlation level (r: 0.93) was obtained for the total scores of the scale. The scale also showed high internal consistency (a: 0.86). The validity analysis of the scale resulted in a significant difference (p<0.001) between the total scores of the group with dementia and depression and the group with dementia but without depression. Two items (9-19) showed a low correlation (r<.30) in the test-retest analysis. On the other hand, two items (6-19) had a low item-total score correlation (r<.30). CONCLUSIONS: The results indicated that the scale is reliable and valid for diagnosing depression in dementia in an elderly Turkish population. We expect that the Cornell Scale for Depression in Dementia will be a useful instrument in pharmacological investigations and in studies of the phenomenology and course of depressive symptoms in demented patients.

Aged↗

Equivalence of the original and revised dental anxiety scales.

PURPOSE: The Corah Dental Anxiety Scale (DAS) was introduced in 1969 as a brief, valid, and reliable instrument to measure anxiety about dental visits. Since then, changes in language usage and dental practice have rendered the scale outdated. In 1994, Ronis introduced the Dental Anxiety Scale-Revised (DAS-R), a version of the DAS revised to acknowledge the roles of dental hygienists and female dentists in the dental office. The current study was conducted to determine whether the original and revised scales are equivalent. METHODS: The study tested the equivalence of the two scales by including both in a questionnaire filled out by 141 male and female college students. Psychometric equivalence was examined by comparing the means, and reliabilities (alphas) of the two scales and by correlating the two scales with each other. RESULTS: Mean scores, variances, and reliabilities of the two versions of the scale did not differ. The Pearson correlation between the two scales was .98. CONCLUSIONS: It appears that the DAS-R is psychometrically equivalent to the DAS and can be used in its place whenever more up-to-date wording is desired.

Adolescent↗

Epidermal differentiation in the developing scales of embryos of the Australian scincid lizard Lampropholis guichenoti.

Formation of the first epidermal layers in the embryonic scales of the lizard Lampropholis guichenoti was studied by optical and electron microscopy. Morphogenesis of embryonic scales is similar to the general process in lizards, with well-developed overlapping scales being differentiated before hatching. The narrow outer peridermis is torn and partially lost during scale morphogenesis. A second layer, probably homologous to the inner peridermis of other lizard species, but specialized to produce lipid-like material, develops beneath the outer peridermis. Two or three lipogenic layers of this type develop in the forming outer surface of scales near to the hinge region. These layers form a structure here termed "sebaceous-like secretory cells." These cells secrete lipid-like material into the interscale space so that the whole epidermis is eventually coated with it. This lipid-like material may help to reduce friction and to reduce accumulation of dirt between adjacent extremely overlapping scales. At the end of their differentiation, the modified inner periderm turns into extremely thin cornified cells. The layer beneath the inner peridermis is granulated due to the accumulation of keratohyalin-like granules, and forms a shedding complex with the oberhautchen, which develops beneath. Typically tilted spinulae of the oberhautchen are formed by the aggregation of tonofilaments into characteristically pointed cytoplasmic outgrowths. Initially, there is little accumulation of beta-keratin packets in these cells. During differentiation, the oberhautchen layer merges with cells of the beta-keratin layer produced underneath, so that a typical syncytial beta-keratin layer is eventually formed before hatching. Between one-fourth distal and the scale tip, the dermis under epidermal cells is scarce or absent so that the mature scale tip is made of a solid rod of beta-keratinized cells. At the time of hatching, differentiation of a mesos layer is well advanced, and the epidermal histology of scales corresponds to Stage 5 of an adult shedding cycle. The present study confirms that the embryonic sequence of epidermal stratification observed in other species is basically maintained in L. guichenoti.

Animals↗

Nine standardized scales for evaluating treatment outcome in a mental health clinic.

Analyzed psychometrics of a package of standardized scales used to assess mental health treatment outcomes in a VA cost-effectiveness study (N = 451). Nine scales were derived: Family involvement, involvement with friends, labor market participation, symptomatology (both self-reported and therapist rated), substance abuse (alcohol and drugs), client satisfaction, and client goal attainment. Scales were drawn from several existing instruments, including the Denver Community Mental Health Questionnaire (CMHQ), the Symptom Checklist 90 (SCL-90), the Global Assessment scale, and others. Item-item and item-total correlations showed each scale to have high internal consistency. Principal components analysis demonstrated distinct factors for each scale and good clustering of items within scales. All scale items are discrete choice and have excellent interrater reliability. Validity was corroborated by multiple regression, which showed different scales to be sensitive to different predictors of follow-up status.

Adult↗

The assessment of denial and physical complaints: the validity of the Hy scale and associated MMPI signs.

Little and Fisher (1958) have demonstrated that the MMPI Hysteria (Hy) scale consists primarily of items that address the denial of psychological problems (the DN scale) and items that involve the admission of physical problems (the AD scale). The traditional interpretation of an elevated Hy score implies that both DN and AD subscales are elevated significantly. Using samples of psychiatric (N = 1,246), medical (N = 330), and chronic pain patients (N = 126), the effectiveness of the HY scale and of various combinations of MMPI scales as predictors of the simultaneous occurrence of these two characteristics was evaluated. The results suggest that when the 13 standard MMPI scales were used, simultaneous elevations on scales K, HS, and HY proved to be the best indicator of the denial of psychological factors associated with a physiological disorder. It was found unwarranted to suggest the presence of hysteroid features on the basis of an elevated HY score unless scales K and HS also were elevated. The value of the HY scale as a measure of psychological denial associated with physical complaints must be considered questionable.

Adult↗

MMPI personality disorder scales and the MCMI: concurrent validity.

A set of DSM-III personality disorder scales recently were developed for the MMPI. The purpose of the present investigation was to provide data on the concurrent validity of these scales. Scores from both the overlapping and nonoverlapping MMPI personality disorder scales were compared against the criterion of the personality disorder scales of the MCMI in 47 psychiatric patients. In general, the MMPI personality scales correlated significantly with the corresponding MCMI scales. However, the antisocial (ANT), compulsive (CPS), and paranoid (PAR) scales of the MMPI failed to achieve adequate concurrent validity. For the ANT scale, this probably reflects conceptual differences between the Millon (1981) typology that underlies the MCMI and the DSM-III. The PAR scale appears to show some bias toward the assessment of paranoid and suspicious ideation, rather than paranoid personality characteristics.

Adjustment Disorders↗

Allometric scaling in the dentition of primates and prediction of body weight from tooth size in fossils.

Tooth size varies exponentially with body weight in primates. Logarithmic transformation of tooth crown area and body weight yields a linear model of slope 0.67 as an isometric (geometric) baseline for study of dental allometry. This model is compared with that predicted by metabolic scaling (slope = 0.75). Tarsius and other insectivores have larger teeth for their body size than generalized primates do and they are not included in this analysis. Among generalized primates, tooth size is highly correlated with body size. Correlations of upper and lower cheek teeth with body size range from 0.90-0.97, depending on tooth position. Central cheek teeth (P44 and M11) have allometric coefficients ranging from 0.57-0.65, falling well below geometric scaling. Anterior and posterior cheek teeth scale at or above metabolic scaling. Considered individually or as a group, upper cheek teeth scale allometrically with lower coefficients than corresponding lower cheek teeth; the reverse is true for incisors. The sum of crown areas for all upper cheek teeth scales significantly below geometric scaling, while the sum of crown areas for all lower cheek teeth approximates geometric scaling. Tooth size can be used to predict the body weight of generalized fossil primates. This is illustrated for Aegyptopithecus and other Eocene, Oligocene, and miocene primates. Regressions based on tooth size in generalized primates yield reasonable estimates of body weight, but much remains to be learned about tooth size and body size scaling in more restricted systematic groups and dietary guilds.

Animals↗

The Forensic Inpatient Observation Scale (FIOS): development, reliability and validity.

INTRODUCTION: Re-offending, as a measure of success in forensic psychiatry, gives no information about other behaviours that may have changed. The development of the Forensic Inpatient Observation Scale (FIOS), an observation instrument to assess the non-offending functioning of forensic patients, is described. STUDY 1: In the first study the development of the initial item pool of the FIOS is described. This resulted in an instrument consisting of 78 items and seven scales. The internal reliability of the scales ranged from 0.78 to 0.91. The inter-rater reliability of the scales varied from 0.50 to 0.85 and the test retest reliability over a period of three weeks was high for most scales, ranging from 0.74 to 0.89. STUDY 2: In the second study the FIOS was developed further in another sample of forensic patients. This time exploratory factor analysis with Varimax rotation and post hoc reliability analysis were applied to determine the factor structure among the items. This resulted in an item pool of 35 items, among which six factors could be distinguished that closely resemble the factor structure of the FIOS in study one: (1) self-care, (2) social behaviour, (3) oppositional behaviour, (4) insight offence/problems, (5) verbal skills and (6) distress. Most items have high loadings on the factor they are assigned; 29 items have a loading of 0.60 or higher. The internal consistency of the scales ranges from 0.73 to 0.91 and the scales appear to be measuring independent constructs. Twenty-five out of the 35 items have an inter-rater correspondence of 90% or higher and 30 out of 35 items have an inter-rater correspondence of 87.5% or higher. The inter-rater reliability on the scale level, however, was somewhat less satisfying with correlations ranging from 0.50 to 0.69. DISCUSSION: It is argued that training the observers on a more regular basis will improve the inter-rater reliability. There is some evidence for the convergent validity of the FIOS. The FIOS has some advantages over existing inpatient scales in that it is developed specifically for forensic patients, it does not particularly focus on axis 1 symptoms but includes oppositional behaviour and attitudes to offending.

Journal Article↗