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PubMed2004

The Hamilton Depression Rating Scale: has the gold standard become a lead weight?

OBJECTIVE: The Hamilton Depression Rating Scale has been the gold standard for the assessment of depression for more than 40 years. Criticism of the instrument has been increasing. The authors review studies published since the last major review of this instrument in 1979 that explicitly examine the psychometric properties of the Hamilton depression scale. The authors' goal is to determine whether continued use of the Hamilton depression scale as a measure of treatment outcome is justified. METHOD: MEDLINE was searched for studies published since 1979 that examine psychometric properties of the Hamilton depression scale. Seventy studies were identified and selected, and then grouped into three categories on the basis of the major psychometric properties examined-reliability, item-response characteristics, and validity. RESULTS: The Hamilton depression scale's internal reliability is adequate, but many scale items are poor contributors to the measurement of depression severity; others have poor interrater and retest reliability. For many items, the format for response options is not optimal. Content validity is poor; convergent validity and discriminant validity are adequate. The factor structure of the Hamilton depression scale is multidimensional but with poor replication across samples. CONCLUSIONS: Evidence suggests that the Hamilton depression scale is psychometrically and conceptually flawed. The breadth and severity of the problems militate against efforts to revise the current instrument. After more than 40 years, it is time to embrace a new gold standard for assessment of depression.

Depressive Disorder↗
PubMed2004

An evaluation of the incremental validity of the MMPI-2 Superlative (S) scale in an inpatient psychiatric sample.

The MMPI-2 Superlative (S) scale was developed by Butcher and Han (1995) to assess individuals' tendencies to present themselves in an unrealistically positive light. The current study examined the performance of the L, K, and S scales in accurately distinguishing the MMPI-2 profiles of 379 psychiatric inpatients who produced one or more elevations on the basic scale profiles, from 82 psychiatric inpatients who produced no clinical range elevation on any of the eight basic clinical scales (excluding scales 5 and 0). The findings from the present study indicate that the S scale appears to be effective in the identification of defensiveness among psychiatric inpatients, with mean effect sizes in the moderate to large range. The optimal T-score cutoff for identifying defensive responders was 70 for both men and women. Further, results of hierarchical regression analyses showed that the S scale added incrementally to the prediction levels achieved by the optimal combination of the L and K scales.

Adult↗
PubMed2006

Incremental validity of the MMPI-2 PSY-5 scales in assessing self-reported personality disorder criteria.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Personality Psychopathology-Five (PSY-5) scales were developed to measure abnormal personality symptomatology. The present study examines the incremental validity of the PSY-5 scales beyond the clinical and content scales in assessing criteria associated with personality disorders. The current sample includes 240 male and 407 female clients from private practice settings who completed the MMPI-2 and the Multiaxial Diagnostic Inventory (MDI), a self-report checklist of Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised) symptoms. Six of the MDI personality disorder scales, conceptually related to the PSY-5 scales, are used as criteria. Hierarchical regression analyses determine the incremental validity of each PSY-5 scale. In most analyses, PSY-5 scales add a significant increment of variance to the clinical and content scales. Implications of the results are discussed.

Adult↗
PubMed2006

Elevation differences between MMPI-2 clinical and restructured clinical (RC) scales: frequency, origins, and interpretative implications.

The frequency, origin, and interpretative implications of elevation differences on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical and restructured clinical (RC) scales were examined. Two large clinical samples consisting of 1,770 outpatients and 2,438 inpatients were used for this study. Three potential factors (Demoralization, subtle items, and K correction) were explored as to the extent to which they contributed to elevation differences between a clinical scale and its restructured counterpart. Results showed that differences in elevation between clinical and RC scales occurred between 10% and 35% of cases. Demoralization, subtle items, and K correction contributed substantially to elevation differences. Findings indicate that core descriptors of a clinical scale should be emphasized only when its corresponding RC scale is also elevated, whereas for Scales 4, 6, and 8, elevated scores on the RC scales are interpretable even when the corresponding clinical scales are not elevated.

Adult↗
PubMed2002

Rating scales in old age psychiatry.

BACKGROUND: There is a vast array of scales available to assess all aspects of mental and physical health in older people which may be of relevance to the work of old age psychiatrists. AIMS: To summarise some of the scales that may be commonly used in clinical and research practice and to give the reader guidelines as to where further information can be obtained. METHOD: The scales were selected on the basis of the authors' own clinical and research knowledge and information was gathered from a comprehensive text on assessment scales in old age psychiatry. Results The selected scales are described in brief and a table outlines the purposes for which they are most suitable. CONCLUSIONS: Although many scales are available, the choice of the individual scale relies specifically on the question that is to be asked. The ideal scale does not exist.

Aged↗
PubMed1993

Clinical correlates of MMPI depression scales.

We investigated whether Scale 2 (Depression [D]) and the Wiggins Content Scale of Depression (DEP) of the Minnesota Multiphasic Personality Inventory (MMPI) have different clinical correlates when only one of these two scales is elevated. According, a group of patients who elevated DEP higher than Scale 2 (DEP > 2) were compared with a group of patients who elevated Scale 2 higher than DEP (2 > DEP). The patients with DEP > 2 were rated as being less severe than the patients with 2 > DEP on the following Brief Psychiatric Rating Scales: Somatic Concern (SOM), Emotional Withdrawal (WDRA), Depressive Mood (DEP), and Blunted Affect (AFF). The patients with DEP > 2 were rated as more severe on Excitement (EXC). The patients with DEP > 2 were more likely to receive the Axis I diagnoses of: bipolar disorder, manic, and alcohol abuse. Schizophrenia was equally probable for patients in the two groups. It appears that these two MMPI scales of depression have different clinical correlates when either one scale or the other is elevated.

Adult↗
PubMed2003

Predicting dangerousness with two Millon Adolescent Clinical Inventory psychopathy scales: the importance of egocentric and callous traits.

Psychopathy in youth has received increased recognition as a critical clinical construct for the evaluation and management of adolescents who have come into contact with the law (e.g., Forth, Hare, & Hart, 1990; Frick, 1998; Lynam, 1996, 1998). Although considerable attention has been devoted to the adult construct of psychopathy and its relation to recidivism, psychopathy in adolescents has been less thoroughly researched. Recently, a psychopathy scale (Murrie and Cornell Psychopathy Scale; Murrie & Cornell, 2000) was developed from items of the Millon Adolescent Clinical Inventory (MACI; Millon, 1993). This scale was found to be highly related to the Psychopathy Checklist-Revised (Hare, 1991) and was judged to have demonstrated good criterion validity. A necessary step in the validation process of any psychopathy scale is establishing its predictive validity. With this in mind, we investigated the ability of the MACI Psychopathy Scale to predict recidivism with 55 adolescent offenders 2 years after they had been evaluated at a juvenile court evaluation unit. In addition, we devised a psychopathy scale from MACI items that aligned more closely with Cooke and Michie (2001) and Frick, Bodin, and Barry's (2001) recommendations for the refinement of psychopathy and tested its predictive validity. Results indicate that both scales had predictive utility. Interpersonal and affective components of the revised scale were particularly important in the prediction of both general and violent reoffending.

Adolescent↗
PubMed1988

A longitudinal study comparing scaling, osseous surgery and modified Widman procedures. Results after one year.

The purpose of this study was to compare, longitudinally, the effectiveness of scaling and root planing, osseous surgery, and the modified Widman procedures. The study was carried out in a private practice setting. Sixteen adult patients with moderate to advanced adult periodontitis were treated with initial scaling and oral hygiene procedures. Posthygiene data were used for comparison of changes in probing depth, clinical attachment levels and gingival recession. The initial examination data were used to compare changes in plaque and gingival indices. Frequency distributions were used to compare changes that occurred at individual sites. At one year, plaque and gingival indices were significantly reduced when compared with the initial examination. At one year, shallow pockets (1-3 mm) were reduced when compared to posthygiene. Four- to six-millimeter pockets were significantly reduced by the three procedures. Osseous surgery and modified Widman had significantly greater pocket reduction when compared with scaling. For pockets greater than 7 mm, osseous surgery and the modified Widman had significantly greater reduction when compared with scaling. For pockets 1-3 mm at one year osseous surgery had significantly greater clinical attachment loss when compared with scaling. For 4-6 mm pockets at one year, the three procedures had slight gains in clinical attachment levels. The results were similar for pockets with greater than 7 mm. Interproximal soft tissue craters were measured for six postoperative weeks. Initially, the modified Widman had a higher percentage of soft tissue craters when compared with osseous surgery. At six weeks, however, there were no significant differences when the surgical procedures were compared. Recession was measured at each examination. Recession for 1-3 mm pockets at one year was greater for osseous surgery when compared with scaling and the modified Widman. Recession for 4-6 mm and greater than 7 pockets was greater for the surgical procedures than scaling. The results from this study indicate that with three-month maintenance recalls, both the modified Widman and osseous surgery are effective for pocket reduction, and each will produce a slight gain of clinical attachment over one year. Scaling was effective at maintaining attachment levels but was not as effective in reducing pocket depth.

Adult↗
PubMed1996

Effectiveness of subgingival scaling and root planing: single versus multiple episodes of instrumentation.

This study evaluates the effectiveness of subgingival scaling and root planing comparing the effect of a single instrumentation to the effect of three instrumentations. A total of 35 teeth in 15 patients were selected; 15 were scaled once (Group A), 15 were scaled three times (Group B), and 5 were used as controls (Group C), representing teeth that were not instrumented. The Group A and B teeth were chosen in the same patient based on random selection. All the teeth were scored by the calculus index of the periodontal disease index. Six surface locations were probed to determine probing depth. The level of the gingival margin was marked on the teeth to locate supra- and subgingival calculus after extraction. The Group A and B teeth received the initial episode of scaling and root planing for not more than 10 minutes, then only the Group B teeth received two additional instrumentations of not more than 5 minutes each. The additional instrumentations were performed 24 hours after the initial scaling. The scaled and control teeth were extracted immediately after the third instrumentation period. The teeth were washed with water and stained with methylene blue. They were viewed under a stereomicroscope which had a tenth grid on its eyepiece. Assessments were made involving the total counts and percents of the surfaces covered with calculus on the scaled and unscaled teeth. The results demonstrated no significant difference in the effectiveness of calculus removal between single and multiple episodes of scaling and root planing. Similar results were found for the total amount of calculus removed, the calculus removed from individual surfaces, and the calculus removed from various probing depth levels.

Adult↗
PubMedDate not supplied

[French validation of a Minor Morphologic Anomalies Scale in schizophrenic patients and their parents].

UNLABELLED: Minor Physical Anomalies represent valuable indices of disturbance in early neurodevelopment. They are frequently observed in individuals with various brain disorders, including mental retardation, autism, epilepsy, hyperactivity, foetal alcohol syndrome and schizophrenia. The high prevalence of Minor Physical Anomalies in schizophrenia provides considerable support for a neurodevelopmental model in this disorder. However, studies in large sample using standardised scale are lacking. Such studies are needed in order to confirm their actual frequency and study the clinical correlates or morphological anomalies. OBJECTIVE: The aim of this study was to revise and validate a French version of a scale designed for the evaluation of Minor Physical Anomalies in adult psychiatric patients and notably in patients with schizophrenia. METHODOLOGY: The scale was revised from the Waldrop scale. The choice of items was done on the basis of frequency, reliability in the adult, reliability of rating. Some new items, related to know syndroms with comportmental symptoms were added. Both raters had previously had a short initiation to the rating of the scale. Interrater reliability between two examiners, blind with regards to the diagnosis was evaluated. RESULTS: The interrater reliability was good, with an intraclass correlation coefficient at 0.97. Patients had significantly more minor physical anomalies than comparison subjects, and also more Minor Physical Anomalies than their parents. Fathers and mothers of these schizophrenic patients had significantly more Minor Physical Anomalies than normal comparison subjects. CONCLUSION: Although the evaluation of physical anomalies relies on subjective appreciation of normal vs abnormal, the revised version of minor physical anomalies scale (French version) was found to be a reliable tool, provided that a short initiation to the rating is performed. The scale differentiated schizophrenic patients from their parents, and the latter from the normal controls. A lot of questions remains unanswered concerning the neurodevelopmental hypothesis of schizophrenia. This scale appeared as a useful complementary tool to help in the determination of the developmental phenotypic status of the patients enrolled in pathophysiological studies aiming the identification of developmental factors in schizophrenia.

Adult↗
PubMed2004

[Assessment of presence and degree of depression in elderly, chronic ill patients: application selected scales advantages and disadvantages of this method of diagnosis].

The aim of our study was to assess diagnostic worth of 3 popular scale of depression in the group of elderly, chronic ill patients, treated in internal hospitals. 3 scales were used: Hamilton Depression Rating Scale (HDRS) Beck Depression Inventory (BDI), Geriatric Depression Scale (GDS). Results were compared to assessment of presence and degree of depression according to ICD-10. The sample consisted of 30 elderly ill patients who were admitted in Internal Institute Medical University in Gdansk. There were 15 women and 15 men, the mean age: 72.8+/-7.02 years. We assessed agreement of diagnosis between 3 psychometric methods in comparison with results after standard psychiatric examination. Specifities of HDRS and BDI were low: 66%. Correlation coefficients between scales were high 0.74-0.87. But only compared to BDI and GDS there were no significant differences between distribution of patients in each group of depression intensity measured chi2 test. In case of HDRS there was significant difference which was an effect of false positive results. Our results showed small usefulness of HDRS in this group of patients. Scales of depression are useful in 2 important conditions: I. Scale should not replace full psychiatric examination. II. Proper scale for age and somatic state should be applied.

Aged↗
PubMedDate not supplied

[Behavioral pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD): Spanish validation].

INTRODUCTION: The Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) is a screening instrument for the evaluation of behavioral disturbances in Alzheimer's patients. Our aim was to validate the BEHAVE-AD test in Spanish, intended for use in routine clinical practice. METHOD: We assessed the validity of the BEHAVEAD in 79 nursing-home patients with diagnosis criteria of dementia, scoring 4 or higher on the Global Deterioration Scale (GDS) scale, by developing a crossed validated form between the Neuropsychiatric Inventory-Questionnaire (NPI-Q) and BEHAVE-AD tests. Both instruments were rated by an expert clinician. In order to study the concurrent validity of some of the BEHAVE-AD subscales, we compared the Cohen-Mansfield Agitation Inventory (CMAI) and the Hamilton Depression Rating Scale (HDRS) tests. RESULTS: The Pearson correlation index between the BEHAVE-AD test and the NPI-Q, was significant but moderate (r=0.694). Pearson's correlation between BEHAVEAD's symptoms scale and NPI-Q's severity scale was r=0.698. When comparing BEHAVE-AD's global evaluation scale (caregiver's disturbance) and NPI-Q's distress scale, the correlation index was 0.535. CONCLUSIONS: The BEHAVE-AD Spanish version offers the possibility to use a screening tool for the detection of neuropsychiatric symptoms in dementia patients, also applicable to nursing home residents, administered by an expert clinician.

Aged↗
PubMed1996

Effects of a scaling gel on forces developed in debridement of supragingival calculus determined by means of a transducer-modified dental scaler: the Quanticalc.

The efficacy of a calculus scaling gel, SofScale (Dentsply, York, PA), has been examined in two protocols by the measurement of scaling forces developed in supragingival calculus debridement from the anterior dentition using hand scaling with a transducer-modified dental scaler, the Quanticalc. In one protocol, the effects of the scaling gel were compared to a placebo gel composed of conventional toothpaste in a double-blind, split-mouth design. In another protocol, the effects of the scaling gel were determined in comparison to non-treated calculus. Results demonstrated that the scaling gel had no apparent effects on the physical forces (work) involved in calculus removal. These results suggest that the application of the scaling gel provides no quantitative benefits in facilitating calculus debridement during manual tooth scaling.

Analysis of Variance↗
PubMed1992

Factors determining the outcome of scaling and root planing.

Scaling and root planing are the predominant and recognized forms of periodontal therapy. They have been known for centuries, and have been investigated with increasing intensity since the turn of the century. Scaling and root planing aim at therapeutic changes of the "hard tissue lesion" at the root surface, in order to render it biologically acceptable to cells capable of attaching to it. Two major components of these root surface alterations are calculus and cementum alterations. Numerous studies have shown that scaling and root planing effectively removes subgingival deposits, and that this removal is seldom complete in deeper pockets. Even though beneficial clinical effects of scaling and root planing have been shown, it is unlikely that the full potential of healing is utilized today due to technical shortcomings. Several studies have shown that the design and dimensions of curets as used today are not optimal. These instruments are for many situations too big, subject to rapid dulling, and produce a smear layer. Chemical agents have been used to remove this layer with limited success. The therapist is a virtually unknown factor in the system of delivering scaling and root planing. A recent study showed that scaling and root planing forces used by different therapists on similar root surfaces varied by factors greater than 10. In addition, higher forces were shown to remove significantly more root substance. Apparently there is a large subjective component included in the delivery of scaling and root planing therapy. Even though scaling and root planing have been shown to be effective therapeutic procedures, many aspects require more research.

Clinical Competence↗
PubMed1998

Comparison of the clinical effects of subgingival application of metronidazole 25% gel and scaling in the treatment of adult periodontitis.

OBJECTIVE: Control of subgingival plaque is of paramount importance in the treatment of periodontal diseases. The role of subgingival sustained-release antibiotic therapy needs elucidation. A single-blind clinical trial was carried out in 13 patients with adult periodontitis to compare the effects of subgingival application of metronidazole dental gel with those of subgingival scaling. METHOD AND MATERIALS: A split-mouth design was used so that each patient received all treatments simultaneously. Randomly selected quadrants were treated with application of 25% metronidazole gel, subgingival scaling, or a combination of scaling and gel application. The remaining quadrant in each patient was left untreated as a control. RESULTS: All three treatments were effective in significantly reducing Plaque Index, Gingival Index, and bleeding on probing over the 14-week observation period. No statistically significant differences were found between scaling alone and combined treatment. Scaling and combined treatment were better than metronidazole. Metronidazole produced transient effects, best noted during the first 4 weeks after treatment. No additive effect of metronidazole was noted in the combined treatment. At week 14, only combined treatment sites and scaled sites showed statistically greater probing depth reduction than control sites. CONCLUSION: For the treatment of mild-to-moderate adult periodontitis, subgingival scaling alone is as effective as the combination of scaling and antibiotic therapy.

Adult↗
PubMed2004

Symptoms and treatment burden of gastroesophageal reflux disease: validating the GERD assessment scales.

BACKGROUND: A comprehensive assessment instrument that measures the burden of both symptoms and treatment is needed to determine the optimal management of gastroesophageal reflux disease (GERD), and we developed such an instrument. METHODS: This validation study included 3 groups: patients with active GERD (n = 193), surgical patients with prior GERD (n = 197), and general medical outpatients (n = 63). All completed an initial survey. General medical patients and patients with active GERD were resurveyed after 2 to 6 weeks. The main outcome measures were test-retest reliability, internal consistency, discriminant validity, and responsiveness to change for 3 scales graduated from 0 to 100: a GERD burden (or overall impact on quality of life scale), a symptoms scale, and a treatment scale. Higher scores indicated greater disease burden. RESULTS: The GERD burden, symptoms, and treatment scales all demonstrated good discriminant validity, as patients in the active-GERD group had the highest scores. Scores on each scale effectively classified the patients who belonged to the active-GERD group. Moreover, scores improved substantially 8 weeks after surgery, thereby demonstrating the scales' responsiveness to change. As hypothesized, the burden of treatment was distinct from that of symptoms, as 23% of patients not bothered by GERD symptoms described their GERD treatment to be a moderate or serious problem. Indeed, the impact of treatment problems approached that of symptoms problems. All pairwise comparisons were significant (P<.02). CONCLUSIONS: The GERD burden, symptoms, and treatment scales were valid, reliable, and responsive instruments for use in patients with GERD. Our analyses highlight the importance of assessing both symptoms and treatment burden in patients with GERD.

Cost of Illness↗
PubMed2000

Development of the vestibular disorders activities of daily living scale.

BACKGROUND: Existing scales of self-perceived disablement in patients with vestibular impairment either are too broad to detect the subtle deficits in this population or omit some important daily life tasks. OBJECTIVES: To develop a scale to assess self-perceived disablement in patients with vestibular impairment and to describe the development and initial testing of this new assessment tool. DESIGN: A list of items was developed, sent to a panel of expert therapists for review, and then revised to yield the preliminary 31-item, 10-point scale that was administered to subjects. The scale was revised again, yielding the final 28-item scale, which was administered to a new group of subjects. SETTING: Data were collected from patients in an outpatient clinic of a tertiary care center. PARTICIPANTS: Patients diagnosed as having benign paroxysmal positional vertigo and patients diagnosed as having chronic vestibulopathy, excluding Ménière disease, postsurgical vertigo, and postconcussion vertigo. RESULTS: The final scale has 3 subscales: functional, ambulation, and instrumental. It has good face validity, high internal consistency (alpha> or =.90), and high test-retest reliability (r(c)> or =0.87). Scale ratings ranged from 1 (independent) to 10 (ceasing to participate in the activity), but median scores for most subjects were 4 or less. From 41% (39/94) to 44% (41/94) of subjects considered themselves to be independent on those tasks. CONCLUSIONS: This scale has good face validity, high internal consistency, and high test-retest reliability. It may be useful for evaluating functional limitation and perceived handicap or disability before and after intervention and for helping patients become more realistic in understanding their own capabilities.

Activities of Daily Living↗
PubMed1978

Methodological advances in the validation of inventory items, scales, profiles and interpretations.

Factor analytic research is still in its infancy--theoretically, methodologically, and interpretively. Definitive research has not yet been done on problems of (a) item design and selection of items suitable for factor analysis; (b) identification of highly significant marker items; (c) tracings of item response distributions across scales, populations, occasions and other relevant variables; (d) determination of the number of items with different loadings necessary to obtain valid scale scores for psychological state measurements; (e) questions about the validity of summating factorially heterogeneous lowly correlated items in arriving at scale scores; (f) the use of clinical judgment to evaluate the possibly differing significances of the same item responses across populations and occasions; i.e., does the same factored item response have the same significance across scales?; (g) how to interpret scales with factorially mixed item compositions; (h) clinical judgement decisions in evaluating and interpreting scale meanings; and (i) the comparison of the results of analyzing data by different scaling methods. This study makes a start toward clarifying these methodological issues by analyzing the results of applying different methods of scale construction that utilized 146,000 item responses made by 730 Ss on the Personal Health Survey, a 200-item inventory designed to measure organ system functioning that contributes to physical and mental health.

Evaluation Studies as Topic↗