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PubMed1998

A preliminary report: a new scale to identify the pseudodementia syndrome.

BACKGROUND: The literature was reviewed to abstract items which were claimed to distinguish organic dementia from pseudodementia. Their discriminating powers were tested in a prospective study. Eighteen of these items were selected to create a questionnaire which should distinguish organic dementia from pseudodementia. The gold standard was the final diagnosis given by a consultant psychiatrist 12-14 months later. METHOD: One hundred and twenty-eight patients referred to our service with a differential diagnosis of depressive pseudodementia were screened using a checklist of 44 characteristic features (in the form of questions with 'yes' or 'no' answers) which were claimed in the literature of differentiate between organic dementia and depressive pseudodementia. This checklist covers the areas of history, clinical data, insight and performance. RESULTS: Forty points (questions) out of the 44 in the checklist showed significant discriminating power to differentiate dementia from depressive pseudodementia (p < 0.01). A principal component and factor analysis was performed from which 18 questions were extracted. The shortened questionnaire was able to classify (43/44 cases) 98% of dementia cases and (60/63) 95% of depression correctly. A new definition has been introduced for 'pseudodementia' as a syndrome of reversible subjective or objective cognitive problems caused by non-organic disorder. Thus depressive pseudodementia may be classified into two subtypes. Type I is a group of patients who have depressive symptoms with subject complaint of dysmnesia without measurable intellectual deficits. Type II is a group of patients who have depressive symptoms and show poor cognitive performance based on poor concentration not due to organic disorder.

Aged↗
PubMed2000

Carbamazepine for cocaine dependence.

BACKGROUND: Cocaine dependence has become a substantial public health problem, developing a significant number of medical, psychological and social problems, including the spread of infectious diseases (e.g. AIDS, hepatitis and tuberculosis), crime, violence and neonatal drug exposure. Although there is no consensus regarding how to treat cocaine dependence, effective pharmacotherapy has a potentially major role to play as part of a broader treatment milieu. The anti-convulsant carbamazepine, a tricyclic medication that is widely used to treat a variety of neurological and psychiatric disorder, has also been used for treatment of cocaine dependence, although its effectiveness has not been established. OBJECTIVES: To determine whether carbamazapine (CBZ) is effective on the treatment of cocaine dependence. SEARCH STRATEGY: Electronic searches of Cochrane Library, EMBASE, MEDLINE, PsycLIT, Biological Abstracts and LILACS; scan of reference list of relevant articles; personal communication; conference abstracts; unpublished trials from pharmaceutical industry; book chapters on treatment of cocaine dependence. SELECTION CRITERIA: The inclusion criteria for all randomised controlled trials were that they should focus on the use of carbamazepine drugs versus placebo on the treatment of cocaine dependence. Trials including patients with additional diagnosis such as opiate dependence were also eligible. DATA COLLECTION AND ANALYSIS: The reviewers extracted the data independently and Odds Ratios, weighted mean difference and number needed to treat were estimated. Qualitative assessments of the methodology of eligible studies were carried out using validated checklists. The reviewers assumed that people who died or dropped out had no improvement and tested the sensitivity of the final results to this assumption. Where possible analysis was carried out according to the "intention to treat" principles. MAIN RESULTS: 5 studies were included in the review, with 455 people randomised. No differences were found regarding positive urine sample for cocaine metabolites. Scores on Spielberg State Anxiety Inventory slightly favoured carbamazepine, but didn't reach statistical significance. Dropouts were high in both groups up to 70% in the placebo group. Less dropout occurred in the Carbamazepine group (RR 0.87 95%CI 0.71-1.06). When no retention in treatment was due to side effects no differences were found. The number of participants presenting at least one side effect, reported in Kranzler (1995), was higher in the carbamazepine group (RR 4.33 95% CI 1.45-12.91). REVIEWER'S CONCLUSIONS: There is no current evidence supporting the clinical use of CBZ in the treatment of cocaine dependence. Larger randomised investigation must be considered taking into account that these time-consuming efforts should be reserved for medications showing more relevant and promising evidence.

Anticonvulsants↗
PubMed2002

Methadone at tapered doses for the management of opioid withdrawal.

BACKGROUND: Despite use in many countries of tapered methadone for detoxification from opiate, the evidence of efficacy to prevent relapse and promote lifestyle change has not been systematically evaluated. OBJECTIVES: To determine whether tapered methadone is effective to manage withdrawal from opioids. SEARCH STRATEGY: We searched: Cochrane Controlled Trial Register (Issue 1, 2000), MEDLINE (OVID 1966-2000), EMBASE (1980-2000); reference list of relevant articles; personal communication; conference abstracts; trials from pharmaceutical industry; Internet. SELECTION CRITERIA: All randomised controlled trials on the use of tapered methadone versus all other detoxification treatments, placebo and different modalities of methadone detoxification programs for the treatment of opiate withdrawal. DATA COLLECTION AND ANALYSIS: One reviewer assessed studies for inclusion and undertook data extraction. The overall process were confirmed by consultation between reviewers. MAIN RESULTS: 20 studies were included, with 1357 people randomised. 10 studies compared methadone with adrenergic agonists, 7 compared different modalities of methadone detoxification, 2 compared methadone with other opioid agonists, 1 study compared methadone with chlordiazepoxide one with placebo. 10 studies that compared methadone with adrenergic agonists showed clinical differences of the treatments; 6 studies that compared different methadone schedules, showed different withdrawal responses; 2 studies that compared methadone and other opioid agonists showed that methadyl acetate performed similarly to methadone, while propoxyphene produced more severe withdrawal symptoms and more drop-outs than methadone; chlordiazepoxide and methadone (1 study) resulted similar in terms of overall effectiveness; more severe withdrawal and more drop outs in the placebo group than in methadone one (1 study). The results indicate that tapered methadone and other medications used are effective although symptoms experienced differed according to the medication used and the program adopted. The medications are similar in terms of overall effectiveness. Improvements were achieved when other services supporting services were offered contemporaneously with detoxification. REVIEWER'S CONCLUSIONS: Data from literature are hardly comparable; programs vary widely with regard to duration, design and treatment objectives, along with reporting impairing the application of meta-analysis. The studies included confirm that slow tapering with temporary substitution of long acting opioid can reduce withdrawal severity. Nevertheless the majority of patients relapsed to heroin use, abstinence cannot be considered a goal as heroin dependence is a chronic, relapsing disorder and the purpose of detoxification should be to remove or reduce dependence on heroin in a controlled and human fashion and not a treatment for heroin dependence.

Humans↗
PubMed2004

Auditory integration training and other sound therapies for autism spectrum disorders.

BACKGROUND: Autism spectrum disorders (ASD) are a heterogeneous group of disorders encompassing Autistic Disorder, Asperger's Disorder, Semantic-Pragmatic disorder and Pervasive Developmental Disorder Not Otherwise Specified. Auditory integration therapy (AIT) was developed as a technique for improving abnormal sound sensitivity in individuals with behavioural disorders including autism. Other sound therapies bearing similarities to AIT include the Tomatis Method and Samonas Sound Therapy. OBJECTIVES: To determine the effectiveness of AIT or other methods of sound therapy in individuals with ASD. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (Cochrane Library Issue 2, 2003), MEDLINE (1966 - February 2002), EMBASE (1980 - February 2002), CINAHL (1982 - December 2001), PsycINFO (1887 - February 2002), ERIC (1965 - December 2001) and LILACS (1982 - March 2002). Reference lists of articles identified electronically were searched for further relevant publications. SELECTION CRITERIA: Randomised controlled trials of adults or children with ASD. Treatment was auditory integration therapy (AIT) or other sound therapies involving listening to music modified by filtering and modulation. Control groups could be no treatment, waiting list, usual therapy or placebo equivalent. Outcomes sought were changes in core and associated features of ASD, auditory processing, quality of life and adverse events. DATA COLLECTION AND ANALYSIS: All outcome data reported in included papers were continuous. Initial intention was to undertake meta-analyses using mean difference and standard deviation to take into account differences between treatment and control groups at baseline. These data were not available. Instead, point estimates and standard errors were calculated from t-test scores and post intervention means. Meta-analysis was attempted but deemed inappropriate at present. MAIN RESULTS: No trials assessing sound therapies other than AIT were found. Six RCTs of AIT, including one cross-over trial, were identified with a total of 171 individuals aged 3-39 years. Four trials had fewer than 20 participants. Allocation concealment was inadequate for all of the studies. Seventeen different outcome measures were used. Only two outcomes were used by three or more studies: Aberrant Behaviour Checklist (ABC) (5) and Fisher's Auditory Problems Checklist (FAPC) (3). Meta-analysis was not possible due to very high heterogeneity (Aberrant Behaviour Checklist subscores), or presentation of data in unusable forms. Three studies (Bettison 1996, Zollweg 1997, Mudford 2000) did not demonstrate benefit of AIT over control conditions. The remaining trials (Veale 1993, Rimland 1995, Edelson 1999) reported improvements at 3 months for the AIT group based on improvements of total mean scores for the ABC, which is of questionable validity. Rimland 1995 also reported improvements at 3 months in the AIT group for ABC subgroup scores. No significant adverse effects of AIT were reported. REVIEWER'S CONCLUSIONS: More research is needed to inform parents', carers' and practitioners' decision making about this therapy for individuals with autism spectrum disorders.

Acoustic Stimulation↗
PubMed2001

Rhemulatologists' performance in dailiy practice.

OBJECTIVE: To assess rheumatologists' performance for 8 rheumatologic conditions and to explore possible explanatory factors. METHODS: After written informed consent was obtained, 27 rheumatologists (21% of all Dutch rheumatologists) practicing in 16 outpatient departments were each visited by 8 incognito "standardized patients" (SPs). The diagnoses of these 8 cases account for about 23% of all new referred patients in the Netherlands. Results for ordered lab tests as well as real radiographs with corresponding results from a radiologist were simulated. Information from the visits was obtained from the SPs, who completed predefined case-specific checklists, and by collecting data on resource utilization. Feedback was provided. RESULTS: Altogether 254 encounters took place, of which 201 were first visits and 53 were followup visits. SPs were unmasked twice during a visit. There was considerable variation in resource utilization (lab tests and imaging) between cases and between rheumatologists. Mean costs per rheumatologist ranged from US $ 4.67 to $ 65.36 per visit for lab tests and from US $ 33.15 to $ 226.84 per visit for imaging tests. No significant correlations were seen between resource utilization costs and number of years of clinical experience or performance on checklist scores. Rheumatologists with longer experience had lower total item checklist scores (r = -0.47; P < 0.05). CONCLUSION: A considerable variation in resource utilization was found among 27 Dutch rheumatologists. The information obtained is an excellent source for discussion on the appropriateness of care.

Adult↗
PubMedDate not supplied

An analysis of autism in fifty males with the fragile X syndrome.

Fifty males with the fragile X [fra(X)] syndrome, which we consider synonymous with the Martin-Bell syndrome, were identified by a chromosome analysis of patients with developmental delays or mental retardation and family studies of known fra(X) pedigrees. These males were evaluated for autism using three criteria: 1) the DSM III diagnostic criteria for Infantile Autism; 2) the Autism Behavior Checklist (ABC); and 3) the Diagnostic Checklist for Behavior Disturbed Children, Form E2. Sixteen percent of patients fulfilled all of the DSM III criteria for Infantile Autism and an additional 30% fulfilled criteria for Infantile Autism Residual State. Thirty-one percent of patients had autism using the ABC checklist but none of the patients fit the classical Kanner syndrome as described by the E2 questionnaire. Some autistic traits were seen in almost all of the 50 fra(X) patients, including eye avoidance in 90%, handflapping, handbiting or handstereotypies in 88%, and language delays with language peculiarities, usually echolalic speech, in 96%. A pervasive lack of responsiveness was seen in 18% at their present age and in 44% in earlier childhood only. Autistic symptoms are common in the fra(X) syndrome. Therefore, any patient with developmental delays and autism or autistic manifestations should have a chromosomal analysis, including fra(X) examination.

Adolescent↗
PubMed1975

A methodological study of some factors influencing the reporting of symptoms.

The spontaneous occurrence of symptoms that are often regarded as adverse drug reactions was studied by means of open questionnaires or by a 38-item checklist of symptoms. Of the 416 respondents who returned an analyzable questionnaire, only 233 (56 per cent) were healthy (defined as having had no illness and/or having taken no medication in the previous three days). Using the open questionnaires, one or more symptoms were reported by 15 per cent of healthy persons (N equals 155) and by 69 per cent of a group of 118 persons who had been ill and/or who had taken medication in the previous three days. In contrast, using the checklist questionnaires 82 per cent of healthy persons (N equals 78) and 97 percent of persons who had been ill and/or who had taken medication in the previous three days (N equals 65) reported one or more symptoms. The total number of symptoms reported by any one person was three with the open questionnaire and 22 with the checklist. In addition, a greater severity of symptoms was associated with the open questionnaire. Sex, educational level, or presence or absence of previous exposure to clinical trials did not influence the nature and incidence of symptoms reported. However, the severity of symptoms reported was significantly different for the latter two factors. Differences in the frequency with which certain symptoms were reported and the relevance of these and other observations to the design of clinical trial record forms are discussed.

Adult↗
PubMed2005

Which instruments are most commonly used to assess traumatic event exposure and posttraumatic effects?: A survey of traumatic stress professionals.

We report findings from a Web-based survey of the International Society for Traumatic Stress Studies' members (n = 227) regarding use of trauma exposure and posttraumatic assessment instruments. Across clinical and research settings, the most widely used tests included the Posttraumatic Stress Diagnostic Scale, Trauma Symptom Inventory, Life Events Checklist, Clinician-Administered Post-traumatic Stress Disorder (PTSD) Scale, PTSD Checklist, Impact of Event Scale-Revised, and Trauma Symptom Checklist for Children. Highest professional degree, time since degree award, and student status yielded no differences in extent of reported trauma assessment test use.

Adult↗
PubMed2006

Psychometric properties of a tool for measuring hormone-related symptoms in breast cancer survivors.

Hormone-related symptoms are common in breast cancer survivors and many aspects of these symptoms are currently under study. Reliable and valid assessment tools are needed to successfully study hormone-related symptoms in breast cancer survivors; however, no gold standard currently exists for measuring these symptoms. This study evaluated the psychometric properties of a shortened version of the Breast Cancer Prevention Trial (BCPT) symptom checklist in a sample of 803 breast cancer survivors. Principal factor analysis with Promax oblique rotation revealed a five-factor structure, identifying five separate hormone-related symptoms scales: vasomotor symptoms, urinary incontinence, cognitive/mood changes, vaginal symptoms, and weight gain/appearance concern. Hormone-related symptom scale scores differed by demographic and clinical characteristics according to expectations, suggesting that these five scales from the shortened BCPT checklist are reasonably reliable and valid. Symptom scale scores were only weakly correlated with health-related quality of life scores; however, the pattern of results generally supported the validity of the symptom scales. This study adds to the evidence that breast cancer survivors experience a significant number of hormone-related symptoms. Future clinical trials and quality of life and symptom management intervention studies would benefit from accurate assessment of hormone-related symptoms with the five scales from the shortened BCPT checklist.

Adult↗
PubMedDate not supplied

Detecting social problems in cancer patients.

Diagnosis of and treatment for cancer may not only create physical and emotional difficulties for patients but may also have an impact on social aspects of patients' lives. Screening for social problems has not become part of routine oncology practice. This may be due to lack of a suitable questionnaire. This paper presents a psychometric analysis of the Problems Checklist with a view to assessing its usefulness as a screening tool for social problems in oncology. Evaluation was undertaken using data from an earlier study of 505 patients who completed the checklist. Frequency of endorsement, missing values, factor analysis and reliability and validity analysis of the summated scales were carried out. Missing data rates ranged from 4 to 18% over the 16 items. Fourteen items were well endorsed. Factor analysis produced a four-factor structure with components labelled daily living, relationships, economics and emotions. Reliability and validity tests endorsed the factor structure with the components on economics and emotions being particularly credible. Difficulties with relationships are harder to measure and results from the analysis suggest that this is an area that warrants further investigation. The checklist is a useful tool for highlighting problems. As a tool for screening for social problems it has some limitations.

Adaptation, Psychological↗
PubMed2001

Standards of neurosurgical procedures.

Written specifications with regard to procedures performed, equipment used, and training of the involved personnel are widely used in the industry and aviation to guarantee constant quality. Similar systems are progressively being introduced to medicine. We have made an effort to standardize surgical procedures by introducing step-by-step guidelines and checklists. The current experience shows that a system of written standards is applicable to neurosurgery and that the use of checklists contributes to the prevention of forgetting essential details. Written standards and checklists are also a useful training tool within a university hospital and facilitate communication of essentials to the residents. Comparison with aviation suggests that standardization leads to a remarkable but nonetheless limited reduction of adverse incidents.

Germany↗
PubMed1980

[Phenomenology of obsessions and compulsions. Experimental diagnosis of obsessive compulsive neurosis. I (author's transl)].

Obsessive-compulsive phenomena occur in 'normal,' neurotic and psychotic individuals. Operational definition, quantitative assessment, and diagnostic evaluation are still unsatisfactory, particularly with regard to differentiation of obsessive-compulsive phenomena (phenomenology), differentiation of trait and symptom factors, and evaluation of different obsessive-compulsive factors in the various kinds of neuroses. Our investigation of phenomenology differs from previous similar ones in basically two aspects: The newly developed obsessive-compulsive checklist covers the whole range of obsessions and compulsions, and questionnaire items of the checklist are operationally difined without reference to constructs from theories of personality or from psychopathology. Results include: Two-thirds of all patients suffer from combined obsessions and compulsions; factorial analysis reveals five symptom factors which are quite different from factor analytic results of previous studies; depression and phobias constitute a factor by themselves; checklist ratings and factor analytic results show the necessity for and basis of a new self-rating questionnaire to substitute for those currently in use. Implications of these results for future research in psychopathology as well as treatment evaluation are discussed.

Adult↗
PubMed1997

Validity of the PAS-ADD for detecting psychiatric symptoms in adults with learning disability (mental retardation).

The Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD) is a semi-structured interview for use with respondents who have learning disability and for key informants. This report investigates the ability of the instrument to detect symptoms that had been found to exist during routine clinical assessment of the patients. Field trials involved 95 referred patients with learning disability and a key informant for each sample member. Clinical opinions of the referring psychiatrists were sought using a symptom checklist. Referrer checklist symptoms and PAS-ADD data were both factor analysed. Validity testing involved (a) computation of correlations between PAS-ADD factors and checklist data and (b) comparison of PAS-ADD and referrers' diagnoses. Results indicated good validity for the PAS-ADD in relation to psychotic symptoms and depressive symptoms. Anxiety symptom identification was not well validated, probably due to small numbers. Expansive mood identified by the referrers was not detected by the PAS-ADD because there is currently no corresponding section in the interview. Where the PAS-ADD produced a diagnosis (in 58 members of the sample), 44 were in agreement with the referrer. Probability of diagnosis by PAS-ADD increased with the number of relevant active symptoms identified by the referrer. The PAS-ADD has been shown in a previous report to have the sensitivity to detect mental disorders not known to psychiatric services. For psychotic and depressive conditions, our results showed that symptom detection was in good agreement with the information provided by the referring psychiatrists on their patients. The PAS-ADD needs a section on hypomania and further investigation of its detection of anxiety disorders.

Adolescent↗
PubMed1992

Measuring life event stress in the lives of college students: the Undergraduate Stress Questionnaire (USQ).

We describe the development of the Undergraduate Stress Questionnaire (USQ), a life events checklist designed to measure stress among undergraduates. Several studies demonstrate the USQ's validity. The USQ correlates positively with physical symptoms and negatively with mood. Students rated the USQ as the most complete and accurate of four different life events questionnaires. In a panel study, the USQ closely tracked subjective reports of stress, both during the term and finals week. The USQ predicted symptoms more reliably than three other stress measures, controlling for negative affect. Students waiting in the college infirmary score higher on the USQ than students socializing on campus. Finally, we compare the checklist format to subjective scaling, and show the superiority of the checklist version. We discuss the usefulness of the USQ in terms of validity, representativeness, adaptability, brevity, and low confounding with negative affect.

Adult↗
PubMed1979

Behavior problems of educationally handicapped and normal pupils.

Male pupils identified as behaviorally disordered, learning disabled, and educable mentally retarded, as well as nonidentified normal boys, were rated by their teachers on the Behavior Problem Checklist. Analyses of the ratings indicated significant differences for pupil category, Behavior Problem Checklist dimension, and category by dimension interaction, but no significant differences for age alone or in interaction with other factors. Categories of pupils were best discriminated from one another on the basis of Conduct Disorder and Personality Problem dimensions of the Behavior Problem Checklist. Results were discussed in terms of some implications for special education and further research suggested by the present findings.

Adolescent↗
PubMed1982

Sex-typing of play and psychological adjustment in young children: an empirical investigation.

Traditional assumptions that sex-role conformity is positively related to psychological adjustment in young children have not, to date, been examined empirically. Seventy-four preschool children, 37 boys and 37 girls aged 3 to 5, were observed over a 3-month period to determine their frequency of play in male and female sex-typed activities during the freeplay period in their classrooms. Teacher ratings on the Kohn and Rosman Symptom Checklist and Social Competence Scale were correlated with individuals' rates of play in male and female preferred activities (M and F scales, respectively). Results indicated that boys' play with male-preferred toys was related to high scores on the "aggression/defiance" dimension of the Symptom Checklist, while boys who scored highly on play in female-preferred activities received high scores on the Social Competence dimension labeled "conforming to classroom rules." For girls, play with male-preferred toys was negatively related to the "apathy/withdrawal" dimension of the Symptom Checklist. These results do not confirm the hypothesis that sex-typed behavior is positively related to adjustment, and they suggest that for both sexes, play in opposite sex-typed activities may contribute positively to children's social and academic functioning in the classroom.

Adaptation, Psychological↗
PubMed1983

The assessment of autistic children: a selective review of available instruments.

This review examines five measures specifically designed to assess autistic symptomatology: Rimland's Diagnostic Checklist for Behavior-Disturbed Children, the Behavior Rating Instrument for Autistic and Atypical Children, the Behavior Observation Scale for Autism, the Childhood Autism Rating Scale, and the Autism Behavior Checklist. Available studies of reliability and validity issues are discussed. Reliability indices for all scales, except Rimland's Diagnostic Checklist, are at acceptable levels. Each scale has been found to suffer from a lack of demonstrated discriminant and/or content validity. Recommendations for future research are provided.

Autistic Disorder↗
PubMed2026

Time to subsequent therapy (TTST) as an endpoint in clinical studies: development of standardized documentation of subsequent therapy through systematic literature review, expert interviews, and Delphi survey.

BACKGROUND: The endpoint Time to Subsequent Therapy (TTST) is an intermediate endpoint used in research and regulatory assessments. TTST denotes initiation of subsequent therapy and is a clearly definable, clinically relevant event for healthcare professionals. However, it has not been systematically established to which extent TTST is subjectively meaningful to patients. The objective of this study was to define TTST as a patient-relevant intermediate endpoint. METHODS: The study examined five oncological indications (breast cancer, prostate cancer, melanoma, multiple myeloma, and non-small cell lung cancer) using a systematic literature review, analysis of case report forms used in international randomized controlled trials, review of German Federal Joint Committee (G-BA) documents, semi-structured interviews and a two-stage Delphi survey with healthcare professionals, patients, and relatives. RESULTS: A total of 35 individuals participated in qualitative interviews. Most of them rated TTST as particularly significant. The Delphi Survey included 264 interviewees in round one, and 117 in round two. Patient-relevance of TTST was confirmed by 81% of respondents (95% confidence interval 76%, 85%). Nine treatment scenarios that justify TTST were identified. To capture patient-relevance, prospective collection of reasons for and consequences of therapy change are required. A checklist with standardized response formats plus free-text fields was developed: a comprehensive master checklist for flexible, complete documentation and a short version focused on therapy change-specific items. CONCLUSIONS: TTST is an intermediate endpoint whose systematic documentation of characteristics demonstrating patient-relevance can be standardized in research and clinical practice using the developed checklists.

Humans↗