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Diagnostic Assessment (diagnostic + assessment)

Distribution by Scientific Domains

Medical Sciences	73%
Psychology	8%

Distribution within Medical Sciences

Psychiatry	41%
Neurology	10%

Selected Abstracts

Reliability and Attribute-Based Scoring in Cognitive Diagnostic Assessment

JOURNAL OF EDUCATIONAL MEASUREMENT, Issue 3 2009
Mark J. Gierl
The attribute hierarchy method (AHM) is a psychometric procedure for classifying examinees' test item responses into a set of structured attribute patterns associated with different components from a cognitive model of task performance. Results from an AHM analysis yield information on examinees' cognitive strengths and weaknesses. Hence, the AHM can be used for cognitive diagnostic assessment. The purpose of this study is to introduce and evaluate a new concept for assessing attribute reliability using the ratio of true score variance to observed score variance on items that probe specific cognitive attributes. This reliability procedure is evaluated and illustrated using both simulated data and student response data from a sample of algebra items taken from the March 2005 administration of the SAT. The reliability of diagnostic scores and the implications for practice are also discussed. [source]

Cognitive functioning in substance abuse and dependence: a population-based study of young adults

ADDICTION, Issue 9 2009
Antti Latvala
ABSTRACT Aims To investigate whether substance use disorders (SUDs) are associated with verbal intellectual ability, psychomotor processing speed, verbal and visual working memory, executive function and verbal learning in young adults, and to study the associations of SUD characteristics with cognitive performance. Participants A population-based sample (n = 466) of young Finnish adults aged 21,35 years. Measurements Diagnostic assessment was based on all available information from a structured psychiatric interview (SCID-I) and in- and out-patient medical records. Established neuropsychological tests were used in the cognitive assessment. Confounding factors included in the analyses were comorbid psychiatric disorders and risk factors for SUDs, representing behavioural and affective factors, parental factors, early initiation of substance use and education-related factors. Findings Adjusted for age and gender, life-time DSM-IV SUD was associated with poorer verbal intellectual ability, as measured with the Wechsler Adult Intelligence Scale,Revised (WAIS-R) vocabulary subtest, and slower psychomotor processing, as measured with the WAIS-R digit symbol subtest. Poorer verbal intellectual ability was accounted for by parental and own low basic education, whereas the association with slower psychomotor processing remained after adjustment for SUD risk factors. Poorer verbal intellectual ability was related to substance abuse rather than dependence. Other SUD characteristics were not associated with cognition. Conclusions Poorer verbal intellectual ability and less efficient psychomotor processing are associated with life-time alcohol and other substance use disorders in young adulthood. Poorer verbal intellectual ability seems to be related to parental and own low basic education, whereas slower psychomotor processing is associated with SUD independently of risk factors. [source]

Parent,ETH;child agreement and prevalence estimates of diagnoses in childhood: Direct interview versus family history method

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 2 2009
Stéphane Rothen
Abstract Diagnostic information on children is typically elicited from both children and their parents. The aims of the present paper were to: (1) compare prevalence estimates according to maternal reports, paternal reports and direct interviews of children [major depressive disorder (MDD), anxiety and attention-deficit and disruptive behavioural disorders]; (2) assess mother,child, father,child and inter-parental agreement for these disorders; (3) determine the association between several child, parent and familial characteristics and the degree of diagnostic agreement or the likelihood of parental reporting; (4) determine the predictive validity of diagnostic information provided by parents and children. Analyses were based on 235 mother,offspring, 189 father,offspring and 128 mother,father pairs. Diagnostic assessment included the Kiddie-schedule for Affective Disorders and Schizophrenia (K-SADS) (offspring) and the Diagnostic Interview for Genetic Studies (DIGS) (parents and offspring at follow-up) interviews. Parental reports were collected using the Family History , Research Diagnostic Criteria (FH-RDC). Analyses revealed: (1) prevalence estimates for internalizing disorders were generally lower according to parental information than according to the K-SADS; (2) mother,child and father,child agreement was poor and within similar ranges; (3) parents with a history of MDD or attention deficit hyperactivity disorder (ADHD) reported these disorders in their children more frequently; (4) in a sub-sample followed-up into adulthood, diagnoses of MDD, separation anxiety and conduct disorder at baseline concurred with the corresponding lifetime diagnosis at age 19 according to the child rather than according to the parents. In conclusion, our findings support large discrepancies of diagnostic information provided by parents and children with generally lower reporting of internalizing disorders by parents, and differential reporting of depression and ADHD by parental disease status. Follow-up data also supports the validity of information provided by adolescent offspring. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Psychometric properties of the Retrospective Self Report of Inhibition (RSRI) in a representative German sample

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 2 2008
Heike Rohrbacher
Abstract The present study examined the internal consistency, factorial structure, and construct validity of the German version of the Retrospective Self Report of Inhibition (RSRI), a questionnaire measure of behavioral inhibition. The research was based on data from a German prospective-longitudinal community study of 3021 adolescents and young adults (aged 14,24 years at baseline). Diagnostic assessment was based on the DSM-IV/M-CIDI and general psychopathological distress was assessed with SCL-90-R. Results of confirmatory factor analysis indicated adequate fit of the two-factor model, suggested by the authors of the original version. Indices of internal consistency of the RSRI and its subscales ,social/school' and ,fear/illness' were shown to be sufficient for the total sample and even higher in subgroups of subjects with certain DSM-IV diagnoses. Associations with variables such as mental distress, parental psychopathology, and DSM-IV disorders were in line with theoretical assumptions and confirm different aspects of the validity (convergent, concurrent, predictive) of the instrument. The psychometric properties of the German RSRI were found to be comparable to those of the English version. The applicability of this questionnaire in German-speaking countries is therefore recommended for adolescents and young adults. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Antipsychotic prescribing trends: a review of pharmaco-epidemiological studies

ACTA PSYCHIATRICA SCANDINAVICA, Issue 1 2010
H. Verdoux
Objective:, To review findings from pharmaco-epidemiological studies exploring antipsychotic (AP) drugs prescribing trends. Method:, We retrieved original studies that explored AP prescribing trends in general population samples since 2000. For each study, we extracted information on sampling method, period, assessment of AP use and corresponding estimates (incidence rates, prevalence rates, pharmacy sales, prescription data) and diagnostic assessment. Results:, Nearly all studies meeting the inclusion criteria (n = 17) showed an increase in AP prescriptions, mainly because of a dramatic rise in second-generation antipsychotics (SGAP) prescriptions. APs are often prescribed for non-psychotic disorders in adults as well as in children and adolescents. Conclusion:, Considering the growing number of persons from the general population exposed to APs, population studies assessing the risk/benefit ratio of SGAP use in disorders other than psychosis are necessary, particularly in children and adolescents. [source]

Fine-needle aspiration cytology in the diagnosis of superficial lymphadenopathy: a 5-year Brazilian experience

DIAGNOSTIC CYTOPATHOLOGY, Issue 2 2006
M.Sc., Marcos Roberto Martins M.D.
Abstract To determine the accuracy of fine-needle aspiration (FNA) in the diagnostic assessment of lymphadenopathies, a retrospective study was conducted on 627 cases of FNA of the lymph nodes performed at Department of Pathology, UNIFESP (Federal University of São Paulo), between 1997 and 2001. Cytology results were compared to the results of biopsies if available. The cytological diagnosis was unsatisfactory in 14.7% of cases, positive in 46%, and negative in 39.3%. Among the positive cases, 79.4% were classified as metastases, 14.2% as lymphoma, and 6.4% as indeterminate. Anatomopathological exams for the determination of cytohistological correlation were available in 218 of the 627 cases. There were three (1.88%) false-negative and two (1.25%) false-positive cases. Accuracy tests revealed 97.41% sensitivity, 95.45% specificity, and 96.88% efficacy, with cytohistological agreement being almost perfect (, = 0.92). The high accuracy of this study based only on cytomorphological criteria associated to the variety of malignant neoplasias diagnosed by the procedure demonstrates its relevance on patient care, especially in areas of limited financial resources. Diagn. Cytopathol. 2006; 34:130,134. © 2006 Wiley-Liss, Inc. [source]

Signs and symptoms at diagnosis of amyotrophic lateral sclerosis: a population-based study in southern Italy

EUROPEAN JOURNAL OF NEUROLOGY, Issue 7 2006
S. Zoccolella
Amyotrophic lateral sclerosis (ALS) diagnostic criteria are used to select patients for clinical trials based on different levels of diagnostic certainty, according to the spread of upper (UMN) and lower motoneuron (LMN) signs in different anatomic regions. However, the clinical presentation of ALS patients is extremely variable and this can delay the time to diagnosis and decrease the likelihood for trial entry. The aims of the study were to describe the signs and symptoms of diagnosis in a population-based incident cohort of ALS cases, using the El Escorial (EEC) and the Revised Airlie Diagnostic Criteria (AHC). The source of the study was a prospective population-based registry established in Puglia, southern Italy, in 1997. The diagnosis and the classification of the cases were based on EEC and AHC. All incident ALS cases during the period 1998,1999 were enrolled and followed up. During the surveillance period, we identified 130 ALS incident cases, and bulbar-ALS represented 20% of our cohort. The highest risk for bulbar onset was among subjects aged >75 years [RR: 20.1, 95% confidence interval (CI) 3.4,118.0] compared with subjects aged <55 years and among females compared with males (Relative risk (RR): 2.75, 95% CI: 1,7.3). The vast majority of patients (72%) referred progressive muscle weakness in the limbs as the presenting symptom. Eighty percent of cases presented contemporary bulbar or spinal involvement; UMN signs in the bulbar region were present in 24% of cases and any motoneuronal sign in thoracic region in only 15% of the cases. In this population-based series, progressive muscle weakness was the most common presenting sign; bulbar onset was associated with advanced age and female sex. UMN signs in the bulbar region and any motoneuronal sign in the thoracic region were observed in 20% of our case series. This may represent the main limitation to show the spread of signs during diagnostic assessment for inclusion in epidemiological studies and clinical trials. [source]

Neuropsychological performance in early and late onset Alzheimer's disease: comparisons in a memory clinic population

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2004
Srinivas Suribhatla
Abstract Objectives To compare the neuropsychological performance associated with early and late onset Alzheimer's disease (AD), in order to identify differences and compare these with previous reports. Methods Patients attending a memory clinic were given a detailed multi-disciplinary diagnostic assessment, including a battery of neuropsychological tests. From those meeting ICD-10 criteria for Alzheimer's disease (AD), an early-onset (EO) group (n,=,40) and a late-onset (LO) group (n,=,90) were identified, and their performances compared. Patients with mixed dementia and co-morbid depression were excluded. Results After adjustment, the EO and LO groups performed at a comparable level on the majority of the neuropsychological tests. The LO group performed better on the WAIS digit span test, AMIPB Complex Design and the written picture description, and the EO group performed better on the WAIS similarities test and the Boston naming test. Conclusions These findings suggest that, after adjusting for overall dementia severity and pre-morbid IQ, there is greater fronto-parietal/right hemisphere involvement in early-onset AD, and greater temporal/left hemisphere involvement in late-onset AD. This may be due to different genetic risk profiles for AD at different ages. Copyright © 2004 John Wiley & Sons, Ltd. [source]

The Italian Preadolescent Mental Health Project (PrISMA): rationale and methods

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 1 2006
Alessandra Frigerio
Abstract The Italian preadolescent mental health project (PrISMA , Progetto Italiano Salute Mentale Adolescenti) is the first Italian study designed to estimate the prevalence of mental disorders in preadolescents (10,14 years old) living in urban areas, and to analyse the demographic and biological correlates of emotional and behavioural problems. This paper describes the rationale, methods and the analysis plan of the project. The design of the study used a two-stage sampling procedure, one screening stage of emotional and behavioural problems in a large sample of subjects attending public and private schools and a second stage of diagnostic assessment in a sample including all high scorers and a proportion of low scorers. In the screening stage, parents of preadolescents were asked to fill in the Child Behavior Checklist (CBCL), whereas in the second stage preadolescents and their parents were administered the Development and Well Being Assessment for the assessment of mental disorders together with the Strengths and Difficulties Questionnaire and two scales (C-GAS and HoNOSCA) designed to evaluate the functioning of the preadolescent in different areas. Genetic samples were collected during the screening stage, after parents gave their informed written consent. The findings of this study are expected to allow an adequate planning of interventions for the prevention and the treatment of mental disorders in preadolescence as well as efficient health services. Copyright © 2006 John Wiley & Sons, Ltd. [source]

A self-applied, Internet-based intervention for fear of public speaking

JOURNAL OF CLINICAL PSYCHOLOGY, Issue 8 2004
Cristina Botella
The aim of this article is to introduce, illustrate, and present effectiveness data on a new telepsychology program for the treatment of fear of public speaking. The Talk to Me program is an Internet-based self-applied intervention that has several components, including a diagnostic assessment, a structured treatment, and an outcome protocol that evaluates treatment efficacy in a continuous manner. We describe the characteristics of the program and present a case study. Results demonstrated a significant decrease in levels of fear and avoidance related to speaking in public. © 2004 Wiley Periodicals, Inc. J Clin Psychol/In Session. [source]

Reliability and Attribute-Based Scoring in Cognitive Diagnostic Assessment

Inhospital management of COPD exacerbations: a systematic review of the literature with regard to adherence to international guidelines

JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 6 2009
Cathy Lodewijckx RN MSc PhD Cand
Abstract Rationale, Chronic obstructive pulmonary disease (COPD) exacerbations are a leading cause of hospitalization. Suboptimal inhospital management is expected to lead to more frequent exacerbations and recurrent hospital admission, and is associated with increased mortality. Aims, To explore inhospital management of COPD and to compare the results with recommendations from international guidelines. Methods, A literature search was carried out for relevant articles published 2000,2009 in the databases Medline, Cochrane Library, Cumulative Index for Nursing and Allied Health Literature and Invert. In addition, the reference lists of the selected articles were examined. Main inclusion criteria were as follows: COPD, exacerbation, hospitalization, description of inpatient management, and clinical trials. Assessment and treatment strategies in different studies were analysed and compared with American Thoracic Society-European Respiratory Society and Global Initiative for Chronic Obstructive Lung Disease guidelines. Outcomes were analysed. Results, Seven eligible studies were selected. Non-pharmacological treatment was infrequently explored. When compared with international guidelines, diagnostic assessment and therapy were suboptimal, especially non-pharmacological treatment. Respiratory physicians were more likely to perform recommended interventions than non-respiratory physicians. Conclusions, Adherence to international guidelines is low for inhospital management of COPD exacerbations, especially in terms of non-pharmacological treatment. Further investigation is recommended to explore strategies like care pathways that improve performance of recommended interventions. [source]

The modified CAMDEX informant interview is a valid and reliable tool for use in the diagnosis of dementia in adults with Down's syndrome

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 6 2004
S. L. Ball
Abstract Background Dementia because of Alzheimer's disease (AD) commonly affects older adults with Down's syndrome (DS). Methods are needed, with established concurrent and predictive validity, to facilitate the diagnostic assessment of dementia, when it is complicated by pre-existing intellectual disabilities (ID). We report on the reliability and validity of a modified version of the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) informant interview, for use when assessing people with DS suspected as having dementia. Methods As part of a previous epidemiological study of older people with DS, the CAMDEX informant interview was used to determine the prevalence of dementia. The 74 people with DS included at that time (Time 1) had also completed the Cambridge Cognitive Examination (CAMCOG), the neuropsychological assessment from the CAMDEX schedule. Fifty-six were assessed again 6 years later (Time 2). Based on the CAMDEX informant interview, nine of the 74 at Time 1, and 11 of the 56 at Time 2, were found to meet clinical criteria for AD. Forty-one scored above floor on the CAMCOG at Time 1 and were included in the analysis of cognitive decline. Concurrent validity was established by comparing diagnosis at Time 2 with independent evidence of objective decline on cognitive tasks since Time 1. Predictive validity was established by examining how accurately diagnosis at Time 1 predicted both cognitive decline and future diagnosis. Inter-rater reliability was determined by comparing the level of agreement between two raters. Results CAMDEX-based diagnosis of AD was shown to be consistent with objectively observed cognitive decline (good concurrent validity) and to be a good predictor of future diagnosis. Although numbers are small, some support is also provided for the accuracy with which diagnosis predicts cognitive decline. Inter-rater reliability was good with Kappa > 0.8 for 91% of items and >,0.6 for all items. Conclusions The use of the modified CAMDEX informant interview enables the structured collection of diagnostic information, so that a valid and a reliable diagnosis of dementia can be made in those with pre-existing ID, using established diagnostic criteria. [source]

Aggression among combat veterans: Relationships with combat exposure and symptoms of posttraumatic stress disorder, dysphoria, and anxiety

JOURNAL OF TRAUMATIC STRESS, Issue 2 2007
Casey T. Taft
Prior research has revealed heightened aggressive behavior among veterans with PTSD. This study tested a model examining the interrelationships among combat exposure, posttraumatic stress disorder (PTSD) symptoms, dysphoric symptoms, and anxiety symptoms in predicting aggressive behavior in a sample of 265 male combat veterans seeking diagnostic assessment of PTSD. Combat exposure was indirectly associated with aggression primarily through its relationship with PTSD symptoms. Symptoms of PTSD were directly related to aggression, and indirectly related to aggression through dysphoric symptoms. Results highlight the role of PTSD symptoms and dysphoric symptoms with respect to aggressive behavior among this population, and suggest the relevance of aggression theory to the study of combat veterans. [source]

Systematic review and meta-analysis of methods of diagnostic assessment for urinary incontinence,,

NEUROUROLOGY AND URODYNAMICS, Issue 7 2006
J.L. Martin
Abstract Aims To evaluate the performance of all tests proposed for the diagnosis of urinary incontinence. Methods A systematic review and meta-analyses of the published literature of methods for diagnostic assessment of urinary incontinence. Results One hundred twenty-one papers were included in the full review [Martin et al., 2006]. The quality of reporting in the primary studies was poor which reduced the number of studies that could be included in the data analysis. The literature suggests that women with urodynamic stress incontinence (USI) can be correctly identified in primary care from clinical history alone with a sensitivity of 0.92 (95% C.I.: 0.91,0.93) and specificity of 0.56 (0.53,0.60). A clinical history for the diagnosis of detrusor overactivity (DO) was found to be 0.61 (0.57,0.65) sensitive and 0.87 (0.85,0.89) specific. Within secondary care imaging of leakage by ultrasound was found to be effective in the diagnosis of USI in women with a sensitivity of 0.89 (0.84,0.93) and specificity of 0.82 (0.73,0.89). Conclusions Clinical interpretation of the results of the review is difficult because few studies could be synthesized and conclusions made. The published evidence suggests that a large proportion of women with USI can be correctly identified in primary care from history alone. Ultrasound offers a useful diagnostic tool which could be used prior to, and possibly instead of, multi-channel urodynamics in some circumstances. If a patient is to undergo urodynamic testing, multi-channel urodynamics is likely to give the most accurate result. Further primary studies adhering to STARD guidelines are required on commonly used tests. Neurourol. Urodynam. 25:674,683, 2006. © 2006 Wiley-Liss, Inc. [source]

Using Task Clarification, Checklists and Performance Feedback to Improve the Appearance of a Grocery Store

PERFORMANCE IMPROVEMENT QUARTERLY, Issue 2 2003
Leslie Shier
ABSTRACT An intervention package of task clarification, checklists, and posted performance feedback was developed to increase completion of tasks contributing to the appearance of a local grocery store. The intervention package was based on an informal diagnostic assessment that examined antecedents, equipment and processes, knowledge and skills, and consequences in the organizational environment. A multiple baseline design across five departments was utilized to evaluate the effects of the intervention package on employee cleaning behavior related to the appearance of the store. The results suggest overall improvement of task completion across the five departments observed, with substantial increases resulting from application of the intervention. The mean percentage of tasks completed in the deli department increased by 36%; by 93% in the meat department; by 38% in the frozen department; by 25% in the produce department; and by 34% in the front-end department. The average increase of task completion across departments was more than 45%. The results of this study are consistent with those of Anderson, Crowell, Hantula, and Siroky (1988), as well as with La Fleur and Hyten (1995), demonstrating that task clarification, checklists, and feedback have positive effects on work performance. [source]

Evaluation of the diagnostic utility of spinal magnetic resonance imaging in axial spondylarthritis

ARTHRITIS & RHEUMATISM, Issue 5 2009
A. N. Bennett
Objective Magnetic resonance imaging (MRI) is increasingly used for the diagnosis of axial spondylarthritis (SpA), but it is unknown whether characteristic lesions are actually specific for SpA. This study was undertaken to compare MRI patterns of disease in active SpA, degenerative arthritis (DA), and malignancy. Methods Fat-suppressed MRI of the axial skeleton was performed on 174 patients with back pain and 11 control subjects. Lesions detected by MRI, including Romanus lesions (RLs) and end-plate, diffuse vertebral body, posterior element, and spinous process bone marrow edema (BME) lesions, were scored in a blinded manner. An imaging diagnosis was given based on MRI findings alone, and this was compared with the gold-standard treating physician's diagnosis. Results The physician diagnosis was SpA in 64 subjects, DA in 45 subjects, malignancy in 45 subjects, other diagnoses in 20 subjects, and normal in 11 subjects. There was 72% agreement between the imaging diagnosis and physician diagnosis. End-plate edema, degenerative discs, and RLs were frequently observed in patients with any of the 3 major diagnoses. Single RLs were of low diagnostic utility for SpA, but ,3 RLs (likelihood ratio [LR] 12.4) and severe RLs (LR infinite) in younger subjects were highly diagnostic of SpA. Posterior element BME lesions of mild or moderate grade were also highly diagnostic of SpA (LR 14.5). The most common diagnostic confusion was between SpA and DA, since both had RLs present and the presence/absence of degenerative discs did not change the diagnostic assessment. Conclusion This study confirms the high diagnostic utility of MRI in axial SpA, with severe or multiple RLs evident on MRI being characteristic in younger patients and mild/moderate posterior element lesions being specific for SpA. However, MRI lesions previously considered to be characteristic of SpA could also be found frequently in patients with DA and patients with malignancy, and therefore such lesions should be interpreted with caution, particularly in older patients. [source]

Diagnostics for Joint Longitudinal and Dropout Time Modeling

BIOMETRICS, Issue 4 2003
Angela Dobson
Summary. We present a variety of informal graphical procedures for diagnostic assessment of joint models for longitudinal and dropout time data. A random effects approach for Gaussian responses and proportional hazards dropout time is assumed. We consider preliminary assessment of dropout classification categories based on residuals following a standard longitudinal data analysis with no allowance for informative dropout. Residual properties conditional upon dropout information are discussed and case influence is considered. The proposed methods do not require computationally intensive methods over and above those used to fit the proposed model. A longitudinal trial into the treatment of schizophrenia is used to illustrate the suggestions. [source]

Design and implementation of a randomized trial evaluating systematic care for bipolar disorder

BIPOLAR DISORDERS, Issue 4 2002
Gregory E Simon
Objectives: Everyday care of bipolar disorder typically falls short of evidence-based practice. This report describes the design and implementation of a randomized trial evaluating a systematic program to improve quality and continuity of care for bipolar disorder. Methods: Computerized records of a large health plan were used to identify all patients treated for bipolar disorder. Following a baseline diagnostic assessment, eligible and consenting patients were randomly assigned to either continued usual care or a multifaceted intervention program including: development of a collaborative treatment plan, monthly telephone monitoring by a dedicated nurse care manager, feedback of monitoring results and algorithm-based medication recommendations to treating mental health providers, as-needed outreach and care coordination, and a structured psychoeducational group program (the Life Goals Program by Bauer and McBride) delivered by the nurse care manager. Blinded assessments of clinical outcomes, functional outcomes, and treatment process were conducted every 3 months for 24 months. Results: A total of 441 patients (64% of those eligible) consented to participate and 43% of enrolled patients met criteria for current major depressive episode, manic episode, or hypomanic episode. An additional 39% reported significant subthreshold symptoms, and 18% reported minimal or no current mood symptoms. Of patients assigned to the intervention program, 94% participated in telephone monitoring and 70% attended at least one group session. Conclusions: In a population-based sample of patients treated for bipolar disorder, approximately two-thirds agreed to participate in a randomized trial comparing alternative treatment strategies. Nearly all patients accepted regular telephone monitoring and over two-thirds joined a structured group program. Future reports will describe clinical effectiveness and cost-effectiveness of the intervention program compared with usual care. [source]

Antiepileptic monotherapy significantly impairs normative scores on common tests of executive functions

ACTA NEUROLOGICA SCANDINAVICA, Issue 3 2009
E. Hessen
Background,,, Understanding how antiepileptic (AED) monotherapy influences normative test scores is of importance in the clinic for correct interpretation of neuropsychological profiles. Previous studies have primarily reported minor influence on neuropsychological raw scores, and the clinical relevance of these findings is unclear. Aim of the study ,To obtain a clinical valid answer to this question, we analysed changes in T-scores after AED withdrawal in a large group of well-controlled epilepsy patients, for tests previously shown to be sensitive to AED withdrawal. Methods ,We report outcomes on measures of choice reaction time from the California Computerized Assessment Package, on the Controlled Oral Word Association Test and on the Stroop Color-Word Interference Test. Results ,Significantly improved T-scores were revealed after AED withdrawal on five of the six tests of executive functions with mean improvement of 5 T-scores. Comparable results were achieved in the subgroup taking carbamazepine, with a mean improvement of 6.2 T-scores. Conclusion ,The present results suggest that T-scores for computerized tests of choice reaction time and tests of verbal fluency and response inhibition may be significantly impaired as a consequence of AED monotherapy, and that careful interpretation of these scores is required in diagnostic assessment of patients receiving AED monotherapy. [source]

Validation of a new diagnostic procedure for DSM IV axis I disorders

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2002
Jean-Yves Loze
Abstract Despite the fact that, in today's psychiatric research and especially in epidemiological studies, diagnostic assessments are made with reliable standardized clinical interviews, recent articles have shown discrepancies in prevalence rates of DSM IV axis I disorders assessed with different, yet reliable, clinical standardized interviews, raising the problem of the clinical relevance of some of these instruments. Within an epidemiological study, we developed a simple method for evaluating DSM IV axis I disorders with the aim of improving the clinical relevance of assessed diagnoses. This method is based on an evaluation performed by two clinicians. The first one used a short structured clinical interview (MINI v 5.0) and the second one completed the procedure with an open clinical interview, intended to be more clinically relevant. Finally, a consensus diagnosis is given by the two investigators. We conducted a survey in order to validate this method by measuring the agreement of diagnoses reported by two pairs of clinicians on a population of 20 inpatients. Results show that this double evaluation led to a high agreement (kappa ranging between 0.76 and 1.00) suggesting that the proposed evaluation procedure, which is intended to be more clinically relevant, is also highly reliable. Copyright © 2002 Whurr Publishers Ltd. [source]

Incidence of autism spectrum disorders: Changes over time and their meaning,

ACTA PAEDIATRICA, Issue 1 2005
M. Rutter
Abstract Aim: Several reviews have noted a huge increase in the rate of diagnosed autism spectrum disorders. The main aims of this paper are: 1) to use published empirical findings to consider whether the rise reflects a true increase in incidence, as distinct from the consequences of better ascertainment and a broadening of the diagnostic concept; and 2) to consider how epidemiological data may be used to test hypotheses about possible causal influences, using MMR and thimerosal as examples. Methods: Search of the literature for studies with a large epidemiological base population, systematic standardized screening, a focus on an age group for which diagnostic assessments are reliable and valid, and diagnosis by trained professionals using high-quality research assessments. Also, search of a broader literature to consider the evidence from all epidemiological studies with respect to the hypothesized causal effect of MMR and thimerosal on autism spectrum disorders. Results: The true incidence of autism spectrum disorders is likely to be within the range of 30,60 cases per 10,000, a huge increase over the original estimate 40 years ago of 4 per 10,000. The increase is largely a consequence of improved ascertainment and a considerable broadening of the diagnostic concept. However, a true risk due to some, as yet to be identified, environmental risk factor cannot be ruled out. There is no support for the hypothesis for a role of either MMR or thimerosal in causation, but the evidence on the latter is more limited. Conclusion: Progress in testing environmental risk hypotheses will require the integration of epidemiological and biological studies. [source]