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Global Assessment Scale (global + assessment_scale)
Selected AbstractsPros and cons of using the mental health act for severe eating Disorders in AdolescentsEUROPEAN EATING DISORDERS REVIEW, Issue 1 2009Agnes Ayton Abstract Background In England and Wales the compulsory treatment of young people with severe eating disorders is controversial. There is a concern that such treatment may impair patient autonomy and negatively influence the outcome. In this study, based in a specialist hospital, we compared patients treated under parental consent with those detained under the Mental Health Act: their characteristics and outcome up to 12 months after discharge. Results 34 patients were informal (treated under parental consent) (age: 16.2,±,1.3 years) and 16 were treated under Section 3 of the Mental Health Act (age: 16.2,±,1) in a 3-year period. Detained patients had an earlier age of onset (12.2,±,5 vs. 14.3,±,1.8) and more previous hospitalisation. On admission, their psychosocial functioning (Children's Global Assessment Scale (C-GAS): 13.6,±,2 vs. 26.9,±,9; Health of the Nation Outcome Scale for Children and Adolescents (HONOSCA): 41.7,±,5 vs. 31.9,±,5) were worse than voluntary patients', they had a higher level of co-morbid depression (BDI: 38.1,±,15.6 vs. 26.6,±,12.4) and a higher rate of suicidal behaviour. All physical and psychosocial measures improved substantially and clinically significantly by discharge and there was no statistically significant difference at this stage between the two patient groups. Two informal patients died within a year after discharge (6.3%), but there were no deaths amongst the detained patients. Comments In contrast with previous findings in adults, the outcome for detained patients was similar to that for informal patients, despite the former having more severe presentation on admission. There was no evidence of higher mortality in the detained group. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Relationship between various clinical outcome assessments in patients with blepharospasm,MOVEMENT DISORDERS, Issue 3 2009Joseph Jankovic MD Abstract The objective was to analyze the metric properties of the Jankovic Rating Scale (JRS) and a self-rating patient response outcome scale, the Blepharospasm Disability Index (BSDI©), in blepharospasm patients. Data from a randomized, double-blind, active-control clinical trial in 300 patients with blepharospasm treated with either botulinum toxin type A (Botox®) or NT201 (Xeomin®) were used to evaluate the metric properties of the JRS and the BSDI compared with the Patient Evaluation of Global Response (PEGR) and Global Assessment Scale (GAS). The internal consistency of the BSDI was high, Cronbach's Alpha = 0.88, and the retest reliability of the BSDI single items was adequate, Spearman's rank coefficient = 0.453 < r < 0.595. The correlation between JRS sum score and BSDI weighted mean score was r = 0.487 (baseline) and r = 0.737 (control visit), respectively. Using the GAS and PEGR, the results suggest that a change of 2 points in the JRS and of 0.7 points in the BSDI are clinically meaningful. JRS and BSDI are objective indicators of clinical efficacy as suggested by their good validity when compared with physicians' and patients' rating scales. Both, JRS and BSDI, can be used to reliably assess blepharospasm in treatment trials. © 2008 Movement Disorder Society [source] St John's Wort treating patients with autistic disorderPHYTOTHERAPY RESEARCH, Issue 11 2009Helmut Niederhofer Abstract Problems of eye contact and expressive language limit the effectiveness of educational and behavioral interventions in patients suffering from pervasive developmental disorders. For that reason, additive psychopharmacological interventions are sometimes needed to improve symptomatology. In our preliminary open trial, three male patients with autistic disorder, diagnosed by ICD-10 criteria, completed an open trial of St John's Wort. Subjects were included in the study if their eye contact and expressive language was inadaequate for their developmental level and if they had not tolerated or responded to other psychopharmacologic treatments (methylphenidate, clonidine or desipramine). Parent and mentor ratings on the Aberrant Behavior Checklist, irritability, stereotypy, and inappropriate speech factors improved slightly during treatment with St John's Wort. Clinician ratings (Psychiatric Rating Scale Autism, Anger and Speech Deviance factors; Global Assessment Scale; Clinical Global Impressions efficacy) did not improve significantly. St John's Wort was only modestly effective in the short-term treatment of irritability in some patients with autistic disorder. Copyright © 2009 John Wiley & Sons, Ltd. [source] Association between feasibility of discharge, clinical state, and patient attitude among inpatients with schizophrenia in JapanPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 3 2009Yoshio Mino md Aim:, There have been some studies on the feasibility of discharging mentally ill inpatients from mental hospitals. The purpose of the present study was to investigate how a psychiatrist judges whether an inpatient can be discharged. Methods:, A survey regarding such judgments on discharge was conducted involving 549 inpatients with schizophrenia with a hospital stay of ,1 year. Relationships between psychiatrist judgments on discharge and the Brief Psychiatric Rating Scale (BPRS), Scales for the Assessment of Negative Symptoms (SANS), Global Assessment Scale (GAS), patient attitude to discharge, and other variables were investigated. A similar analysis was conducted regarding patient attitudes toward discharge. Results:, After controlling for potential confounding factors using multiple logistic regression, the judgments showed significant relationships with BPRS-P, SANS, GAS, and age. Patient attitudes showed significant relationships with the length of the current hospital stay, SANS, and psychiatrists' judgments. Conclusion:, A psychiatrist's judgment regarding discharge is a comprehensive decision that takes into account psychiatric symptoms, social functioning, and age. Such a judgment could also affect a patient's own attitude toward discharge. [source] Parent,infant relationship global assessment scale: A study of its predictive validityPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2002YUTAKA AOKI Abstract The Parent,Infant Relationship Global Assessment Scale (PIRGAS; Zero to Three, 1994) provides a continuously distributed scale of infant,parent relationship adaptation, raging from ,well-adapted' to ,dangerously impaired'. The present study examines the predictive validity of the PIRGAS in a high-risk sample by coding relationship adaptation level from a single sample of 10 min of unstructured free play between mothers and their 20-month-old infants and examining its relationship to subsequent interaction with mothers and behavior problems at 24 months. Relationship adaptation assessed reliably from observations of only 10 min of free play between mothers and their infants at 20 months of age using PIRGAS predicted subsequent mother, infant interaction in a laboratory based problem-solving paradigm (Crowell procedure) at 24 months and internalizing symptomatology of Child Behavior Checklist at age 24 months. These results contribute to the predictive validity of the PIRGAS as a measure of mother,infant relationship adaptation. [source] Inpatient treatment in child and adolescent psychiatry , a prospective study of health gain and costsTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 12 2007Jonathan Green Background:, Inpatient treatment is a complex intervention for the most serious mental health disorders in child and adolescent psychiatry. This is the first large-scale study into its effectiveness and costs. Previous studies have been criticised for methodological weaknesses. Methods:, A prospective cohort study, including economic evaluation, conducted in 8 UK units (total n = 150) with one year follow-up after discharge. Patients acted as their own controls. Outcome measurement was the clinician-rated Childhood Global Assessment Scale (CGAS); researcher-rated health needs assessment; parent- and teacher-rated symptomatology. Results:, We found a significant (p < .001) and clinically meaningful 12-point improvement in CGAS following mean 16.6 week admission (effect size .92); this improvement was sustained at 1 year follow-up. Comparatively, during the mean 16.4 week pre-admission period there was a 3.7-point improvement (effect size .27). Health needs assessment showed similar gain (p < .001, effect size 1.25), as did teacher- and parent-rated symptoms. Improvement was found across all diagnoses. Longer stays, positive therapeutic alliance and better premorbid family functioning independently predicted better outcome. Mean cost of admission was £24,100; pre-admission and post-discharge support costs were similar. Conclusions:, Inpatient treatment is associated with substantive sustained health gain across a range of diagnoses. Lack of intensive outpatient-treatment alternatives limits any unqualified inference about causal effects, but the rigour of measurement here gives the strongest indication to date of the positive impact of admission for complex mental health problems in young people. [source] Psychopathology among preterm infants using the Diagnostic Classification Zero to ThreeACTA PAEDIATRICA, Issue 12 2009A Janssens Abstract Aim:, To compare the prevalence of psychopathology in infants born preterm with matched full-term infants at the corrected age of 1 year. Methods:, Between June 2003 and April 2005, a case-control longitudinal cohort study was conducted at the neonatal unit of the University Hospital of Antwerp, Belgium. We prospectively enrolled 123 live-born infants between 25 and 35 weeks of gestation and/or infants with a birth-weight of <1500 g. Thirty full-term infants were recruited among day care centres in the region. Diagnoses were based on the Diagnostic Classification Zero to Three (DC: 0,3), using the MacArthur Communicative Developmental Inventory Dutch version, Infant,Toddler Sensory Profile, Bayley Scales of Infant Development II, Parent Infant Relationship Global Assessment Scale and Functional Emotional Assessment Scale. Results:, At the (corrected) age of 12 months, 89 infants were eligible for follow-up and complete data were available for 69 (77%) infants. Fifty-four percentage of the preterm infants fulfilled one or more DC 0,3 diagnoses. Premature infants had significantly more diagnoses than full-term infants on axis I, axis III and axis V of the DC: 0,3. Conclusion:, In this study, the prevalence of psychopathology was significantly higher among preterm infants in comparison with full-term infants. This study did not confirm previous findings of higher rates of relationship disorders among preterm infants. [source] Parent,infant relationship global assessment scale: A study of its predictive validityPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2002YUTAKA AOKI Abstract The Parent,Infant Relationship Global Assessment Scale (PIRGAS; Zero to Three, 1994) provides a continuously distributed scale of infant,parent relationship adaptation, raging from ,well-adapted' to ,dangerously impaired'. The present study examines the predictive validity of the PIRGAS in a high-risk sample by coding relationship adaptation level from a single sample of 10 min of unstructured free play between mothers and their 20-month-old infants and examining its relationship to subsequent interaction with mothers and behavior problems at 24 months. Relationship adaptation assessed reliably from observations of only 10 min of free play between mothers and their infants at 20 months of age using PIRGAS predicted subsequent mother, infant interaction in a laboratory based problem-solving paradigm (Crowell procedure) at 24 months and internalizing symptomatology of Child Behavior Checklist at age 24 months. These results contribute to the predictive validity of the PIRGAS as a measure of mother,infant relationship adaptation. [source] Reliability of a Rating Scale to Assess Post-stroke Psychiatric SymptomsPSYCHOGERIATRICS, Issue 1 2001Tadashi Kusunoki Background: Various rating scales for post-stroke psychiatric symptoms such as cognitive impairment have long been used in drug efficacy trials in Japan. However, their reliability has not been established. The purpose of the present study was to examine the inter-rater and intra-rater reliability of a rating scale, which has been conventionally used in Japan. Methods: The most frequent symptoms, including apathy, emotional and cognitive impairment, found in post-stroke patients were assessed using a rating scale comprising 17 items and 4 global assessment scales. Semi-structured interviews of 18 patients with symptoms with various degrees of severity were videotaped. Twelve physicians who were not interviewers independently assessed the severity of symptoms in the 18 patients by replaying the videotapes. This procedure was repeated twice with an interval of two months to examine inter-rater and test-retest reliability. Results: The results revealed almost satisfactory reliability. Intraclass correlation coefficients were over 0.6 in the inter-rater analysis for most items and the concordance correlation coefficients were over 0.7 in the intra-rater analysis. The rating scale was considered to be reliable, although some items showed relatively low agreement. Conclusion: The conventional rating scale to assess post-stroke psychiatric symptoms showed satisfactory inter-rater and intra-rater reliability by the videotape method. The validity study should be further investigated. [source] Measuring disease activity and functional status in patients with scleroderma and Raynaud's phenomenonARTHRITIS & RHEUMATISM, Issue 9 2002Peter A. Merkel Objective To document disease activity and functional status in patients with scleroderma (systemic sclerosis [SSc]) and Raynaud's phenomenon (RP) and to determine the sensitivity to change, reliability, ease of use, and validity of various outcome measures in these patients. Methods Patients with SSc and moderate-to-severe RP participating in a multicenter RP treatment trial completed daily diaries documenting the frequency and duration of RP attacks and recorded a daily Raynaud's Condition Score (RCS). Mean scores for the 2-week periods prior to baseline (week 0), end of trial (week 6), and posttrial followup (week 12) were calculated. At weeks 0, 6, and 12, physicians completed 3 global assessment scales and performed clinical assessments of digital ulcers and infarcts; patients completed the Health Assessment Questionnaire (HAQ), the Arthritis Impact Measurement Scales 2 (AIMS2) mood and tension subscales, 5 specific SSc/RP-related visual analog scales (VAS), and 3 other VAS global assessments. We used these measures to document baseline disease activity and to assess their construct validity, sensitivity to change, and reliability in trial data. Results Two hundred eighty-one patients (248 women, 33 men; mean age 50.4 years [range 18,82 years]) from 14 centers participated. Forty-eight percent had limited cutaneous SSc; 52% had diffuse cutaneous SSc. Fifty-nine patients (21%) had digital ulcers at baseline. Patients had 3.89 ± 2.33 (mean ± SD) daily RP attacks (range 0.8,14.6), with a duration of 82.1 ± 91.6 minutes/attack. RCS for RP activity (possible range 0,10) was 4.30 ± 1.92. HAQ scores (0,3 scale) indicated substantial disability at baseline (total disability 0.86, pain 1.19), especially among the subscales pertaining to hand function (grip, eating, dressing). AIMS2 mood and tension scores were fairly high, as were many of the VAS scores. Patients with digital ulcers had worse RCS, pain, HAQ disability (overall, grip, eating, and dressing), physician's global assessment, and tension, but no significant difference in the frequency of RP, duration of RP, patient's global assessment, or mood, compared with patients without digital ulcers. VAS scores for digital ulcers as rated by the patients were not consistent with the physician's ratings. Factor analysis of the 18 measures showed strong associations among variables in 4 distinct domains: disease activity, RP measures, digital ulcer measures, and mood/tension. Reliability of the RCS, HAQ pain and disability scales, and AIMS2 mood and tension subscales was high. The RP measures demonstrated good sensitivity to change (effect sizes 0.33,0.76). Conclusion Our findings demonstrate that the significant activity, disability, pain, and psychological impact of RP and digital ulcers in SSc can be measured by a small set of valid and reliable outcome measures. These outcome measures provide information beyond the quantitative metrics of RP attacks. We propose a core set of measures for use in clinical trials of RP in SSc patients that includes the RCS, patient and physician VAS ratings of RP activity, a digital ulcer/infarct measure, measures of disability and pain (HAQ), and measures of psychological function (AIMS2). [source] | |||||||||||||