Affective disorders symposium

Question 1

Describe clinician administered rating scales

Answer 1

Clinical interview
Individual clinician judgment
Training
Structured interviews

Question 2

Describe self rated scales

Answer 2

Less time consuming
No training of staff required
standardised administration and scoring process
Requires ability to read and understand language

Question 3

What is the state of a patient?

Answer 3

E.g. At the moment of interview

Past n. weeks

Question 4

What is validity?

Answer 4

The degree to which the scale measures what it is supposed to measure

Question 5

What is internal consistency?

Answer 5

General agreement between multiple items that make-up a composite score of a measurement. This agreement is generally measured by the correlation between items

Question 6

What is inter rater reliability?

Answer 6

The degree of agreement among different raters

Depends on structured interviews and training

Question 7

What is test retest reliability?

Answer 7

The degree to which rating scores are consistent over time (within same rater)

Question 8

Describe the Montgomery-Asberg Depression Rating Scale (MADRS)

Answer 8

Clinician-administered
10 items (all core symptoms of depression)
Time to complete: 5 to 20 minutes
Based on clinical interviews and informant reports
Structured interview

Monodimensional
More focused toward psychological as opposed to somatic aspects
Design to maximise sensitivity to effects of antidepressants
Lack of reverse neurovegetative symptoms
Atypical signs

Very high Internal consistency
Very high inter rater reliability also with minimal training
High validity, correlates with other scales

Question 9

What are the cut off scores of the MADRS?

Answer 9

<10: remission

>30: severe depression

Question 10

Describe the young mania rating scale YMRS

Answer 10

Clinician-administered
Gold standard of mania rating scales
Wide use in clinical and research setting
11 items Scores for each item: 0 to 8, or 0 to 4
Total score: Up to 60
Time to complete: 15 to 30 minutes

Timeframe: during interview and previous 48 hours
To be administered in conjunction with depression rating scale for mixed episodes
Very clear concise anchor points
Internal consistency: 0.41 to 0.85
Interater reliability: 0.93
Good validity

Question 11

Describe the anchor points of MADRS

Answer 11

Each item is rated from 0 to 6 
Use the full range of the scale 
Even ratings given if both anchor points met unless symptom is severe enough to warrant concern and high rating 
Odd ratings should be used appropriately
Highest possible score is 60

Question 12

Describe the MADRS criteria of depressed mood

Answer 12

Low spirits
Despondency
Feeling beyond help or without hope

Question 13

What can you ask in terms of depressed mood in MADRS?

Answer 13

Intensity
Duration
Mood reactivity

Question 14

What is a MADRS rating of apparent sadness based on?

Answer 14

Responses
Speech
Facial expression
Posture
Depth and inability to brighten up

Question 15

What does MADRS inner tension evaluate?

Answer 15

Feelings of ill defined discomfort
Anxiety, nervousness and worry
Panic, dread and anguish

Question 16

What can you ask about to determine inner tension?

Answer 16

Frequency 
Duration
Intensity
Impairment
Distress and need for reassurance

Question 17

What should you not ask about to evaluate inner tension?

Answer 17

Irritability
Anxious appearance
Agitation Physical symptoms of anxiety

Question 18

What does MADRS reduced sleep evaluate?

Answer 18

Reduction in depth and duration of sleep
Comparison to patients normal sleep pattern when well
High scores - sleep reduced by more than an hour

Question 19

What does MADRS reduced appetite evaluate?

Answer 19

Loss of desire for food
Reduced pleasure in eating
Need to force oneself to eat

Question 20

What doesnt MADRS reduced appetite consider?

Answer 20

How much food eaten
Weight loss
Efforts to diet

Question 21

What does MADRS evaluate about concentration difficulty?

Answer 21

Difficulty collecting thoughts and concentrating
Ask about key activities involving concentration
Frequency, intensity, degree of incapacity

Question 22

What is a rating of lassitude based on?

Answer 22

Difficulty initiating activity
Slowness performing everyday activity
Pay attention to - work, leisure activities, simple routine tasks, extra effort needed to starting and doing tasks

Question 23

What does a rating of lassitude not include?

Answer 23

Low energy

Fatigue

Question 24

What does inability to feel evaluate?

Answer 24

Interests in and enjoyment of surroundings/normally pleasurable activity
Ability to react with adequate emotion

Question 25

What should you ask about to evaluate a persons inability to feel?

Answer 25

Subjects interests compared to when well
Ability to feel emotion towards family and friends
Ability to experience emotion such as grief and irratibility

Question 26

What do pessimistic thoughts rate?

Answer 26

Self reproach
Inferiority 
Guilt
Sinfulness
Pessimism about the future 
Delusions of ruin, remorse or sin

Question 27

What do suicidal thoughts evaluate?

Answer 27

Feeling of wery life - not worth living
A natural death would be welcome
Suicidal thoughts
Preparations for suicide