Affective disorders symposium Flashcards
Describe clinician administered rating scales
Clinical interview
Individual clinician judgment
Training
Structured interviews
Describe self rated scales
Less time consuming
No training of staff required
standardised administration and scoring process
Requires ability to read and understand language
What is the state of a patient?
E.g. At the moment of interview
Past n. weeks
What is validity?
The degree to which the scale measures what it is supposed to measure
What is internal consistency?
General agreement between multiple items that make-up a composite score of a measurement. This agreement is generally measured by the correlation between items
What is inter rater reliability?
The degree of agreement among different raters
Depends on structured interviews and training
What is test retest reliability?
The degree to which rating scores are consistent over time (within same rater)
Describe the Montgomery-Asberg Depression Rating Scale (MADRS)
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
What are the cut off scores of the MADRS?
<10: remission
>30: severe depression
Describe the young mania rating scale YMRS
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
Describe the anchor points of MADRS
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
Describe the MADRS criteria of depressed mood
Low spirits
Despondency
Feeling beyond help or without hope
What can you ask in terms of depressed mood in MADRS?
Intensity
Duration
Mood reactivity
What is a MADRS rating of apparent sadness based on?
Responses Speech Facial expression Posture Depth and inability to brighten up
What does MADRS inner tension evaluate?
Feelings of ill defined discomfort
Anxiety, nervousness and worry
Panic, dread and anguish
What can you ask about to determine inner tension?
Frequency Duration Intensity Impairment Distress and need for reassurance
What should you not ask about to evaluate inner tension?
Irritability
Anxious appearance
Agitation Physical symptoms of anxiety
What does MADRS reduced sleep evaluate?
Reduction in depth and duration of sleep
Comparison to patients normal sleep pattern when well
High scores - sleep reduced by more than an hour
What does MADRS reduced appetite evaluate?
Loss of desire for food
Reduced pleasure in eating
Need to force oneself to eat
What doesnt MADRS reduced appetite consider?
How much food eaten
Weight loss
Efforts to diet
What does MADRS evaluate about concentration difficulty?
Difficulty collecting thoughts and concentrating
Ask about key activities involving concentration
Frequency, intensity, degree of incapacity
What is a rating of lassitude based on?
Difficulty initiating activity
Slowness performing everyday activity
Pay attention to - work, leisure activities, simple routine tasks, extra effort needed to starting and doing tasks
What does a rating of lassitude not include?
Low energy
Fatigue
What does inability to feel evaluate?
Interests in and enjoyment of surroundings/normally pleasurable activity
Ability to react with adequate emotion
What should you ask about to evaluate a persons inability to feel?
Subjects interests compared to when well
Ability to feel emotion towards family and friends
Ability to experience emotion such as grief and irratibility
What do pessimistic thoughts rate?
Self reproach Inferiority Guilt Sinfulness Pessimism about the future Delusions of ruin, remorse or sin
What do suicidal thoughts evaluate?
Feeling of wery life - not worth living
A natural death would be welcome
Suicidal thoughts
Preparations for suicide
