Tag: Screening Tool

What is the Young Mania Rating Scale?

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Introduction

The Young Mania Rating Scale (YMRS), developed by Vincent E Ziegler and popularised by Robert Young, is an eleven-item multiple choice diagnostic questionnaire which psychiatrists use to measure the presence and severity of mania and associated symptoms.

Background

The scale was originally developed for use in the evaluation of adult patients with bipolar disorder, but has since been adapted for use in paediatric patients. The scale is widely used by clinicians and researchers in the diagnosis, evaluation, and quantification of manic symptomology.

A similar scale was later developed to allow clinicians to interview parents about their children’s symptoms, in order to ascertain a better diagnosis of mania in children. This parent version (P-YMRS) can be completed by a parent or a teacher to determine whether a child should receive further evaluation from a psychologist or psychiatrist. Clinical studies have demonstrated the reliability and validity of the parent version of the scale, which has been found to provide “clinically meaningful information about mood disorders in youth.” The P-YMRS does succeed in identifying most cases of childhood bipolar disorder, but it has an extremely high false positive rate.

What is the Mood Disorder Questionnaire?

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Introduction

The Mood Disorder Questionnaire (MDQ) is a self-report questionnaire designed to help detect bipolar disorder.

It focuses on symptoms of hypomania and mania, which are the mood states that separate bipolar disorders from other types of depression and mood disorder. It has 5 main questions, and the first question has 13 parts, for a total of 17 questions. The MDQ was originally tested with adults, but it also has been studied in adolescents ages 11 years and above. It takes approximately 5-10 minutes to complete. In 2006, a parent-report version was created to allow for assessment of bipolar symptoms in children or adolescents from a caregiver perspective, with the research looking at youths as young as 5 years old.

The MDQ has become one of the most widely studied and used questionnaires for bipolar disorder, and it has been translated into more than a dozen languages.

Development

The MDQ was developed as a screening tool for bipolar disorder, and assesses symptoms of mania and hypomania It was developed in the hopes that it would reduce the mis-diagnosis and delayed diagnosis of bipolar disorder. The first 13 items on the measure ask about any manic/hypomanic symptoms that may have occurred during one’s lifetime. These items are based on the DSM-IV criteria for bipolar disorder. Additional items then ask if these symptoms have happened during the same period of time (an “episode”), and how severely these symptoms affected functioning (assessing impairment).

In developing this tool, the MDQ was administered to a group of bipolar patients to assess feasibility and face validity, leading to revision of the items. Following this initial study, researchers have assessed psychometric properties of the MDQ, finding that the measure possesses adequate internal consistency. The measure has also demonstrated fair sensitivity in several studies, although sensitivity may be greater in inpatient versus community settings. First built for use in adults, it has been translated into many languages and tested in a range of different settings. Researchers also have studied whether parents could use this to provide useful information about their child or adolescent. Meta-analyses have found that the MDQ is one of the best self-report tools for assessing hypomania or mania in adults, and the parent report version is one of the three best options available for parents to use about their children.

Limitations

One limitation of the MDQ is that it has shown higher sensitivity when detecting bipolar I compared to other bipolar spectrum disorders. It is much less sensitive to bipolar II, often missing more than half of the cases with this diagnosis when using the recommended algorithm. Additionally, the sensitivity and specificity of the MDQ has been shown to differ by the use of a standard vs. modified cutoff (i.e. simplifies the cutoff to be based only on symptom endorsement, rather than impairment). Sensitivity and specificity of the MDQ also depend on study inclusion and exclusion criteria. Including more severe cases will increase the apparent sensitivity, because it is more likely that they will have high scores. Including healthy controls or people who are not seeking services will exaggerate the specificity of the test, as these individuals are unlikely to have manic symptoms and will score very low on the measure as a result.

Another major limitation of the MDQ is that it is not to be sensitive to treatment effects. It asks about lifetime history of symptoms, which is a strength for screening and detection, but a weakness for measuring the current severity of mood symptoms. The MDQ also uses a yes/no format for the symptoms, rather than asking about the severity of each. Other rating scales are more useful for measuring severity and treatment outcomes.

Additionally, self-report measures have some disadvantages, including bias that can stem from social desirability and demand characteristics.

What is the Bipolar Spectrum Diagnostic Scale?

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Introduction

The Bipolar Spectrum Diagnostic Scale (BSDS) is a psychiatric screening rating scale for bipolar disorder.

Background

It was developed by Ronald Pies, and was later refined and tested by S. Nassir Ghaemi and colleagues. The BSDS arose from Pies’s experience as a psychopharmacology consultant, where he was frequently called on to manage cases of “treatment-resistant depression”. Patients are typically diagnosed during their 20s. The lifetime prevalence of BD is approximately 1%, rising to 4% if a broader definition of bipolar spectrum disorder is used.

The English version of the scale consists of 19 question items and two sections. It differs from most scales in that it does not list separate items, but rather presents a short paragraph talking about experiences that people with bipolar spectrum disorders often have. The person checks off which phrases or experiences fit them. Bipolar spectrum disorder includes bipolar I and bipolar II, and other cases not meeting criteria for those disorders.

The scale was validated in its original version and demonstrated high diagnostic sensitivity, meaning that most people with confirmed bipolar diagnoses scored high on the BSDS. The BSDS may do better than other scales at detecting types of bipolar disorder that do not involve a full manic episode, such as bipolar II or cyclothymic disorder.

What is the Toronto Alexithymia Scale?

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Introduction

The Toronto Alexithymia Scale is a measure of deficiency in understanding, processing, or describing emotions.

Background

It was developed in 1986 and later revised, removing some of the items.

The current version has twenty statements rated on a five-point Likert scale.

The reliability and validity of the TAS-20 was established by a series of articles by Bagby and colleagues (1994).

Reference

Bagby, R.M., Parker, J.D.A. & Taylor, G.J. (1994) The Twenty-Item Toronto Alexithymia Scale—I. Item Selection and Cross-Validation of the Factor Structure. Journal of Psychosomatic Research. 38(1), pp.23-32.

What is the Yale-Brown Obsessive Compulsive Scale?

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Introduction

The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) is a test to rate the severity of obsessive-compulsive disorder (OCD) symptoms.

The scale, which was designed by Wayne K. Goodman and his colleagues, is used extensively in research and clinical practice to both determine severity of OCD and to monitor improvement during treatment. This scale, which measures obsessions separately from compulsions, specifically measures the severity of symptoms of obsessive-compulsive disorder without being biased towards or against the type of content the obsessions or compulsions might present. Following the original publication the total score is usually computed from the subscales for obsessions (items 1-5) and compulsions (items 6-10) but other algorithms exist.

Accuracy and Modifications

Goodman and his colleagues have developed the Yale-Brown Obsessive-Compulsive Scale-Second Edition (Y-BOCS-II) in an effort to modify the original scale which, according to Goodman, “[has become] the gold standard measure of obsessive-compulsive disorder (OCD) symptom severity”. In creating the Y-BOCS-II, changes were made “to the Severity Scale item content and scoring framework, integrating avoidance into the scoring of Severity Scale items, and modifying the Symptom Checklist content and format”. After reliability tests, Goodman concluded that “Taken together, the Y-BOCS-II has excellent psychometric properties in assessing the presence and severity, of obsessive-compulsive symptoms. Although the Y-BOCS remains a reliable and valid measure, the Y-BOCS-II may provide an alternative method of assessing symptom presence and severity.”

Studies have been conducted by members of the Iranian Journal of Psychiatry & Clinical Psychology to determine the accuracy of the Yale-Brown Obsessive Compulsive Scale (specifically as it appears in its Persian format). The members applied the scale to a group of individuals and, after ensuring a normal distribution of data, a series of reliability tests were performed. According to the authors, “[the] results supported satisfactory validity and reliability of translated form of Yale-Brown Obsessive-Compulsive Scale for research and clinical diagnostic applications”.

Children’s Version

The children’s version of the Y-BOCS, or the Children’s Yale-Brown Obsessive Compulsive Scales (CY-BOCS), is a clinician-report questionnaire designed to assess symptoms of obsessive compulsive disorder from childhood through early adolescence.

The CY-BOCS contains 70 questions and takes about 15-25 minutes. Each question is designed to ask about symptoms of obsessive compulsive behaviour, though the exact breakdown of questions is unknown. For each question, children rate the degree to which the question applies on a scale of 0-4. Based on research, this assessment has been found to be statistically valid and reliable, but not necessarily helpful.

Other Versions

The CY-BOCS has been adapted into several self- and parent-report versions, designed to be completed by parent and child working together, although most have not been psychometrically validated. However, these versions still ask the child to rate the severity of their obsessive compulsive behaviours and the degree to which each has been impairing. While this measure has been found to be useful in a clinic setting, scores and interpretations are taken with a grain of salt, given the lack of validation.

Another version, which is parent-focused, is similar to the original CY-BOCS and is administered to both parent and child by the clinician. This version was distributed by Solvay Pharmaceuticals in the late 1990s, creating an association between the measure and a number of pharmaceutical groups that has caused it to be avoided by most clinicians. Severity cut-off scores for this version have not been empirically determined.

What is the Neurotic Personality Questionnaire KON-2006?

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Introduction

The Neurotic Personality Questionnaire KON-2006 is a psychometric tool used for diagnosing personality dysfunctions that contribute to the development of neurotic disorders.

The use of the questionnaire may facilitate the diagnosis of neurotic disorder, as well as make it easier to differentiate between neurotic and pseudoneurotic syndroms, e.g. reaction to stress. Moreover, the questionnaire enables evaluation of changes occurring in the course of treatment.

The questionnaire has been created by Jerzy W. Aleksandrowicz, Katarzyna Klasa, Jerzy A. Sobański and Dorota Stolarska in the Department of Psychotherapy of the Jagiellonian University Medical College in Kraków, Poland.

Refer to Neuroticism and Neurosis.

The Content of the Questionnaire

The questionnaire consists of 243 items that require positive or negative answer. They determine the values of 24 scales that describe areas related to the development of neurotic disorders, as well as the value of X-KON index that describes the global intensity of neurotic personality. Currently, only the Polish and Ukrainian versions of KON-2006 are available, however a number of studies based on the tool has been published in English.

Scales

The following working (approximate) names were given to KON-2006 scales:

  • Feeling of being dependent on the environment.
  • Asthenia.
  • Negative self-esteem.
  • Impulsiveness.
  • Difficulties with decision making.
  • Sense of alienation.
  • Demobilisation.
  • Tendency to take risks.
  • Difficulties in emotional relations.
  • Lack of vitality.
  • Conviction of own resourcelessness in life.
  • Sense of lack of control.
  • Deficit in internal locus of control.
  • Imagination. indulging in fiction.
  • Sense of guilt.
  • Difficulties in interpersonal relations.
  • Envy.
  • Narcissistic attitude.
  • Sense of being in danger.
  • Exaltation.
  • Irrationality.
  • Meticulousness.
  • Ponderings.
  • Sense of being overloaded.

Methodology of the Questionnaire Creation

Search for and selection of items that were used for the creation of the KON-2006 questionnaire were based on empirical methods. Analysis of usefulness of 779 items was conducted (including items drawn from scales belonging to various personality and temperament inventories e.g. 16PF, MMPI, PTS, TTS, IPIP, TCI). Clarity, explicitness and comprehensiveness of each item was evaluated and appropriate improvements were implemented. Next, a comparison of answers was made between healthy individuals and the patients that were beginning treatment due to neurotic disorders. This allowed to select 243 items most useful in differentiation of the patients with neurotic disorders from the healthy individuals. These items were used for the creation of Neurotic Personality Questionnaire. The construction of 24 scales was based on cluster analysis conducted on the population of patients at the beginning of treatment and control groups.

What is the CAGE Questionnaire?

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Introduction

The CAGE questionnaire, the name of which is an acronym of its four questions, is a widely used screening test for problem drinking and potential alcohol problems.

The questionnaire takes less than one minute to administer, and is often used in primary care or other general settings as a quick screening tool rather than as an in-depth interview for those who have alcoholism. The CAGE questionnaire does not have a specific intended population, and is meant to find those who drink excessively and need treatment. The CAGE questionnaire is reliable and valid; however, it is not valid for diagnosis of other substance use disorders, although somewhat modified versions of the CAGE questionnaire have been frequently implemented for such a purpose.

Overview

The CAGE questionnaire asks the following questions:

  1. Have you ever felt you needed to Cut down on your drinking?
  2. Have people Annoyed you by criticising your drinking?
  3. Have you ever felt Guilty about drinking?
  4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

Two “yes” responses indicate that the possibility of alcoholism should be investigated further.

The CAGE questionnaire, among other methods, has been extensively validated for use in identifying alcoholism. CAGE is considered a validated screening technique with high levels of sensitivity and specificity. It has been validated via receiver operating characteristic analysis, establishing its ability to screen for problem drinking behaviours.

Brief History

The CAGE questionnaire was developed in 1968 at North Carolina Memorial Hospital to combat the paucity of screening measures to detect problem drinking behaviours. The original study, conducted in a general hospital population where 130 patients were randomly selected to partake in an in-depth interview, successfully isolated four questions that make up the questionnaire today due to their ability to detect the sixteen alcoholics from the rest of the patients.

Reliability

Reliability refers to whether the scores are reproducible. Not all of the different types of reliability apply to the way that the CAGE is typically used. Internal consistency (whether all of the items measure the same construct) is not usually reported in studies of the CAGE; nor is inter-rater reliability (which would measure how similar peoples’ responses were if the interviews were repeated again, or different raters listened to the same interview).

Rubric for Evaluating Norms and Reliability for the CAGE Questionnaire

CriterionRating [1]Explanation
NormsN/ANormative data are not gathered for screening measures of this sort.
Internal ConsistencyNot ReportedA meta-analysis of 22 studies reported the median internal consistency was
α= 0.74.
Inter-Rater ReliabilityNot Usually Reported1. Inter-rater reliability studies examine whether people’s responses are scored the same by different raters, or whether people disclose the same information to different interviewers.
2. These may not have been done yet with the CAGE; however, other research has shown that interviewer characteristics can change people’s tendencies to disclose information about sensitive or stigmatised behaviours, such as alcohol or drug use.
Test-Retest Reliability (Stability)Not Usually ReportedRetest reliability studies help measure whether things behave more as a state or trait; they are rarely done with screening measures.
RepeatabilityNot ReportedRepeatability studies would examine whether scores tend to shift over time; these are rarely done with screening tests.

Validity

Validity describes the evidence that an assessment tool measures what it was supposed to measure. There are many different ways of checking validity. For screening measures such as the CAGE, diagnostic accuracy and discriminative validity are probably the most useful ways of looking at validity.

Evaluation of Validity and Utility for the CAGE Questionnaire

CriterionRating [1]Explanation
Content ValidityAdequateItems are face valid; not clear that they comprehensively cover all aspects of problem drinking.
Construct Validity [2]GoodMultiple studies show screening and predictive value across a range of age groups and samples.
Discriminative ValidityExcellentStudies not usually reporting AUCs, but combined sensitivity and specificity often excellent.
Validity GeneralisationExcellentMultiple studies show screening and predictive value across a range of age groups and samples.
Treatment SensitivityN/ACAGE not intended for use as an outcome measure.
Clinical UtilityGoodFree (public domain), extensive research base, brief.

Notes:

  1. Ratings = Adequate, Good, Excellent, Too Good.
  2. For example: predictive, concurrent, convergent, and discriminant validity.

Limitations

The CAGE is designed as a self-report questionnaire. It is obvious to the person what the questions are about. Because talking about drinking behaviour can be uncomfortable or stigmatized, people’s responses may be subject to social desirability bias. The honesty and accuracy of responses may improve if the person trusts the person doing the interview or interpreting the score. Responses also may be more honest when the form is completed online, on a computer, or in other anonymous formats.

Alternatives

Some alternatives to the CAGE include:

TestDescription
TWEAKA 5-item questionnaire that was originally developed for pregnant women at risk for drinking problems.
Michigan Alcoholism Screening Test (MAST)A 25-item scale designed to assess lifetime symptoms of alcoholism with a focus on late-stage symptoms.
Brief MASTShortened 10-item version of the MAST.
Short MASTA second shortened version of the MAST that does not include questions pertaining physical symptoms of drinking.
Veterans Alcoholism Screening Test (VAST)A 25-item questionnaire similar to the MAST that distinguishes between current and past symptoms.
Alcohol Use Disorders Identification Test (AUDIT)A 10-item scale that focuses on symptoms experienced within the past year.
Adolescent Drinking IndexA 24-item scale developed specifically to assess the degree of an adolescent (age 12-17) individual’s drinking problem.

What is the Suicide Behaviours Questionnaire-Revised?

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Introduction

The Suicide Behaviors Questionnaire-Revised (SBQ-R) is a psychological self-report questionnaire designed to identify risk factors for suicide in children and adolescents between ages 13 and 18.

Background

The four-question test is filled out by the child and takes approximately five minutes to complete. The questionnaire has been found to be reliable and valid in recent studies. One study demonstrated that the SBQ-R had high internal consistency with a sample of university students. However, another body of research, which evaluated some of the most commonly used tools for assessing suicidal thoughts and behaviours in college-aged students, found that the SBQ-R and suicide assessment tools in general have very little overlap between them. One of the greatest strengths of the SBQ-R is that, unlike some other tools commonly used for suicidality assessment, it asks about future anticipation of suicidal thoughts or behaviours as well as past and present ones and includes a question about lifetime suicidal ideation, plans to commit suicide, and actual attempts.

Question Breakdown, Scoring, and Interpretation

Each of the four questions addresses a specific risk factor: the first concerns presence of suicidal thoughts and attempts, the second concerns frequency of suicidal thoughts, the third concerns the threat level of suicidal attempts, and the fourth concerns likelihood of future suicidal attempts. The first item has often been used on its own in order to assign individuals to a suicidal and a non-suicidal control group for studies. Each question has an individual scale, and each response corresponds to a certain point value.

Domain Breakdown

A maximum score of 18 is possible on the SBQ-R, and the following responses to the 4 questions correspond to the following point values:

Point ValueQuestion 1 ResponseQuestion 2 ResponseQuestion 3 ResponseQuestion 4 Response
0–––Never
11Never1No chance at all
22, 3a, or 3bRarely2a or 2bRather unlikely
3–Sometimes3a or 3bUnlikely
44a or 4bOften–Likely
5–Very often–Rather likely
6–––Very likely

Interpretation of Subscale Scores

A total score of 7 and higher in the general population and a total score of 8 and higher in patients with psychiatric disorders indicates significant risk of suicidal behaviour.

What is the Cambridge Neuropsychological Test Automated Battery?

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Introduction

The Cambridge Neuropsychological Test Automated Battery (CANTAB), originally developed at the University of Cambridge in the 1980s but now provided in a commercial capacity by Cambridge Cognition, is a computer-based cognitive assessment system consisting of a battery of neuropsychological tests, administered to subjects using a touch screen computer.

Outline

The CANTAB tests were co-invented by Professor Trevor Robbins and Professor Barbara Sahakian.

The 25 tests in CANTAB examine various areas of cognitive function, including:

  • General memory and learning.
  • Working memory and executive function.
  • Visual memory.
  • Attention and reaction time (RT).
  • Semantic/verbal memory.
  • Decision making and response control.

The CANTAB combines the accuracy and rigour of computerised psychological testing whilst retaining the wide range of ability measures demanded of a neuropsychological battery. It is suitable for young and old subjects, and aims to be culture and language independent through the use of non-verbal stimuli in the majority of the tests.

The CANTAB PAL touchscreen test, which assesses visual memory and new learning, received the highest rating of world-leading 4* grade from the Research Excellence Framework (REF) 2014. CANTAB and CANTAB PAL were highlighted in the Medical Schools Council ‘Health of the Nation’ 2015 publication.

What is the Alcohol Use Disorders Identification Test?

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Introduction

The Alcohol Use Disorders Identification Test (AUDIT) is a ten-item questionnaire approved by the World Health Organisation (WHO) to screen patients for hazardous (risky) and harmful alcohol consumption.

Background

It was developed from a WHO multi-country collaborative study, the items being selected for the AUDIT being the best performing of approximately 150 items including in the original survey. It is widely used as a summary measure of alcohol use and related problems. It has application in primary health care, medical clinics, and hospital units and performs well in these settings. Using different cut-off points, it can also screen for Alcohol Use Disorder (DSM-5) and Alcohol Dependence. Guidelines for the use of the AUDIT have been published by WHO and are available in several languages. It has become a widely used instrument and has been translated into approximately fifty languages.

The AUDIT consists of ten questions, all of which ask explicitly about alcohol:

  • Questions 1 to 3 ask about consumption of alcohol (frequency, quantity or typical drinking occasions, and consumption likely to cause impairment);
  • Possible dependence on alcohol (Questions 4 to 6); and
  • Harmful alcohol use, including concern expressed by others (Questions 7 to 10).

Each question is scored between 0 and 4 depending on the response and so the total score ranges between 0 and 40. Based on responses in the original WHO multi-centre study a score of 8 or more is the threshold for identifying hazardous or harmful alcohol consumption with a score of 15 or more indicating likely alcohol dependence, and 20 or more indicating likely severe dependence and harm. Using the cut-off point of 8, its performance in the original collaborative WHO study indicated a sensitivity of 92% and a specificity of 94% for the diagnoses of hazardous and harmful alcohol consumption.

The AUDIT was designed to be used internationally, and was derived from a WHO collaborative study drawing patients from six countries, representing different regions of the world and different political and economic systems. More than 300 studies have been undertaken to examine its usefulness and validity in various settings. Multiple studies have found that the AUDIT is a reliable and valid measure in identifying alcohol abuse, hazardous consumption and harmful alcohol use (consumption leading to actual harm) and it has also been found to be a valid indicator for severity of alcohol dependence. There is some evidence that the AUDIT works in adolescents and young adults; it appears less accurate in older adults. It appears well-suited for use with college students, and also with women and members of minority groups. There has also been significant evidence for its use in the trauma patient population to screen for possible alcohol use disorders. In the trauma patient population, AUDIT has been shown to be more effective at identifying possible alcohol abuse than physician judgement and the blood alcohol content (BAC) test.

A shorter version of the Alcohol Use Disorders Identification Test (AUDIT-C) has been created for rapid use, and is composed of the first 3-question of the full length AUDIT pertaining specifically to quantity of alcohol consumed. It is appropriate for screening for problem drinking in a doctor’s office.