Quantifizierung psychotischer Symptome unter transkulturellen Aspekten

Comparisons of Psychopathology Across Cultures

Comparative cross-cultural studies of psychopathology were reviewed in relation to the parameters of incidence, mode of manifestation, patterning, response to treatment, and outcome. A general model was proposed of regarding such differences as the joint function of subject, observer, setting, community, and instrument factors. The findings surveyed, even in their present nondefinitive state, favor the notion of cultural plasticity of psychopathology and, moreover, converge in suggesting that psychopathology represents a caricature and an exaggeration of culturally shared adaptive patterns of behavior. For a more conclusive examination of this possibility, concurrent research on normal and abnormal subjects drawn from several cultures was proposed and a number of specific modes of implementing this objective were presented.

Some problems concerning the reliability and structure of the scales in the inpatient multidimensional psychiatric scale (IMPS)

Two problems concerning the IMPS are revealed. First, the importance of an appropriate reliability measure is demonstrated in a sample of 124 inpatients. Widely divergent results are found using three different intraclass correlation coefficients. The one producing the highest results was used by Klett and McNair (1966) and by Behrends et al. (1971). However, the results from this measure only apply to certain types of investigation. A measure more applicable to most investigations in psychiatric research (the intraclass correlation coefficient of individual ratings with between-rater variance included) produced results that were clearly lower, although still acceptable, with an average correlation of 0.72 between the 12 scales. Secondly, the multiplication of item scores by 2 or 8 when forming the scale scores is shown to lead to unusual and undesirable scale distributions in a sample of 1932 inpatients. The resulting implications for assessing change scores on some of the IMPS scales are discussed.

The stability of the symptom groupings in the Inpatient Multidimensional Psychiatric Scale (IMPS)

A full set of data has been gathered on admission of 1654 inpatients and included information on all 90 items from the Inpatient Multidimensional Psychiatric Scale (IMPS). The sample was divided into two by means of an odd-even split and principal component analyses with Varimax rotation as well as Ward hierarchical cluster analyses of symptoms were run on both subsamples. Comparisons of results were than made between the two subsamples, between the two methods of analysis, and with the studies of Lorr and Klett and Behrends et al. In general, earlier results concerning the structure of the symptom groupings have been confirmed. However, by comparing all the different sets of results, those symptom groupings that are particularly stable or unstable have been identified. In addition, comparisons have been made between the results from analyses using the full range of scores on the items and those using dichotomized scores in order to determine whether the use of different rating scales for different items has an effect on the resulting item groupings.

[Stability of the factor structure in the AMDP-Scale (author's transl)]

A factor analytic study of the Psychopathology Scale and the Somatic Symptoms Scale of the AMDP System in reported. The random sample was comprised of 1166 psychiatric inpatients, and the resulting factors are compared with other factor analytic studies based on the AMDP System. The study concluded that the AMDP scales have a stable factorial structure, but more exact comparative methods of factorial structure should be applied in future studies.

The measurement of change in endogenous affective disorders

Psychopathological syndromes, as originally revealed by clinical observation, can also be detected by multivariate statistical analyses of symptom ratings. Changes in the course of psychiatric syndromes may be rated simply by improvement scales or by consecutive quantifications of symptoms and their comparison in chronological order. For the latter approach, which is less liable to bias, clinical ratings of psychopathology by staff members, self-ratings by the patients, analyses of patients' overt behavior (including video and speech records), or objective measurements of psychological and/or physiological variables can be used. Advantages and limitations of these different methods are discussed and illustrated by examples from ongoing clinical research in affective disorders. Generally, the combined use of different rating procedures is recommended. Self-ratings are economical, but they may represent aspects of psychopathology other than clinical ratings. In endogenous depression, mood scales are valid (supplementary) tools for the quantification of long-term as well as short-term changes, including diurnal variations. In severe conditions of mania, however, clinical rating has been--until now--the only valid basis for quantifying the degree of psychopathology and its changes with time. Precise evaluation of changes in psychopathology is essential in longitudinal investigations of endogenous affective disorders, since psychopathology up to now seems to have been the most sensitive and the most specific indicator of the hypothetical underlying abnormalities of cerebral functioning.

[The effect of the beta-adrenergic blocking agent propranolol in mania (author's transl)]

Six patients with the diagnosis of acute mania were treated with high doses of the beta-adrenergic blocking agent propranolol. One of these patients was treated during two manic phases. Psychopathologic change during treatment was rated daily by a psychiatrist not informed on the patients medication. The IMPS (Inpatient Multidimensional Psychiatric Scale) was used. Three cases were placebo-controlled under double blind conditions. Four times we had a second medication period, twice with propranolol and once with oxprenolol and dexpropranolol respectively. Propranolol was administered every 4 h (six times per day), starting with single doses of 20-40 mg. Doses were increased individually under control of pulse rate, blood pressure, and ECG. Augmentation of doses was continued until an effect on manic symptomatology was undoubtedly seen or until therapy had to be discontinued because of side-effects. In four patients definite improvement of manic symptomatology could be achieved during altogether five manic phases within usually two treatment periods of 5-15 days. Manic behavior disappeared completely in two of these patients. The effective dosage of propranolol varied between 280 and 2320 mg per day. All of the improved patients relapsed after discontinuation of the drug. In the only case on dexpropranolol (5 days up to 900 mg daily) the effect was questionable. No extrapyramidal side-effects were observed. In one patient treatment was discontinued because of lack of cooperation, in another because of extrasystoles. Gastrointestinal bleeding occurred in the patient who received dexpropranolol. This complication was possibly due to other medication. Other side-effects were insomnia, hypertension, precordial pain, abdominal pain as well as the expected hypotension and bradycardia. The significance of these results regarding the catecholamine hypothesis of manic-depressive illness is discussed.

[Attempts at a nosological classification with two standardized psychiatric rating scales (author's transl)]

Three different procedures for classification of psychiatric patients, a modified form of Q factor analysis, the classical discriminant analysis and a simple procedure based on clinical concepts, were compared empirically. On the basis of the psychopathological state rated by means of the Inpatient Multidimensional Psychiatric Scale (IMPS) and psychopathological and somatic scales of the AMP documentation system (AMP scale), the three procedures were applied in order to reproduce the psychiatric diagnosis. The classification was made by paired comparison of the following four diagnoses: schizophrenia, paranoid form (n = 45), schizophrenia, unspecified form (n = 47), depressive psychosis (n = 44), and depressive neurosis (n = 53). The procedures were evaluated according to their crossvalidation results. The mean percentages of correct classification were the following: 83% for the modified form of Q factor analysis, 77% for the classical discriminant analysis, 73% for the simple procedure based on clinical concepts using the IMPS, and 79% for the same procedure, but using the AMP scale, all three procedures reaching about the same level of validity.

[Psychiatric classification by means of a discriminatory application of Q factor analysis (author's transl)]

An attempt is made to separate different pairs of psychiatric patient groups by means of a modified form of Q factor analysis comparable to discriminant analysis. The psychopathological state of 454 patients had been rated using two psychiatric rating scales, the IMPS (Inpatient Multidimensional Psychiatric Scale) by Lorr et al. and the psychopathological and somatic scales of the AMP documentation system. Out of these patients the four most frequently occurring groups (schizophrenia, paranoid form, n = 45; schizophrenia, unspecified form, n = 47; depressive psychosis, n = 44; depressive neurosis, n = 53) were selected. Each patient group was divided randomly into two samples, an analysis sample and a validation sample. Only those items were selected which discriminated best between any two analysis samples. Using G indices a Q factor analysis was calculated, and the results improved by a criterion-related additional rotation. The resulting weights were transferred to the validation samples in order to have a cross validation. The mean percentage of correct placements within the validation samples was 83%.