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Llorca-Bofí V, Garriga M, Bioque M, Amoretti S. Making symptom measurement feasible: The clinical case for PANSS-6. Eur Neuropsychopharmacol 2025; 96:67-68. [PMID: 40412294 DOI: 10.1016/j.euroneuro.2025.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2025] [Accepted: 04/26/2025] [Indexed: 05/27/2025]
Affiliation(s)
- Vicent Llorca-Bofí
- Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Barcelona, Spain; University of Barcelona, Barcelona, Catalonia, Spain
| | - Marina Garriga
- University of Barcelona, Barcelona, Catalonia, Spain; Bipolar and Depressive Disorders Unit, Neuroscience Institute, Hospìtal Clinic de Barcelona. Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Barcelona, Spain
| | - Miquel Bioque
- Barcelona Clínic Schizophrenia Unit (BCSU), Neuroscience Institute, Hospital Clínic de Barcelona, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Barcelona, Spain; University of Barcelona, Barcelona, Catalonia, Spain.
| | - Silvia Amoretti
- Group of Psychiatry, Mental Health and Addictions, Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain
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Chawla V, Bansal N, Spelber D, Desai A, Frehlich L, Ballon JS, Kalinowski A, Noordsy DL. Inspire self report scale (ISRS): A feasibility study of a Novel self report scale for people with schizophrenia spectrum disorders. J Psychiatr Res 2023; 165:248-253. [PMID: 37531843 DOI: 10.1016/j.jpsychires.2023.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 08/04/2023]
Abstract
Clinician-rated symptom scales are the current standard for outcome measures in Schizophrenia Spectrum Disorders (SSD) research. There has been growing interest in the development of self-report measures for people with SSD to support measurement-based care and inclusive research. We developed the Inspire Self Report Scale (ISRS), which measures the current magnitude of well-being, mood symptoms, psychosis, negative symptoms and cognition using 10 questions on a Likert or Visual analogue scale (VAS). The main aim of this report was to investigate the correlation and concordance between patient self-report and clinician ratings on the ISRS during a clinical encounter. When ratings were discordant, we sought to identify whether the participant's or psychiatrist's rating was more accurate. The results indicated a moderately strong statistically significant correlation between participant and clinician ratings. There was a moderate concordance between participant and clinician ratings on the ISRS. When the results were discordant, the participant ratings were assessed to be more accurate than the clinician rating over 70% of the time. The ISRS has distinct utility compared to existing scales due to the measurement of present symptom severity, capturing multiple clinical domains, and time efficiency and ease of use. Thus, it may be useful in clinical and research settings.
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Affiliation(s)
- Vanika Chawla
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Nandini Bansal
- McMaster University, 90 Main St W, Hamilton, ON, L8P 1H6, Canada.
| | - David Spelber
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Aakash Desai
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Levi Frehlich
- Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Canada.
| | - Jacob S Ballon
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Agnieszka Kalinowski
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Douglas L Noordsy
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
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Ko H, Shin J, Cooper LD. Brief Adjustment Scale-6 for Measurement-Based Care: Psychometric Properties, Measurement Invariance, and Clinical Utility. Assessment 2022:10731911221115144. [PMID: 35923134 DOI: 10.1177/10731911221115144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Brief Adjustment Scale-6 (BASE-6) was recently developed for measuring general psychological functioning within measurement-based care (MBC). The present study further evaluated psychometric properties, generalizability to race/ethnic populations, and clinical utility of the BASE-6. Three adult samples, Sample 1: online community participants (n = 394); Sample 2: college students (n = 249); Sample 3: outpatient clinic clients (n = 80), were included. The results demonstrated a high level of internal consistency, good test-retest reliability, and convergent validity in all samples. The unidimensional structure of BASE-6 was confirmed and factorial invariance was established across groups. Finally, the BASE-6 captured change over time by demonstrating a large effect size of pre-post treatment changes and significant linear change in multilevel growth modeling. These results support the BASE-6 as a reliable and valid measure regardless of race/ethnicity and can sensitively detect clinical change over the course of the treatment. Thus, the BASE-6 appears to accurately monitor overall psychological adjustment.
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Affiliation(s)
- Hayoung Ko
- Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Jaehyun Shin
- Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Lee D Cooper
- Virginia Polytechnic Institute and State University, Blacksburg, USA
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Khau M, Tabbane K, Bloom D, Abadi S, Villemus C, Rabinovitch M, Shah JL, Veillette A, Iyer SN, Boksa P, Joober R. Measurement Based Care in a first episode psychosis program: Development of an algorithm of care based on the Clinical Global Impressions Scale. J Psychiatr Res 2022; 150:8-16. [PMID: 35339740 DOI: 10.1016/j.jpsychires.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/26/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Adherence to therapeutic guidelines in psychiatry is anchored and facilitated by rating scales. However, they are rarely used in routine care, particularly for psychotic disorders. Consequently, adherence to treatment guidelines are not ideal and patient outcomes are often sub-optimal. In this study, we used the clinician-rated Clinical Global Impressions Scale (CGI) to implement a measurement-based care (MBC) approach and derive indices of quality of care at a first episode psychosis (FEP) program. METHODS At the individual level, an algorithm was created using CGI scores and their changes over time to define the concept of Patient Requiring Clinical Attention (PRCA) that encompasses several categories (e.g. episode of severity, treatment inertia, or treatment resistance). At the service level, CGI scores were used to derive several indices of quality of care: severity of illness and its change over time, conformity to the use of low doses of antipsychotic medications, and clozapine offer index. RESULTS 135 Patients were included in this study of whom 19 patients were identified as PRCA. Of these, 12 (63%) received timely medication, and 7 (37%) were suspected cases of therapeutic inertia. Additionally, 15 patients met criteria for treatment resistance of whom 7 were offered clozapine (47%). At the service level, the average CGI improved by 2 points from baseline to month 1 and average doses of antipsychotic medications prescribed were in line with prescription guidelines for FEP patients. CONCLUSION The proposed CGI-based treatment algorithm and service evaluation strategy can help to optimize quality care and services for patients.
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Affiliation(s)
- Michelle Khau
- Integrated Program of Neuroscience, McGill University, Montreal, Qc, Canada; Douglas Mental Health University Institute, Verdun, Qc, Canada
| | - Karim Tabbane
- Douglas Mental Health University Institute, Verdun, Qc, Canada; Department of Psychiatry, McGill University, Montreal, Qc, Canada
| | - David Bloom
- Douglas Mental Health University Institute, Verdun, Qc, Canada
| | - Sherezad Abadi
- Douglas Mental Health University Institute, Verdun, Qc, Canada
| | - Celine Villemus
- Douglas Mental Health University Institute, Verdun, Qc, Canada
| | - Mark Rabinovitch
- Douglas Mental Health University Institute, Verdun, Qc, Canada; Department of Psychiatry, McGill University, Montreal, Qc, Canada
| | - Jai L Shah
- Integrated Program of Neuroscience, McGill University, Montreal, Qc, Canada; Douglas Mental Health University Institute, Verdun, Qc, Canada; Department of Psychiatry, McGill University, Montreal, Qc, Canada
| | | | - Srividya N Iyer
- Douglas Mental Health University Institute, Verdun, Qc, Canada; Department of Psychiatry, McGill University, Montreal, Qc, Canada
| | - Patricia Boksa
- Douglas Mental Health University Institute, Verdun, Qc, Canada; Department of Psychiatry, McGill University, Montreal, Qc, Canada
| | - Ridha Joober
- Douglas Mental Health University Institute, Verdun, Qc, Canada; Department of Psychiatry, McGill University, Montreal, Qc, Canada.
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Kronick J, Sabesan P, Burhan AM, Palaniyappan L. Assessment of treatment resistance criteria in non-invasive brain stimulation studies of schizophrenia. Schizophr Res 2022; 243:349-360. [PMID: 34183208 DOI: 10.1016/j.schres.2021.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/13/2021] [Accepted: 06/18/2021] [Indexed: 01/17/2023]
Abstract
Novel treatment modalities, such as non-invasive brain stimulation (NIBS), typically focus on patient groups that have failed multiple treatment interventions. Despite its promise, the clinical translation of NIBS in schizophrenia has been limited. One important obstacle to implementation is the inconsistent reporting of treatment resistance in the clinical trial literature contributing to heterogeneity in reported effects. In response, we develop a numerical approach to synthesize quality of assessment of Treatment-Resistant Schizophrenia (TRS) and apply this to studies investigating therapeutic response to NIBS in patients with schizophrenia. Literature search conducted through PubMed database identified 119 studies investigating Transcranial Magnetic Stimulation and Transcranial Electrical Stimulation in treating resistant schizophrenia symptoms. A quality score out of 11 was assigned to each study based on adherence to the international consensus guidelines for TRS developed by the Treatment Response and Resistance in Psychosis (TRRIP) group. Results revealed an overall paucity of studies with thorough assessment and/or reporting of TRS phenomenon, as evidenced by a mean quality score of 3.38/11 (SD: 1.01) for trials and 5.16/11 (SD: 1.57) for case reports, though this improved minimally since the publication of consensus criteria. Most studies considered treatment-resistance as a single dimensional construct by reporting resistance of a single symptom, and failed to establish treatment adherence, resistance time course and functional impairment. We conclude that the current NIBS literature in schizophrenia do not reflect its true effects on treatment-resistance. There is an urgent need to improve assessment and reporting standards of clinical trials that target TRS.
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Affiliation(s)
- Jami Kronick
- Schulich School of Medicine & Dentistry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 5C1, Canada.
| | - Priyadharshini Sabesan
- Department of Psychiatry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
| | - Amer M Burhan
- Department of Psychiatry, University of Toronto, 250 College Street 8th floor, Toronto, Ontario M5T 1R8, Canada; Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, Ontario L1N 5S9, Canada; Department of Psychiatry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
| | - Lena Palaniyappan
- Department of Psychiatry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada; Robarts Research Institute, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 5B7, Canada; Lawson Health Research Institute, 750 Base Line Road East Suite 300, London, Ontario N6C 2R5, Canada.
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Khau M, Tabbane K, Bloom D, Abadi S, Villemus C, Rabinovitch M, Shah JL, Veillette A, Iyer SN, Boksa P, Joober R. Pragmatic implementation of the Clinical Global Impression Scale of Severity as a tool for measurement-based care in a first-episode psychosis program. Schizophr Res 2022; 243:147-153. [PMID: 35339824 DOI: 10.1016/j.schres.2022.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/27/2021] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Measurement-based care (MBC) is an evidence-based practice wherein clinical decisions are informed by patient data collected throughout treatment. MBC has yielded superior patient outcomes compared to standard care. However, the implementation of MBC in the day-to-day practice, particularly in psychotic disorders, poses several challenges. This study evaluates the clinician-rated Clinical Global Impressions Scale of Severity (CGI-S), for MBC implementation at a first-episode psychosis program. METHODS The CGI-S was evaluated in the context of routine care on fidelity to practice, inter-rater reliability among psychiatrists and concurrent validity with scales measuring different domains of psychopathology (SAPS, SANS, GAF, BPRS, PANSS-6). RESULTS A high fidelity to practice (67%) and inter-rater reliability was found (rwg = 0.92). CGI-S correlations were significant and strongest with BPRS (r = 0.55; p < 0.01), GAF (r = 0.53; p < 0.01), SAPS (r = 0.52, p < 0.01), and PANSS-6 (r = 0.41; p < 0.05) scores. However, correlations with SANS and PANSS-6 Negative sub-scale were weak. CONCLUSION Findings suggest the CGI may be used to overcome important barriers towards MBC implementation within the context of first episode psychosis. However, as suggested by data, further improvements in capturing negative symptoms by rating clinicians are needed. TWITTER A novel strategy for measurement-based care to optimize treatment for individuals with first episode psychosis and related psychotic disorders.
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Affiliation(s)
- Michelle Khau
- Integrated Program of Neuroscience, McGill University, Montreal, QC, Canada; Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Karim Tabbane
- Douglas Mental Health University Institute, Verdun, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - David Bloom
- Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Sherezad Abadi
- Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Celine Villemus
- Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Mark Rabinovitch
- Douglas Mental Health University Institute, Verdun, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Jai L Shah
- Integrated Program of Neuroscience, McGill University, Montreal, QC, Canada; Douglas Mental Health University Institute, Verdun, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | - Srividya N Iyer
- Douglas Mental Health University Institute, Verdun, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Patricia Boksa
- Douglas Mental Health University Institute, Verdun, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Ridha Joober
- Douglas Mental Health University Institute, Verdun, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada.
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Kølbæk P, Guinart D, Opler M, Correll CU, Mors O, Østergaard SD. Clinical validation of the Symptom Self-rating Scale for Schizophrenia (4S) among inpatients. Nord J Psychiatry 2021; 75:454-464. [PMID: 33630698 DOI: 10.1080/08039488.2021.1881821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Self-reports of psychosis-related symptoms may be a valuable supplement to clinician-ratings, but more validation studies are required. The aim of this study was to conduct clinical validation for the Symptom Self-rating Scale for Schizophrenia (4S) in an inpatient setting. MATERIALS AND METHODS Inpatients diagnosed with schizophrenia were invited to participate in the study. The participants completed the 4S, the 5-item World Health Organization Wellbeing Index (WHO-5) and the Sheehan Disability Scale (SDS) at two time points. Trained raters assessed participants using the 6-item Positive And Negative Syndrome Scale (PANSS-6). The relationship between the 4S and PANSS-6, self-reported side effects, functioning and wellbeing was assessed using Spearman's correlation coefficient (rho). RESULTS Sixty-one participants completed the 4S at least once (yielding a total of 91 completed 4S questionnaires). The 4S total score was weakly correlated with the PANSS-6 total score (rho = 0.37, p < 0.001). The rho's for individual 4S and PANSS-6 subscales and item comparisons ranged from -0.24 (thought disorder) to 0.69 (hallucinations). Finally, the 4S hallucination subscale was also sensitive to change. The 4S was strongly inversely correlated with wellbeing (WHO-5) and moderately inversely correlated with functioning (SDS total score). CONCLUSION The 4S holds promise as a valid self-report of core schizophrenia symptoms among inpatients. While the hallucination subscale seems superior to existing scales, the thought disorder subscale needs to be re-developed.
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Affiliation(s)
- Pernille Kølbæk
- Psychosis Research Unit, Aarhus University Hospital-Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Daniel Guinart
- Division of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Mark Opler
- MedAvante-ProPhase Inc, NY, USA.,Department of Psychiatry, New York University School of Medicine, NY, USA
| | - Christoph U Correll
- Division of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Child and Adolescent Psychiatry and Psychotherapy, Charite Universitätsmedizin, Berlin, Germany
| | - Ole Mors
- Psychosis Research Unit, Aarhus University Hospital-Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Søren D Østergaard
- Psychosis Research Unit, Aarhus University Hospital-Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
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