A comparison of information sources in the study of psychotic illness

Interrater reliability of the Structured Clinical Interview for the Positive and Negative Syndrome Scale for schizophrenia

The Swedish version of the Positive and Negative Syndrome Scale for schizophrenia (PANSS) has been tested and construct validity, internal reliability and interrater reliability have been demonstrated to be quite satisfactory. However, the interrater reliability of the negative symptoms was unsatisfactory low. In this study, the Swedish version of the Structured Clinical Interview for the PANSS has been tested. The interrater reliability is increased as compared with the inter-rater reliability achieved by means of the PANSS. As concerns the positive scale, the intraclass coefficients increased to 0.98-0.99 with the SCID-PANSS. For the negative scale, the intraclass coefficients increased to 0.83-0.90 with the SCID-PANSS, and for the general scale the increase was to 0.95-0.98 with the SCID-PANSS. It was also demonstrated that the interrater reliability is higher for the positive and the negative factors derived from the PANSS than for the positive and the negative scales.

Use of the Brief Psychiatric Rating Scale by Nurses

1. Nurses are intimately involved in the assessment of patients in inpatient clinical settings and in community settings--and nurses have a role to play in the systematic rating of severe psychopathology. 2. The Brief Psychiatric Rating Scale (BPRS) provides a means of assessing mental health status from an interview using 16 rating concepts. Analysis of BPRS rating profiles obtained from a variety of patients and settings have consistently revealed four syndromes: withdrawal-retardation, anxious depression, hostile-suspiciousness, and thinking disturbance. 3. Once properly trained regarding the BPRS, nurses can use the scale effectively in the assessment and ongoing monitoring of patient conditions. The scale is an added tool for nurses to use in monitoring the effectiveness and outcome of both medical and nursing interventions.

The validity of the assessment of psychopathology in the psychoses

This paper reviews recent progress in the assessment of the psychopathology of psychosis and focuses upon a number of persistent limitations. In particular the over-emphasis upon reliability at the expense of validity is highlighted and the relationship between reliability and validity is reconsidered. A number of strategies aimed at improving the validity of psychopathological measures are outlined. Proposals to deploy such variables differently in research strategies and analyses are endorsed.

The development, use, and reliability of the brief psychiatric rating scale (nursing modification)--an assessment procedure for the nursing team in clinical and research settings

The role of nursing staff in the systematic rating of psychopathology has been explored in a small number of studies in recent years. Nurses are uniquely placed to carry out relatively continuous observations of high validity which are sensitive to change, yet on the basis of the limited data available, some doubts remain concerning the reliability of such ratings, particularly when they extend to nonobservational phenomena. Nevertheless, since in practice nurse ratings form an important part of the psychopathological assessment arm in many research settings, continuing uncertainty about their reliability is clearly undesirable. Following a brief review of nurse rating, this report describes the role of the nursing team in a developing research environment and reports interrater reliability data for randomly selected pairings of nurses drawn from a mainstream clinical team who had been trained in the use of a specially modified version of the Brief Psychiatric Rating Scale (Nursing Modification) (BPRS[NM]). The findings indicate that nursing staff can reliably rate this range of psychopathology under ordinary clinical conditions, provided they have been properly trained and that appropriate modifications have been made to the procedure. Although validity was not formally assessed in this study, the extension of the time period covered by the BPRS, combined with the special place of nurses in the ward milieu can also be expected to enhance the validity and sensitivity of the ratings. Other effects of the involvement of therapeutically-oriented nursing staff in research procedures are also discussed.

The clinical picture of the depressed form of puerperal psychosis

The clinical features of 104 patients admitted to a mother and baby unit over a 5-year period with RDC diagnoses of depression or schizoaffective depression were studied by self-ratings, measurements of non-verbal behaviour from standardised videotaped interviews, and observer ratings based on multiple information sources. The hypothesis was tested that they included a large subset which represented the depressed form of a bipolar puerperal psychosis. It was deduced that these illnesses would start early in the puerperium, and would have some specific clinical features. A comparison of patients with onset of depression within 2 weeks of delivery with those with onset during pregnancy or much later in the postnatal period showed a number of significant differences. A discriminant function analysis using serial reclassification of atypical patients refined the early-onset group by the exclusion of about one third of the patients who had an atypical clinical picture; the patients who remained, who are considered to represent the depressed form of puerperal psychosis, showed less anger, less self-rated emotion and more animation than the other depressed patients.

Direct assessment of depression by microcomputer. A feasibility study

A self-rating depression questionnaire based on the Hamilton Depression Questionnaire was given directly by a microcomputer to 43 controls and 125 depressed patients. Scores obtained from the two groups differed very significantly; choosing an appropriate cut-off point, the computer-delivered questionnaire accurately detected the presence of depression. The severity of depression in the patients, as indicated by their scores, correlated significantly with assessments of severity by qualified clinicians. Patients commented favourably on the procedure, and the medical and nursing staff found it instructive and helpful. The use of this technique appears practicable and further evaluation is in progress.

Ethnicity and psychiatric diagnosis

Examined diagnostic differences between black, white, and Hispanic-American patients (N = 1968) seen in psychiatric outpatient clinics of a large hospital in the South Bronx. Distribution of diagnoses also was compared statistically in relation to the diagnostician's ethnicity. Results indicated statistical differences between the patient's ethnicity and psychiatric diagnosis, as well as interactions between the therapists' ethnicity and these variables. Implications of the findings were discussed, and suggestions were offered for future research.