Archives 1992-2013

2003, volume 12, issue 3

Assesment instruments

Assessment instruments used in Poland in scientific research in psychiatry (part 1)

JOANNA RYMASZEWSKA, ADRIAN SIERADZKI, Andrzej Kiejna
Postępy Psychiatrii i Neurologii, 2003, 12 (3), 251-259

Aim – The article presents a review of assessment instruments used in Polish psychiatric research. Review – The review covers instruments concerned to mental disorders in elderly people, alcohol and drug abuse, social functioning and health-related quality of life of the mentally ill, and also tests used by clinical psychologists for diagnosing anxiety and personality disorders. Moreover, same suggestions are given concerning the existing needs for adaptation of assessment instruments.

Conclusions – The presented data indicate that psychological assessment tools have the best psychometric properties. Advisability of new assessment instruments implementation was pointed out.

Assesment instruments

Assessment instruments used in Poland in scientific research in psychiatry (part 2)

ADRIAN SIERADZKI, Andrzej Kiejna, JOANNA RYMASZEWSKA
Postępy Psychiatrii i Neurologii, 2003, 12 (3), 261-268

Aim – This article is a review of both original and adapted instruments used in psychiatric research in our country.

Review – The importance of epidemiological studies and of multi-center; randomized clinical trials has been growing over recent years. Instruments used for these purposes are not only separate questionnaires, but also diagnostic interviews and test batteries. The dynamic and multidirectional progress in psychiatry implicates a strong demand for adaptation of new scientific tools. The adaptation process besides an accurate two-way translation includes also an evaluation of the adapted instrument reliability, validity and practical applicability. The paper presents instruments for the assessment of general mental status and of specific mental conditions including schizophrenia and mood disorders. Moreover, tools are also presented for the evaluation of psychopharmacotherapy outcome.

Conclusions – The authors suggest that the already available instruments should be used more widely, while these developed in Poland should be popularized. Evaluation of the latter should be continued, and standard foreign-language instruments should be adapted correctly.

Original article

Psychometric properties of the Family Burden Questionnaire

Elżbieta Słupczyńska-Kossobudzka, STANISŁAW WÓJTOWICZ, Ludmiła Boguszewska
Postępy Psychiatrii i Neurologii, 2003, 12 (3), 269-276

The Family Burden Questionnaire (FBQ) is designed to measure treatment outcome in patients with psychotic disorders. Following an interview with the patient's key relative (i.e. a family representative significant and close to the patient) the questionnaire is filled out by the interviewer:

Aims – To analyse psychometric properties or the questionnaire and to establish its possible limitations.

Subjects – Three groups participated in validation of the tool: (1) 113 patients included in a program of evaluation of care provided by mobile community treatment teams; (2) 40 patients receiving inpatient treatment at the Institute of Psychiatry and Neurology, and (3) 32 representatives of the general population.

Method – The following properties of the questionnaire were assessed: (1) reliability (internal consistency, using the Cronbach α); (2) validity (a) theoretical validity (including an analysis of intergroup differences, a matrix of intercorrelation between items, and factor analysis), (b) diagnostic criterion validity (i.e. correlation between the FBQ score and scores on a social functioning scale); (3) test-retest stability (or susceptibility to change over time).

Results – The Cronbach a reliability coefficient was 82. The FBQ score turned out to significantly correlate with the level of the patient's social functioning. Family burden was significantly lower in families of patients participating in the community-based care evaluation program than in inpatients' families, at the same time being significantly higher than that in the general population. Two factors were found in the factor analysis: contrary to expectations, the first factor included 6 items, while the second one – only 2 items. During the 2 years of care pro vision by mobile community treatment teams the family burden has decreased by almost 40%.

Discussion – The study indicates that the questionnaire has satisfaction reliability, diagnostic criterion and theoretical validity, as well as test-retest stability. The instrument should be used as a single scale, since its present construction does not justify any separate subscales.

Conclusions – Psychometric properties of the FBQ are rather good and the too/may be used to evaluate treatment outcomes.

Original article

Psychometric properties of the Problem Behaviours Questionnaire (PBQ)

Elżbieta Słupczyńska-Kossobudzka, STANISŁAW WÓJTOWICZ, Ludmiła Boguszewska
Postępy Psychiatrii i Neurologii, 2003, 12 (3), 277-286

The Problem Behaviours Questionnaire (PBQ) is designed to measure treatment outcome in patients with psychotic disorders. The interviewer fills out the questionnaire after an interview with the patient s key relative (i.e. family representative significant and close to the patient).

Aim –The aim of the study was to assess psychometric properties of the questionnaire.

Subjects – Three groups participated in the study: (1) 113 patients included in a program of evaluation of care provided by mobile community treatment teams; (2) 40 patients admitted to an inpatient department of the Institute of Psychiatry and Neurology, and (3) 32 representatives of the general population.

Method – The following properties of' the questionnaire were analysed: (1) reliability (internal consistency, using the Cronbach α; (2) validity (a) theoretical validity (including an analysis of intergroup differences, a matrix of intercorrelation between items, and factor analysis), (b) diagnostic criterion validity (i.e. correlation between the PBQ score and scores on a social functioning scale); (3) test-retest stability (or susceptibility to change over lime).

Results – The hitherto used version of the PBQ (14 items) was found to include three items dealing with behaviours that had never occurred in a vast majority (i.e. over 90%) of our patients. This resulted in an unsatisfactory differential validity of the questionnaire and besides could decrease its test-retest stability. Consequently, these 3 items were excluded from the questionnaire and its abbreviated version consisting of 11 items was submitted to validation. The Cronbach α reliability coefficient for the abbreviated version was .76; the level of problem behaviours turned out to be significantly correlated with the patients' social functioning scores, and the three groups differed significantly from each other in terms of their problem behaviour levels. Three factors were distinguished in factor analysis: aggression/bizarre behaviour (reliability coefficient = .77), withdrawal (reliability coefficient = .71), and self-destruction/alcohol abuse (reliability coefficient = .46).

Discussion – The study indicated that the former version of the PBQ (14 items) included three items evidently diminishing its psychometric properties. Validation of the abbreviated version (11 items) has evidenced that its reliability, diagnostic criterion validity, theoretical validity. And test-retest stability are satisfactory. The questionnaire may be used either as a single global scale, or its two sub-scales may be analysed separately – of aggression/bizarre behaviour (4 items) and withdrawal (3 items). The remaining four items do not constitute a subscale. Conclusions – The PBQ has rather good psychometric properties and may be used for treatment outcome evaluation.

Original article

Porównanie cierpienia psychicznego i funkcjonowania w wybranych zaburzeniach lękowych i depresyjnych

Krzysztof Małyszczak
Postępy Psychiatrii i Neurologii, 2003, 12 (3), 287-292

Aims – Distress and functioning levels were compared in groups of patients diagnosed with: depression, mixed anxiety and depressive disorder; generalised anxiety disorder (GAD), agoraphobia, panic disorder; social phobia, or specific phobias.

Subjects – 67 non-treated patients participated in the study (20 men and 47 women aged from 18 to 71, median age 42 years).

Method – Diagnoses were made using a diagnostic questionnaire based on the Schedule for Clinical Assessment in Neuropsychiatry (SCAN 2.0), distress was evaluated with the General Health Questionnaire (GHQ-30), while the patients' general functioning – by means of the Global Assessment of Functioning (GAF) scale.

Results – The mean GHQ score was 27 in the group with depression, ranging from 16 to 20 in anxiety disorders (except for specific phobias, where it declined to 7.5). The mean score on the GAF was 60 in depression, and 64-70 in anxiety disorders with the exception o(specific phobias, where it amounted to 77.5.

Conclusions – The research findings indicate that (1) more pronounced distress and functioning impairment result from depression than from anxiety disorders, (2) levels of distress and functioning in anxiety disorders (except for specific phobias) are much the same, with a slightly lower distress in GAD, (3) patients with specific phobias as compared to those with other anxiety disorders are less distressed and their functioning is less impaired.

Original article

Relationship between schizophrenic patients’ subjective quality of life and their functioning assessed by themselves, their families and therapists

KATARZYNA SPIRIDONOW, BEATA KASPEREK, Małgorzata Chądzyńska
Postępy Psychiatrii i Neurologii, 2003, 12 (3), 293-309

Aims – An answer was sought in the study lo the question whether schizophrenic patients' subjective quality of life is related to the level of their functioning in daily life.

Subjects – Participants in the study were 29 patients diagnosed with schizophrenia attending day wards of the Institute of Psychiatry and Neurology or of the "Drewnica" hospital, and the same number of their family members.

Method – The patients were examined using two self-report questionnaires measuring their subjective quality of life (the WHOQOL-BREF) and functioning in everyday life (the Daily Life Functioning Scale from the questionnaire by Tempier and Mercier). The patients' .functioning level was assessed both by family members using the Daily Life Coping Skills Assessment by Wallace et al., and by therapists using the GAS.

Results – Correlation between the patients' subjective quality of life (the WHOQOL-BREF) and their functioning as assessed either by therapists oar by family members turned out to be statistically insignificant. However; their self-rated functioning was much more strongly related to their subjective quality of life. The patients' self-rated functioning was related to their self-satisfaction, satisfaction with their health and life, availability of various resources (not only financial) enabling them to live independently, and to the level of vigour (life energy) they experienced.

Discussion – In the group under study a significant relationship was found between the patients' subjective quality of life and their self-rated functioning level, while the former was not related to the level of their functioning assessed by either families or therapists. Except for money, the other constituents of subjective quality of life significantly related to their self-rated functioning level were "uncountable" and indefinable – difficult to assess adequately by an external observer.

Conclusions – The research findings again highlight the difference in the assessment of schizophrenic patients' quality of life by patients themselves and by healthy people. If we really want to improve the patients' quality of life, then in our planning of their rehabilitation we must take into account their perceptions and feelings, and not only the norms currently in force.

Original article

Self-rated mental status in schizophrenia: usefulness of an abbreviated version of the Frankfurter Befindlichkeits-Skala

Jacek Wciórka, ANNA BEMBENEK, DOROTA BOŻYK, BARBARA BUDYTA, BEATA HINTZE, MONIKA KASPRZAK, HANNA KOZDRA-POPIEL, MAGDALENA MAŁECKA, ANNA OLAK, JUSTYNA RAWSKA, JANUSZ WÓJCICKI
Postępy Psychiatrii i Neurologii, 2003, 12 (3), 311-321

Self-rating scales that measure schizophrenic patients' mental state could be useful for some clinical purposes. However, the issue is the subject of much controversy. In our earlier studies the Frankfurter Befindlichkeits-Skala (sFBS) developed by Süllwold and Herrlich was found to have a high reliability and specific validity. Nevertheless, in order to improve its practical applicability, we proposed to abbreviate the original instrument on the grounds of a secondary, retrospective psychometric analysis.

Aims – The aim of this prospective study was to evaluate basic psychometric properties of the shortened version of the Frankfurter Befindlichkeits-Skala (sFBS) in a new sample.

Subjects – 30 patients diagnosed with various disorders (in that number 19 with the diagnosis of schizophrenia according to ICD-10) participated in the study.

Method – Two scales of visual analogy were used as the referential self-rating instrument, while the Clinical Assessment of Schizophrenic Syndromes (CASS) scale served as an alternative clinical diagnostic tool. The patients' mental state was self-rated weekly, and besides independently by physicians (psychiatrists?) every two to four weeks.

Results - The sFBS may be used reliably. Its validity seems to be specific and only slightly related to clinical diagnosis. The scale has a one dimensional factorial structure (disorganization signals). Both reliability and factorial structure of the scale were stable over successive weeks, despite changes in the patients, mental state. The scale differentiated the description of the observed mental states and seemed useful in practice.

Discussion – The results of the sFBS evaluation directly on a new sample corroborated the conclusions drawn from our earlier; secondary analyses of the scale properties. The shortened version retained the psychometric properties of the full scale, but can be more easily administered in practice.

Conclusions – The sFBS may be useful for monitoring changes in the patients' self-rating of their mental stale.

Original article

Self-rating of mental state in schizophrenia: usefulness of an abbreviated version of the Paranoid-Depressivitäts-Skala

Jacek Wciórka, ALEKSANDRA DYMECKA-KÜHN, JANUSZ WÓJCICKI
Postępy Psychiatrii i Neurologii, 2003, 12 (3), 323-333

In our earlier studies the Paranoid Depressivitäts-Skala (PD-S) designed by von Zerssen to measure schizophrenic patients' mental state was found to have a high reliability, specific validity and limited practical usefulness. In order to improve its practical usefulness we proposed to shorten the original scale on the grounds of a secondary, retrospective psychometric analysis. This turned out to be feasible, with the psychometric properties of the original retained.

Aims – In the present prospective study psychometric properties of the shortened version of the scale (sPD-S) were assessed directly.

Subjects – 41 patients diagnosed with various mental disorders (in that number 23 patients with the diagnosis of schizophrenia according to the ICD-10) were examined using the sPD-S.

Method – The Clinical Assessment of Schizophrenic Syndromes (CASS) both in the .full version of the CGI type (CASS-C) and in that describing basic clinical dimensions of the psychopathological syndrome (CASS-W) were used as alternative instruments of clinical diagnosis. The patients self-rated their mental state every week, while psychiatrists assessed the patients' state every two to four weeks.

Results – The sPD-S may be used reliably – the tool indicates a very high internal consistency and test-retest stability. However, its validity seems to be specific and only slightly related to the clinical diagnosis. The best approximation of the scale factorial structure seems to be a two-dimensional solution (depressive experiences and paranoid experiences) corresponding to what was intended by the author of the original tool. The scale reliability and factorial structure were stable over successive weeks, despite changes in the patients' mental state. Besides, the scale turned out to be less tiresome for the patients who were more willing to co-operate. Thus, the sPD-S as compared to the full scale seems to be more useful in clinical practice, especially if it is to be used repeatedly.

Discussion – The results of the direct evaluation of the sPD-S psychometric properties are in agreement with the conclusions drawn from our earlier; secondary evaluation of the scale.

Conclusions – The sPD-S may be useful for monitoring changes in the patients' self-rating of their mental state.

Review article

The application of c-Fos-immunoreactivity in neuropsychopharmacology

ALEKSANDRA WISŁOWSKA, MAŁGORZATA LEHNER, EWA TARACHA, MAŁGORZATA ZIENOWICZ, Adam Płaźnik
Postępy Psychiatrii i Neurologii, 2003, 12 (3), 335-345

Aims – The article presents new data concerning the c-Fos-immunoreactivity technique application to localization of the CNS structures activated by such substances as antidepressants, narcoleptics, or habit-forming substances, as well as to mapping of pathways implicated in pain transmission, anxiety and learning.

Review – C-Fos protein is a product of c-fos gene – a member or the immediate early gene family (IEG). The basal level of c-fos mRNA is hardly detectable in non-stimulated cells, but its expression increases rapidly on administration or various stimuli. Fos immunochemistry offers a mapping tool enabling the investigation or functional neural activity (the so-called a transcriptional activity) in the brain.

Conclusions – Despite certain limitations, the technique of c-Fos protein mapping proved to be helpful in both in neurobiological and neuropharmacological studies investigating the central nervous system functioning in physiological and pathological states.

Review article

Neurodevelopmental theory of childhood autism

Piotr Wierzbiński, Tadeusz Pietras, AGNIESZKA KWIATKOWSKA
Piotr Wierzbiński, Wyższa Szkoła Finansów i Illformatyki im. Proj: Janusza Chechlillskiego, ul. Św. Jerzego 10112, 91-072 Łódź, tel/fax: (42) 6310460

Aims – To present arguments justifying the view that autism is a primary disorder of the CNS development resulting in an impairment of the child's interpersonal communication, restricted and stereotyped patterns of interests and activities, and the onset of other developmental abnormalities by the age of 3.

Review – Both genetic and environmental factors contribute to the pathogenesis of a wide variety of neurodevelopmental disorders, including autism. It has been suggested that autism may result from the developing foetus exposure to chemical substances (such as thalidomide or high levels of testosterone) or viral infection (with e.g. rubella, mumps and cytomegalovirus). In the paper also genes involved in the pathogenesis of autism as well as relevant chromosomal loci are discussed.

Case report

A hallucinatory-delusional syndrome in the course of tuberculous neuroinfection in a 14-year-old girl

Małgorzata Janas-Kozik, Irena Krupka-Matuszczyk, KATARZYNA WOJACZYŃSKA-STANEK, BARBARA SZWED-BIAŁOŻYT, DOROTA BURZAWA, BEATA TATROCKA, MACIEJ MATUSZCZYK
Postępy Psychiatrii i Neurologii, 2003, 12 (3), 357-362

Aims – Despite compulsory preventive vaccinations tuberculous infections have not been filly eliminated. Atypical infections with tubercle bacillus may present a varied clinical picture. Various mental disorders associated with tuberculous infection of the cerebrospinal meninges and the brain, have been reported.

Case – In the reported case of a 14-year-old girl the onset of symptoms of an intermittent hallucinatory-delusional syndrome was due to neuroinfection of a specific (tuberculous) etiology.

Commentary – The authors emphasize diagnostic difficulties, doubts in the interpretation of laboratory test results, and involvement of a wide range of specialists in the care provided to this patient.

Case report

Obsessive tendencies and impulsiveness. The dynamics of personality disorders in anorexia nervosa – a case report

Cezary Żechowski, ANTONI JAKUBCZYK
Postępy Psychiatrii i Neurologii, 2003, 12 (3), 363-367

Aims – In recent years eating disorders concomitant with a personality disorder have been the subject of many studies seeking a common etiological background, and focusing on the prognosis and appropriate treatment in such cases.

Case report – The authors describe an anorexic patient who developed obsessive-compulsive personality traits or symptoms of borderline personality in various stages of her therapy.

Commentary – In some female patients with eating disorders symptoms of both these personality types may be present, with predominance of one or the other – depending on the stage of illness, degree of emaciation, as well as the patient s psychological and familial situation.