Diagnostic efficiency and validity of the DSM-oriented Child Behavior Checklist and Youth Self-Report scales in a clinical sample of Swedish youth

Publisher Copyright: Copyright: © 2021 Skarphedinsson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.The Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) are widely used measures of psychiatric symptoms and lately also adapted to the DSM. The incremental validity of adding the scales to each other has not been studied. We validated the DSM subscales for affective, anxiety, attention deficit/hyperactivity (ADHD), oppositional defiant (ODD), conduct problems (CD), and obsessive-compulsive disorder (OCD) in consecutively referred child and adolescent psychiatric outpatients (n = 267) against LEAD DSM-IV diagnoses based on the K-SADS-PL and subsequent clinical work-up. Receiver operating characteristic analyses showed that the diagnostic efficiency for most scales were moderate with an area under the curve (AUC) between 0.70 and 0.90 except for CBCL CD, which had high accuracy (AUC>0.90) in line with previous studies showing the acceptable utility of the CBCL DSM scales and the YSR affective, anxiety, and CD scales, while YSR ODD and OCD had low accuracy (AUC<0.70). The findings mostly reveal incremental validity (using logistic regression analyses) for adding the adolescent to the parent version (or vice versa). Youth and parent ratings contributed equally to predict depression and anxiety disorders, while parent ratings were a stronger predictor for ADHD. However, the youth ADHD rating also contributed. Adding young people as informants for ODD and OCD or adding the parent for CD did not improve accuracy. The findings for depression, anxiety disorders, and ADHD support using more than one informant when conducting screening in a clinical context.Peer reviewe

Validity of the Brief Child and Family Phone Interview by comparison with Longitudinal Expert All Data diagnoses in outpatients

Background: The Brief Child and Family Phone Interview (BCFPI) is a standardized intake and follow-up interview used in child and adolescent mental health services (CAMHS). Although it has shown good validity compared with other measures using parent reports, it has not yet been compared with diagnoses derived from a Longitudinal Expert All Data (LEAD) procedure, which includes information from separate diagnostic interviews with parent(s) and child. The aim was to compare the BCFPI evaluation in an outpatient child and adolescent psychiatry setting with an evaluation derived from a LEAD procedure.Methods: At four Swedish outpatient CAMHS, 267 patients were interviewed at intake with the BCFPI. Within six weeks, patients and parents were interviewed separately with the 2009 version of the semi-structured Kiddie Schedule for Affective Disorders and Schizophrenia for School-age Children, Present and Lifetime Version (K-SADS-PL) and parents completed the Child Behavior Checklist (CBCL). LEAD diagnoses were subsequently determined by two senior clinicians based on 1.2 years of clinical records including the K-SADS-PL and ensuing information from further assessments, psychological tests, information from teachers and other informants as well as treatment outcome. The Diagnostic and Statistical Manual of Mental Disorders subscales from the CBCL and the subscales from the BCFPI were compared with LEAD diagnoses. These measured symptoms of attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, separation anxiety disorder, generalized anxiety disorder, and major depressive disorder.Results: The criterion validity for BCFPI versus LEAD diagnoses was fair for oppositional defiant disorder (area under curve, 0.73), generalized anxiety disorder (0.73) and major depressive disorder (0.78), good for attention-deficit hyperactivity disorder (0.81) and conduct disorder (0.83), and excellent for separation anxiety disorder (0.90). The screening properties of BCFPI and CBCL were similar.Conclusion: The BCFPI is a concise and valid tool, performed along with the larger and more established CBCL, in screening for major psychiatric disorders. It is well suited as an intake interview in CAMHS

Long-term Outcome, Suicidal behaviour, Quality of Life and Expressed Emotion in Adolescent Onset Psychotic Disorders

This study investigated a consecutive cohort of 88 youngsters with onset of a psychotic disorder at age 15.7 (sd 1.5) years and followed-up 10.6 (sd 3.6) years after first admission at the age of 26.5 (sd 3.7) years. A subsample of 15 subjects were assessed with the Five Minute Speech Sample for measuring Expressed Emotion and subsequent recording of relapses during a two year period. A diagnostic split between schizophrenia spectrum psychosis and affective psychotic disorder was usually stable over time. The main diagnostic shift was an influx to schizophrenia spectrum disorder of subjects with a better premorbid function and less insidious onset as compared to those with a stable schizophrenia diagnosis. Early onset schizophrenia spectrum disorder usually had a poor functional outcome. Most subjects needed support in the form of a disability pension. Early onset affective psychotic disorder usually had a good functional outcome. Most subjects worked and enjoyed regular friendships. The functional level before onset of illness was the best predictor of future functional level in psychotic disorders. A family history of non-affective psychosis predicted a worse function in schizophrenia. Frequent episodes and low intelligence predicted a worse function in affective disorders. Four men (4.5% of the sample) committed suicide. The risk of suicide was increased about 30 times. Almost a third of subjects attempted suicide. Females made more attempts. Suicide attempts were related to more depressive symptoms but less negative symptoms at first episode, to readmissions and to dependence on nicotine. Subjects with schizophrenia spectrum psychoses were less satisfied with life than those with affective psychotic disorder. Subjective satisfaction in schizophrenia was strongly associated to depressive mood while in affective disorders it was associated to degree of employment. Adolescents with psychosis in families rated high or borderline high in Expressed Emotion either during first episode or after discharge had an increased risk of relapse

En kluven personlighet - fallstudie av Fjällräven i Sverige och USA

Allt fler företag väljer att etablera sitt varumärke utanför ursprungsmarknaden. I samband med detta är det inte ovanligt att marknadsföringsaktiviteterna anpassas för att möta den nya marknadens förutsättningar och konkurrenssituation. Detta medför eventuellt att en annorlunda varumärkespersonlighet uppträder. Denna uppsats är en fallstudie av Fjällräven som år 2009 etablerade sig i USA. Den beskriver Fjällrävens varumärkespersonlighet i Sverige och utreder vilka skillnader som uppträtt på den amerikanska marknaden. Slutligen diskuteras de effekter detta kan komma att få på de svenska konsumenternas relation till varumärket. Undersökningen baserades på fokusgruppsdiskussioner med svenska konsumenter respektive text och bildanalys av Fjällrävens annonsmaterial i katalog och på hemsidor samt artiklar i tidskrifter och på så kallade bloggar. Resultatet visade att den svenska Fjällräven i första hand presenterar uppriktiga, kompetenta och robusta personlighetsdrag. Den amerikanska skiljer sig genom att den i första hand består av sofistikerade och spännande drag. Det visade sig att om den amerikanska Fjällrävens personlighet överförs till Sverige så skulle denna personlighetsklyvning kunna innebära att framförallt friluftsintresserade konsumenter upplever att varumärket urholkas. Detta kan medföra skador på konsumentrelationen, vilket på sikt riskerar företagets tillväxt och lönsamhet

Adult quality of life and associated factors in adolescent onset schizophrenia and affective psychotic disorders

Background Subjects in treatment for affective disorders are usually less satisfied with life compared to subjects with schizophrenia. Aims The aims of this study were to compare subjective quality of life (QoL) at adult age of adolescent onset psychotic disorders and analyse associated factors. Method Fifty-three patients with adolescent onset psychotic disorders were followed up at age 25, diagnostically re-evaluated according to the DSM-IV and assessed with the Positive and Negative Symptoms Scale, the Strauss-Carpenter Scale and the Lancashire Quality of Life Profile. Results Subjects diagnosed with schizophrenia or schizoaffective disorder (n = 27) experienced significantly lower overall QoL than subjects with psychotic mood disorders (n = 26). Overall QoL was strongly associated to depressed mood (R-2 = 0.49) in the schizophrenia group and to degree of employment (R-2 = 0.39) in the mood disordered group. Conclusion Depression is a major concern in the evaluation and treatment of patients with schizophrenia, while vocational support seems particularly important after an episode of psychotic mood disorder

Diagnostic stability in adolescent onset psychotic disorders

The purpose was to examine the long-term stability of a diagnosis of psychotic disorder in adolescence and to focus on diagnostic change over time. A total of 88 patients with a first episode of early onset psychosis (before 19 years) were followed up an average of 10.5 years (range 5.1-18.2) after admission. This report includes the 68 patients who could be traced and interviewed with the Positive and Negative Symptom Scale and lifetime Structured Clinical Interview for DSM-IV diagnosis. An initial diagnostic split between schizophrenia spectrum and affective disorder had a good (> 80 %) Positive Predictive Validity and Sensitivity. The main diagnostic shift was an influx to schizophrenia spectrum disorder (n = 6). These patients resembled the stable affective group (n = 27) in premorbid and prodromal aspects but changed over time to resemble the poor outcome of the stable schizophrenia spectrum group (n = 28) albeit with fewer negative symptoms and a better social function. Family history of nonaffective psychosis in first or second degree relatives was often found in the "change to schizophrenia group". A diagnosis in adolescence of schizophrenia spectrum or affective psychotic disorder is usually stable over time. A subgroup of non-schizophrenia patients go on to develop a schizophrenia spectrum disorder

En kluven personlighet - fallstudie av Fjällräven i Sverige och USA

Allt fler företag väljer att etablera sitt varumärke utanför ursprungsmarknaden. I samband med detta är det inte ovanligt att marknadsföringsaktiviteterna anpassas för att möta den nya marknadens förutsättningar och konkurrenssituation. Detta medför eventuellt att en annorlunda varumärkespersonlighet uppträder. Denna uppsats är en fallstudie av Fjällräven som år 2009 etablerade sig i USA. Den beskriver Fjällrävens varumärkespersonlighet i Sverige och utreder vilka skillnader som uppträtt på den amerikanska marknaden. Slutligen diskuteras de effekter detta kan komma att få på de svenska konsumenternas relation till varumärket. Undersökningen baserades på fokusgruppsdiskussioner med svenska konsumenter respektive text och bildanalys av Fjällrävens annonsmaterial i katalog och på hemsidor samt artiklar i tidskrifter och på så kallade bloggar. Resultatet visade att den svenska Fjällräven i första hand presenterar uppriktiga, kompetenta och robusta personlighetsdrag. Den amerikanska skiljer sig genom att den i första hand består av sofistikerade och spännande drag. Det visade sig att om den amerikanska Fjällrävens personlighet överförs till Sverige så skulle denna personlighetsklyvning kunna innebära att framförallt friluftsintresserade konsumenter upplever att varumärket urholkas. Detta kan medföra skador på konsumentrelationen, vilket på sikt riskerar företagets tillväxt och lönsamhet