Internal consistency and discriminant validity of the Structured Clinical Interview for Panic Agoraphobic Spectrum (SCI-PAS)

This paper reports on the feasibility, acceptability and psychometric properties of the Structured Clinical Interview for Panic-Agoraphobic Spectrum (SCI-PAS). This interview was designed to assess the lifetime presence of symptoms and other clinical features considered to comprise the panic-agoraphobic spectrum. The interview has 114 items grouped into nine domains. A total of 422 subjects, from 11 centres located throughout Italy, participated in this study. Data were collected from three groups of subjects: psychiatric patients meeting DSM-IV criteria for panic disorder (n = 141), cardiovascular patients (n = 140), including 29 with post-myocardial infarction, and university students (n = 141). The inter-rater reliability and the internal consistency of the SCI-PAS measures were assessed using the intra-class correlation coefficient and the Kuder-Richardson coefficient, respectively. Discriminant validity was assessed by comparing results in patients with panic disorder to those in the other groups. The interview required an average of 25 (±5) minutes to administer. Patients and clinicians found the scale to be highly useful, providing information not previously obtained. Internal consistency was good (>0.70) for six out of nine SCI-PAS domains. The inter-rater reliability was excellent (>0.70) for all the domains except for 'other phobias' (0.467). Patients with panic disorder scored significantly higher on each domain, and on the overall panic spectrum, than did the control subjects. In conclusion, the SCI-PAS is a useful clinical interview, which can be administered in a reasonable period of time. This assessment further demonstrates good internal consistency, discriminant validity, and inter-rater reliability. Copyright © 1999 Whurr Publishers Ltd

De geprotocolleerde Interapy-behandeling van depressie via het internet; resultaten van een gerandomiseerde trial

Psychologische behandelingen via internet bieden een nieuwe mogelijkheid voor de geestelijke gezondheidszorg. In samenwerking met de Stichting Mentrum ggz Amsterdam heeft Interapy een behandeling voor depressie via internet opgezet. De behandeling bestaat uit cognitief-gedragstherapeutische interventies, zoals psycho-educatie, schrijfopdrachten, registratie, activatie, het uitdagen van negatieve automatische gedachten en terugvalpreventie. Dit artikel beschrijft de procedure, de behandeling en de resultaten van een vergelijkende studie onder cliënten die matig tot ernstig depressief waren. De cliënten die direct actief werden behandeld (N = 32) verbeterden significant meer dan de cliënten in de psycho-educatieconditie (N = 14). Deze tweede groep kreeg de actieve behandeling ongeveer twaalf weken later. De effecten waren groot. In de actief behandelde groep liet 75 procent van de cliënten klinisch relevante verbetering zien, in de psycho-educatieconditie was dat percentage 36. Uit de follow-up na zes weken bleek dat de verbeteringen standhielden

SJS/TEN 2019: From Science to Translation

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are potentially life-threatening, immune-mediated adverse reactions characterized by widespread erythema, epidermal necrosis, and detachment of skin and mucosa. Efforts to grow and develop functional international collaborations and a multidisciplinary interactive network focusing on SJS/TEN as an uncommon but high burden disease will be necessary to improve efforts in prevention, early diagnosis and improved acute and long-term management. SJS/TEN 2019: From Science to Translation was a 1.5-day scientific program held April 26-27, 2019, in Vancouver, Canada. The meeting successfully engaged clinicians, researchers, and patients and conducted many productive discussions on research and patient care needs

A multidimensional spectrum approach to post-traumatic stress disorder: comparison between the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) and the Self-Report instrument (TALS-SR)

Dimensional approaches to psychiatric disorders have shown an increased relevance in the ongoing debate for the forthcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. In line with previously validated instruments for the assessment of different mood, anxiety, eating and psychotic spectra, we tested the validity and reliability of a newly developed Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS). The instrument is based on a multidimensional approach to post-traumatic stress spectrum that includes a range of threatening or frightening experiences, as well as a variety of potentially significant losses, to which an individual can be exposed. Furthermore, it explores the spectrum of the peritraumatic reactions and post-traumatic symptoms that may ensue from either type of life events, targeting soft signs and subthreshold conditions, as well as temperamental and personality traits that may constitute risk factors for the development of the disorder. The aim of the present study is to describe the reliability of the self-report version of the SCI-TALS: the TALS-SR. Thirty patients with PTSD and thirty healthy control subjects were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Half of the patients and controls received the TALS-SR first and the SCI-TALS after 15 days; for the other half of the sample, the order of administration was reversed. Agreement between the self-report and the interview formats was substantial. Intraclass correlation coefficients ranged from 0.934 to 0.994, always exceeding the threshold of 0.90. Our findings provide substantial support for the reliability of the TALS-SR questionnaire

The structure of lifetime panic-agoraphobic spectrum

The heterogeneity of the clinical presentation of panic disorder (PD) has prompted researchers to describe different subtypes of PD, on the basis of the observed predominant symptoms constellation. Starting from a dimensional approach to panic disorder, an instrument to assess lifetime panic-agoraphobic spectrum (PAS) available in interview or self-report form (SCI-PAS, PAS-SR) was developed which proved to have sound psychometric properties and the ability to predict delayed response to treatment in patients with mood disorders. However, the structure of the instrument was defined a priori and an examination of its empirical structure is still lacking. Aim of the present report is to analyse the factor structure of the PAS taking advantage of a large database of subjects with panic disorders (N=630) assessed in the framework of different studies. Using a classical exploratory factor analysis based on a tetrachoric correlation matrix and oblique rotation, 10 factors were extracted, accounting overall for 66.3% of the variance of the questionnaire: panic symptoms, agoraphobia, claustrophobia, separation anxiety, fear of losing control, drug sensitivity and phobia, medical reassurance, rescue object, loss sensitivity, reassurance from family members. The first two factors comprise the DSM-IV criteria for panic disorder and agoraphobia. The other factors had received limited empirical support to date. We submit that these symptoms profiles might be clinically relevant for tailoring drug treatments or psychotherapeutic approaches to specific needs. Future perspectives might include the use of these factors to select homogeneous subgroups of patients for brain-imaging studies and to contribute to elucidating the causes and pathophysiology of panic disorder at molecular level

Predictors and moderators of time to remission of major depression with interpersonal psychotherapy and SSRI pharmacotherapy.

BACKGROUND: Although many studies suggest that, on average, depression-specific psychotherapy and antidepressant pharmacotherapy are efficacious, we know relatively little about which patients are more likely to respond to one versus the other. We sought to determine whether measures of spectrum psychopathology are useful in deciding which patients with unipolar depression should receive pharmacotherapy versus depression-specific psychotherapy. METHOD: A total of 318 adult out-patients with major depression were randomly assigned to escitalopram pharmacotherapy or interpersonal psychotherapy (IPT) at academic medical centers at Pittsburgh, Pennsylvania and Pisa, Italy. Our main focus was on predictors and moderators of time to remission on monotherapy at 12 weeks. RESULTS: Participants with higher scores on the need for medical reassurance factor of the Panic-Agoraphobic Spectrum Self-Report (PAS-SR) had more rapid remission with IPT and those with lower scores on the psychomotor activation factor of the Mood Spectrum Self-Report (MOODS-SR) experienced more rapid remission with selective serotonin reuptake inhibitor (SSRI) pharmacotherapy. Non-specific predictors of longer time to remission with monotherapy included several panic spectrum and mood spectrum factors and the Social Phobia Spectrum (SHY) total score. Higher baseline scores on the 17- and 25-item Hamilton Depression Rating Scales (HAMD-17 and HAMD-25) and the Work and Social Adjustment Scale (WSAS) also predicted a longer time to remission, whereas being married predicted a shorter time to remission. CONCLUSIONS: This exploratory study identified several non-specific predictors but few moderators of psychotherapy versus pharmacotherapy outcome. It offers useful indicators of the characteristics of patients that are generally difficult to treat, but only limited guidance as to who benefits from IPT versus SSRI pharmacotherapy