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

The Effects of Contingency Contracting on Student Performance in a Personalized System of Instruction

29 leaves. Advisor: W. Scott WoodThe problem. A large body of evidence indicates that the self-pacing feature of PSI may result in a high frequency of incompletes and postponed work by students, oftentimes leading to a high withdrawal rate in personalized systems of instruction. In addition, student procrastination results in massed testing at the end of the semester, putting additional burdens on both students and staff, thus reducing the effectiveness and efficiency of the system. The present study proposed to examine the effectiveness of contingency contracting across an entire semester in a PSI course as a procedure to reduce procrastination, withdrawal rate. and logistic problems. Procedure. Students determined their own deadlines for taking unit tests by making an appointment with the graduate assistant at the learning center for one test attempt at a time. A comparison was made of the performances of students with low, medium, and high high school class ranks within and across semesters. Findings. The major effect that contingency contracting had on student performance was the steadier rate of unit completion for all groups, when compared to student performance in a non-contracting semester. The percentage of students withdrawing from the course did not change with the contingency contracting system, nor was there a reduction in performance differences among the three different groups of students within each semester. Conclusions. A contingency contracting procedure which retained the self-management aspects of PSI and was manageable within a large university course resulted in a steadier rate of unit completion when compared to the pacing pattern of students in a semester without contracting. Classroom logistic problems were reduced to the extent that testing was more evenly distributed across the semester. However students in the low groups continued to perform less satisfactorily than other students in the course

Growth hormone secretion timing in depression: Clinical outcome comparisons

Franz, Bettina; Kupfer, David J.; Miewald, Jean M.; Jarrett, David B.; Grochocinski, Victoria J

Using Computerized Adaptive Testing to Reduce the Burden of Mental Health Assessment

10sireservedObjective: This study investigated the combination of item response theory and computerized adaptive testing (CAT) for psychiatric measurement as a means of reducing the burden of research and clinical assessments. Methods: Data were from 800 participants in outpatient treatment for a mood or anxiety disorder; they completed 616 items of the 626-item Mood and Anxiety Spectrum Scales (MASS) at two times. The first administration was used to design and evaluate a CAT version of the MASS by using post hoc simulation. The second confirmed the functioning of CAT in live testing. Results: Tests of competing models based on item response theory supported the scale's bifactor structure, consisting of a primary dimension and four group factors (mood, panic-agoraphobia, obsessive-compulsive, and social phobia). Both simulated and live CAT showed a 95% average reduction (585 items) in items administered (24 and 30 items, respectively) compared with administration of the full MASS. The correlation between scores on the full MASS and the CAT version was .93. For the mood disorder subscale, differences in scores between two groups of depressed patients - one with bipolar disorder and one without - on the full scale and on the CAT showed effect sizes of .63 (p<.003) and 1.19 (p<.001) standard deviation units, respectively, indicating better discriminant validity for CAT. Conclusions: Instead of using small fixed-length tests, clinicians can create item banks with a large item pool, and a small set of the items most relevant for a given individual can be administered with no loss of information, yielding a dramatic reduction in administration time and patient and clinician burden.mixedGIBBONS, R.D.; WEISS, D.J.; KUPFER, D.J.; FRANK, E.; FAGIOLINI, A.; GROCHOCINSKI, V.J.; BHAUMIK, D.K.; STOVER, A.; BOCK, R.D.; IMMEKUS, J.C.Gibbons, R. D.; Weiss, D. J.; Kupfer, D. J.; Frank, E.; Fagiolini, A.; Grochocinski, V. J.; Bhaumik, D. K.; Stover, A.; Bock, R. D.; Immekus, J. C

Clinical significance of lifetime panic spectrum symptoms in the treatment of patients with bipolar I disorder

Background: Given the observed association between panic disorder and bipolar disorder and the potential negative influence of panic symptoms on the course of bipolar illness, we were interested in the effects of what we have defined as "panic spectrum" conditions on the clinical course and treatment outcome in patients with bipolar I (BPI) disorder. We hypothesized that lifetime panic spectrum features would be associated with higher levels of suicidal ideation and a poorer response to acute treatment of the index mood episode in this patient population. Methods: A sample of 66 patients with BPI disorder completed a self-report measure of lifetime panic-agoraphobic spectrum symptoms. Patients falling above and below a predefined clinical threshold for panic spectrum were compared for clinical characteristics, the presence of suicidal ideation during acute treatment, and acute treatment response. Results: Half of this outpatient sample reported panic spectrum features above the predefined threshold. These lifetime features were associated with more prior depressive episodes, higher levels of depressive symptoms, and greater suicidal ideation during the acute-treatment phase. Patients with BPI disorder who reported high lifetime panic-agoraphobic spectrum symptom scores took 27 weeks longer than those who reported low scores to remit with acute treatment (44 vs 17 weeks, respectively). Conclusions: The presence of lifetime panic spectrum symptoms in this sample of patients with BPI disorder was associated with greater levels of depression, more suicidal ideation, and a marked (6-month) delay in time to remission with acute treatment. Alternate treatment strategies are needed for patients with BPI disorder who endorse lifetime panic spectrum features

Age at onset in bipolar I affective disorder in the USA and Europe

Objective. To test for differences in reported age at onset (AAO) of bipolar I affective disorder in clinical samples drawn from Europe and the USA. Methods. Admixture analysis was used to identify the model best fitting the observed AAO distributions of two large samples of bipolar I patients from Europe and USA (n = 3616 and n = 2275, respectively). Theoretical AAO functions were compared between the two samples. Results. The model best fitting the observed distribution of AAO in both samples was a mixture of three Gaussian distributions. The theoretical AAO functions of bipolar I disorder differed significantly between the European and USA populations, with further analyses indicating that (i) the proportion of patients belonging to the early-onset subgroup was higher in the USA sample (63 vs. 25%) and (ii) mean age at onset (±SD) in the early-onset subgroup was lower for the USA sample (14.5 ± 4.9 vs. 19 ± 2.7 years). Conclusions. The models best describing the reported AAO distributions of European and USA bipolar I patients were remarkably stable. The intermediate- and late-onset subgroups had similar characteristics in the two samples. However, the theoretical AAO function differed significantly between the USA and European samples due to the higher proportion of patients in the early-onset subgroup and the lower mean age-at-onset in the USA sample

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

15sireservedBACKGROUND: 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.mixedFRANK, E.; CASSANO, G.B.; RUCCI, P.; THOMPSON, W.K.; KRAEMER, H.C.; FAGIOLINI, A.; MAGGI, L.; KUPFER, D.J.; SHEAR, M.K.; HOUCK, P.R.; CALUGI, S.; GROCHOCINSKI, V.J.; SCOCCO, P.; BUTTENFIEL, J.; FORGIONE, R.N.Frank, E.; Cassano, G. B.; Rucci, P.; Thompson, W. K.; Kraemer, H. C.; Fagiolini, A.; Maggi, L.; Kupfer, D. J.; Shear, M. K.; Houck, P. R.; Calugi, S.; Grochocinski, V. J.; Scocco, P.; Buttenfiel, J.; Forgione, R. N

Addressing the Challenges of a Cross-National Investigation: Lessons from the Pittsburgh-Pisa Study of Treatment-Relevant Phenotypes of Unipolar Depression

17sireservedBackground: To date, no cross-national RCT has addressed the mechanisms underlying the relative success of pharmacological and psychotherapeutic interventions for depression. A multi-site clinical trial that includes psychotherapy as one of the treatments presents numerous challenges related to cross-site consistency and communication. Purpose: This report describes how those challenges were met in the study "Depression: The Search for Treatment Relevant Phenotypes", being carried out at the University of Pittsburgh and the University of Pisa, Italy. Methods: Implementing the study required the investigators to address methodological and practical challenges related to the different requirements of the two Institutional Review Boards (IRBs), psychotherapy training, independent evaluator training, patient recruitment, development of common tools for data entry, quality control and generation of weekly reports of patient progress as well as establishing a similar clinical and research framework in two countries with substantially different health care systems. Results: By having bilingual investigators and staff members who spent time at one another's sites, making use of frequent conference-call staff meetings and being flexible within the bounds of the sometimes contradictory requirements of the IRBs, the investigators were able to meet the human subjects protection requirements of both institutions, surmount language barriers to consistent therapist and evaluator training and develop common tools for study management. As a result, recruitment goals were met at both sites and retention rates were high. One instance of inconsistent implementation of the protocol was corrected within the first year. Limitations: This study was conducted in two Western cultures by researchers with long-standing collaboration. Our findings may not be generalizable to other countries or research settings. Conclusions: The implementation of a cross-national protocol and the adoption and maintenance of common procedures is possible when investigators are aware of the challenges this may present and are proactive in trying to address them. © Society for Clinical Trials 2008.mixedFRANK, E.; CASSANO, G.B.; RUCCI, P.; FAGIOLINI, A.; MAGGI, L.; KRAEMER, H.; KUPFER, D.J.; POLLOCK, B.; BIES, R.; NIMGAONKAR, V.; PILKONIS, P.; SHEAR, M.K.; THOMPSON, W.K.; GROCHOCINSKI, V.; SCOCCO, P.; BUTTENFIELD, J.; FORGIONE, R.N.Frank, E.; Cassano, G. B.; Rucci, P.; Fagiolini, A.; Maggi, L.; Kraemer, H.; Kupfer, D. J.; Pollock, B.; Bies, R.; Nimgaonkar, V.; Pilkonis, P.; Shear, M. K.; Thompson, W. K.; Grochocinski, V.; Scocco, P.; Buttenfield, J.; Forgione, R. N

Enhancing Outcomes in Patients with Bipolar Disorder:Results from the Bipolar Disorder Center for Pennsylvanians Study

INTRODUCTION: We developed models of Specialized Care for Bipolar Disorder (SCBD) and a psychosocial treatment [Enhanced Clinical Intervention (ECI)] that is delivered in combination with SCBD. We investigated whether SCBD and ECI + SCBD are able to improve outcomes and reduce health disparities for young and elderly individuals, African Americans, and rural residents with bipolar disorder. METHOD: Subjects were 463 individuals with bipolar disorder, type I, II, or not otherwise specified, or schizoaffective disorder, bipolar type, randomly assigned to SCBD or ECI + SCBD and followed longitudinally for a period of one to three years at four clinical sites. RESULTS: Both treatment groups significantly improved over time, with no significant differences based on age, race, or place of residence, except for significantly greater improvement among elderly versus adult subjects. Improvement in quality of life was greater in the ECI + SCBD group. Of the 299 participants who were symptomatic at study entry, 213 achieved recovery within 24 months, during which 86 of the 213 subjects developed a new episode. No significant difference was found for race, place of residence, or age between the participants who experienced a recurrence and those who did not. However, the adolescent patients were less likely than the adult and elderly patients to experience a recurrence. CONCLUSION: This study demonstrated the effectiveness of SCBD and the additional benefit of ECI independent of age, race, or place of residence. It also demonstrated that new mood episodes are frequent in individuals with bipolar disorder who achieve recovery and are likely to occur in spite of specialized, guideline-based treatments