Development and validation of the computerized clinician administered post-traumatic stress disorder scale-1-revised

Slow gait speed as a predictor of 1-year cognitive decline in a veterans' retirement community in southern Taiwan

AIM

Slow gait speed has been associated with mortality, poor physical function and disability in older people. Our aim was to evaluate the association between slow gait speed and rapid cognitive decline among oldest-old men in Taiwan.

METHODS

We carried out a longitudinal cohort study in a veterans' retirement community, and enrolled 249 male residents aged 80 years and older. Slow gait speed was defined as <1 m/s, and rapid cognitive decline was defined as a Mini-Mental State Examination (MMSE) decline of ≥3 points over 1 year. Body mass index, Charlson's Comorbidity Index, handgrip strength, gait speed and Mini-Mental State Examination datasets were collected, and a logistic regression model was built to evaluate the association between fast cognitive decline and slow gait speed.

RESULTS

In all, 249 residents (mean age 86.4 ± 4.01 years) were recruited, including 58 (23.3%) with rapid cognitive decline. Univariate analysis showed that slow gait speed could predict rapid cognitive decline (OR 4.10, 95% CI 1.20-14.00, P = 0.024). After adjusting for age, Charlson's Comorbidity Index, polypharmacy, psychiatric drug usage, cigarette smoking experience, baseline cognitive function, depressive mood, handgrip strength, nutritional status and history of fall, slow gait speed was still independently associated with rapid cognitive decline (adjusted OR 4.58, 95% CI 1.22-17.2, P = 0.024).

CONCLUSIONS

Slow gait speed was thus an independent predictor of rapid cognitive decline in oldest-old men in a veterans' retirement community in Taiwan. Geriatr Gerontol Int 2017: 17 (Suppl. 1): 14-19.

Changes in pain catastrophizing following physical therapy for musculoskeletal injury: the influence of depressive and post-traumatic stress symptoms

PURPOSE

The aim of the present study was to investigate the factors that influence the change in pain catastrophizing during the course of a physical therapy intervention for musculoskeletal injury.

METHODS

187 clients enrolled in a 7-week physical therapy intervention were divided into four mutually exclusive groups on the basis of a pre-treatment assessment: (1) clients whose pre-treatment catastrophizing scores and measures of mental health problems were below clinical threshold, (2) clients whose pre-treatment catastrophizing scores were above clinical threshold but who scores on measures of mental health problems were below clinical threshold, (3) clients whose pre-treatment catastrophizing scores were above clinical threshold and whose scores on measures of mental health problems were also above clinical threshold, and (4) clients whose pre-treatment catastrophizing scores were below clinical threshold but whose scores on measures of mental health problems were above clinical threshold.

RESULTS

The most prevalent risk profile consisted of clients with high levels of pain catastrophizing and high mental health problems (37 %), followed by the low catastrophizing and low mental health problems profile (35 %), the high catastrophizing and low mental health problems profile (16 %), and low catastrophizing and high mental health problems profile (10 %). Clients were considered non-responders if their post-treatment catastrophizing score remained above clinical threshold following treatment. Chi square analyses revealed a significantly higher proportion of non-responders in the high catastrophizing and mental health problem group than in any other group.

CONCLUSIONS

The presence of mental health symptoms markedly reduces the effectiveness of physical therapy for reducing catastrophizing scores. The 'risk value' of high catastrophizing scores thus appears to vary as a function of the presence or absence of mental health symptoms. The findings argue for the inclusion of measures of mental health problems in the routine screening of individuals treated in physical therapy.

Psychometric properties of a Swedish translation of the Clinician-Administered PTSD Scale--Diagnostic Version

Internal consistency (N = 172) and convergent validity (N = 73) of a Swedish translation of the Clinician-Administered PTSD Scale-Diagnostic Version (CAPS-DX) were evaluated with violence victims with posttraumatic stress disorder (PTSD). The CAPS-DX evidenced a promising internal consistency, and significant correlations (Pearson product-moment) with the PTSD Symptom Scale Self-Report version (PSS-SR) and the Impact of Event Scale-Revised (IES-R). Additionally, each subscale of the CAPS-DX (intrusion, avoidance/numbing, and arousal) was significantly correlated with the corresponding subscales of the PSS-SR and the IES-R. Results of the present study are discussed in the context of internal consistencies and convergent validity coefficients of the CAPS with other PTSD symptom measures in previous studies.

Intrarace Differences Among Black and White Americans Presenting for Chronic Pain Management: The Influence of Age, Physical Health, and Psychosocial Factors

OBJECTIVE

Emerging comparative literature documents significant racial differences in the chronic pain experience in terms of physical, psychological, and social well-being. However, the intrarace differences of chronic pain among black Americans and white Americans has not been extensively investigated. The purpose of this investigation was to examine the potential within-race-group differential effects and the psychosocial aspects of chronic pain in black and white Americans across age groups.

DESIGN

A retrospective study of patients presenting for chronic pain management.

SETTING

A tertiary care multidisciplinary pain center.

PATIENTS

Patients were younger (<50 years) (mean +/- SD: 36.7 +/- 8.4) and older (> or =50 years) (60 +/- 9.3) black Americans (N = 525), and younger (36.6 +/- 8.1) and older (63 +/- 9.8) white Americans (N = 5,298).

OUTCOME MEASURES

Participants were measured on depressive symptoms, social functioning, pain intensity, pain-related disability, and physical comorbidities.

RESULTS

Younger black Americans reported more depressive symptoms, pain intensity, and were less successful at coping with pain when compared to older black Americans. Similar within-group differences were also observed for reports of depressive symptoms, pain intensity, and coping abilities among white Americans. Results further showed that younger white Americans also experienced more symptoms related to post-traumatic distress than older white Americans.

CONCLUSION

Examining within-race-group variability suggests that chronic pain differentially affects the quality of life and health status of black Americans and white Americans across age groups. This study emphasizes the need for further chronic pain studies examining pain indicators within defined racial and ethnic groups.

Race and chronic pain: a comparative study of young black and white Americans presenting for management

Chronic pain is a debilitating problem for many Americans. It affects physical, social, and emotional health. This study addresses the potential differential effects of chronic pain cross-culturally in younger Americans. A retrospective analysis of persons younger than 50 years of age presenting for chronic pain management in a multidisciplinary pain center was done. White and black American adults aged 18 to 50 years (N = 3669) were compared to determine whether there were differences in (1) psychologic functioning, (2) pain characteristics, (3) pain disability, and (4) comorbidities. Our results suggest that black Americans had more depressive symptoms and symptoms consistent with post-traumatic stress disorder when compared to white Americans. These results showed that on initial assessment, black Americans with chronic pain report significantly more pain and sleep disturbance as well as more symptoms consistent with post-traumatic stress disorder and depression than white Americans. They also experience a higher prevalence of self-identified comorbidities, including dizziness, chest pain, and high blood pressure. In conclusion, considerable diminution in the overall physical and emotional health of black Americans 18 to 50 years of age with chronic pain was noted. These data support the need for further study of the chronic pain experiences of racial and ethnicity minority persons.

German version of Clinician-Administered PTSD Scale

This study assessed the reliability of a German translation of the Clinician-Administered PTSD Scale (CAPS) by using data from 45 survivors of accidents who were hospitalized at the department of traumatology of a university hospital. Assessments were carried out 5 days (Time 1) and 6 months (Time 2) after the accident. Internal consistency proved to be comparable to that of the original English version: Cronbach's alpha was .88 at T1 and .92 at T2 for the CAPS total score. The CAPS correlated significantly with the validated German version of the Impact of Event Scale (IES) (T1: r = .56, T2: r = .78). The data suggest that the German version of the CAPS is a reliable instrument for the assessment of posttraumatic stress disorder symptomatology in accident victims. Further studies are necessary to validate further the questionnaire.

Test-retest reliability and factor stability of the behavioral evaluation for epidemiology studies test battery

The Behavioral Evaluation for Epidemiology Studies test battery uses touch-screen technology and novel methodologies to enhance neurobehavioral assessment. Scores generally show differential stability from the first trial with individual test reliabilities at or above .80 when normalized to a 3-min. administration. Six highly reliable (r > or = .87) factors were identified that cover functions known to be sensitive to neurotoxicants and physical exposures. These results strongly support recommendation of the new test battery for use in repeated-measures epidemiologic studies where first trial stability is desired.

Bias in computerized neuropsychological assessment of depressive disorders caused by computer attitude

OBJECTIVE

Psychiatric patients are increasingly confronted to computerized psychological and psychopathological assessment. Patients' attitude to computers was reported to affect acceptance of computerized assessment.

METHOD

In 78 psychiatric in-patients neuropsychological impairment was examined following admission on an open ward by conventional as well as computerized memory and attention tasks. Besides psychopathological assessment, self ratings of computer attitude and acceptance of the computerized assessment were completed.

RESULTS

A more negative attitude to computers was found to be significantly correlated to higher nervousness in patients' self report (R=0.38, P=0.0005) as well as to poorer results of computerized attention tasks (R=0.39, P=0.0007). Particularly in patients with depressive disorders computer attitude could be shown to explain 39% of the variance of attention performance.

CONCLUSION

Results indicate a significant effect of negative computer attitude on acceptance and thus reliability of computerized examination, resulting in a bias in computerized attention-related assessment in patients with depressive disorders.

Clinician-administered PTSD scale: a review of the first ten years of research

The Clinician-Administered PTSD Scale (CAPS) is a structured interview for assessing posttraumatic stress disorder (PTSD) diagnostic status and symptom severity. In the 10 years since it was developed, the CAPS has become a standard criterion measure in the field of traumatic stress and has now been used in more than 200 studies. In this paper, we first trace the history of the CAPS and provide an update on recent developments. Then we review the empirical literature, summarizing and evaluating the findings regarding the psychometric properties of the CAPS. The research evidence indicates that the CAPS has excellent reliability, yielding consistent scores across items, raters, and testing occasions. There is also strong evidence of validity: The CAPS has excellent convergent and discriminant validity, diagnostic utility, and sensitivity to clinical change. Finally, we address several concerns about the CAPS and offer recommendations for optimizing the CAPS for various clinical research applications.

Test-retest reliability of psychological and neurobehavioral tests self-administered by computer

A series of 12 psychological and 7 neurobehavioral performance tests were administered twice to a nonclinical normative sample with 1 week between administrations. The tests were presented in a self-administered computerized format. One week test-retest reliabilities were comparable to conventional administration formats. The results suggest that individual test reliability is not affected when tests are administered as part of an extensive multi-measure battery. Computer administered test reliability coefficients also were compared to a Mixed Format (computer-conventional) administration with mixed format reliabilities generally similar to the reliabilities of published conventional tests but also generally lower than same format testing. Compared to psychological test reliability, neurobehavioral test reliability appeared more vulnerable to decreases with mixed format testing. These conclusions should not be generalized to all computer implemented tests as the qualities of the test implementation will affect the outcome.

Computerized self-assessment in psychiatric in-patients: acceptability, feasibility and influence of computer attitude

In recent years various approaches using computerized assessments and tests in psychiatry have been published. In our study, the acceptability and feasibility of computerized self-assessments and attitude to computers were examined in psychiatric in-patients, using an improved interactive schedule, the Interactive Self-Assessment Scale (ISAS), based on the Windows operating system. In general we found a good level of acceptability and feasibility of the computerized self-assessment. Our results confirm the influence of attitude to computers on acceptability, and indicate a lack of self-confidence in interacting with computers, accompanied by a less positive attitude to computers than reported by healthy subjects and psychiatric out-patients. Computerized self-assessment is suitable for psychiatric in-patients. Nevertheless, further research is necessary in order to improve attitude to computers and the patient-computer interaction.

Development and validation of a computerized screening test for personality disorders in DSM-III-R

The available self-report instruments designed to measure personality disorder (PD) are time-consuming to administer and/or score and can be impractical for routine clinical use. There is a need for a computerized method of personality assessment based on contemporary systems of classification. A computerized DSM-III-R-based questionnaire was developed and validated against the structured clinical interview for DSM-III-R Axis-II disorders on a sample of 60 subjects. The computerized test showed moderate validity as a diagnostic instrument (mean kappa coefficient = 0.47). With adjusted cut-off scores it was valid as a screening instrument (mean sensitivity = 0.87). Antisocial, borderline and avoidant PD scores were strongly correlated across measures and not subject to significant observer bias.

Factitious post traumatic stress disorder: a case report

A 24-year-old man presented with a convincing history of Post Traumatic Stress Disorder (PTSD). He claimed to be the victim of a widely publicized 'human bomb' attack by the IRA in Northern Ireland when he was serving with the armed forces. Psychometric tests for PTSD confirmed his symptoms. A subsequent check of public and military records demonstrated that he was a serviceman at that time, but showed conclusively that he could not have been present at the terrorist incident.

Incorporating psychological debriefing techniques within a brief group psychotherapy programme for the treatment of post-traumatic stress disorder

BACKGROUND

The Royal Air Force Wroughton Post-Traumatic Stress Disorder (PTSD) Rehabilitation Programme is described. It comprised a 12-day structured in-patient 'course' of group psychotherapy and day-case group follow-up sessions over a one-year period. Psychological debriefing was the main therapeutic technique employed.

METHOD

This is a 'before and after' open outcome study. A comprehensive assessment protocol confirmed the presence and severity of PTSD and measured co-morbid psychopathological status, occupational and social function longitudinally.

RESULTS

A highly significant global response to treatment is demonstrated in the 34 subjects included in the study, with 85.3% not fulfilling the DSM-III-R criteria for PTSD at one year after treatment.

CONCLUSIONS

Further controlled studies assessing the value of psychological debriefing techniques in the treatment of established PTSD are required.