Validation and bifactor structure of the French Adult ADHD Symptoms Rating Scale v1.1 (ASRS)

BACKGROUND

Three scoring methods for the widely available Adult ADHD Symptoms Rating Scale v1.1 (ASRS) have been proposed to screen for ADHD, but these three methods have rarely been compared against formal clinical diagnoses. We aimed to validate the French version of the ASRS against a clinical interview using DSM-IV and DSM-5 diagnostic algorithms.

METHODS

One hundred five adults from a convenience sample were evaluated with the ASRS and the DIVA 2.0, using both DSM-IV and DSM-5 criteria. We used Confirmatory Factor Analysis to investigate the underlying structure of the ASRS. Sensitivity, specificity, and classification accuracy were compared between the rating algorithms of the ASRS.

RESULTS

The full score method had worse predictive performance than the Screener and the 2-stage scoring method. All characteristics of the three scoring methods for the ASRS were worse when applying DSM-5 criteria. The best-fitting structure was a bi-factor model with a general ADHD factor and three specific factors.

CONCLUSIONS

ADHD was best conceived as a one-dimensional construct. The 2-stage scoring method superseded the Screener with comparable sensitivity and specificity.

Validation of a French questionnaire assessing knowledge of suicide

OBJECTIVES

The objective of this study was to develop and validate the Knowledge of Suicide Scale (KSS), elaborated to assess adherence to myths about suicide.

METHODS

The KSS is a self-questionnaire including 22 statements relating to myths about suicide for which the respondent is asked to rate his degree of adherence on a scale ranging from 0 ("strongly disagree") to 10 ("completely agree"). Using the script concordance test scoring method, the respondents' scores were compared with those of experts to obtain, for each item, a score between 0 (maximum deviation with the experts) and 1 (minimum deviation with the experts). One thousand and thirty-five individuals (222 psychiatric interns, 332 medical interns in the first semester excluding psychiatry and 481 journalism students) were included.

RESULTS

According to the exploratory factor analysis, the KSS is a two-dimensional scale: the first subscale includes 15 items and the second seven items. The tool showed excellent face validity, correct convergent and divergent validities (multi-method multi-feature analyzes), and good internal consistency (Cronbach's alpha coefficient between 0.66 and 0.83 for scales and subscales). The KSS is moderately and negatively correlated with the Stigma of Suicide Scale (r=-0.3). It significantly discriminates groups with different expected levels of knowledge regarding suicide (P<0.001).

CONCLUSIONS

The KSS demonstrated good psychometric properties to measure adherence to myths about suicide. This tool could be useful in assessing the effectiveness of suicide prevention literacy improvement programs.

Validation and clinical usefulness of the Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) among French-speaking voice-hearers

Auditory verbal hallucinations (AVH), also called voices, are often distressing to individuals experiencing them. Valid and reliable instruments are necessary to document the hearing voices experience across cultures. The Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) is becoming a widely used self-administered instrument for assessing characteristics, content and subjective effect of AVH. This study investigates the psychometric characteristics of the HPSVQ French version (HPSVQ FV) in a clinical sample of voice-hearers. The results showed that the HPSVQ yields a global score (HPSVQ-Global) as well as a distress (HPSVQ-Distress) and a severity (HPSVQ-Severity) sub-score having good, acceptable and questionable internal consistency respectively. Significant correlations were found between hallucination severity (BPRS 4.0), distress (PSYRATS-AH), voices acceptance (VAAS-9), anxiety and depression (HADS). However, no significant associations were observed between Suspicion and Unusual Thoughts (BPRS 4.0). At a one-week interval, the temporal stability of the three indices was excellent. Moreover, after a brief cognitive intervention, a significant reduction was observed in all indices. Taken together, the HPSVQ FV demonstrated good construct validity, reliability and sensitivity to change. These findings support the use of the HPSVQ in francophone clinical and research settings. However, the bi-factorial solution of the HPSVQ FV should be further examined in larger samples.

Concordance and validity between versions of the ADHD Conners scale for Parents

INTRODUCTION

The Conners Scale for Parents (CRS-P) is one of the reference tools for the diagnostic assessment of Attention Deficit and Hyperactivity Disorders (ADHD). It is commonly used in both research and clinical practice. The latest edition of the Conners Parents Scale Long Version (CRS-P3L) has undergone extensive modifications but has never been compared with the 2nd edition (CRS-P2L). We aim to study the concordance between the last two editions of the CRS-P, their internal consistency, and their validity against the criteria of the ADHD-RS.

METHODS

The study population was a cohort of 30 children diagnosed with ADHD participating in a clinical trial. The parents of these children completed both editions of the CRS (P2L and P3L), as well as a DSM-IV ADHD Diagnostic Criteria Rating Scale (ADHD-RS). A linear regression model with the calculation of Lin's concordance coefficient (LCC) was used to study the concordance between the scales. Internal validity was estimated with Cronbach's alpha and inter-criteria validity with Spearman's correlation coefficient.

RESULTS

The internal consistency found was "correct" to "good" for both editions (Cronbach alpha 0.85 and 0.77), their correlation with the ADHD-RS was medium to low (Spearman's coefficient 0.25 and 0.09). Concordance between the overall score and the sub-scores of the two editions of the same Conners scale (CRS-P2L and CRS-P3L) was fair to medium (LCC 0.29 to 0.69).

CONCLUSIONS

The third edition of the long version of the CRS-P showed very poor concordance with the previous edition. The diagnostic profile of the children seems to have evolved with the new edition, which appears to affect the interpretation of the tests.

[Is personality assessment with the French Big Five Inventory (BFI-Fr) invariant according to gender and activity of the respondents?]

OBJECTIVES

The BFI-Fr is an effective tool to assess the five dimensions of the five-factor model of personality. The psychometric qualities are excellent in several validation studies. However, because the inconsistency of certain items may be due to a lack of invariance between groups, we examined this invariance according to the gender and activity of the respondents.

METHODS

The sample consists of 1904 participants (1232 women and 672 men; 1159 students and 745 professionals). Recruitment was done by "snowball" from different studies conducted over four years. Respondents completed the BFI-Fr. The 45 items were corrected for the acquiescence bias. The Item Response Theory methodology was used to test the invariance using the differential item functioning (DIF) test. The T scores were subject to ANCOVA and correlations to compare the differences between subgroups.

RESULTS

Whatever the subsample, we found the same five-factor structure (similarities were especially high for C). The cumulative explained variances are comparable for all groups. The functioning of eight items varied between men and women; and six between activity groups, however, all but one DIF values were low. No item in domain A varied in its measure. ANCOVA results showed that women have higher A and N scores than men and that professionals have higher C and lower N scores than students. There is no interaction effect between gender and activity. When we removed the non-invariant items, the effect of gender became significant in favor of women on dimension C even if the difference remained minimal. The difference by activity on N became non-significant. There was a very strong link between activity and age and between gender and activity: in the sample, women were more often students and vice versa.

CONCLUSIONS

Overall and once again, the structure and internal consistency of the Big Five as measured by the BFI-Fr was replicated in new samples. There was a differential functioning of 12 items out of 45 (about a quarter). These differences were small since only one was of moderate magnitude. The deletion of these items did not strongly change the mean comparisons between groups. Therefore, our results do not call into question the usefulness of the BFI-Fr but invite to control the extent of this differential functioning. In all cases (with or without the non-invariant items) the analyses showed significant gender differences for A and N, differences which are typically found in many studies. Students and professionals differ in their levels of C and E. Certain inconsistencies are probably due to the translation from American to French, since the BFI-Fr is based on the lexical approach (in this context, item content was somewhat dependent of languages peculiarities). Thus, the BFI-Fr allows a robust evaluation of the five dimensions but requires a prior control of the invariance of item functioning in order to ensure that the intergroup differences in E-A-C-N-O mean scores do not reflect a psychometric artifact but genuine personality differences.

[Acceptance of "voices" in people with or without psychiatric disorders: Francophone validation of the 9-item VAAS scale]

OBJECTIVES

Hearing voices is a common experience for people with schizophrenia. Perceived voices are in most cases a source of great distress for patients. This experience also exists in the general population and is considered as "non-clinical". Much research has focused on the psychological and neuropsychological mechanisms behind the emergence of voices. With regard to voice persistence factors, the acceptance of the voice-hearing phenomenon is still relatively unexplored. In addition, there are few standardized tools that specifically assess this dimension of voice experience. The Voices Acceptance and Actions Scale (VAAS) is the only validated tool to address voice acceptance in individuals with schizophrenia. However, to date, there is no French version. The objective of this research was to validate the VAAS in a French speaking population.

METHOD

Our sample consisted of individuals with schizophrenia (N=65) and voice hearers from the general population (N=321). For the clinical population, individuals with schizophrenia and auditory hallucinations were assessed using the VAAS scale in its two abbreviated versions (9 and 12 items). In order to validate the measure in French, we administered psychopathology scales (BPRS) and voice belief scales (BAVQ-R) for convergent and divergent validity. For the non-clinical population, we administered the VAAS scale online (via LimeSurvey), accompanied by a brief sociodemographic questionnaire (age, sex, country of origin, existence of medical or psychological follow-up).

RESULTS

The psychometric properties of the VAAS scale were satisfactory and similar to the original English-language tool for both versions, with a slight advantage for the one with 9-items. The convergent validity measured with the BAVQ-R scale, and the divergent one measured with the BPRS depression subscale, were found to be satisfactory. In addition, the re-test performed 6 weeks after the first test (N=30) was satisfactory for both scales, with a Pearson correlation index greater than 70 (r=0.70; P<0.001 for the VAAS 9 items) and (r=0.79; P<0.001 for the 12 item version). In individuals with schizophrenia (clinical population), the level of voice acceptance was low and strongly correlated with depression. This point seems to corroborate the current data in the field suggesting that voice hearing in this population is associated with significant distress and has a significant impact on their lives. Conversely, the level of acceptance obtained from the non-clinical population was much higher, reflecting a higher level of acceptance in this population. People from the non-clinical population seemed to accept and experience their voices with less distress than people from the clinical population in this study.

CONCLUSION

To date, a paucity of studies have investigated the acceptance of auditory hallucinations. Our results support the psychometric validity of the French version of the VAAS, particularly the 9-item version. Furthermore, our study supports the need to continue studying voice acceptance, as it appears to be strongly linked to depression in people with psychiatric disorders such as schizophrenia. In addition, our study is novel in that it also explored, with a standardized tool, the level of voice acceptance in a non-clinical population and found people to be more accepting of the voices they hear and better at living with them. These data provide new evidence to better understand the links between the level of acceptance of voices, their experiences, and depression. Clinically, it seems essential to conduct more systematic and regular evaluations of the level of voice acceptance in those hearing voices. Finally, in terms of rehabilitation, voice acceptance can become a therapeutic target in order to improve the psychological and behavioral functioning of the person.

[Elaboration and psychometric properties of a well-being scale at work. The Serenat study among employees in occupational medicine unit]

BACKGROUND

Well-being at work is nowadays a major public health challenge. It includes, among others, absence of psychological (anxio-depressive) symptoms, perceived positive work conditions (environment and organization), happiness and good quality of life at work. Many studies have shown that social support and control at work protect mental health while high job demands and effort-reward imbalance are risk factors for anxiety and depression. There is currently no global indicator to measure both the state of mental health and social working conditions. The main objective of this work is to construct and explore the psychometric properties of scale of well-being at work called "Serenat" in order to validate it.

METHODS

The Serenat Scale is a self-report questionnaire composed of 20 items. All items are scored on a four-point Likert scale ranging from 0 (strongly disagree) to 3 (strongly agree) resulting in a range of 0 to 60. It was constructed from data collected from the literature and from consultations in an Occupational Health Unit. From January 2014 to May 2017 193 subjects who have consulted an occupational doctor are included in this cross sectional survey. Validation included item quality and data structure diagnosis, internal consistency, intraobserver reliability evaluation and external consistency.

RESULTS

The Serenat scale showed very good item quality, with a maximal non-response rate of 0.01 % per item, and no floor effect. Factor analysis concluded that the scale can be considered unidimensional. Cronbach's alpha of internal consistency was 0.89. The intraclass correlation coefficient for intraobserver reliability was 0.89. Serenat scale was correlated with HADS (r=-0.54; P<0.001), STAI-Y (r=-0.78; P<0.001) and BDI-13 (r=-0.57; P<0.001).

CONCLUSION

Serenat's well-being at work scale shows good psychometric properties for final validation. It could be useful to occupational physicians for individual and collective screening.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT02905071.

[Smartphone addiction: French validation of the Internet Addiction Test-Smartphone version (IAT-smartphone) and associated psychopathological features]

INTRODUCTION

Since their first appearance in 1992 smartphones have improved constantly, and their use, combined with the rapid spread of the Internet, has increased dramatically. The recent emergence of this technology raises new issues, at both individual and societal levels. Several studies have investigated the physical and psychological harm that may be caused by smartphones. The issue of excessive smartphone use as an addictive disorder is frequently raised and debated, although it is not acknowledged in international classifications. In France, there is no validated assessment tool for smartphone addiction. Therefore, the aims of this research were: to validate a French translation of the Internet Addiction Test-smartphone version (IAT-smartphone); to study the links between smartphone addiction, Internet addiction, depression, anxiety and impulsivity.

METHOD

Two hundred and sixteen participants from the general population were included in the study (January to February 2016), which was available online using Sphinx software. We assessed smartphone addiction (French version of the Internet Addiction Scale - smartphone version, IAT-smartphone), specificity of smartphone use (time spent, types of activity), Internet addiction (Internet Addiction Test, IAT), impulsivity (UPPS Impulsiveness Behavior Scale), and anxiety and depression (Hospital Anxiety and Depression scale, HAD). We tested the construct validity of the IAT-smartphone (exploratory factor analysis, internal consistency, non-parametric correlation tests for convergent validity). We also carried out multiple linear regressions to determine the factors associated with IAT-smartphone.

RESULTS

Mean age was 32.4±12.2 years; 75.5% of the participants were women. The IAT-smartphone had a one-factor structure (explaining 42 % of the variance), excellent internal consistency (α=0.93) and satisfactory convergent validity. Smartphone addiction was associated with Internet addiction (ρ=0.85), depression (ρ=0.31), anxiety (ρ=0.14), and some impulsivity subscales, including "negative urgency" (ρ=0.20; P<0.01), "positive urgency" (ρ=0.20; P<0.01), and "lack of perseverance" (ρ=0.16; P<0.05). Age was negatively associated with the IAT-S total score (ρ=-0.25; P<0.001), and there was a non-significant difference between the IAT-S total scores of men and women (29.3±10.2 vs. 32.7±12.4; P=0.06). Multiple linear regression showed that age, anxiety, depression, average time spent on the smartphone, impulsivity and Internet addiction explained 71.4 % of the variance of IAT-smartphone scores. However, this score dropped to 13.2 % when Internet addiction was removed from the model. This variable alone explained 70.8 % of the IAT-smartphone scores.

CONCLUSION

The French version of the IAT-smartphone is a reliable and valid questionnaire to assess smartphone addiction. This addiction appears to be strongly linked to anxiety, depression and impulsivity. The strong association between smartphone addiction and Internet addiction suggests that smartphone addiction is one of the many forms of Internet addiction. In fact, smartphones may not be the object of the addiction but rather a medium facilitating Internet access as it makes it possible to connect anywhere anytime. This raises the issue of the potential role of smartphones in speeding up and facilitating the development of Internet addiction.

The Generalized Problematic Internet Use Scale-2 in a French sample: Psychometric evaluation of the theoretical model

OBJECTIVES

The Generalized Problematic Internet Use Scale-2 (GPIUS-2) is a short self-report questionnaire assessing Internet addiction based on a cognitive behavioral model. Our main goal was to evaluate the psychometric properties of its French version among a sample of students and to appraise the relevance of the generalized problematic Internet use model.

METHODS

A sample of 563 university students aged between 18 and 35 years (M=20.8; SD=2.7) completed several online self-report questionnaires including the GPIUS-2, the Internet Addiction Test (IAT) and the Center for Epidemiologic Study-Depression scale (CES-D).

RESULTS

Confirmatory Factorial Analyses revealed a poor but acceptable overall fit for the original five-factor model and the original four-factor model. Path analyses, testing Structural Equation Modeling provided showed a poor fit to the data, suggesting insufficient construct validity. Convergent and concurrent validities analyzed through correlational analyses revealed significant relationships between the GPIUS-2, its factors, the IAT, time spent online and the CES-D.

CONCLUSIONS

This research highlights the insufficient psychometric properties of the GPIUS-2 in a French sample, similar to previous results. However, this French version appears to be a useful multidimensional tool for assessing problematic Internet use among students, and reveals promise for future research and clinical applications of the measure, given its solid theoretical basis and despite the results of this psychometric study.

The development of an outcome measures toolkit for spinal cord injury rehabilitation

BACKGROUND

Spinal cord injury (SCI) is a complex medical condition that can be difficult to monitor.

PURPOSE

This study aimed to establish a common set of validated outcome measures specifically for SCI clinical practice.

METHOD

In a three-round online Delphi process, experts in SCI care across Canada suggested and ranked outcome measures for clinical practice. The facilitators provided feedback between rounds and determined if consensus (at least 75% agreement) was reached on a single outcome measure per clinical area.

FINDINGS

One hundred and forty-eight outcome measures were initially considered for inclusion. After three rounds, consensus was reached for 23 out of 30 clinical areas. In the remaining seven, more than one outcome measure was recommended. The final toolkit comprises 33 outcome measures with sufficient measurement properties for use with a SCI population.

IMPLICATIONS

An outcome measures toolkit validated specifically for SCI should lead to improved identification of best practice and enable clinicians to monitor client progress effectively.

[The alexithymia questionnaire for children (AQC): Psychometric properties in a sample of 105 adolescents hospitalized in an adolescent psychiatric department]

OBJECTIVE

The 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used measure of alexithymia in non-clinical or clinical populations. The TAS-20 evaluates three dimensions of the alexithymia construct: the difficulty identifying feelings (DIF), the difficulty describing feelings (DDF) and externally oriented thinking (EOT). The TAS-20 is also used in adolescents or children, and the psychometric properties of the scale have not been systematically evaluated in these populations. Recently several studies have shown systematic age differences in the factor structure and a decrease of the quality of the measurement with age. Notably, low reliability measured by the Cronbach α coefficient has been found for the EOT factor. Taking into account the limitations of the TAS-20 in pre-adult populations the Alexithymia Questionnaire for Children (AQC), an adaptation of the TAS-20, has been proposed by a reformulation of the TAS-20 items (Rieffe et al., 2006). Two studies in healthy children found satisfactory psychometric properties with the three-factor structure demonstrating adequate parameters in the confirmatory factorial analyses (CFA). In the two studies low reliabilities of the EOT factor were reported, and recent studies in adolescents using the TAS-20 found that a two-factor model (DDF, DIF) had a better fit than the original three-factor model. Thus, the aim of the present study was firstly to verify the psychometric properties of the AQC in a sample of adolescents presenting various psychiatric disorders and secondly to test the adequacy of the bi- or tridimensional model of the scale.

METHOD

One hundred and five adolescents (27 males, 78 females) with a mean age of 15.06 years (sd=1.55, range: 12-18 years) were hospitalized in the adolescent psychiatric department of the Erasme Hospital (Bruxelles, Belgium) for various psychiatric disorders. The main diagnoses were: adjustment disorder (n=56, 53.5%), mood or anxiety disorders (n=17, 16.2%), impulse control disorder (n=11, 10.5%). The subjects completed the French version of the AQC. CFA were done testing the adequacy of the three or two-factor structure of the scale. Two indices were considered: the normed χ² (ratio of χ² and degrees of freedom) and the root mean square error of approximation (RMSEA). The values for acceptable fit were normed χ²<3 and RMSEA<0.05. Cronbach α were also calculated.

RESULTS

Fit indices for the three-factor model were respectively 1.165 and 0.0303 for the normed χ² and RMSEA. For the two-factor model, the values were respectively 0.819 and 0. Thus, these two well-fitting models were compared using the χ²-difference test, which indicated a significantly better fit for the two-factor model over the three-factor model (χ²-difference=151.447, delta df=114, P<0.05). The values of the Cronbach α coefficients were respectively 0.72, 0.75, 0.18 for DIF, DDF and EOT subscales. Moreover, the values of the Cronbach α coefficients were respectively 0.71 and 0.83 for the full scale and the scale without the EOT items.

CONCLUSION

The Alexithymia Questionnaire for Children had satisfactory psychometric properties found in a sample of adolescent psychiatric inpatients. Taking into account firstly the superiority of the two-factor model over the classical three-factor model and secondly the low value of the Cronbach α for the EOT factor, it is proposed to use only the twelve-item scale by excluding the EOT items.

[Autism spectrum disorder and evaluation of perceived stress parents and professionals: Study of the psychometric properties of a French adaptation of the Appraisal of Life Event Scale (ALES-vf)]

INTRODUCTION

Autism and related disorders are grouped into the category of « Autism Spectrum Disorder » (ASD) in the DSM-5. This appellation reflects the idea of a dimensional representation of autism that combines symptoms and characteristics that vary in severity and intensity. Despite common characteristics, there are varying degrees in intensity and in the onset of symptoms, ranging from a disability that can be very heavy with a total lack of communication and major disorders associated with the existence of a relative autonomy associated, sometimes, with extraordinary intellectual abilities. Parents are faced with several difficult situations, such as sleep disturbances, agitation, shouting, hetero violence, self-harm, learning difficulties, stereotyping, lack of social and emotional reciprocity, inappropriate behavior, etc. They can feel helpless and may experience stress related to these developmental and behavioral difficulties. The heterogeneity of symptoms, the presence of behavioral problems, the lack of reciprocity and autonomy also represent a challenge for practitioners in institutions and teachers at school. The objective of this research is to present the validation of a French translation of the Appraisal of Life Events Scale (ALES-vf) from Ferguson, Matthex and Cox, specifically adapted to the context of ASD. ALES was originally developed to operationalize the three dimensions of perceived stress (threat, loss and challenge) described by Lazarus and Folkman.

METHODOLOGY

ALES-vf was initially translated into French and adapted to the situation of parents of children with ASD. It was subsequently administered to 343 parents, 150 paramedical professionals involved with people with ASD, and 155 teachers from an ordinary school environment and from specialized schools, welcoming in their classroom at least one child with ASD.

RESULTS

An exploratory factor analysis performed on data from 170 parents highlighted two exploratory models with four and three factors, slightly different from the original three-factor model of Ferguson and his collaborators. Confirmatory analyzes were conducted on data from 173 other parents to test two exploratory models and the original model of Ferguson. It has also been tested on data from 305 professionals (paramedical professionals and teachers) and on the whole sample (parents and professionals). The results suggest a better match of the original three-factor model. In addition, Cronbach's alpha coefficients and inter-item correlations showed a good internal consistency for these three factors. Finally, variance analysis and regressions were performed to test the effect of the nationality of the parents, the child's level of autonomy, the child's level of communication, and on the perceived stress by experienced professionals.

CONCLUSION

ALES-vf, after our adaptation has good psychometric properties for use not only with parents but also with professionals (teachers, educators, psychologists) working with children with ASD. Our analyses showed that the nationality of the parents does not significantly influence the subscales « threat » and « challenge » of ALES-vf, which makes it usable in other Francophone countries. Specificities in the subscales were identified based on group membership (parents and professionals). For example parents get higher average scores on subscales « loss » and « threat » and a lower average score on the subscale « challenge », compared to professionals. Finally, regarding the specifics found among professionals, the results show that the years of experience have an effect on perceived stress. Specifically, teachers and educators who have more experience perceive their work with children with ASD as a challenge. This is consistent with the results of studies showing that teachers who have had experience with children with ASD had less difficulty in their interventions.

[Validation of the French version of the "Beliefs About Voices Questionnaire-Revised" (BAVQ-R)]

INTRODUCTION

The BAVQ-R explores the beliefs and reactions that "voice hearers" have about their voices. Recently, the BAVQ-R was translated into French, but little is known regarding its validity and reliability. Thus, the aim of this study was to examine further the psychometric characteristics of the BAVQ-R French version.

METHOD

Seventy-six adult outpatients participated in the study. In addition to the BAVQ-R, patients were administered a psychiatric symptoms severity interview, and self-esteem and quality of life questionnaires. Then, the BAVQ-R was again completed six weeks later after the seven sessions of brief group cognitive behavioral therapy: the Voices Group.

RESULTS

The BAVQ-R was well accepted and was completed in less than 10minutes. All items presented floor and ceiling effects. For 15 items, item-total correlations were inferior to 0.30. Internal consistency was 0.83 for the global score, 0.83 for the malevolence, 0.81 for the benevolence, 0.64 for the omnipotence, 0.82 for the resistance and 0.77 for the engagement. The temporal stability was superior to 0.70, except for the omnipotence (0.65). Regarding, the construct validity, on the one hand malevolence, omnipotence and resistance were correlated (0.56≤r≤0.64; P<0.001) and on the other hand benevolence and engagement (r=0.62; P<0.001). Regarding convergent validity significant correlations were found between malevolence, omnipotence resistance and severity of anxio-depressive symptoms, negative self-esteem (0.40≤r≤0.52; P<0.001). The BAVQ-R allows discriminating neither between psychotic and non-psychotic patients (Mann-Whitney, all P>0.05) nor between groups established on the basis of the voice sources (Kruskal-Wallis, all P>0.05). Moreover, the BAVQ-R does not seem to be sensitive to change: no difference was observed after Voices Group intervention (Mann-Whitney, all P>0.05). Sociodemographic variables are not related to BAVQ-R.

DISCUSSION

The French version of the BAVQ-R has sufficiently adequate psychometric characteristics to be used in a clinical setting. However, floor and ceiling effects suggest a lack of sensitivity of the items. Psychometric characteristics of the BAVQ-R could be improved by selecting items and extending the Likert scale to score them.

[The clinic of apathy in schizophrenia: a critical review of the issue]

INTRODUCTION

Today the concept of apathy is subject to many questions. This psychological state is present and predominant in different disorders such as neurodegenerative and psychiatric diseases or neurological acquired disorders. Apathy is a part of the clinical vocabulary, however, we can note that in the literature there remains confusion in its definition, and we can find an amalgam with other clinical symptoms.

OBJECTIVES

The aim of this review is to provide a clarification of the concept of apathy in clinical practice in schizophrenia as well as to highlight the gaps that exist.

LITERATURE FINDINGS

Apathy belongs to the negative symptoms of schizophrenia. For its understanding, it is necessary to define apathy as a multidimensional syndrome (cognitive, emotional, and behavioral) manifesting as a quantitative reduction of voluntary behaviors directed toward one or several goals. However, at present, we are witnessing a reductionist and simplistic conception of the syndrome of apathy and this especially in the Anglo-Saxon literature. Several authors reduce apathy to its behavioral component, so in other words, to avolition/amotivation. Avolition refers to a loss of self-initiated and spontaneous behaviors. In this definition only observable behavior is taken into account and not the underlying mechanisms (cognitive and emotional). In order to understand the syndrome of apathy, it is necessary to have a holistic and multidimensional outlook. Some authors have proposed diagnostic criteria for apathy by taking into account the different dimensions of apathy. Moreover not only is apathy confused with avolition, but it is also still difficult to distinguish it from depression. Apathy and depression share common clinical signs (i.e. loss of interest), but they also have distinct clinical signs (lack of motivation for apathy, and suicidal ideation for depression). Authors have shown that the presence of one symptom (apathy or depression) does not predict the presence of the other. An apathetic patient does not have to be necessarily in a depressive state and vice versa. However, to our knowledge, there is no data capable of distinguishing depression from apathy in schizophrenia, and knowing what is the part of one and the other when the patient has both symptoms. In addition, we can see that the confusion that persists between those two symptoms also stems from assessment tools. Indeed, some assessment tools such as the Montgomery and Asberg Depression Rating Scale (MARDS) have an apathy subscale. Therefore, this scale does not only evaluate depression. Regarding the assessment of apathy in schizophrenia, there are specific and nonspecific tools. Nonspecific tools define apathy differently. For this reason, authors have proposed to measure apathy by using analytic factors of negative symptoms. In this case, apathy is going to be assessed by the factor "motivation/pleasure" including anhedonia, asociality and avolition. This factor will provide the possibility of a better assessment of apathy. Concerning specific scales (like AES), there are gaps such as a lack of standardization in the execution and the quotation. Furthermore, no scale takes into account the factors causing apathy.

CONCLUSION

Knowing the reasons for apathy is necessary because this syndrome is frequent in schizophrenia, and it is found in the different phases of this disease (prodromal, first episode psychosis, and chronic). In addition, apathy has significant functional consequences on the patient's quality of life, as well as on his or her global functioning. Indeed, apathy impacts on his or her social and professional life. Patients with schizophrenia have a loss of autonomy, less employment and social withdrawal. Consequently, interest in its drug or treatment it is obvious. However, drug and non-drug treatments are not specific to apathy and therefore little effective on this syndrome. Implications to stimulate future research are presented.