Alex Kørner

The Geriatric Depression Scale and the Cornell Scale for Depression in Dementia. A validity study

The study is a validation study of two psychogeriatric depression rating scales, The Geriatric Depression Scale (GDS) and the Cornell Scale for Depression in Dementia (CSDD). The sensitivity and specificity, and the convergent and criterion validity of the two scales as well as the inter-rater reliability of the CSDD are reported. Two independent clinicians using the ICD-10 for depression and dementia, the Clinical Global Impression (CGI), the Hamilton Depression rating scale 17-items and the Mini-Mental-State Examination (MMSE), interviewed each patient or control subject. One hundred forty-five persons of 65 years or more of age were included, 73 were depressed only, 36 depressed and demented; 36 persons were control subjects, 11 of these were demented. The inter-rater reliabilities were high or very high equalling perfect correlation. There was very high convergent validity between the screening tools and the severity scales; the shorter versions of the GDS (15-, 10- or four-item version) had lower though still almost perfect correlations. The criterion validity in the total population showed the CSDD as the better scale with sensitivity and specificity of 93% and 97% with a cut-off value of ≥6. The GDS versions had sensitivities and specificities ranging from 82% to 90% and 75% to 94% respectively with cut-off values ≥9, 4, 3 and 1. The CSDD retained its validity and specificity as a screening tool for depression in a population of demented, while the GDS versions all diminished in validity. The GDS and the CSDD are both valid screening tools for depression in the elderly; however, the CSDD alone seems to be equally valid in populations of demented and non-demented.

The Brief Psychiatric Rating Scale

This study has focussed on a 10-item Brief Psychiatric Rating Scale (BPRS) subscale for the quantification of schizophrenic states. Seven psychiatrists interviewed jointly patients who all fulfilled the DSM-III criteria of schizophrenia, and in a subsequent pencil-and-paper procedure a judgment analysis was performed. The reliability analysis showed that less experienced BPRS raters made less consistent judgments implying the cautionary statement that the proper use of a scale for schizophrenia requires specialized training with the scale. The validity analysis showed that the BPRS items had an additive relationship implying that the sum of these items is a sufficient statistic for the measurement of severity of schizophrenic states. Finally, the results seem to indicate, that the underlying dimension defined by the 10-items BPRS subscale includes hierarchically the negative and positive symptoms of schizophrenia.

Late and very-late first-contact schizophrenia and the risk of dementia--a nationwide register based study.

To examine whether late and very‐late first‐contact schizophrenia carry a risk for later development of dementia.

Acute and transient psychosis in old age and the subsequent risk of dementia: a nationwide register-based study.

Aim:  Using the unique Danish psychiatric and somatic health registers, we investigated the rate of subsequent dementia in patients with late‐onset acute and transient psychosis.

The Brief Psychiatric Rating Scale: Schizophrenia, Reliability and Validity Studies

In an attempt to increase uniformity and unambiguity of evaluation through rating scales of schizophrenia and schizophrenialike psychosis, the 5-step edition of the Brief Psychiatric Rating Scale (BPRS) is used. In this edition of BPRS the 18 symptoms and the symptom grading are expressed in explicit item definitions. Symptoms in the Hamilton Depression Scale and in the Beigel Mania Scale which correlate with BPRS have been incorporated as far as possible. Despite wide international application of BPRS, only few reliability and validity studies have been made, the fact notwithstanding that the scale is used as a reference when new scales are introduced.This interim statement includes weekly co-rating of in-patients on the BPRS. The studies were commenced in August 1984. The rating procedure takes place between 8.15 and 9.00 a.m. and each patient is examined only once. The maximum number of raters is six but varies between three and six per rating procedure. The evaluated patients all comply with DSM-III c...

The Neuropsychiatric Inventory*NPI. Validation of the Danish version

Assessment of neuropsychiatric symptoms in dementia has great clinical importance. The aim of the study was validation of the Danish version of the NPI, using assessments of 72 demented and 29 non-demented of age 65+ years and their caregivers at three visits. The NPI was administered by the same psychiatric nurse interviewing the same caregiver. At visits 1 and 3, a psychogeriatrician assessed the participant using the ICD-10, the Geriatric Deterioration Scale (GDS) and the Clinical Global Impression (CGI) as well as the NPI in a visual analogue scale (VAS) version. These scores were blindly converted into scores equalling the frequency and severity of the NPI by one of the investigators. Data analysis comprised inter-rater reliabilities (intra-class coefficients, ICC); NPI scores and corresponding VAS scores were compared using Spearmans correlation coefficients. NPI scores at visits 1 and 2 were used to assess the test–retest reliabilities. The scalability of the NPI was assessed with Mokken and Loevinger coefficients. The ICC for all the NPI domains and the GDS (>0.80) were perfect, the ICC for the NPI-VAS (0.68–0.95) and the CGI (0.69) was satisfactory to perfect. Correlations between NPI and NPI-VAS were high; only two domains had coefficients below 0.60: depression and agitation/aggression. NPI-total scores increase with increasing severity of dementia. The NPI did not fulfil the scalability assessed by the Mokken and Loevinger coefficients. The NPI Danish version is valid and reliable in assessing neuropsychiatric symptoms in dementia but not fully scalable. The use of single item scores and not total sum score is recommended.

The Danish version of the Baylor Profound Mental State Examination.

Background: An instrument of assessing the cognitive status of the severely demented is needed. Aim: To validate the Danish version of the cognitive part of the Baylor Profound Mental State Examination (BPMSE-cog). Design: Participants were residents in dementia care units. The Mini-Mental State Examination (MMSE), the Severe Impairment Battery (SIB), the Geriatric Deterioration Scale (GDS) and the Disability Assessment of Dementia (DAD) were co-administered. Three assessments were performed: at baseline, 1 week and 6 months later. At visits 1 and 3, participants were assessed blinded by a geriatric psychiatrist (GDS, MMSE and diagnosis) and by a registered nurse (BPMSE-cog, SIB, DAD). At visit 2, assessments were made by the RN only. Test–retest and inter-rater reliabilities were calculated. External validity was assessed in terms of correlation to MMSE, SIB, GDS and DAD; internal validity was assessed using Cronbachs alpha, Mokken/Loevinger coefficients and the item response analysis. Results: Inter-rater reliability and test–retest reliability were very high for total scale as well as for the subscales. The external validity was satisfactory with correlation coefficients: MMSE: 0.74; SIB: 0.89; the GDS 0.83; DAD: 0.67 (P < 0.001). Results further indicate that there is a ceiling but no floor effect of the BPMSE-cog. The internal validity was highly satisfactory demonstrating sufficient internal consistency and homogeneity of the scale. The item response analysis showed an even distribution of the 25 items. Conclusion: The BPMSE-cog is a very stable and strong scale and is recommended as a severity measurement for the cognitive performance of patients suffering from severe dementia.

Rolipram versus nortriptyline in gerontopsychiatric inpatients with major depression

To define the therapeutic profile of the new putative antidepressant rolipram, a double-blind (double-dummy) study with 0.5 mg rolipram versus 25 mg nortriptyline three times daily was conducted in hospitalized gerontopsychiatric inpatients with major depression. During both therapies, improvement was achieved compared with base line. However, the rate of recovery in patients treated with 3×25 mg nortriptyline was significantly greater than in those treated with 3×0.5 mg rolipram. Overall, rolipram was better tolerated than nortriptyline and produced fewer adverse effects that could be attributed to cholinergic blocking. We conclude that 3×0.5 mg rolipram presumably is too low a dosage for the treatment of major depression in gerontopsychiatric inpatients.

The impact of the Danish Medico-Legal Council on the choice between treatment and punishment for non-psychotic offenders.

Abstract Background. The Danish Medico-Legal Council provides the court with statements based on available psychiatric assessment reports to assist the law in the use of the Penal Code sections on mentally disordered offenders. Aims. To analyse the impact of the Council on the courts’ choice between punishment and treatment in cases of offenders falling under §69 of the Penal Code, i.e. mentally disordered, although not psychotic offenders. Methods. In 298 cases of defendants who according to the Medico-Legal Council might fall under §69 the recommendations of the assessment reports, the recommendations of the Council and the final verdicts are compared; and assessment reports from forensic psychiatric centres are compared with those from other psychiatrists. Results. The recommendations of the Medico-Legal Council were often, but not blindly followed by the courts. The probability for the Council to recommend some measure of treatment was about 50% for adult males, and higher for adolescents and for females. In court, however, the two genders as well as adolescents and adults alike all had the same probability, approximately 50%, of being sentenced with treatment instead of punishment. When measured by the final verdict, the Medico-Legal Council is of higher quality than the assessment reports, especially those from outside forensic psychiatry. Conclusion. The Council serves as a quality assurance of Danish forensic psychiatric assessments, and the Councils statements are by the court considered to represent the state of the art of these assessments.

Mentally disordered non-psychotic criminal offenders—Treatment instead of punishment

Abstract Background: By including §69 into the Danish Penal Code, it has since 1975 been possible to use psychiatric measures as legal sanctions for even non-psychotic offenders—if the measure is believed to be preventive of future crime. To be able to decide on the applicability of treatment measures as sanctions in criminal cases, the court will request a psychiatric report. They may furthermore ask a medical expert consultation board, the Danish Medico-Legal Council, for an opinion on the mental status of the defendant. Aims: To describe a sample of offenders falling under §69 and the use of the section in sentencing offenders to treatment instead of punishment. Methods: All 298 opinions given by the Medico-Legal Council between April 1, 2005 and December 31, 2007 of defendants definitely or possibly falling under §69 of the Danish Penal Code were rated together with the psychiatric assessment reports and the final verdicts on socio-demographic, health and criminal items, and the data were computerized. Results: The sample was characterized by severe criminality and mental disorder. Forty-six percent (138/298) were sentenced by the court to a psychiatric measure instead of punishment. Conclusions: The results document that §69 of the Danish Penal Code is used as intended by the law.