María Teresa Bobes-Bascarán

Psychometric evaluation of the negative syndrome of schizophrenia

In this paper, we reviewed the available instruments for assessing the negative syndrome of schizophrenia, describing their strengths and weaknesses. Current instruments were classified into two categories according to their content validity and assessment approach as first- or second-generation instruments. The BPRS, SANS, the SENS and the PANSS belong to the first generation, while the BNSS, the CAINS and the MAP-SR belong to the second generation. The NSA can be considered a transitional instrument between the two. First-generation instruments have more content validity problems than second-generation instruments do, as they do not accurately reflect the currently accepted negative syndrome (they do not include all negative symptoms and signs or they include symptoms from other dimensions). They also have more problems relative to the use of behavioural referents instead of internal experiences of deficits when assessing symptoms, which may lead to measuring functioning instead of negative symptoms. Further research needs to be done in this area in order to ensure the evaluation of primary negative symptoms and internal experiences involved in negative symptoms rather than external behaviours.

Development and Cross-Validation of the UPSA Short Form for the Performance-Based Functional Assessment of Patients With Mild Cognitive Impairment and Alzheimer Disease

BACKGROUND Functional capacity includes basic and complex behaviors necessary to independently live in the community. It has been found that patients with cognitive impairment have daily living functional skills altered at very early stages of illness. OBJECTIVES 1) To develop and validate a brief scale derived from the University of California, San Diego, performance-based skills assessment (UPSA); 2) to cross-validate this new UPSA short form with an independent healthy elderly sample. METHOD Fifty-one healthy elderly subjects, 26 mild cognitive impairment (MCI) subjects defined per Petersens criteria, and 22 probable Alzheimer Disease (AD) subjects according to National Institute of Neurological and Communicative Disorders and Stroke-AD and Related Disorders Association criteria were included. For cross-validation purpose, a comparison group of 108 older healthy subjects with Mini-Mental scores of 25 or greater was also recruited. A modified four-functional domain version of the UPSA was administered. RESULTS Communication and comprehension/planning domains accounted for almost 90% of the variance (R = 0.89) and in all models entered first and second, respectively. An UPSA short form using these two domains was significantly correlated with the full UPSA scale in all the groups examined: 0.86 for healthy controls; 0.87 for MCI; and 0.88 for AD. Acceptable sensitivity and specificity values for the UPSA short form were found in receiver operating characteristic (ROC) analysis. A correlation of 0.80 was found between the short and the full UPSA scales in the cross-validation sample. CONCLUSIONS The UPSA short form is a rapid, reliable, and efficient measure of functional capacity that is able to detect performance impairment in an ecologically valid setting in much less time compared with the extended form of the scale. Furthermore, it demonstrated adequate discriminative properties among healthy subjects, MCI patients, and AD patients.

Validation of a European Spanish-version of the University of California performance Skills Assessment (Sp-UPSA) in patients with schizophrenia and bipolar disorder

AIMS To validate the Spanish version of the University of California Performance Skills Assessment (UPSA) in patients with severe mental disorders. METHODS Naturalistic, 6month follow-up, multicentre, validation study. 139 patients with schizophrenia, 57 bipolar patients and 31 controls were evaluated using the following scales: Spanish UPSA (Sp-UPSA), Clinical Global Impression, Severity (CGI-S), Global Assessment of Functioning (GAF), and Personal and Social Performance (PSP). RESULTS Reliability: Internal consistency (Cronbachs alpha) was 0.81 in schizophrenia and 0.58 in bipolar patients. Test-retest was 0.74 and 0.65 (p<0.0001) respectively. Construct validity: Pearson correlation coefficients between Sp-UPSA and PSP total scores were 0.42 (p<0.0001) for schizophrenia and 0.44 (p=0.001) for bipolar patients. For Sp-UPSA and GAF scores correlation coefficients were 0.43 and 0.52 (p<0.0001) respectively. Discriminant validity: The Sp-UPSA discriminated between patients and controls. In schizophrenia patients it also discriminated among different levels of illness severity according to CGI-S scores. In control versus patients with schizophrenia contrasts, the area under the curve was 0.89 and a cut-off point of 85 provided a sensitivity of 82.7% and a specificity of 77.4%. In bipolar patients, the area under the curve was 0.85 and a cut-off point of 90 provided a sensitivity of 82.5% and a specificity of 64.5%. CONCLUSION The Spanish UPSA is a reliable and valid instrument for assessing functional capacity in severe mentally ill patients. It seems to be appropriate for use in clinical trials and in everyday clinical practice as a means of monitoring functional outcomes.

Psychometric Properties of the Spanish Version of the Changes in Sexual Functioning Questionnaire Short‐Form (CSFQ‐14) in Patients with Severe Mental Disorders

INTRODUCTION Sexual dysfunction in patients with severe mental disorders is often underestimated or overlooked by psychiatrists. A brief and valid self-report instrument for assessing sexual functioning may well contribute to changing this situation. AIMS To validate the Short Form of the Changes in Sexual Functioning Questionnaire (CSFQ-14) in Spanish patients with severe mental disorders. METHODS Naturalistic, cross-sectional, multicenter, validation study. Eighty-nine patients with schizophrenia and 82 with bipolar disorder were evaluated using the CSFQ-14, the Visual Analogue Scale for Sexual Functioning Satisfaction (VAS-SFS), and the Clinical Global Impression-Severity scales for mental disorders (CGI-S) and for Sexual Dysfunction (CGI-SSD). MAIN OUTCOME MEASURES The 14-item Changes in Sexual Functioning Questionnaire. RESULTS Internal reliability (Cronbachs alpha) = 0.90. Construct validity = 3 principal components, of which the first, arousal-orgasm, explained 46.4% of the total variance. Convergent validity: Pearson correlation coefficients between CSFQ-14 and VAS-SFS = 0.33 (P < 0.01) and between CSFQ-14 and CGI-SDS = -0.71 (P < 0.01). Discriminant validity: The CSFQ-14 was able to discriminate among patients with no, mild, moderate, and severe sexual dysfunction according to CGI-SDS scores, both in males (P < 0.001) and females (P < 0.001). In males, the area under the curve (AUC) was 0.833 and a cutoff point of 49 provided a sensitivity of 92.9% and a specificity of 59.5%. In females, the AUC was 0.834 and a cutoff point of 43 provided a sensitivity of 91.9% and a specificity of 62.5%. CONCLUSION The Spanish version of the CSFQ-14 is a reliable and valid instrument for assessing sexual functioning in patients with severe mental disorders. As a brief, self-rated instrument, the CSFQ-14 scale seems to be appropriate for use in everyday clinical practice as a means of identifying and monitoring changes in sexual functioning.

Desarrollo de la versión española de la Escala Breve para la Evaluación de la Capacidad Funcional [Sp-UPSA-Brief] para pacientes con esquizofrenia y trastorno bipolar

INTRODUCTION In patients with severe mental disorders outcome measurement should include symptoms, cognition, functioning and quality of life at least. Shorter and efficient instruments have greater potential for pragmatic and valid clinical utility. Our aim was to develop the Spanish UPSA Brief scale (Sp-UPSA-Brief). MATERIAL AND METHODS Naturalistic, 6-month follow-up, multicentre study. 139 patients with schizophrenia, 57 with bipolar disorder and 31 controls were evaluated using the Sp-UPSA, CGI-S, GAF, and PSP. We conducted a multivariate linear regression model to identify candidate subscales for the Sp-UPSA-Brief. RESULTS The stepwise regression model for patients with schizophrenia showed that communication and transportation Sp-UPSA subscales entered first and second at p<0.0001 (R(2)=0.88, model df=2, F=395.05). In patients with bipolar disorder transportation and communication Sp-UPSA subscales entered first and second at p<0.0001 (R(2)=0.87, model df=2, F=132.32). Cronbachs alpha was 0.78 in schizophrenia and 0.64 in bipolar patients. Test-retest was 0.66 and 0.64 (p<0.0001) respectively. Pearson correlation coefficients between Sp-UPSA and Sp-UPSA-Brief were 0.93 for schizophrenia and 0.92 for bipolar patients (p<0.0001).The Sp-UPSA-Brief discriminated between patients and controls. In schizophrenia patients it also discriminated among different levels of illness severity according to CGI-S scores. CONCLUSION The Sp-UPSA-Brief is an alternate instrument to evaluate functional capacity that is valid and reliable. Having a shorter instrument makes it more feasible to assess functional capacity in patients with severe mental disorders, especially in everyday clinical practice.

Validación española de la escala de evaluación de los síntomas negativos-16 (NSA-16) en pacientes con esquizofrenia

INTRODUCTION Negative symptoms are prevalent in schizophrenia and associated with a poorer outcome. Validated newer psychometric instruments could contribute to better assessment and improved treatment of negative symptoms. The Negative Symptom Assessment-16 (NSA-16) has been shown to have strong psychometric properties, but there is a need for validation in non-English languages. This study aimed to examine the psychometric properties of a Spanish version of the NSA-16 (Sp-NSA-16). MATERIAL AND METHOD Observational, cross-sectional validation study in a sample of 123 outpatients with schizophrenia. ASSESSMENTS NSA-16, PANSS, HDRS, CGI-SCH and PSP. RESULTS The results indicate appropriate psychometric properties, high internal consistency (Cronbachs alpha=0.86), convergent validity (PANSS negative scale, PANSS Marder Negative Factor and CGI-negative symptoms r values between 0.81 and 0.94) and divergent validity (PANSS positive scale and the HDRS r values between 0.10 and 0.34). In addition, the NSA-16 also exhibited discriminant validity (ROC curve=0.97, 95% CI=0.94 to 1.00; 94.3% sensitivity and 83.3% specificity). CONCLUSIONS The Sp-NSA-16 is reliable and valid for measuring negative symptoms in patients with schizophrenia. This provides Spanish clinicians with a new tool for clinical practice and research. However, it is necessary to provide further information about its inter-rater reliability.

Métodos de exploración de la función cognitiva en la práctica clínica

Resumen Los sintomas cognitivos son uno de los criterios diagnosticos de la depresion y, sin embargo, no existe en la actualidad un metodo gold standard para su deteccion y evaluacion. En el presente articulo se revisan los metodos de evaluacion existentes en la actualidad, desde la historia clinica a la evaluacion mediante instrumentos de evaluacion psicometrica. Dentro de los instrumentos de evaluacion psicometrica se diferencian 3 tipos de medidas: a) valoradas por el clinico (CROM, clinician rated outcome measures); b) valoradas por el paciente (PROM, patient reported outcome measures), y c) mixtas, valoradas por el clinico y por el paciente (CROM + PROM). La tendencia en la actualidad es utilizar medidas de evaluacion que combinen ambos tipos de informacion: objetiva, proporcionada por el clinico basandose en la observacion de la ejecucion de determinadas tareas del paciente, y subjetiva, basada en las dificultades autopercibidas por el paciente.

A Review of Quality-of-Life Assessment Measures in Schizophrenia: Limitations and Future Developments

The assessment of quality of life (QoL) in patients with schizophrenia is an area of growing concern since it is considered an essential distal outcome for clinical trials and patient management (Auquier et al. 2003; Awad and Voruganti 2012) according to the patient-reported outcome (PRO) movement in medicine (see Fig. 5.1). Its evaluation is founded on the notion that every patient has a right to self-determination in health-care decisions and his/her subjective perspective should be considered in both diagnosis and care planning processes (Awad and Voruganti 2012; Badia et al. 1999; Bilker et al. 2003).

Psychometric properties of a Spanish-version of the Schizophrenia Objective Functioning Instrument (Sp-SOFI)

The Schizophrenia Objective Functioning Instrument (SOFI) is an interviewer-administered scale designed to objectively assess the actual level of patient functioning and to measure community functioning related to cognitive impairment and psychopathology. The aim was to examine the psychometric properties of the Spanish version of the SOFI (Sp-SOFI) in a sample of 155 Spanish outpatients with schizophrenia disorder. The instruments applied were Sp-SOFI, Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression-Schizophrenia Scale (CGI-SCH), Personal and Social Performance Scale (PSP), and Global Assessment of Functioning (GAF). The discrimination indexes of the Sp-SOFI items range from .21 to .77. Exploratory factor analysis showed an essentially one-dimensional structure. Cronbachs alpha was .93. Test-retest reliability for the Sp-SOFI total score was .87 (p < .001). The canonical correlation between SP-SOFI domains and PSP dimensions was .83. The multiple correlation coefficient between Sp-SOFI domains and GAF score was .84. Sp-SOFI scores were significantly different between high and low scores on the PANSS scales (p < .001). Sp-SOFI measures discriminated among patients with doubtful, mild, moderate, and severe schizophrenia disorder according to CGI-SCH scales (p < .001). New evidence about the validity of the SOFI was provided. The Sp-SOFI is a reliable and valid tool for using in clinical practice.