Concise Associated Symptoms Tracking Scale: A Brief Self-Report and Clinician Rating of Symptoms Associated With Suicidality

Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9119, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 06/2011; 72(6):765-74. DOI: 10.4088/JCP.11m06840
Source: PubMed


US Food and Drug Administration (FDA) warnings recommend monitoring negative symptoms associated with the initiation of antidepressant medications as these symptoms may interfere with full recovery and pose safety concerns. There is currently no brief, reliable rating instrument for assessing treatment-emergent, negative symptoms. We evaluated the psychometric properties of 2 versions of the newly developed 17-item Concise Associated Symptom Tracking (CAST) scale, the CAST Clinician Rating (CAST-C) and CAST Self-Rated (CAST-SR), which are brief instruments designed to measure the 5 relevant associated symptom domains (irritability, anxiety, mania, insomnia, and panic).
The study enrolled 265 outpatients with major depressive disorder (MDD), from July 2007 through February 2008, into an 8-week, open-label trial with a selective serotonin reuptake inhibitor. Diagnosis of MDD was determined by the Psychiatric Diagnostic Screening questionnaire and an MDD checklist based on DSM-IV-TR criteria. Suicidality (suicidal ideation with associated behaviors) is 1 of 9 symptoms of MDD (depressed mood, loss of interest, appetite or weight change, sleep disturbance, reduced concentration or indecisiveness, fatigue or decreased energy, psychomotor agitation or retardation, feelings of worthlessness or excessive guilt). Psychometric evaluations were conducted on both versions of the CAST.
Cronbach α was .80 (CAST-C) and .81 (CAST-SR). Factor analysis identified 5 factors for each scale: (1) irritability, (2) anxiety, (3) mania, (4) insomnia, and (5) panic. When the item that cross-loaded on 2 factors was eliminated, the 16-item solution had a better goodness of fit (CAST-C: 0.90 vs 0.87; CAST-SR: 0.88 vs 0.84). Cronbach α for the 16-item versions was .77 (CAST-C) and .78 (CAST-SR). The 5 associated CAST symptom domains correlated well with other standard measures of these domains.
The 16-item CAST-C and CAST-SR demonstrated excellent psychometric properties. These are potentially useful measures for monitoring treatment-emergent negative symptoms associated with antidepressants, as recommended by the FDA.

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    • "To maximize clinical and research utility, the Concise Health Risk Tracking (CHRT) scale was designed to be used as both self-rated (CHRT-SR) and clinician-rated (CHRT-C) instruments. Although previously studied in unipolar major depressive disorder, prior to the current study, the psychometric properties of the CHRT have not been examined in subjects with bipolar disorder (Trivedi et al., 2011a,b). Presently, measures such as the Columbia Suicide Severity Rating Scale (C-SSRS; Posner et al., 2011), Suicidal Behaviors Questionnaire (SBQ; Linehan and Nielsen, 1981) and the Beck Scale for Suicide Ideation (SSI; Beck et al., 1979) are used to assess risk factors for suicidal behavior. "
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    • "Ketamine for suicidal ideation 5 the majority of patients in our study had a primary diagnosis of MDD or bipolar disorder. We did find a significant effect of treatment on irritability and panic using the CAST (Trivedi et al. 2011b), wherein patients treated with ketamine compared to midazolam had lower levels of irritability and panic symptoms 24 h following treatment. These findings raise the possibility that ketamine may reduce suicidal thinking in part by reducing irritability and panic. "
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