Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder

Bipolar Disorders Program & Molecular Psychiatry Laboratory, Hospital Clinic of Porto Alegre, Ramiro Barcelos, 2350, 90035-003, Porto Alegre, RS, Brazil.
Clinical Practice and Epidemiology in Mental Health 06/2007; 3(1):5. DOI: 10.1186/1745-0179-3-5
Source: PubMed


Numerous studies have documented high rates of functional impairment among bipolar disorder (BD) patients, even during phases of remission. However, the majority of the available instruments used to assess functioning have focused on global measures of functional recovery rather than specific domains of psychosocial functioning. In this context, the Functioning Assessment Short Test (FAST) is a brief instrument designed to assess the main functioning problems experienced by psychiatric patients, particularly bipolar patients. It comprises 24 items that assess impairment or disability in six specific areas of functioning: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships and leisure time.
101 patients with DSM-IV TR bipolar disorder and 61 healthy controls were assessed in the Bipolar Disorder Program, Hospital Clinic of Barcelona. The psychometric properties of FAST (feasibility, internal consistency, concurrent validity, discriminant validity (euthymic vs acute patients), factorial analyses, and test-retest reliability) were analysed.
The internal consistency obtained was very high with a Cronbach's alpha of 0.909. A highly significant negative correlation with GAF was obtained (r = -0.903; p < 0.001) pointing to a reasonable degree of concurrent validity. Test-retest reliability analysis showed a strong correlation between the two measures carried out one week apart (ICC = 0.98; p < 0.001). The total FAST scores were lower in euthymic (18.55 +/- 13.19; F = 35.43; p < 0.001) patients, as compared with manic (40.44 +/- 9.15) and depressive patients (43.21 +/- 13.34).
The FAST showed strong psychometrics properties and was able to detect differences between euthymic and acute BD patients. In addition, it is a short (6 minutes) simple interview-administered instrument, which is easy to apply and requires only a short period of time for its application.

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Available from: Jose Sánchez-Moreno, Oct 13, 2015
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    • "It was composed of six domains: (1) estimated IQ, which was evaluated with the Wechsler Adult Intelligence Scale – III (WAIS-III) vocabulary subtest (Wechsler, 1997a); (2) the processing speed index, which consists of two subtests of the WAIS-III, the digit–symbol coding and symbol search (Wechsler, 1997a); (3) executive function, which was tested by set shifting, verbal fluency, planning, and response inhibition using the Computerized Wisconsin Card Sorting Test (Heaton, 1981), the Stroop Color– Word Interference Test (Golden, 1978), the phonemic (F-A-S) and categorical (animal naming) components of the Controlled Oral Word Association Test (Benton & Hamsher, 1976), the Trail Making Test, part B (Reitan, 1958), and the Rey–Osterrieth Complex Figure (Rey, 1997); (4) visual memory and verbal learning/memory, which were assessed with the Rey– Osterrieth Complex Figure for visual memory and the California Verbal Learning Test (CVLT) (Delis et al. 1987) and the Logical Memory Scale (Wechsler Memory Scale-III; WMS-III) (Wechsler, 1997b) for learning/memory; (5) the working memory index, which was tested with three subtests of the WAIS-III (Wechsler, 1997a): arithmetic, digits forward and backward, and letter–number sequencing; and (6) attention , which was tested with the Trail Making Test, part A (Reitan, 1958), administered together with the Continuous Performance Test-II, version 5 (Conners, 2000), to measure sustained attention. Finally, psychosocial functioning was assessed by means of the FAST scale (Rosa et al. 2007). "
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    ABSTRACT: Background: Functional remediation is a novel intervention with demonstrated efficacy at improving functional outcome in euthymic bipolar patients. However, in a previous trial no significant changes in neurocognitive measures were detected. The objective of the present analysis was to test the efficacy of this therapy in the enhancement of neuropsychological functions in a subgroup of neurocognitively impaired bipolar patients. Method: A total of 188 out of 239 DSM-IV euthymic bipolar patients performing below two standard deviations from the mean of normative data in any neurocognitive test were included in this subanalysis. Repeated-measures analyses of variance were conducted to assess the impact of the treatment arms [functional remediation, psychoeducation, or treatment as usual (TAU)] on participants' neurocognitive and functional outcomes in the subgroup of neurocognitively impaired patients. Results: Patients receiving functional remediation (n = 56) showed an improvement on delayed free recall when compared with the TAU (n = 63) and psychoeducation (n = 69) groups as shown by the group × time interaction at 6-month follow-up [F 2,158 = 3.37, degrees of freedom (df) = 2, p = 0.037]. However, Tukey post-hoc analyses revealed that functional remediation was only superior when compared with TAU (p = 0.04), but not with psychoeducation (p = 0.10). Finally, the patients in the functional remediation group also benefited from the treatment in terms of functional outcome (F 2,158 = 4.26, df = 2, p = 0.016). Conclusions: Functional remediation is effective at improving verbal memory and psychosocial functioning in a sample of neurocognitively impaired bipolar patients at 6-month follow-up. Neurocognitive enhancement may be one of the active ingredients of this novel intervention, and, specifically, verbal memory appears to be the most sensitive function that improves with functional remediation.
    Psychological Medicine 09/2015; DOI:10.1017/S0033291715001713 · 5.94 Impact Factor
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    • "The subjects with bipolar disorder and substance abuse/dependence were considered in the group BD þSAD, and the subjects with bipolar disorder and without substance abuse/ dependence were classified in the BD group. Functioning was assessed using the Functional Assessment Short Test (FAST) (Cacilhas et al., 2009; Rosa et al., 2007). FAST includes 24 items that evaluate six specific areas of functioning: autonomy, occupational functioning , cognitive functions, financial issues, interpersonal relationships , and leisure time. "
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    ABSTRACT: To assess the functional impairment of young adults with bipolar disorder with substance abuse/dependence comorbidity. Cross-sectional study within a community sample. Bipolar Disorder was assessed by qualified psychologists using The Mini International Neuropsychiatric Interview - PLUS (MINI-PLUS). Substance abuse and dependence was assessed using the "Alcohol, Smoking and Substance Involvement Screening Test" (ASSIST). Functional impairment was assessed using the Functional Assessment Short Test (FAST). The sample included 1259 young adults. The prevalence of Bipolar Disorder (BD) without Substance Abuse/Dependence (SAD) comorbidity was 5.9% (n=74), and the prevalence of bipolar disorder with substance abuse/dependence comorbidity was 1.4% (n=17). Both groups showed higher impairment in overall functioning, interpersonal relationship, and leisure time as compared to controls. In addition, BD+SAD showed higher impairment in the cognitive functioning domain of FAST. A battery of neuropsychological tests was not performed. Functional impairment is associated with BD, independently of substance abuse or dependence. In addition, BD+SAD present a more severe impairment in the cognitive domain of FAST as compared to controls. Copyright © 2015. Published by Elsevier B.V.
    Journal of Affective Disorders 08/2015; 187:179-182. DOI:10.1016/j.jad.2015.08.046 · 3.38 Impact Factor
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    • "symptoms can affect cognitive function. Assessment of socio-occupational function was performed with the Functional Assessment Short Test (FAST), a 24-item interviewer-administered instrument that has shown high concurrent validity and internal reliability in patients with BD (Rosa et al., 2007), and patients with first episode psychosis (González-Ortega et al., 2010). Participants provided ratings of their quality of life and socio-occupational function with the World "
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    ABSTRACT: Cognitive impairment is common in bipolar disorder and contributes to socio-occupational difficulties. The objective was to validate and evaluate instruments to screen for and monitor cognitive impairments, and improve the understanding of the association between cognitive measures and socio-occupational capacity. Patients with bipolar disorder in partial or full remission (n=84) and healthy controls (n=68) were assessed with the Screen for Cognitive Impairment in Psychiatry (SCIP), Cognitive Complaints in Bipolar Disorder Rating Scale (COBRA), and established neuropsychological tests and subjective rating scales. Socio-occupational function and affective symptoms were evaluated with the Functional Assessment Short Test, and the Hamilton Depression Rating Scale 17-items and Young Mania Rating Scale, respectively. Concurrent validity of the SCIP and COBRA were assessed by correlation with established objective and subjective cognitive measures, and decision validity was determined with Receiver-Operating-Characteristic analyses. Correlations and linear regression analyses were conducted to determine the associations between objective and subjective cognitive impairment, and socio-occupational difficulties. The SCIP and COBRA correlated strongly with established objective and subjective cognitive measures, respectively. The SCIP yielded higher sensitivity and specificity for detection of cognitive dysfunction than the COBRA or a combined SCIP-COBRA measure. Correlations between objective and subjective cognitive impairment were weak but both were associated with socio-occupational difficulties. Influence of ageing was not investigated. The SCIP and COBRA are valid for detection of objective and subjective cognitive impairment in bipolar disorder. Screening for cognitive dysfunction should be conducted with an objective measure like the SCIP. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 08/2015; 187:10-19. DOI:10.1016/j.jad.2015.07.039 · 3.38 Impact Factor
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