An Inexpensive Family Index of Risk for Mood Issues Improves Identification of Pediatric Bipolar Disorder
Family history of mental illness provides important information when evaluating pediatric bipolar disorder (PBD). However, such information is often challenging to gather within clinical settings. This study investigates the feasibility and utility of gathering family history information using an inexpensive method practical for outpatient settings. Families (N = 273) completed family history, rating scales, and the Mini-International Neuropsychiatric Interview (Sheehan et al., 1998) and the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (Kaufman et al., 1997) about youths 5-18 (median = 11) years of age presenting to an outpatient clinic. Primary caregivers completed a half-page Family Index of Risk for Mood issues (FIRM). All families completed the FIRM quickly and easily. Most (78%) reported 1+ relatives having a history of mood or substance issues (M = 3.7, SD = 3.3). A simple sum of familial mood issues discriminated cases with PBD from all other cases (area under receiver operating characteristic [AUROC] = .63, p = .006). FIRM scores were specific to youth mood disorder and not attention-deficit/hyperactivity disorder or disruptive behavior disorder. FIRM scores significantly improved the detection of PBD even controlling for rating scales. No subset of family risk items performed better than the total. Family history information showed clinically meaningful discrimination of PBD. Two different approaches to clinical interpretation showed validity in these clinically realistic data. Inexpensive and clinically practical methods of gathering family history can help to improve the detection of PBD. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Available from: Heinz Grunze
- "The classification of parental history of psychiatric illness was also based only on the probands' reports and not confirmed with direct interviews of the family members. Again, some investigators question the reliability of this type of family history, but others indicate that it has considerable reliability and validity (Algorta et al., 2011). However, our exclusive use of a parental history of illness, rather than that of any first-degree relative, may also increase accuracy of reporting. "
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ABSTRACT: OBJECTIVE: A role for childhood adversity in the development of numerous medical conditions in adults has been described in the general population, but has not been examined in patients with bipolar disorder who have multiple medical comorbidities which contribute to their premature mortality. METHODS: More than 900 outpatients (average age 41) with bipolar disorder completed questionnaires that included information about the occurrence of verbal, physical, or sexual abuse in childhood and whether their parents had a mood or substance abuse disorder, or a history of suicidality. These factors were combined to form a total childhood adversity score, which was then related to one or more of 30 medical conditions patients rated as present or absent. RESULTS: The child adversity score was significantly related to the total number of medical comorbidities a patient had (p<.001), as well as to 11 specific medical conditions that could be modeled in a logistic regression (p<.03). These included: asthma, arthritis, allergies, chronic fatigue syndrome, chronic menstrual irregularities, fibromyalgia, head injury (without loss of consciousness), hypertension, hypotension, irritable bowel syndrome, and migraine headaches. LIMITATIONS: The contribution of parental diagnosis to childhood adversity is highly inferential. CONCLUSIONS: These data link childhood adversity to the later occurrence of multiple medical conditions in adult outpatients with bipolar disorder. Recognition of these relationships and early treatment intervention may help avert a more severe course of not only bipolar disorder but also of its prominent medical comorbidities and their combined adverse effects on patients'health, wellbeing, and longevity.
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ABSTRACT: Assessment has been a historical strength of psychology, with sophisticated traditions of measurement, psychometrics, and theoretical underpinnings. However, training, reimbursement, and utilization of psychological assessment have been eroded in many settings. Evidence-based medicine (EBM) offers a different perspective on evaluation that complements traditional strengths of psychological assessment. EBM ties assessment directly to clinical decision making about the individual, uses simplified Bayesian methods explicitly to integrate assessment data, and solicits patient preferences as part of the decision-making process. Combining the EBM perspective with psychological assessment creates a hybrid approach that is more client centered, and it defines a set of applied research topics that are highly clinically relevant. This article offers a sequence of a dozen facets of the revised assessment process, along with examples of corollary research studies. An eclectic integration of EBM and evidence-based assessment generates a powerful hybrid that is likely to have broad applicability within clinical psychology and enhance the utility of psychological assessments.
Available from: Eric Youngstrom
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ABSTRACT: Assessment plays an essential role in diagnosis, treatment planning, and progress monitoring, but assessment data are often used in ways that are impressionistic and prone to biases. Evidence-based medicine (EBM) principles, underutilized in psychology, can be used to streamline the assessment process and increase the accuracy of conclusions. Using a case example to illustrate the application of each step, this paper outlines a 12-step approach for applying EBM assessment strategies in clinical practice. The initial steps utilize information about clinical base rates, psychopathology risk factors, rating scale scores, and selected in-depth assessment to conduct an iterative, efficient approach to estimating the probability of a given diagnosis until that probability falls into a range suggesting the diagnosis is unlikely to be present, or likely enough to warrant treatment. Once the practitioner and client agree on the treatment plan, subsequent steps monitor progress and outcomes and use that information to make decisions about termination, and then continued monitoring guards against relapse.
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