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Internal consistency and discriminant validity of the Structured Clinical Interview for Panic Agoraphobic Spectrum (SCI‐PAS)
Abstract
This paper reports on the feasibility, acceptability and psychometric properties of the Structured Clinical Interview for Panic-Agoraphobic Spectrum (SCI-PAS). This interview was designed to assess the lifetime presence of symptoms and other clinical features considered to comprise the panic-agoraphobic spectrum. The interview has 114 items grouped into nine domains. A total of 422 subjects, from 11 centres located throughout Italy, participated in this study. Data were collected from three groups of subjects: psychiatric patients meeting DSM-IV criteria for panic disorder (n = 141), cardiovascular patients (n = 140), including 29 with post-myocardial infarction, and university students (n = 141). The inter-rater reliability and the internal consistency of the SCI-PAS measures were assessed using the intra-class correlation coefficient and the Kuder-Richardson coefficient, respectively. Discriminant validity was assessed by comparing results in patients with panic disorder to those in the other groups. The interview required an average of 25 (±5) minutes to administer. Patients and clinicians found the scale to be highly useful, providing information not previously obtained. Internal consistency was good (>0.70) for six out of nine SCI-PAS domains. The inter-rater reliability was excellent (>0.70) for all the domains except for ‘other phobias’ (0.467). Patients with panic disorder scored significantly higher on each domain, and on the overall panic spectrum, than did the control subjects. In conclusion, the SCI-PAS is a useful clinical interview, which can be administered in a reasonable period of time. This assessment further demonstrates good internal consistency, discriminant validity, and inter-rater reliability. Copyright © 1999 Whurr Publishers Ltd.
... A significant body of studies has been drawing attention to the importance of spectrum approaches for the purpose of optimization of diagnosis and treatment of mental disorders [30][31][32][33][34][35][36][37][38][39][40][41][42]. In the framework of the so-called Spectrum Project, an Italian-American collaboration research project (www.spectrumproject.org), a spectrum approach has been proposed, encompassing not only core features associated with DSM mental disorders, but also isolated and atypical symptoms, as well as subthreshold symptom clusters, personality traits and behavioral manifestations that may precede, follow or be manifested in concurrence with DSM mental disorders [30,39]. ...
... In the framework of the so-called Spectrum Project, an Italian-American collaboration research project (www.spectrumproject.org), a spectrum approach has been proposed, encompassing not only core features associated with DSM mental disorders, but also isolated and atypical symptoms, as well as subthreshold symptom clusters, personality traits and behavioral manifestations that may precede, follow or be manifested in concurrence with DSM mental disorders [30,39]. The application of this model of spectrum provides a more accurate representation of clinical syndromes, including the recognition of subthreshold prodromal symptoms that can lead to early diagnosis and prevention [32][33][34][40][41][42]. ...
... The AdAS Spectrum was developed by a group of researchers from the University of Pisa, within the framework of the Spectrum Project, an international Italy-USA research network started in 1995 [32][33][34][39][40][41][42]. In line with all the spectrum assessment instruments, the AdAS Spectrum was developed simultaneously in Italian and English, by researchers that are essentially bilingual and some also studied in the United States (CC and CG), and revised by an Italian/ English bilingual translator that is trained in the field of psychiatry; all questions were discussed extensively, always with an eye toward deciding precisely how the concept was expressed in both languages and revised for inconsistencies between the two languages. ...
Aim:
Increasing literature has shown the usefulness of a dimensional approach to autism. The present study aimed to determine the psychometric properties of the Adult Autism Subthreshold Spectrum (AdAS Spectrum), a new questionnaire specifically tailored to assess subthreshold forms of autism spectrum disorder (ASD) in adulthood.
Methods:
102 adults endorsing at least one DSM-5 symptom criterion for ASD (ASDc), 143 adults diagnosed with a feeding and eating disorder (FED), and 160 subjects with no mental disorders (CTL), were recruited from 7 Italian University Departments of Psychiatry and administered the following: SCID-5, Autism-Spectrum Quotient (AQ), Ritvo Autism and Asperger Diagnostic Scale 14-item version (RAADS-14), and AdAS Spectrum.
Results:
The AdAS Spectrum demonstrated excellent internal consistency for the total score (Kuder-Richardson's coefficient=.964) as well as for five out of seven domains (all coefficients>.80) and sound test-retest reliability (ICC=.976). The total and domain AdAS Spectrum scores showed a moderate to strong (>.50) positive correlation with one another and with the AQ and RAADS-14 total scores. ASDc subjects reported significantly higher AdAS Spectrum total scores than both FED (p<.001) and CTL (p<.001), and significantly higher scores on the Childhood/adolescence, Verbal communication, Empathy, Inflexibility and adherence to routine, and Restricted interests and rumination domains (all p<.001) than FED, while on all domains compared to CTL. CTL displayed significantly lower total and domain scores than FED (all p<.001). A significant effect of gender emerged for the Hyper- and hyporeactivity to sensory input domain, with women showing higher scores than men (p=.003). A Diagnosis* Gender interaction was also found for the Verbal communication (p=.019) and Empathy (p=.023) domains. When splitting the ASDc in subjects with one symptom criterion (ASD1) and those with a ASD, and the FED in subjects with no ASD symptom criteria (FED0) and those with one ASD symptom criterion (FED1), a gradient of severity in AdAS Spectrum scores from CTL subjects to ASD patients, across FED0, ASD1, FED1 was shown.
Conclusions:
The AdAS Spectrum showed excellent internal consistency and test-retest reliability and strong convergent validity with alternative dimensional measures of ASD. The questionnaire performed differently among the three diagnostic groups and enlightened some significant effects of gender in the expression of autistic traits.
... Thus, a first step to increasing our understanding of MDD-SI might be developing a rich clinical phenotype of MDD-SI that includes lifetime and concurrent mood and anxiety symptomatologies. To this end, the Spectrum Assessment Method (Cassano et al., 1997(Cassano et al., , 1999(Cassano et al., , 2004) seems particularly well suited. ...
... The Spectrum Assessment Method is a reliable and valid way to document the phenomenology and clinical phenotype of MDD-SI (Cassano et al., 1997(Cassano et al., , 1999(Cassano et al., , 2004Fagiolini et al., 1999). ...
... The Spectrum Project Group has demonstrated that the MOODS has good internal consistency (0.79-0.92) and high test-retest reliability (r = 0.93-0.94) (Fagiolini et al., 1999; The Panic-Agoraphobic Spectrum Self-Report (PAS) (Cassano et al., 1999;Shear et al., 2001) was designed to evaluate the lifetime (PAS-Lifetime) and past month (PAS-PM) presence or absence of a broad array of manifestations of panic disorder including DSM-IV core symptoms of panic, subthreshold manifestations, and behavioral traits that arise as a means of coping with anxiety symptoms (See Section 2.6.). A total score that exceeds 35 is clinically These include physical health or activities, feelings, work, household duties, school or course work, leisure time activities, social relations, and general activities. ...
... They were selected from a larger sample of subjects consecutively presenting over a 6-month period to receive clinical assistance. Subjects who scored ≥ 35 in the Panic-Agoraphobic Self-Report (Cassano et al., 1999;Shear et al., 2001) were selected for participating in the study. ...
... The Panic Agoraphobic Spectrum-Self Report (PAS-SR; Cassano et al., 1999;Shear et al., 2001; Spanish adaptation of Berrocal et al., 2006). This instrument was used to select the participants in the study as well as to measure variables of interest. ...
... Paniclike Symptoms and Agoraphobia domains, in turn, include two sub-domains each: Typical and Atypical Symptoms. The questionnaire largely proved to feature good reliability and validity (Berrocal et al., 2006;Cassano et al., 1999;Shear et al., 2001). Panic spectrum scores ≥ 35 have proved to be useful in predicting the response time to treatment in depression and Bipolar I disorders (Frank et al., 2002). ...
The present study tests the mediating role of hypochondriasis to explain the relation between anxiety sensitivity and panic symptomatology. Fifty-seven outpatients with clinically significant levels of panic symptomatology were selected to participate in the study. Measures of anxiety sensitivity, hypochondriasis, and panic symptomatology were obtained from standardized, selfadministered questionnaires: the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), the Whiteley Index of Hypochondriasis (WI; Pilowsky, 1967), and the Panic- Agoraphobic Spectrum Self-Report (PAS-SR; Cassano et al., 1997; Shear et al., 2001). Regression analyses were performed to test for the mediation models. The results show that the effect of anxiety sensitivity on panic symptomatology is not significant when controlling the hypochondriacal concerns, whereas the latter predicted panic symptoms. This result holds for the overall ASI as well as for the Physical Concerns and the Mental Incapacitation Concerns dimensions of the ASI scale. No evidence of a direct relation between the Social Concerns dimension and panic symptoms was found. The findings suggest that hypochondriacal concerns might represent the mechanism through which anxiety sensitivity is able to influence panic symptoms. El objetivo del presente estudio es explorar el papel mediador de las preocupaciones hipocondríacas para explicar la relación entre la sensibilidad a la ansiedad y la sintomatología de pánico. Un total de 57 pacientes con niveles clínicamente significativos de sintomatología de pánico fueron seleccionados para participar en el estudio. Se han obtenido medidas de la sensibilidad a la ansiedad, mediante el Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), la sintomatología de pánico, mediante la subescala Panic-like-symptoms del Panic-Agoraphobic Spectrum Self-Report (PAS-SR; Cassano et al., 1997; Shear et al., 2001), e hipocondríasis mediante el Whiteley Index of Hypochondriasis (WI, Pilowsky, 1967) y la subsescala Illness-related Phobia del PAS-SR. Se han llevado a cabo análisis de regresión para poner a prueba los modelos mediacionales. Los resultados obtenidos indican que el efecto de la sensibilidad a la ansiedad sobre la sintomatología de pánico no es significativo cuando se controlan las puntuaciones en hipocondríasis, si bien ésta última variable predice las puntuaciones en pánico. Dichos resultados se han obtenido sea para las puntuaciones totales en el ASI que para dos de las dimensiones que conforman la escala: preocupaciones relativas a problemas físicos y preocupaciones relativas a problemas mentales. La dimensión del ASI relacionada con preocupaciones de carácter social no se asocia con la sintomatología de pánico. Los resultados sugieren que las preocupaciones hipocondríacas podrían representar el mecanismo a través del cual la sensibilidad a la ansiedad ejerce un efecto sobre los síntomas de pánico.
... In the framework of a spectrum approach to psychopathology, proposed by the Italian-American research project named Spectrum-project (www.spectrumproject.org) [76][77][78][79][80][81][82][83][84][85][86], we recently developed and validated the Adult Autism Subthreshold Spectrum (AdAS Spectrum), which aims to assess both typical and atypical symptoms, but also attenuated manifestations, personality traits, and behavioural features that may be associated with ASD but which may also be present in subthreshold or partial forms [55]. Compared to other available instruments, the AdAS Spectrum, besides assessing more subtle manifestations of autism spectrum, investigates features that have been suggested as the female phenotype of ASD [62][63][64][65][66][67]. ...
... The AdAS Spectrum is a questionnaire developed by Dell'Osso et al. [55], within the framework of the international research network called Spectrum Project [47,48,[76][77][78][79][80][89][90][91]. The instrument was devised to assess the lifetime presence of the wide spectrum of manifestations associated with ASD, but which could be found even in individuals who do not fulfill diagnostic criteria for a formal disorder: in this regard, it was not developed to be a diagnostic instrument. ...
Aim:
Increasingly data suggest a possible overlap between psychopathological manifestations of eating disorders (EDs) and autism spectrum disorders (ASD). The aim of the present study was to assess the presence of subthreshold autism spectrum symptoms, by means of a recently validated instrument, in a sample of participants with EDs, particularly comparing participants with or without binge eating behaviours.
Methods:
138 participants meeting DSM-5 criteria for EDs and 160 healthy control participants (HCs), were recruited at 3 Italian University Departments of Psychiatry and assessed by the SCID-5, the Adult Autism Subthreshold Spectrum (AdAS Spectrum) and the Eating Disorders Inventory, version 2 (EDI-2). ED participants included: 46 with restrictive anorexia (AN-R); 24 with binge-purging type of Anorexia Nervosa (AN-BP); 34 with Bulimia Nervosa (BN) and 34 with Binge Eating Disorder (BED). The sample was split in two groups: participants with binge eating behaviours (BEB), in which were included participants with AN-BP, BN and BED, and participants with restrictive behaviours (AN-R).
Results:
participants with EDs showed significantly higher AdAS Spectrum total scores than HCs. Moreover, EDs participants showed significantly higher scores on all AdAS Spectrum domains with the exception of Non verbal communication and Hyper-Hypo reactivity to sensory input for AN-BP participants, and Childhood/Adolescence domain for AN-BP and BED participants. Participants with AN-R scored significantly higher than participants with BEB on the AdAS Spectrum total score, and on the Inflexibility and adherence to routine and Restricted interest/rumination AdAS Spectrum domain scores. Significant correlations emerged between the Interpersonal distrust EDI-2 sub-scale and the Non verbal communication and the Restricted interest and rumination AdAS Spectrum domains; as well as between the Social insecurity EDI-2 sub-scale and the Inflexibility and adherence to routine and Restricted interest and rumination domains in participants with EDs.
Conclusions:
Our data corroborate the presence of higher subthreshold autism spectrum symptoms among ED participants with respect to HCs, with particularly higher levels among restrictive participants. Relevant correlations between subthreshold autism spectrum symptoms and EDI-2 Subscale also emerged.
... All patients fulfilled the following: Patient Health Questionnaire (PHQ) (Spitzer et al., 1994(Spitzer et al., , 1999, PAS-SR Lifetime Version (Cassano et al., 1999), Global Assessment of Functioning (GAF) (Endicott et al., 1976), and Clinical Global Impression (CGI) (Guy, 1976). ...
Frequent attenders (FAs) of general practitioners (GPs) often complain of nonspecific physical symptoms that are difficult to define according to typical medical syndromes criteria but could be acknowledged as atypical manifestations of mental disorders. We investigated the possible correlation between somatic symptoms and panic-agoraphobic spectrum symptoms in a sample of 75 FAs of GPs in Italy, with particular attention to the impact on functional impairment. Assessments included the Patient Health Questionnaire, Panic-Agoraphobic Spectrum-Self-Report (PAS-SR) lifetime version, Global Assessment of Functioning, and Clinical Global Impression. The PAS-SR total and domains scores were significantly higher among low-functioning FAs, especially anxious somatizations, hypochondriasis, anxious expectation, and reassurance orientation domains, suggesting this undetected symptom may determine the selective attention to the physical symptoms, illness-phobic/hypochondriac elaboration, and GP frequent attendance, often aimed at searching for reassurance, leading to severe impact on overall functioning and often inefficacious treatments.
... With respect to ERS in panic disorder with agoraphobia (PD/A), many individuals experience anxiety when in places or situations in which escape might be difficult or help might not be available during a panic attack. Anxiety in PD/A can often be reduced substantially when the individual is accompanied by a "safe" reassuring person (Carter, Hollon, Carson, & Shelton, 1995), and individuals with PD/A often seek reassurance from others, either through the presence of others or the belief they could provide help if necessary (Cassano et al., 1997(Cassano et al., , 1999 suggesting that ERS in PD/A may be triggered frequently around contexts that are perceived as generally threatening (and leading to panic). ...
... The Mood and Anxiety Spectrum Scales (MASS) consist of 626 items and assess four domains: mood (161 items), panic-agoraphobia (114 items), obsessive-compulsive disorder (183 items), and social phobia (168 items). Traditional psychometric properties of the MASS have been reported (34,35). Test-retest and interrater reliability ranged from .89 to .99, and measures for each domain showed concurrent validity compared with established measures of comparable constructs. ...
Objective:
This study investigated the combination of item response theory and computerized adaptive testing (CAT) for psychiatric measurement as a means of reducing the burden of research and clinical assessments.
Methods:
Data were from 800 participants in outpatient treatment for a mood or anxiety disorder; they completed 616 items of the 626-item Mood and Anxiety Spectrum Scales (MASS) at two times. The first administration was used to design and evaluate a CAT version of the MASS by using post hoc simulation. The second confirmed the functioning of CAT in live testing.
Results:
Tests of competing models based on item response theory supported the scale's bifactor structure, consisting of a primary dimension and four group factors (mood, panic-agoraphobia, obsessive-compulsive, and social phobia). Both simulated and live CAT showed a 95% average reduction (585 items) in items administered (24 and 30 items, respectively) compared with administration of the full MASS. The correlation between scores on the full MASS and the CAT version was .93. For the mood disorder subscale, differences in scores between two groups of depressed patients--one with bipolar disorder and one without--on the full scale and on the CAT showed effect sizes of .63 (p<.003) and 1.19 (p<.001) standard deviation units, respectively, indicating better discriminant validity for CAT.
Conclusions:
Instead of using small fixed-length tests, clinicians can create item banks with a large item pool, and a small set of the items most relevant for a given individual can be administered with no loss of information, yielding a dramatic reduction in administration time and patient and clinician burden.
... In line with a spectrum approach, that in the last decades has been applied to most mental disorders, including FEDs [67][68][69][70][71][72][73], we could speculate that AN and ON share a common psychopathological process that is triggered by different factors, also depending on differential cultural pressures, and leading to clinical features that lie on a common spectrum [10]. From this perspective, ON could be a manifestation of restrictive, AN-like FEDs spectrum, elicited by the increasing attention devoted in modern society to healthy food. ...
Aims:
Orthorexia nervosa (ON) has been recently defined as a pathological approach to feeding related to healthiness concerns and purity of food and/or feeding habits. This condition recently showed an increasing prevalence particularly among young adults. In order to investigate the prevalence of ON and its relationship with gender and nutritional style among young adults, we explored a sample of students from the University of Pisa, Italy.
Methods:
Assessments included the ORTO-15 questionnaire and a socio-demographic and eating habits form. Subjects were dichotomized for eating habits (i.e. standard vs vegetarian/vegan diet), gender, parents' educational level, type of high school attended, BMI (low vs high vs normal BMI). Chi square tests were performed to compare rates of subjects with overthreshold ORTO-15 scores, and Student's unpaired t test to compare mean scores between groups. Two Classification tree analyses with CHAID growing method were employed to identify the variables best predicting ON and ORTO-15 total score.
Results:
more than one-third of the sample showed ON symptoms (ORTO-15 ≥ 35), with higher rates among females. Tree analyses showed diet type to predict ON and ORTO-15 total score more than gender.
Conclusions:
Our results seem to corroborate recent data highlighting similarities between ON and anorexia nervosa (AN). We propose an interpretation of ON as a phenotype of AN in the broader context of Feeding and eating disorders (FEDs) spectrum.
... Spectrum-Self-Report Version (SCI PAS-sr). SCI-PAS [32] is a clinical interview aimed to evaluate the presence or absence of panic and agoraphobic spectrum symptomatology. It consists of 114 items grouped into 8 domains: (1) separation sensitivity; (2) panic-like symptoms (typical and atypical); (3) stress sensitivity; (4) substance and medication sensitivity; (5) anxious expectation; (6) agoraphobia; (7) illness-related phobia; and (8) reassurance orientation. ...
Background and Aims
Functional gastrointestinal disorders (FGDs) are multifactorial disorders of the gut-brain interaction. This study investigated the prevalence of Axis I and spectrum disorders in patients with FGD and established the link between FGDs and psychopathological dimensions.
Methods
A total of 135 consecutive patients with FGD were enrolled. The symptoms' severity was evaluated using questionnaires, while the psychiatric evaluation by clinical interviews established the presence/absence of mental (Diagnostic and Statistical Manual—4th edition, Axis I Diagnosis) or spectrum disorders.
Results
Of the 135 patients, 42 (32.3%) had functional dyspepsia, 52 (40.0%) had irritable bowel syndrome, 21 (16.2%) had functional bloating, and 20 (15.4%) had functional constipation. At least one psychiatric disorder was present in 46.9% of the patients, while a suprathreshold panic spectrum was present in 26.2%. Functional constipation was associated with depressive disorders (p < 0.05), while functional dyspepsia was related to the current major depressive episode (p < 0.05). Obsessive-compulsive spectrum was correlated with the presence of functional constipation and irritable bowel syndrome (p < 0.05).
Conclusion
The high prevalence of subthreshold psychiatric symptomatology in patients with FGD, which is likely to influence the expression of gastrointestinal symptoms, suggested the usefulness of psychological evaluation in patients with FGDs.
... The relationship between SEPAD and PD has long been of interest. Separation sensitivity has been considered a dimension of PD and it is included in the panic-agoraphobic spectrum [2,61,62]. However, SEPAD clearly occurs in association with a range of mood and anxiety disorders without PD comorbidity [3,7,54]. ...
Introduction:
Complicated grief (CG) has been the subject of increasing attention in the past decades but its relationship with separation anxiety disorder (SEPAD) is still controversial. The aim of the current study was to explore the prevalence and clinical significance of adult SEPAD in a sample of help-seeking individuals with CG.
Methods:
151 adults with CG, enrolled in a randomized controlled trial comparing the effectiveness of (CG) treatment to that of interpersonal therapy, were assessed by means of the Inventory of Complicated Grief (ICG), the Structured Clinical Interview for DSM-IV, the Hamilton Rating Scale for Depression (HAM-D), the Work and Social Adjustment Scale (WSAS), the Adult Separation Anxiety Questionnaire (ASA-27), the Grief Related Avoidance Questionnaire (GRAQ), the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), and the Impact of Events Scale (IES).
Results:
104 (68.9%) individuals with CG were considered to have SEPAD (ASA-27 score ≥22). Individuals with SEPAD were more likely to have reported a CG related to the loss of another close relative or friend (than a parent, spouse/partner or a child) (p=.02), as well as greater scores on the ICG (p=<.001), PDEQ (p=.004), GRAQ (p<.001), intrusion (p<.001) and avoidance (p=<.001) IES subscales, HAM-D (p<.001) and WSAS (p=.006). ASA-27 total scores correlated with ICG (p<.0001), PDEQ (p<.001) GRAQ (p<.0001) scores and both the IES intrusion (p<.0001) and IES avoidance (p<.0001) subscale scores. People with SEPAD had higher rates of lifetime post-traumatic stress disorder (PTSD) (p=.04) and panic disorder (PD) (p=.01).
Conclusions:
SEPAD is highly prevalent among patients with CG and is associated with greater symptom severity and impairment and greater comorbidity with PTSD and PD. Further studies will help to confirm and generalize our results and to determine whether adult SEPAD responds to CG treatment and/or moderates CG treatment response.
... There is, however, another model that fits the separation anxiety, together with other symptoms of anxiety, within the panic-agoraphobic spectrum . In the model developed by Cassano et al. (1999) there is a specific subset of items for the separation anxiety dimensions that refers to a whole series of symptoms directly linked to the separation from attachment figures. ...
Separation anxiety disorder was described in DSM-IV-TR as a childhood disorder that rarely persists into adulthood, but several empirical studies have demonstrated that adult separation anxiety disorder (ASAD) is more common than suggested. This could be due to either of two possibilities: 1) a higher proportion of childhood-onset cases persist into adulthood than was assumed in DSM-IV-TR; 2) a substantial proportion of first onsets occur in adulthood (these subjects never having had childhood separation anxiety disorder). The position of separation anxiety disorder in the DSM-5 is different. Indeed, the DSM-5 discontinues the section for disorders that have their first onset in childhood, where separation anxiety disorder was previously placed. Differently, in the DSM-5, it moves within the general section for anxiety disorders. Moreover, a crucial change in the criteria is the removal of the assertion that onset of the disorder must be before the age of 18 years, a modification that is consistent with clinical and population-level research evidence. Finally, symptoms have been reworded to remove any implicit bias towards childhood. However, the relationships of ASAD with other psychopathological conditions are not clear. In particular, studies of pathological mechanisms, including the role of attachment, shared by both separation anxiety disorder and other anxiety and mood disorders are needed and deserve further neurobiological and clinical research. Finally, from a treatment perspective, there is increasing evidence that unaddressed separation anxiety lessens the effects of both medication and psychotherapy.
... 6-Yaşam Boyu Panik-Agorafobik Spektrum Ölçeği (PASÖ-YB): Panik ve agorafobi ile ilişkili spektrum belirtilerini araştıran bir ölçektir (20). Toplam 114 maddeden ve 8 alt alandan oluşan ölçekte, belirtilerin varlığı "evet" ya da "hayır" şeklinde yanıtlanmaktadır. ...
Objective: The aim of this study was to assess psychometric properties of the Turkish version of the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS). Methods: The study sample included 410 participants: 282 adult psychiatric outpatients with Axis I anxiety and/or major depressive disorders according to the DSM-IV criteria and 128 non-psychiatric control subjects. The presence or absence of a psychiatric disorder was determined by M.I.N.I. (Mini International Neuropsychiatric Interview). The Separation Anxiety Symptoms Inventory (SASI), Adult Separation Anxiety Questionnaire (ASA), Panic Disorder Severity Scale (PDSS), Panic Agoraphobic Spectrum Scale-Self Report (PAS-SR) and the Anxiety Sensitivity Index (ASI) were used to determine convergent and discriminant validity of the SCI-SAS. Results: The validity assessments revealed that both parts of the SCI-SAS have discriminated the patients from the healthy controls. There was a high correlation between the childhood and adulthood parts of the SCI-SAS and also of the SCI-SAS with SASI, ASA and PAS-SR. The SCI-SAS correlated moderately with ASI and weakly with PDSS. Factor analysis showed the existence of 3 factors for the SCI-SAS-childhood and 2 factors for the SCI-SAS-adulthood. The SCI-SAS had a moderate level of internal consistency (Cronbach's alpha coefficient was 0.57 for the childhood and 0.59 for the adulthood parts). The items in both parts of the SCI-SAS have been found to have a moderate consistency with the instrument. The SCI-SAS had a very good test-retest and inter-rater reliability. Conclusion: The Turkish version of the SCI-SAS has been found to be a valid and reliable tool that can be used in clinical studies. © Archives of Neuropsychiatry, published by Galenos Publishing.
... This scale assesses symptoms related to panic and agoraphobia spectra (Cassano et al. 1999). The scale is composed of 8 subscales and 114 items responded to either as "yes" or "no" according to the presence or absence of a particular symptom. ...
The Validity and Reliability of Turkish Version of Separation Anxiety Symptom Inventory and Adult Separation Anxiety Questionnaire Aim: The aim of this study is to evaluate the validity and reliability of Separation Anxiety Symptoms Inventory (SASI) that assess childhood separation anxiety retrospectively and Adult Separation Anxiety Questionnaire (ASA). Method: The study sample included a group of 410 participants comprised of 282 adult psychiatric outpatients with anxiety and/or major depressive disorders according to DSM-IV criteria and 128 nonpsychiatric control subjects. The presence of psychiatric disorders was determined by using the MINI. (Mini International Neuropsychiatric Interview). Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), Separation Anxiety Symptoms Inventory (SASI), Adult Separation Anxiety Questionnaire (ASA), Panic Disorder Severity Scale (PDSS), "Sensitivity to Separations" subscale of Panic Agorapfobic Spectrum Scale (PAS-SR), Anxiety Sensitivity Index (ASI) were also given. Findings: The validity assessments of the instruments revealed that SASI and ASA discriminated the psychiatric patients from control subjects. Both instruments displayed high correlation with SCI-SAS and PAS-SR, a moderate correlation with ASI and PDSS. Factor structure assessments revealed the existence of 3 factor for SASI and 5 factor for ASA. Both SASI and ASA has a high level of internal consistency (Cronbach alfa coefficients are 0.89 and 0.93 respectively) and their test-retest reliability is fairly good. Results: Turkish versions of SASI and ASA were found to be valid and reliable. Results indicate that those instruments can be used in clinical studies for surveying adult separation anxiety disorder and determining its severity.
... There is, however, another model that fits the separation anxiety, together with other symptoms of anxiety, within the panic-agoraphobic spectrum . In the model developed by Cassano et al. (1999) there is a specific subset of items for the separation anxiety dimensions that refers to a whole series of symptoms directly linked to the separation from attachment figures. In any case, since the separation anxiety disorder may have its onset in adulthood and it seems also relatively common in this phase, there will be no reason to enter the SAD in the section of disorders that begin only in childhood (Kessler et al., 2005). ...
... 6-Yaşam Boyu Panik-Agorafobik Spektrum Ölçeği (PASÖ-YB): Panik ve agorafobi ile ilişkili spektrum belirtilerini araştıran bir ölçektir (Cassano ve ark. 1999). Toplam 114 maddeden ve 8 alt alandan oluşan ölçekte, belirtilerin varlığı "evet" ya da "hayır" şeklinde yanıtlanmaktadır. Ölçeğin Türkçe'ye uyarlanması, güvenirlik ve geçerlilik çalışması yapılmıştır (Onur ve ark. 2006). Bu çalışmada PASÖ-ÖB ölçeğinin 15 maddeli olan ve ayrılma anksiyetesinin bir ölçümünü veren "Ayrılma Duyarlılığı" al ...
ZET Amaç: Bu çalışmada, Ayrılma Anksiyetesi Belirti Envanteri (AABE) ve Yetişkin Ayrılma Anksiyetesi Anketinin (YAA) geçerlik ve güvenirliğinin değerlendirilmesi amaçlanmıştır. Yöntem: Çalışma DSM-IV tanı ölçütlerine göre anksiyete bozukluğu ve/veya majör depresyonu olan 282 hasta ve 128 kişilik kontrol gru-bundan oluşan, toplam 410 kişilik bir örneklemde yapılmıştır. Katılım-cılara M.I.N.I. (Kısa Uluslararası Nöropsikiyatrik Görüşme) uygulana-rak tanısal değerlendirme yapılmıştır. AABE ve YAA'nın ayırt edici ve benzer ölçek geçerliliğin gösterilmesi amacıyla Ayrılma Anksiyetesi Be-lirtileri için Yapılandırılmış Klinik Görüşme (AAB-YKG), Panik Bozuk-luğu Şiddet Ölçeği (PBŞÖ), Yaşam Boyu Panik-Agorafobik Spektrum Ölçeği'nin (PASÖ-YB) "Ayrılmaya Duyarlılık Alt Ölçeği" ve Kaygı Du-yarlılığı İndeksi (KDİ) kullanılmıştır. Hasta gurubundan 80 kişi AABE ve YAA'yı 7-21 gün içinde tekrar yanıtladılar. Bulgular: İki ölçeğin de hastaları kontrol grubundan ayırt ettiği, AABE ve YAA'nın birbirleriyle ve AAB-YKG, PASÖ-YB ayrılmaya duyarlılık puanlarıyla yüksek düzeyde, KDİ'le orta düzeyde ve PBŞÖ'yle düşük düzeyde korelasyon gösterdiği anlaşılmıştır. Faktör analizi AABE'nin 3 ve YAA'nin ise 5 faktörlü yapıya sahip olduklarını göstermiştir. AABE ve YAA'nin yüksek iç tutarlılığı (Cronbach alfalar sırasıyla 0.89 ve 0.93) olduğu ve test-tekrar test güvenirliklerinin de oldukça iyi olduğu sap-tanmıştır. Tartışma ve Sonuç: Bulgularımız AABE ve YAA'nın Türkçe versiyonla-rının iyi psikometrik özelliklere sahip geçerli ve güvenilir ölçüm araçla-rı olduğunu göstermiştir.
... Le aree dello spettro panico-agorafobico descritte sono state codificate in domini da esplorare attraverso una lista di 114 domande (item dicotomici) che hanno costituito l'Intervista Clinica Strutturata per lo Spettro Panico-Agorafobico (SCI-PAS) e, in seguito, il Questionario di Spettro Panico-Agorafobico (PAS-SR). 41,42 Il questionario ha incluso i criteri diagnostici del DSM-IV che sono confluiti sostanzialmente invariati nel DSM-5 e le altre manifestazioni descritte come surrounding il nucleo psicopatologico del disturbo. La struttura del questionario è stata analizzata con un'analisi fattoriale esplorativa basata su una matrice di correlazione tetracorica a rotazione obliqua. ...
RIASSUNTO
Negli ultimi decenni diversi autori hanno proposto un approccio dimensionale ai disturbi dell’umore. Il concetto di spettro dei disturbi dell’umore configura un approccio di tipo dimensionale nato dalla collaborazione di un gruppo di ricercatori e clinici delle università di Pittsburgh, New York, San Diego e Pisa. Lo spectrum model ipotizza che segni e sintomi dei disturbi dell’umore possano presentarsi non soltanto nel corso del disturbo conclamato ma anche isolati o in cluster. Questa fenomenica può interferire con la presentazione clinica e la risposta al trattamento di altri disturbi mentali o di disturbi organici e con la qualità di vita e il funzionamento di un soggetto. Scopo di questa trattazione è la descrizione del percorso che ha portato dalla stesura alla validazione e all’utilizzo del questionario per lo spettro dei disturbi dell’umore (MOODS-SR). Il questionario, nato per facilitare al clinico il riconoscimento della fenomenica dello spettro affettivo, ha dimostrato la sua utilità non soltanto in pazienti con disagio psichico ma anche in soggetti con patologie organiche.
Parole chiave: umore, spettro, bipolare, unipolare, dimensionale.
SUMMARY
The mood spectrum model and the Mood Spectrum Questionnaire: state of the art
In the last decades, several authors proposed a dimensional approach to mood disorders. The mood spectrum concept is a dimensional approach to mood disorders conceptualized by clinicians and researchers from the university of Pittsburgh, New York, San Diego and Pisa. The “spectrum model” suggests that signs and symptoms of mood disorders can appear not only during a mood disorder but even alone or in clusters without reaching the severity of a full blown disorder. These aspects can interfere with the clinical presentation and with the response to treatment of mental and medical disorders or interfere with quality of life and functioning in healthy subjects. Aim of this paper is to describe the construction, the validation and the usefulness of the mood spectrum questionnaire (MOODS-SR). The MOODS-SR, developed in order to facilitate the recognition of the mood spectrum phenomenology, has proved its usefulness in several medical and psychiatric settings.
Key words: mood, spectrum, bipolar, unipolar, dimensional.
... Agoraphobia was assessed using the Panic-Agoraphobic Spectrum Self-Report (PAS-SR) (Cassano et al., 1999). This 114-item questionnaire was developed to assess lifetime panic-agoraphobic spectrum symptoms and displays good psychometric properties . ...
Epidemiological studies indicate that separation anxiety disorder occurs more frequently in adults than children. It is unclear whether the presence of adult separation anxiety disorder (ASAD) is a manifestation of anxious attachment, or a form of agoraphobia, or a specific condition with clinically significant consequences. We conducted a study to examine these questions. A sample of 141 adult outpatients with panic disorder participated in the study. Participants completed standardized measures of separation anxiety, attachment style, agoraphobia, panic disorder severity and quality of life. Patients with ASAD (49.5% of our sample) had greater panic symptom severity and more impairment in quality of life than those without separation anxiety. We found a greater rate of symptoms suggestive of anxious attachment among panic patients with ASAD compared to those without ASAD. However, the relationship between ASAD and attachment style is not strong, and adult ASAD occurs in some patients who report secure attachment style. Similarly, there is little evidence for the idea that separation anxiety disorder is a form of agoraphobia. Factor analysis shows clear differentiation of agoraphobic and separation anxiety symptoms. Our data corroborate the notion that ASAD is a distinct condition associated with impairment in quality of life and needs to be better recognized and treated in patients with panic disorder.
... Esiste, tuttavia, un altro modello che inserisce l'ansia di separazione, insieme ad altri sintomi d'ansia, all'interno dello spettro panico-agorafobico (43). Nel modello sviluppato da Cassano et al. (44) è stata prevista una dimensione specifica per l'ansia di separazione che comprende al suo interno tutta una serie di sintomi accomunati dal fatto di presentarsi come risposta diretta alla separazione, figurata o reale, da una figura d'attaccamento. In ogni caso, dal momento che il disturbo d'ansia di separazione può avere il proprio esordio nell'età adulta e che sembra anche relativamente comune in questa fase, non ci sarà più motivo per inserire il disturbo d'ansia di separazione nella sezione dei disturbi che cominciano esclusivamente nell'infanzia (8). ...
... Using the term "Spectrum", these researchers refer to a broad array of manifestations of a mental disorder, including its core and most severe range of symptoms, as well as its subthreshold manifestations. The latter may be either temperamental traits, or prodromal or residual symptoms following or preceding a fully developed episode (25,10). The TALS-SR is the last developed instrument (15), with the first ones being those for the assessments of the panic-.agoraphobic ...
PTSD is one of the most frequently occurring sequelae in earthquake survivors and increasing literature has been focused on its potential risk factors. More recently increasing evidence has highlighted the onset of maladaptive behaviours in the same populations. The aim of the present study was to explore: 1) the role of degree of exposure ("direct" vs "indirect"), gender and age (> o ≤40) as potential risk factors for PTSD in a sample of L'Aquila 2009 earthquake survivors; 2) the role of these same variables and of PTSD as potential risk factors for maladaptive behaviours in the same sample. A group of 444 subjects was evaluated by the Trauma and Loss-Self Report (TALS-SR) 10 months after exposure. Results showed significantly higher PTSD prevalence rates in: exposed with respect to not exposed subjects; women with respect to men (in the whole sample and in all subgroups, with the only exception of the older subjects not exposed); not exposed younger women with respect to the older ones. PTSD and "direct" exposure represented a major risk factor for the presence of at least one maladaptive behaviour, with female gender playing a role only among no-PTSD subjects. For the TALS-SR item n.99 ("Use alcohol or drugs or over-the-counter medications to calm yourself...?") only PTSD and "direct" exposure emerged as risk factors. Our results confirm the pervasive effects of earthquakes for mental health in the general population, and highlight the role of gender and proximity as primary correlates of PTSD, and of PTSD and degree of exposure for maladaptive behaviours, particularly alcohol and substance use.
... Davidson, Hughes, George and Blazer (1994) emphasized that subjects with subthreshold social phobia present disability levels comparable to those who met DSM-IV criteria (APA, 1994) for full-fledged social phobia, confirming the impact of subthreshold symptomatology on psychosocial adjustment. In order to systematically inquire about the entire spectrum of each of these two disorders, we developed two structured interviews for the assessment and clinical evaluation of the obsessive-compulsive and social phobic phenomenology, which follow the model previously validated for the assessment of mood spectrum and panic spectrum (SCI-MOODS, SCI-PAS) (Fagiolini, Dell'Osso, Pini, Armani, Bouanani, Rucci, Cassano, Endicott, Maser, Shear, Grochocinsky and Frank, 1999; Cassano, Banti, Mauri, Dell'Osso, Miniati, Maser, Shear, Grochocinski, Rucci and Frank, 1999). The aim of this paper is to analyse internal consistency, discriminant and concurrent validity, inter-rater and test-retest reliability, and acceptability of these clinical interviews (SCI-OBS and SCI-SHY) for obsessive-compulsive and social-phobic spectra. ...
This paper reports on the psychometric properties of the Structured Clinical Interview for Obsessive-Compulsive Spectrum (SCI-OBS) and the Structured Clinical Interview for Social Phobia Spectrum (SCI-SHY). Interviews were administered to 135 patients with psychiatric disorders and 119 controls. During the same session, subjects were given the Mini International Neuropsychiatric Interview (MINI), the Liebowitz Social Anxiety Scale (LSAS), the Checklist for Obsessions and Compulsions and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Patients and raters also answered specific questions on acceptability and usefulness of the interviews. Inter-rater reliability was assessed by administering the interviews to 36 patients with psychiatric disorders and 12 controls. The internal consistency of all domains of the interviews was from moderate to substantial (Kuder-Richardson coefficient >0.60). Discriminant validity was excellent. The concurrent validity of the SCI-SHY versus the LSAS and of the SCI-OBS versus the Checklist for Obsessions and Compulsions was satisfactory. However, no association was found between Y-BOCS and the SCI-OBS domains. Inter-rater reliability was substantial. Both interviews were rated as meaningful and clear by most subjects. Raters' attitudes toward the utility of these interviews for understanding patients and their foreseeable use in their practice varied, but most were in favour of administering them as self-report instruments. Copyright © 2000 Whurr Publishers Ltd.
... In the last few years, the investigators of the Collaborative Spectrum Project, including all the authors of the present paper, have developed five structured clinical interviews to assess the lifetime presence of symptoms, behavioral tendencies, and temperamental traits that are commonly found in association with specific mood and anxiety disorders, but not included in the standard DSM-IV or ICD-10 assessments, or, in other words, the ''spectrum'' of some psychiatric disorders. The first interviews that were developed explored the spectrum of panic– agoraphobia [SCI-PAS; Cassano et al., 1999; Shear et al., 2001], mood [SCI-MOODS; Fagiolini et al., 1999], social phobia [SCI-SHY; Dell'Osso et al., 2000], eating [SCI-ABS; Mauri et al., 2000], and obsessive– compulsive disorders [SCI-OBS; Dell'Osso et al., 2000]. Our shared view is that a broader definition of mood and anxiety phenotypes could add to the knowledge of course and outcome of mood and anxiety disorders and inform treatment decisions. ...
The Collaborative Spectrum Project has developed structured interviews and self-report instruments to assess the spectrum of symptomatology related to panic–agoraphobia, mood, social phobia, and obsessive–compulsive and eating disorders. In order to obtain a rapid pre-test on all five of these spectrum conditions, the authors sought to develop a brief instrument that would tap these conditions. This paper reports on 1) the procedures to derive this composite instrument, the General 5-Spectrum Measure (GSM-V), by selecting items from five existing spectrum instruments, and 2) preliminary testing of the internal consistency and test–retest reliability of the GSM-V. The GSM-V consists of 54 items grouped into scales that explore the five spectra described above. It was derived from existing data on five Structured Clinical Interviews that were designed to assess spectrum features by using multiple regression models. The GSM-V was administered as a stand-alone instrument along with the self-report versions of the spectrum interviews to a sample of 56 psychiatric patients in order to determine the internal consistency of its scales and the correlation with the parent spectrum measures. Moreover, to determine whether subjects would respond consistently to the same items on two different occasions (test–retest reliability), the GSM-V was re-administered within 1 month from the baseline. From each of the five spectrum interviews, items were selected that accounted for a significant proportion of variance of the total score of the parent instrument. The five sets of items so selected constitute separate scales. The scales of the GSM-V had a good to excellent internal consistency, excellent test–retest reliability, and proved to reproduce adequately the long-form measures. The GSM-V appears to provide a reliable alternative to the five longer spectrum interviews. It is envisaged that the instrument will be most useful as a pre-test to identify subjects with spectrum features that should be explored in greater detail. Additionally, it could provide a better characterization of patients with a syndromal level Axis-I disorder, who might require specific treatment strategies targeted to co-occurring subsyndromal conditions. Depression and Anxiety 18:109–117, 2003. © 2003 Wiley-Liss, Inc.
... This scale assesses symptoms related to panic and agoraphobia spectra (Cassano et al. 1999). The scale is composed of 8 subscales and 114 items responded to either as "yes" or "no" according to the presence or absence of a particular symptom. ...
The aim of this study is to evaluate the validity and reliability of Separation Anxiety Symptoms Inventory (SASI) that assess childhood separation anxiety retrospectively and Adult Separation Anxiety Questionnaire (ASA).
The study sample included a group of 410 participants comprised of 282 adult psychiatric outpatients with anxiety and/or major depressive disorders according to DSM-IV criteria and 128 nonpsychiatric control subjects. The presence of psychiatric disorders was determined by using the M.I.N.I. (Mini International Neuropsychiatric Interview). Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), Separation Anxiety Symptoms Inventory (SASI), Adult Separation Anxiety Questionnaire (ASA), Panic Disorder Severity Scale (PDSS), "Sensitivity to Separations" subscale of Panic Agorapfobic Spectrum Scale (PAS-SR), Anxiety Sensitivity Index (ASI) were also given.
The validity assessments of the instruments revealed that SASI and ASA discriminated the psychiatric patients from control subjects. Both instruments displayed high correlation with SCI-SAS and PAS-SR, a moderate correlation with ASI and PDSS. Factor structure assessments revealed the existence of 3 factor for SASI and 5 factor for ASA. Both SASI and ASA has a high level of internal consistency (Cronbach alfa coefficients are 0.89 and 0.93 respectively) and their test-retest reliability is fairly good.
Turkish versions of SASI and ASA were found to be valid and reliable. Results indicate that those instruments can be used in clinical studies for surveying adult separation anxiety disorder and determining its severity.
... The Trauma and Loss Spectrum was developed in the framework of the Spectrum Project and is based on a dimensional approach to psychopathology that considers as clinically relevant not only threshold-level manifestations of PTSD but also atypical symptoms, behavioral traits, and temperamental features associated with established diagnostic constructs. In addition to the instrument described in the present study, the Spectrum Project has developed and validated other psychometrically sound instruments [15][16][17][18][19][20] for the assessment of mood, panic-agoraphobic, obsessivecompulsive, social phobic, eating, substance use, and psychotic spectra. All instruments can be downloaded at www.spectrum-project.net. ...
Dimensional approaches to psychiatric disorders have shown an increased relevance in the ongoing debate for the forthcoming Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. In line with previously validated instruments for the assessment of different mood, anxiety, eating and psychotic spectra, we tested the validity and reliability of a newly developed Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS). The instrument is based on a multidimensional approach to post-traumatic stress spectrum that includes a range of threatening or frightening experiences, as well as a variety of potentially significant losses, to which an individual can be exposed. Furthermore, it explores the spectrum of the peritraumatic reactions and post-traumatic symptoms that may ensue from either type of life events, targeting soft signs and subthreshold conditions, as well as temperamental and personality traits that may constitute risk factors for the development of the disorder. The aim of the present study is to describe the reliability of the self-report version of the SCI-TALS: the TALS-SR. Thirty patients with PTSD and thirty healthy control subjects were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Half of the patients and controls received the TALS-SR first and the SCI-TALS after 15 days; for the other half of the sample, the order of administration was reversed. Agreement between the self-report and the interview formats was substantial. Intraclass correlation coefficients ranged from 0.934 to 0.994, always exceeding the threshold of 0.90. Our findings provide substantial support for the reliability of the TALS-SR questionnaire.
Frequent attenders (FAs), defined as patients repeatedly attending general practitioners, frequently exhibit underdiagnosed psychiatric comorbidities, leading to the hypothesis that frequent attendance may be related to an undetected psychiatric burden. This study explores the role of psychiatric comorbidities and psychopharmacological treatment on the clinical outcomes of a cohort of FAs of the general medical practice in Italy. The study included 75 FAs assessed by the Structured Clinical Interview for DSM-5, Clinical Global Impression, Global Assessment Functioning, and Illness Behavior Inventory, administered at baseline (T0) and after 3 months (T1). Data were analyzed on the bases of the presence of any mental disorder and selective serotonin reuptake inhibitor (SSRI) treatment, with respect to other psychopharmacological treatments. Results showed better outcomes among patients with a mental disorder, particularly anxiety, depression, and somatic symptoms disorders, and when under SSRI treatment. Our findings corroborate the role of psychiatric comorbidity on frequent attendance in the context of general clinical practice with a positive outcome when receiving appropriate treatment with SSRI.
Background:
Reassurance seeking has been hypothesized to be a key factor in the maintenance of anxiety and obsessive-compulsive disorders according to contemporary cognitive-behavioural therapy (CBT) approaches. The present study sought to examine the structure, clinical correlates, and malleability of reassurance seeking in the context of CBT treatment.
Methods:
Treatment-seeking participants (N = 738) with DSM-IV-TR (American Psychiatric Association, 2000) panic disorder with agoraphobia (PD/A), social anxiety disorder (SAD), generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) completed the Reassurance Seeking Scale (RSS) with other symptom measures prior to and following CBT treatment.
Results:
A confirmatory factor analysis supported a three factor solution: the need to seek excessive reassurance regarding decisions, attachment and the security of relationships, and perceived general threat and anxiety. The RSS was moderately correlated with general measures of anxiety and depression as well as disorder-specific symptom scales. Further, CBT was found to produce changes in reassurance seeking across CBT treatments and these reductions were significantly associated with disorder-specific clinical improvement.
Conclusion:
Reassurance seeking appears to be a common factor across anxiety disorders and its reduction in CBT treatment is associated with improved clinical outcomes.
Dissociative phenomena are characterised by alterations in the functions of conscienceness, memory, identity and perception. These are placed along a continuum ranging from normal daily experiences to real mental disorders that interfere with the performance of usual activities. Dissociation may represent the foundation for specific disorders, Dissociative Disorders, as well as the prospect of symptoms of psychopathological conditions of various kinds. This study has evaluated the clinical efficiency of quetiapine during dissociative episodes in the acute phase in patients referred in the last year to the Mental Health Centre (NHS Salerno). Participants in the study were subjected to the administration of a series of tests at the onset of symptoms (T0); after two weeks (T1); and after four weeks (T2). The assessment tools used were: the Dissociative Experience Scale (DES); the Brief Psychiatric Rating Scale (BPRS); the Clinical Global Impressions (CGI); the Global Assessment of Functioning (GAF). All observed patients showed an improvement in symptoms, no patients discontinued pharmacological therapy and side effects did not emerge which would have required the discontinuation of therapy. The analysis of the results showed that quetiapine monotherapy next to a good efficacy and tolerability may be a viable therapeutic option for the pharmacological treatment of dissociative episodes in the acute phase.
Objectives: This study evaluates the validity and reliability of a new self-report instrument that assess GAD spectrum symptoms: the WORRY-SR. Methods: Participants included 120 patients with mood and anxiety disorders recruited at the Department of Psychiatry of the University of Pisa and two comparison groups included 47 participants recruited at the Department of Occupational Medicine and 45 outpatients with gastrointestinal disorders. Participants completed the WORRY-SR, the Penn State Worry Questionnaire (PSWQ), the State Trait Anxiety Inventory (STAI), the Work and Social Adjustment Scale (WSAS), the Panic-Agoraphobia Spectrum (PAS-SR) and the WHO Quality of Life Assessment (WHOQOL-BREF). Results: Internal consistency of the total WORRY-SR score (KR = 0.96) and for the domains (Childhood, Worry, Beliefs about Worry, Somatic and Emotional Symptoms, Cognitive Tendencies, and Behavioral and Interpersonal Tendencies) was excellent. Furthermore, the WORRY-SR showed good concurrent validity with the PSWQ (p = 0.71). Finally, the WORRY-SR discriminates participants with psychiatric disorders from controls and patients with severe functional impairment from those with mild/moderate functional impairment. Conclusions: Our findings provide support for reliability and validity of the WORRY-SR questionnaire.
Growing interest has recently been devoted to partial forms of autism, lying at the diagnostic boundaries of those conditions previously diagnosed as Asperger’s Disorder. This latter includes an important retrieval of the European classical psychopathological concepts of adult autism to which Hans Asperger referred in his work. Based on the review of Asperger's Autistische Psychopathie, from first descriptions through the DSM-IV Asperger’s Disorder and up to the recent DSM-5 Autism Spectrum Disorder, the paper aims to propose a Subthreshold Autism Spectrum Model that encompasses not only threshold-level manifestations but also mild/atypical symptoms, gender-specific features, behavioral manifestations and personality traits associated with Autism Spectrum Disorder. This model includes, but is not limited to, the so-called broad autism phenotype spanning across the general population that does not fully meet Autism Spectrum Disorder criteria. From this perspective, we propose a subthreshold autism as a unique psychological/behavioral model for research that could help to understand the neurodevelopmental trajectories leading from autistic traits to a broad range of mental disorders.
Separation Anxiety Disorder has been recently classified into the DSM-5 section of Anxiety Disorders, acknowledging its role not only in childhood and adolescence but also across the whole lifespan. In the DSM-IV-TR, in fact, this condition was typically considered to begin in childhood. Clinical data report prevalence rates from 20 to 40%, showing high comorbidity rates with most mental disorders. Epidemiological data highlight that in fact one third of childhood cases persist into adulthood, while the majority of adult cases reports its first onset in adulthood. In all cases, Separation Anxiety Disorder is associated with a severe impact on the overall functioning. Most relevant research in the field is discussed highlighting the need of a paradigm shift in which clinicians are alerted to identify and treat this condition in all age upon the recent DSM-5 reformulation will be highlighted.
Background:
Individuals diagnosed with bipolar 1 disorder (BP1), bipolar 2 disorder (BP2), or major depressive disorder (MDD) experience varying levels of depressive and (hypo)manic symptoms. Clarifying symptom heterogeneity is meaningful, as even subthreshold symptoms may impact quality of life and treatment outcome. The MOODS Lifetime self-report instrument was designed to capture the full range of depressive and (hypo)manic characteristics.
Methods:
This study applied clustering methods to 347 currently depressed adults with MDD, BP2, or BP1 to reveal naturally occurring MOODS subgroups. Subgroups were then compared on baseline clinical and demographic characteristics and as well as depressive and (hypo)manic symptoms over twenty weeks of treatment.
Results:
Four subgroups were identified: (1) high depressive and (hypo)manic symptoms (N=77, 22%), (2) moderate depressive and (hypo)manic symptoms (N=115, 33%), (3) low depressive and moderate (hypo)manic symptoms (N=82, 24%), and (4) low depressive and (hypo)manic symptoms (N=73, 21%). Individuals in the low depressive/moderate (hypo)manic subgroup had poorer quality of life and greater depressive symptoms over the course of treatment. Individuals in the high and moderate severity subgroups had greater substance use, longer duration of illness, and greater (hypo)manic symptoms throughout treatment. Treatment outcomes were primarily driven by individuals diagnosed with MDD.
Limitations:
The sample was drawn from three randomized clinical trials. Validation is required for this exploratory study.
Conclusions:
After validation, these subgroups may inform classification and personalized treatment beyond categorical diagnosis.
Aims: The present study is the result of the collaborative work of the Center for the Study of Occupational Health and the Psychiatric Clinic of University of Pisa and aims to investigate the consequences of work harassment and vulnerability factors for work-related distress through use of a diagnostic interview and validated self-report assessments of lifetime psychopathology. Methods: The study sample was recruited from subjects who referred to the Center for the Study of Occupational Health operating at Pisa for work harassment. Results: The 304 participants were predominantly females, with a mean age of 46.7 years (Table I). On average, they had a length of service of 13 years (SD = 10) in the work where the claimed harassment situation took place (Table II). Twenty-three participants (7.5%) had definite mobbing. The claimed harassment actions had been occurring for about 4 years, and were usually perpetrated by the supervisor/boss (84.8%) with a weekly frequency (69.4%). Harassment actions were usually meant to isolate (75.2%) or humiliate the employee (60.6%), or consisted in professional demoting (67.3%) (Table III). Of the 207 participants who received a diagnostic assessment, 89.9% met criteria for lifetime and 77.3 % for current psychiatric diagnoses (Table IV). The most common current disorders were adjustment disorder, major depression and panic disorder, but while the frequency of adjustment disorder increased across the diagnostic subgroups, the proportion of subjects with mood and anxiety disorders was relatively stable (Fig. 1). Conclusions: Although for only 7.5% of the sample a mobbing related disorder was determined, the high frequency of subjects with a current Axis-I disorders (77.3%) exceeds to a large extent the 12-month prevalence in the Italian population. Part of these disorders could be ascribed to harassment (47%), and a tendency attributing to mobbing to the conflicts experienced in the workplace or a low tolerance to stress that leads to symptoms brought to medical attention. Indeed, in 35% of cases, the onset of Axis-I disorders preceded the onset of harassment by 1 to 45 years (median 12 years). It is likely that these individuals were more prone to experiencing mood or anxiety symptoms as a result of distressing work situations. Our results suggest that instruments and strategies to identify indicators of vulnerability conditions of workers are warranted, along with specific training for managers that aims to increase their awareness of psychological problems, to help them involve and motivate workers and to improve interpersonal relationships.
Objectives: The aim of the present study was to evaluate gender differences in mood spectrum symptomatology in a sample of bipolar and unipolar patients and gastroenterological patients. Methods: This study was carried out in 102 patients with bipolar disorder, 117 with recurrent depression, both in partial or complete remission, and 114 subjects without lifetime or current mental disorders, recruited among outpatients of a gastroenterology clinic; they were assessed through the Mini International Neuropsychiatric Interview and the Structured Clinical Interview for Mood Spectrum. Results: The mean total scores on the Structured Clinical Interview for Mood Spectrum in women of the gastroenterological group were significantly higher as compared with men (p < 0.05) (Fig. 1). Considering the Structured Clinical Interview for Mood Spectrum depressive component, the total scores were higher in women in the bipolar disorder (p = 0.05) and in the gastroenterological groups (p < 0.01) (Figs. 2, 3). Conclusions: Gender differences in mood spectrum symptomatology were less prominent in patients than in gastroenterological patients, suggesting that the impact of gender is stronger in subthreshold mood conditions than in Axis I mood disorders. The systematic study of gender differences in the phenomenology of mental disorders could represent a useful method for investigating some mechanisms that may underlie psychopathology.
Eating dyscontrol constitutes a potential negative predictor for the outcome of treatment strategies for obese patients. The aim of this study was to examine the qualitative characteristics of eating dyscontrol in obese patients who engage in binge eating (BE) compared with those who do not (NBE), and to analyse the relationship between eating dyscontrol and axis-I, axis-II, spectrum psychopathology using instruments that explore mood, panic-agoraphobic, social-phobic, obsessive-compulsive and eating disorders spectrum psychopathology (SCI-MOODS-SR, SCI-PAS-SR, SCI-SHY-SR, SCI-OBS-SR, SCI-ABS-SR). This was a cross-sectional study involving a clinical sample of adult obese patients with severe obesity (average body mass index = 45 ± 8 kg m(-2) ) and candidate to bariatric surgery who were recruited between November 2001 and November 2010 at the Obesity Center of the Endocrinology Unit, University Hospital of Pisa. All participants completed a face-to-face interview, including a diagnostic assessment of axes-I and II mental disorders (using the Structured Clinical Interview for Manual of Mental Disorders, fourth edition [SCID]-I and SCID-II) and filled out self-report spectrum instruments. Among obese patients not affected by BE, eating dyscontrol was highly represented. Indeed, 39.7% (N = 177) of subjects endorsed six or more items of the Anorexia-Bulimia Spectrum Self-Report, lifetime version domain exploring this behaviour. The cumulative probability of having axis-I, axis-II and a spectrum condition disorder increased significantly with the number of eating dyscontrol items endorsed. In both BE and NBE obese subjects, eating dyscontrol may represent an independent dimension strongly related to the spectrum psychopathology and axes I/II disorders. A systematic screening for eating dyscontrol symptoms by means of self-report spectrum instruments may be valuable to assign specific treatment strategies.
© 2015 World Obesity.
Opioid users often cycle in and out of opioid maintenance treatment (OMT), consistent with opioid dependence being a chronic, relapsing condition. Results from the European Quality Audit of Opioid Treatment (EQUATOR), the largest analysis of OMT undertaken in Europe to date, revealed similar demographic profiles for patients in OMT and out-oftreatment opioid users (most of whom have been in OMT previously). Demographic profiles appeared relatively consistent across all 10 participating countries. Overall, EQUATOR data suggest that the healthcare setting for OMT is far more varied than the demographics of the OMT patient population, supporting the idea that variability in treatment outcomes is unlikely to be related to the clinical characteristics of patients but rather to other 'environmental' factors.
Patients receiving treatment for opioid dependence are prone to relapse into illicit drug use, risking significant harms to themselves and to society. The European Quality Audit of Opioid Treatment (EQUATOR) analysis assessed aspects of opioid maintenance treatment (OMT) delivery and the quality of care offered to patients undergoing OMT across 10 European countries. Findings suggest quality of care may be improved by: ensuring patients and physicians discuss the range of available treatment options, achieving the appropriate balance between control and patient flexibility, reducing the likelihood of misuse and diversion, and providing appropriate psychosocial care in conjunction with pharmacotherapy.
According to the European Quality Audit of Opioid Treatment (EQUATOR) analysis, there is large variation across Europe in the conditions attached to treatment of opioid dependence. Treatment conditions, such as supervised dosing and the need to attend regular appointments, may constitute important barriers to treatment that may impact on successful outcomes for opioid-dependent individuals. Greater flexibility in the provision of treatment and improved education for patients, users and physicians with regards to therapy options may help to improve recruitment and retention of opioid users in treatment, and consequently improve patient outcomes.
The European Quality Audit of Opioid Treatment (EQUATOR) analysis suggests that current systems of opioid-dependence treatment in Europe may be failing to achieve optimal outcomes in a substantial subset of patients. In general, opioiddependent patients report high rates of cycling in and out of opioid maintenance treatment (OMT), past misuse or diversion of their medication, and continued on-top heroin use despite being prescribed OMT. Building on evidence from this analysis of variable treatment delivery across Europe, these findings suggest that greater treatment benefits could be achieved by optimising treatment structures as well as available interventions.
Many opioid users across Europe remain outside treatment, and not all of those in treatment derive optimal benefit. The European Quality Audit of Opioid Treatment (EQUATOR) analysis shows that opioid-dependent people report high levels of polydrug use, high rates of unemployment and past imprisonment, and significant physical and mental health comorbidities regardless of whether they are currently in or out of treatment. Improved strategies are required to deliver the benefits of treatment while managing the risks of non-compliance (e.g., misuse/diversion/drug use). Treatment systems should be judged by their ability to effectively reduce harm and promote individual recovery and social reintegration.
ÖZET Var olan tan› sistemleriyle ruhsal bozukluklar›n nesnel, gü- venli ve geçerli bir biçimde s›n›fland›r›lmas› büyük ölçüde salanm›flt›r. Bu tan› sistemleri, ruhsal bozukluklara bö- lümsel (kategorik) ya da ikiye ay›r›c› (dichotomous) bir yaklafl›m göstermektedirler. Kat› biçimde belirlenmifl tan› ölçütleri ile yüksek efltan› oranlar› oluflmaktad›r. Dahas›, bu tan› sistemlerinin hastal›klar›n eflik alt› durumlar›n›, ati- pik bulgular› ve belirtileri, çekirdek belirtilerle iliflkili olan baz› kiflilik hatlar›n› ve davran›fl özelliklerini saptamada ye- tersiz kald›¤› bildirilmektedir. Bu eflikalt› belirtiler yeti yiti- mi yaratmalar› ve yaflam kalitesini bozmalar› aç›s›ndan an- laml›d›r. Bu k›s›tl›l›klar, bozukluklara boyutsal ya da spekt- ral yaklafl›m kavram›n›n ç›k›fl noktas›n› oluflturmufltur. Pa- nik bozukluu alan›nda yap›lan çal›flmalar hastal›¤›n klinik görünümünde çeflitlilik olduunu göstermektedir. Çeflitlilik sorunlar›n› aflmak için panik-agorafobi spektrumu kavram› tan›mlanm›flt›r. Panik-agorafobi spektrumu kavram›, DSM- IV ve ICD-10 tan› ölçütlerinin yan› s›ra bunlarla iliflkili ola- bilecek atipik ya da eflikalt› panik belirtilerini de içermekte- dir. Böylece panik ve agorafobi belirti s›n›rlar› genifl tutul- mufltur. Panik-agorafobi spektrumu klinik belirtileri sekiz alt alanda ele almaktad›r: 1) ayr›lma duyarl›l›¤›, 2) panik- benzeri belirtiler, 3) stres duyarl›l›¤›, 4) madde ve ilaç du- yarl›l›¤›, 5) endifleli beklenti, 6) agorafobi, 7) hastal›k fobisi ve hipokondriyazis, 8) güvence arama. SUMMARY: Panic-Agoraphobic Spectrum Current diagnostic classification systems have provided reliable, objective and valid diagnoses of mental disor- ders. They present both categorical and dichotomous app- roaches to mental disorders. However, rigid usage of di- agnostic criteria may cause high comorbidity rates. More- over, these classification systems fail to identify subthres- hold conditions, atypical signs and symptoms, and perso- nality traits associated with the core symptoms of a given mental disorder. These subclinical manifestations are cli- nically meaningful in terms of disability and effects on qu- ality of life. For these reasons, many researchers have be- gun to develop dimensional or spectral approaches for a number of mental disorders. Studies on panic disorder with or without agoraphobia have revealed a substantial clinical heterogeneity. The panic-agoraphobic spectrum concept was defined to overcome these difficulties. This concept includes DSM-IV and ICD-10 diagnostic criteria together with atypical and subthreshold symptoms of pa- nic disorder, and constitutes a broader band of panic and agoraphobia symptoms. The panic-agoraphobic spectrum incorporates eight domains of clinical features: 1) separa- tion sensitivity, 2) panic-like symptoms, 3) stress sensiti- vity, 4) medication and substance sensitivity, 5) anxious expectation, 6) agoraphobia, 7) illness phobia and hypoc- hondriasis, 8) reassurance orientation. In this article, we reviewed the spectrum conceptualization of panic disorder and agoraphobia, particularly focusing on the domains of the panic-agoraphobic spectrum and their assessment.
Introduction Alterations of the hypothalamic-pituitary-adrenal (HPA) axis and of its peripheral indices have been reported in both normal and pathological anxiety with controversial findings. The aim of the present study was to investigate the possible correlations between serum cortisol and dehydroepiandrosterone-sulfate (DHEA-S) levels and DHEA-S/cortisol ratio, and panic-agoraphobic spectrum dimensions in a sample of healthy subjects.
Forty-two healthy subjects of both sexes, with no current or lifetime psychiatric disorders, were assessed by means of the Structured Clinical Interview for DSM-IV (SCID-I/P) and the so-called Panic Agoraphobic Spectrum-Self Report lifetime version (PAS-SR).
Significant, negative correlations were found between cortisol levels and the total score of the separation sensitivity, panic-like symptoms, and medication/substance sensitivity PAS-SR domains. The PAS-SR total and the panic-like symptoms domain scores were positively related to the DHEAS/cortisol ratio. When the sample was divided in women and men, these correlations were present in women only. Discussion These findings, while indicating the presence of significant relationships between panic-agoraphobic traits and some indices of HPA axis functioning in healthy women, would suggest this as one of the factors explaining the greater vulnerability of women to cross the line between normal and pathological anxiety.
Further studies are needed to explore gender differences in the relationships between HPA axis alterations and the panic-agoraphobic spectrum dimensions.
Since the mid-90s several studies have proven the existence of an Adult form of the Separation Anxiety Disorder (ASAD) not yet nosologically recognized by the international psychiatric classification systems (DSM and ICD). An increasing amount of evidence showed that the separation anxiety disorder may arise at any age, not always in continuation with the correspondent childhood disorder. So, a revision of the diagnostic criteria for this disorder is brought into question, as the onset is currently limited before 18 years of age. Different tools have been developed for the assessment of ASAD: 1) the Adult Separation Anxiety Structured Interview (ASA-SI), a semi-structured interview with items derived and adapted from the DSM-IV-TR childhood disorder; 2) the Adult Separation Anxiety-27 (ASA-27), a self-administered rating scale containing the same items of ASA-SI; 3) the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), a structured interview including two specific forms for childhood and adulthood. However, according to available evidence, the separation anxiety may be a dimension with cross-nosographical presentation in nearly all the commonest mood and anxiety disorders; moreover, it is connected to greater personal dysfunction and lower responsiveness to treatment. Furthermore, a deeper comprehension of the psychobiological nature of separation anxiety should lead to newer and more effective therapeutic intervention. Literature is reviewed awaiting the publication of DSM-V.
RESUMEN: El Trastorno del Pánico es una patología psiquiátrica que está bien definida en la nomenclatura oficial. En los últimos años muchos autores han enfatizado que a la presente clasificación, faltaba identificar una variedad y un continuum de síntomas que caracteriza la realidad clínica. Cassano y colaboradores propusieron con el modelo del Espectrum, una Entrevista Clínica estructurada para el Espectrum del Pánico agorafobico (SCI-PAS) y un cuestionario de Auto Evaluación (PAS-SR)como instrumento para una evaluación comprensiva del Trastorno del Pánico. El N.A.T.A(Núcleo de Atendimiento de los Trastornos de la Ansiedad) es un ambulatorio del Departamento de Psicologia Médica y Psiquiatria del Hospital de las Clínicas de la UNICAMP, y está arrollado en esta encuesta, con interés en el uso del SCI-PAS/PAS-SR con una clasificación diagnostica a más. El principal objetivo de la presente encuesta es la traducción adaptación y estudio de confiabilidad de SCI-PAS y PAS-SR para el portugués de Brasil.
Objective: This paper aims to describe some of the challenges in psychiatric classification, using generalized anxiety disorder (GAD) as an example. A range of different conceptualizations of GAD are presented. Some are based on theoretical formulations, while others draw on epidemiological data. Each has merit, but also deficiencies. The evolution of diagnostic criteria is not simply a theoretical exercise, but reflects assumptions about the nature of the underlying pathology and the relationships between different disorders. Furthermore, these criteria determine which subjects are included in research and in clinical trials, so they shape the further development of psychiatric classification systems.
Conclusion: The controversies about the classification of GAD illustrate the complexities and challenges of developing a valid classification system for psychiatric disorders.
Objective: To assess the reliability and validity of Turkish version of the Lifetime Panic Agoraphobic Spectrum Scale (PAS-SR). Method: The study sample consisted of 196 subjects, 82 with DSM-IV panic disorder with (n= 71) or without agoraphobia (n= 11), 23 with major depressive disorder, 24 with obsessive compulsive disorder (OCD), and 67 healthy controls. Convergent and discriminant validity were assessed with Adult Separation Anxiety Disorder Questionnaire, Separation Anxiety Inventory, Beck Anxiety Inventory, Marks and Mathews Fear Inventory, Anxiety Sensitivity Index (ASI), Panic-Agoraphobia Scale (PAS) and Panic Disorder Severity Scale (PDSS). Ninety two subjects were reassessed within 7-30 days for test-retest reliability. Findings: Internal consistency was high, with a Croncbach alpha value of 0.82. Correlation for test-retest reliability was 0.88. There was also a high correlation between total score of PAS-SR and its domains. The highest correlation was with the domain II (panic-like symptoms). PAS-SR has high correlations with ASI (r= 0.651), PAS (r= 0.635) and PDSS (r=0.587). We conducted a ROC analysis comparing total score of PAS-SR with DSM-IV diagnosis, and the cut-off point of 46 was, with 91 % sensitivity and 80% specificity. The mean PAS-SR scores were significantly higher in the panic disorder group (66.33+14.13) compared with the OCD and major depressive patients (47.86+16.55), and healthy controls (29.19+14.87). The findings support the discriminant validity of the PAS-SR. Discussion and Conclusion: Turkish version of PAS-SR self report form is a reliable and valid instrument for assessing panic disorder and related spectral symptoms.
The authors tested the hypothesis that a lifetime history of panic-agoraphobic spectrum symptoms predicts a poorer response to depression treatment.
A threshold for clinically meaningful panic-agoraphobic spectrum symptoms was defined by means of receiver operating characteristic curve analysis of total scores on the Structured Clinical Interview for Panic-Agoraphobic Spectrum in a group of 88 outpatients with and without panic disorder. This threshold was then applied to a group of 61 women with recurrent major depression, who completed a self-report version of the same instrument, in order to compare treatment outcomes for patients above and below this clinical threshold.
Women with high scores (> or =35) on the Panic-Agoraphobic Spectrum Self-Report were less likely than women with low scores (<35) to respond to interpersonal psychotherapy alone (43.5% versus 68.4%, respectively). Women with high scores also took longer (18.1 versus 10.3 weeks) to respond to a sequential treatment paradigm (adding a selective serotonin reuptake inhibitor when depression did not remit with interpersonal psychotherapy alone). This effect was only partially accounted for by the higher likelihood that patients with high scores required the addition of antidepressants. Although four domains from the Panic-Agoraphobic Spectrum Self-Report were individually associated with a longer time to remission, only stress sensitivity emerged as significant in multivariate regression analyses.
A lifetime burden of panic-agoraphobic spectrum symptoms predicted a poorer response to interpersonal psychotherapy and an 8-week delay in sequential treatment response among women with recurrent depression. These results lend clinical validity to the spectrum construct and highlight the need for alternate psychotherapeutic and pharmacologic strategies to treat depressed patients with panic spectrum features.
The Collaborative Spectrum Project aims to define subthreshold and atyical conditions not sufficiently characterized in the current diagnostic nomenclature and for which adequate assessment instruments are not available. This paper reports on the development and validation of new instruments to assess the spectrum of five psychiatric disorders.
Three multicenter studies and one single-site study were conducted in Italy to assess the validity and reliability of the five spectrum interviews. Another cross-sectional study to validate the panic-agoraphobia spectrum has been conducted in Pittsburgh.
Outpatients attending various university clinics, university students and, in one Italian study, gym attenders were recruited for the studies.
Five structured clinical interview to assess the spectrum of panic-agoraphobia (SCI-PAS), mood (SCI-MOODS), social phobia (SCI-SHY), and the obsessive-compulsive (SCI-OBS) and eating disorder spectra (SCI-ABS) were administered along with a diagnostic interview and a number of self-report and interviewer-rated instruments.
All the domains of the interview showed high test-retest reliability (intraclass correlation coefficient > 0.61) and satisfactory internal consistency. Mean domain scores were significantly higher in cases than in controls and in patients with the disorder of interest than in patients with other disorders. Convergent validity was satisfactory for panic-agoraphobia, social phobia and obsessive-compulsive spectrum domains. Differences emerged between SCI-ABS and self-report instruments assessing eating disorders. A cut-off score for the panic-agoraphobia spectrum was defined and its clinical validity was tested.
The psychometric properties of the five spectrum interviews are very satisfactory, and studies are currently ongoing to test the clinical validity of all the spectra. Subthreshold and atypical symptoms deserve attention in epidemiological investigation.
This paper describes a model of psychopathology termed the panic-agoraphobic spectrum. The model has been constructed by identifying different psychopathologic and clinical domains that incorporate and extend the diagnosis of panic disorder as described in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
Categorical classifications do not take into account the subthreshold, atypical, and often enduring symptoms that accompany the core manifestations of full-blown mental disorders. These often-neglected spectrums of symptoms, however, may be as distressing and debilitating as the full-blown disorders and can have unrecognized importance in selection of and response to treatment. At the Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology, Institute of Psychiatry of the University of Pisa, Italy, a spectrum approach to mental disorders (eg, bipolar, obsessive-compulsive, eating, and panic disorders) has been used extensively and has proven effective in clinical practice.
The need for systematic identification and assessment of a broad array of symptoms and behavioral features has led, as a first step, to the conceptualization of the panic-agoraphobic spectrum model. In collaboration with researchers from the University of Pittsburgh, PA, and elsewhere, the University of Pisa scientists have further refined the panic-agoraphobic spectrum model and have developed a structured interview for this spectrum called the Structured Clinical Interview for Panic-Agoraphobic Spectrum. The rationale, clinical usefulness, and heuristic significance of the panic-agoraphobic spectrum model are discussed below.
The current tools used to define and diagnose mental disorders, including the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, have added specificity to the psychiatric nomenclature. However, their stereotypic rigidity in classification has resulted in the failure to identify the full range of potentially' debilitating psychiatric symptoms with which patients may present. A spectrum model of psychopathology is more adept at recognizing the subclinical or threshold symptomatology that may occur concomitantly with core psychiatric disorders. The authors discuss the development of a spectrum approach to the diagnosis of mental disorders, which offers the potential to improve treatment selection and therapeutic outcomes.
Background:
The authors define 6 groups of subthreshold psychiatric symptoms that do not meet the full criteria for a DSM-IV Axis I disorder and examine the clinical significance of these symptoms in an outpatient primary care sample.
Methods:
The subjects were 1001 adult primary care patients in a large health maintenance organization. Data on sociodemographic characteristics and functional impairment, including scores on the Sheehan Disability Scale, were collected at the time of the medical visit, and a structured diagnostic interview for DSM-IV disorders was completed by telephone within 4 days of the visit. Subthreshold symptoms were defined for depressive, anxiety, panic, obsessive-compulsive, drug, and alcohol symptoms.
Results:
Subthreshold symptoms were as or more common than their respective Axis I disorders: panic (10.5% vs 4.8%), depression (9.1% vs 7.3%), anxiety (6.6% vs 3.7%), obsessive-compulsive (5.8% vs 1.4%), and alcohol (5.3% vs 5.2%) and other drug (3.7% vs 2.4%) cases. Patients with each of the subthreshold symptoms had significantly higher Sheehan Disability Scale scores (greater impairment) than did patients with no psychiatric symptoms. Many patients (22.6%-53.4%) with subthreshold symptoms also met the full criteria for other Axis I disorders. After adjusting for the confounding effects of other Axis I disorders, other subthreshold symptoms, age, sex, race, marital status, and perceived physical health status, only depressive symptoms, major depressive disorder, and, to a lesser extent, panic symptoms were significantly correlated with the impairment measures.
Conclusions:
In these primary care patients, the morbidity of subthreshold symptoms was often explained by confounding mental, physical, or demographic factors. However, depressive symptoms and, to a lesser extent, panic symptoms were disabling even after controlling for these factors. Primary care clinicians who detect subthreshold psychiatric symptoms should consider a broad psychiatric assessment.
Epidemiological studies have found that few cases of panic disorder arise for the first time after the age of 40 years, and there is a steady decline in the prevalence of existing cases in the latter half of life. The authors review these epidemiological findings and explore various hypotheses that might explain the decreased frequency of panic disorder in old age. There is no available evidence to suggest that methodological factors have led to an underestimation of the prevalence of this disorder in older rather than younger age groups. However, there is evidence that disorder-associated mortality and age-related changes in brain neurochemistry may contribute to the decreased frequency of this illness in later life. A cohort effect also should be considered, although currently there are no data available to support or refute this idea.
Copyright (C) 1996 American Association for Geriatric Psychiatry
A previously described coefficient of agreement for nominal scales, kappa, treats all disagreements equally. A generalization to weighted kappa (Kw) is presented. The Kw provides for the incorpation of ratio-scaled degrees of disagreement (or agreement) to each of the cells of the k * k table of joint nominal scale assignments such that disagreements of varying gravity (or agreements of varying degree) are weighted accordingly. Although providing for partial credit, Kw is fully chance corrected. Its sampling characteristics and procedures for hypothesis testing and setting confidence limits are given. Under certain conditions, Kw equals product-moment r. The use of unequal weights for symmetrical cells makes Kw suitable as a measure of validity.
We report the analyses of daily journal descriptions of 790 self-defined panic attacks from 59 patients meeting DSM-III criteria for panic disorder or agoraphobia with panic attacks. The DSM-III-R specified symptoms occurred with frequencies ranging from choking (17% of attacks) to palpitations (63% of attacks). The mean weekly panic attack severity correlated significantly with the number of symptoms per attack, but not their weekly frequency. Within a given person, situational and spontaneous panic attacks did not significantly differ over a number of characteristics, including severity, duration, frequency per week, diurnal distribution, and the number of symptoms per attack. Limited symptom attacks were less severe, but were otherwise similar to panic attacks. Also, panic attacks during sleep were less frequent than panic attacks in the awake state, but did not significantly differ on other descriptive characteristics. These data support the validity of the symptoms specified for panic attacks by DSM-III-R. They also suggest that within an individual, panic attacks of various subtypes may be descriptively similar, despite the differing contexts in which they arise. In addition, these data question the diagnostic significance of the limited symptom attack-panic attack distinction.
The authors define 6 groups of subthreshold psychiatric symptoms that do not meet the full criteria for a DSM-IV Axis I disorder and examine the clinical significance of these symptoms in an outpatient primary care sample.
The subjects were 1001 adult primary care patients in a large health maintenance organization. Data on sociodemographic characteristics and functional impairment, including scores on the Sheehan Disability Scale, were collected at the time of the medical visit, and a structured diagnostic interview for DSM-IV disorders was completed by telephone within 4 days of the visit. Subthreshold symptoms were defined for depressive, anxiety, panic, obsessive-compulsive, drug, and alcohol symptoms.
Subthreshold symptoms were as or more common than their respective Axis I disorders: panic (10.5% vs 4.8%), depression (9.1% vs 7.3%), anxiety (6.6% vs 3.7%), obsessive-compulsive (5.8% vs 1.4%), and alcohol (5.3% vs 5.2%) and other drug (3.7% vs 2.4%) cases. Patients with each of the subthreshold symptoms had significantly higher Sheehan Disability Scale scores (greater impairment) than did patients with no psychiatric symptoms. Many patients (22.6%-53.4%) with subthreshold symptoms also met the full criteria for other Axis I disorders. After adjusting for the confounding effects of other Axis I disorders, other subthreshold symptoms, age, sex, race, marital status, and perceived physical health status, only depressive symptoms, major depressive disorder, and, to a lesser extent, panic symptoms were significantly correlated with the impairment measures.
In these primary care patients, the morbidity of subthreshold symptoms was often explained by confounding mental, physical, or demographic factors. However, depressive symptoms and, to a lesser extent, panic symptoms were disabling even after controlling for these factors. Primary care clinicians who detect subthreshold psychiatric symptoms should consider a broad psychiatric assessment.
We had investigated the clinical characteristics of panic disorder (PD) in a Japanese outpatient population comprised of more than 250 patients diagnosed as having PD during a 13-year study period and observed that some PD patients had both panic attacks (PA) and limited symptom panic attacks (LPA). In the criteria for PD based on the Diagnostic and Statistics Manual of Mental Disorders, third edition-revised (DSM-III-R), episodes involving four or more symptoms are classified as PA, while those involving fewer than four symptoms are described as LPA. Therefore, LPA is identified as part of an episode of PA, since the difference between the two episodes is only in the number of symptoms. However, some recent research suggests that there is a distinct subgroup of individuals who suffer LPA. Using cluster analysis, we investigated the differences between PA and LPA groups in terms of the structures of several panic symptoms, which included anticipatory anxiety, agoraphobia and 13 clinical symptoms based on the DSM-III-R at the time of panic attacks, in 247 patients with PD. Cluster analysis revealed clusters of three and four panic symptoms in the PA group and LPA group, respectively, and there were also differences in symptom structure between the two groups. These results suggest that there may be a subgroup of individuals who show LPA among PD patients.
Psychiatric classification is still a topic of considerable discussion and debate in spite of major advances in the past two decades. The debate involves categorical versus dimensional approaches, cutoff numbers of symptoms to define a case, degree of impairment, objective diagnostic criteria versus more theoretically based criteria, episodic versus trait-like symptoms, and the role of atypical and subclinical symptoms. All of these issues have been raised for the anxiety disorders and depression. This article presents the conceptualization of a relatively novel and testable approach to the diagnosis and classification of panic and agoraphobia, the panic-agoraphobic spectrum, and pilot data on a new questionnaire to assess it.
Pilot testing of the Panic-Agoraphobic Spectrum Questionnaire was undertaken with 100 inpatients who had lifetime diagnoses of panic disorder, unipolar depression, comorbid panic and unipolar depressive disorders, or an eating disorder. The instrument emphasizes impairment related to 144 behaviors and experiences in seven panic-agoraphobic symptom domains.
Patients with panic disorder scored highest on the questionnaire, and those with comorbid depression showed even greater severity of illness. The scores of the patients with eating disorders and of the depressed patients differed from those of the other groups but also differed from 0.
The spectrum model of panic and agoraphobia is a flexible and comprehensive means of describing this clinical complex. The proposed model, complementary to the categorical approach, presumably expresses a unitary pathophysiology. Its usefulness is discussed in terms of its value for patient-therapist communication, outcome measures, identification of subtle personality traits, and subtyping of patients for research and treatment.
Data are presented on the prevalence of DSM-IV panic and agoraphobia in a community sample of adolescents and young adults in Munich, Germany.
A total of 3021 respondents aged 14 to 24 years were assessed with a revised version of the Composite International Diagnostic Interview (CIDI). Respondents classified as having agoraphobia without panic were subtyped by number of agoraphobic trigger situations and subjected to a clinical review.
Lifetime prevalence of DSM-IV agoraphobia in the revised CIDI was higher (8.5%) than that of panic attack (4.3%) or panic disorder with (0.8%) or without (0.8%) agoraphobia. Marked differences in symptomatology, course, and associated impairments between panic disorder and agoraphobia were found. Most patients with agoraphobia reported neither full nor limited attacks or uncued paniclike experiences. Clinical review revealed that many respondents classified by the CIDI as having agoraphobia actually have specific phobia, resulting in a corrected agoraphobia prevalence of 3.5%. Number of agoraphobia trigger situations was identified as a useful way of differentiating patients with true agoraphobia from those with simple phobia. Even after correcting for overdiagnosis, however, the majority of respondents with confirmed agoraphobia were found not to have a prior history of panic.
The results call into question the assumed key pathogenic role of panic attacks in the onset of agoraphobia. Consistent with findings that agoraphobia without panic is rarely seen in clinical settings, we find that such patients seldom seek professional treatment.
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