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

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


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

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    • "To maximize clinical and research utility, the Concise Health Risk Tracking (CHRT) scale was designed to be used as both self-rated (CHRT-SR) and clinician-rated (CHRT-C) instruments. Although previously studied in unipolar major depressive disorder, prior to the current study, the psychometric properties of the CHRT have not been examined in subjects with bipolar disorder (Trivedi et al., 2011a,b). Presently, measures such as the Columbia Suicide Severity Rating Scale (C-SSRS; Posner et al., 2011), Suicidal Behaviors Questionnaire (SBQ; Linehan and Nielsen, 1981) and the Beck Scale for Suicide Ideation (SSI; Beck et al., 1979) are used to assess risk factors for suicidal behavior. "
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    ABSTRACT: Objective: People with bipolar disorder are at high risk of suicide, but no clinically useful scale has been validated in this population. The aim of this study was to evaluate the psychometric properties in bipolar disorder of the 7- and 12-item versions of the Concise Health Risk Tracking Self-Report (CHRT-SR), a scale measuring suicidal ideation, suicidal behavior, and associated symptoms. Methods: The CHRT was administered to 283 symptomatic outpatients with bipolar I or II disorder who were randomized to receive lithium plus optimized personalized treatment (OPT), or OPT without lithium in a six month longitudinal comparative effectiveness trial. Participants were assessed using structured diagnostic interviews, clinician-rated assessments, and self-report questionnaires. Results: The internal consistency (Cronbach α) was 0.80 for the 7-item CHRT-SR and 0.90 for the 12-item CHRT-SR with a consistent factor structure, and three independent factors (current suicidal thoughts and plans, hopelessness, and perceived lack of social support) for the 7-item version. CHRT-SR scores are correlated with measures of depression, functioning, and quality of life, but not with mania scores. Conclusions: The 7- and 12-item CHRT-SR both had excellent psychometric properties in a sample of symptomatic subjects with bipolar disorder. The scale is highly correlated with depression, functioning, and quality of life, but not with mania. Future research is needed to determine whether the CHRT-SR will be able to predict suicide attempts in clinical practice.
    Full-text · Article · Oct 2015 · Journal of Psychiatric Research
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    • "Ketamine for suicidal ideation 5 the majority of patients in our study had a primary diagnosis of MDD or bipolar disorder. We did find a significant effect of treatment on irritability and panic using the CAST (Trivedi et al. 2011b), wherein patients treated with ketamine compared to midazolam had lower levels of irritability and panic symptoms 24 h following treatment. These findings raise the possibility that ketamine may reduce suicidal thinking in part by reducing irritability and panic. "
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    ABSTRACT: Suicide is a devastating public health problem and very few biological treatments have been found to be effective for quickly reducing the intensity of suicidal ideation (SI). We have previously shown that a single dose of ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, is associated with a rapid reduction in depressive symptom severity and SI in patients with treatment-resistant depression. We conducted a randomized, controlled trial of ketamine in patients with mood and anxiety spectrum disorders who presented with clinically significant SI (n = 24). Patients received a single infusion of ketamine or midazolam (as an active placebo) in addition to standard of care. SI measured using the Beck Scale for Suicidal Ideation (BSI) 24 h post-treatment represented the primary outcome. Secondary outcomes included the Montgomery-Asberg Depression Rating Scale - Suicidal Ideation (MADRS-SI) score at 24 h and additional measures beyond the 24-h time-point. The intervention was well tolerated and no dropouts occurred during the primary 7-day assessment period. BSI score was not different between the treatment groups at 24 h (p = 0.32); however, a significant difference emerged at 48 h (p = 0.047). MADRS-SI score was lower in the ketamine group compared to midazolam group at 24 h (p = 0.05). The treatment effect was no longer significant at the end of the 7-day assessment period. The current findings provide initial support for the safety and tolerability of ketamine as an intervention for SI in patients who are at elevated risk for suicidal behavior. Larger, well-powered studies are warranted.
    Full-text · Article · Aug 2015 · Psychological Medicine
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    ABSTRACT: This article outlines the role of measurement-based care in the management of antidepressant treatment for patients with unipolar depression. Using measurement-based care, clinicians and researchers have the opportunity to optimize individual treatment and obtain maximum antidepressant treatment response. Measurement-based care breaks down to several simple components: antidepressant dosage, depressive symptom severity, medication tolerability, adherence to treatment, and safety. Quick and easy-to-use, empirically validated assessments are available to monitor these areas of treatment. Utilizing measurement-based care has several steps-screening and antidepressant selection based upon treatment history, followed by assessment-based medication management and ongoing care. Electronic measurement-based care systems have been developed and implemented, further reducing the burden on patients and clinicians. As more treatment providers adopt electronic health care management systems, compatible measurement-based care antidepressant treatment delivery and monitoring systems may become increasingly utilized.
    No preview · Article · Sep 2011 · Current Psychiatry Reports
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