RESUMO
Objective: The marked increase in the prevalence of attention-deficit/hyperactivity disorder (ADHD) among university students gives rise to questions about how best to diagnose in this setting. The aim of the present study was to calculate ADHD prevalence in a large non-clinical sample of medical students using a stepwise design and to determine whether ADHD diagnosis varies if interviewees use additional probing procedures to obtain examples of positive DSM items. Methods: A total of 726 students were screened with the Adult Self-Report Scale (ASRS) and invited for an interview with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) adapted for adults. Results: The ASRS was positive for 247 students (37%), although only 83 (7.9%) received an ADHD diagnosis. ASRS sensitivity and specificity rates were 0.97 and 0.40, respectively. Probing procedures were used with a subgroup of 226 students, which decreased the number of ADHD diagnoses to 12 (4.5%). Conclusion: Probing for an individual's real-life examples during the K-SADS interview almost halved ADHD prevalence rate based on the ASRS and K-SADS, which rendered the rate consistent with that typically reported for young adults. In reclassified cases, although examples of inattention did not match the corresponding DSM item, they often referred to another DSM inattention item.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Escalas de Graduação Psiquiátrica/normas , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Estudantes de Medicina/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Estudantes de Medicina/estatística & dados numéricos , Prevalência , Sensibilidade e Especificidade , Diagnóstico Diferencial , Autorrelato , Entrevista Psicológica/normasRESUMO
OBJECTIVE: The marked increase in the prevalence of attention-deficit/hyperactivity disorder (ADHD) among university students gives rise to questions about how best to diagnose in this setting. The aim of the present study was to calculate ADHD prevalence in a large non-clinical sample of medical students using a stepwise design and to determine whether ADHD diagnosis varies if interviewees use additional probing procedures to obtain examples of positive DSM items. METHODS: A total of 726 students were screened with the Adult Self-Report Scale (ASRS) and invited for an interview with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) adapted for adults. RESULTS: The ASRS was positive for 247 students (37%), although only 83 (7.9%) received an ADHD diagnosis. ASRS sensitivity and specificity rates were 0.97 and 0.40, respectively. Probing procedures were used with a subgroup of 226 students, which decreased the number of ADHD diagnoses to 12 (4.5%). CONCLUSION: Probing for an individual's real-life examples during the K-SADS interview almost halved ADHD prevalence rate based on the ASRS and K-SADS, which rendered the rate consistent with that typically reported for young adults. In reclassified cases, although examples of inattention did not match the corresponding DSM item, they often referred to another DSM inattention item.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Escalas de Graduação Psiquiátrica/normas , Estudantes de Medicina/psicologia , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Entrevista Psicológica/normas , Masculino , Prevalência , Autorrelato , Sensibilidade e Especificidade , Estudantes de Medicina/estatística & dados numéricos , Adulto JovemRESUMO
While the classification of psychiatric disorders has been critiqued for failing to adequately account for culture, the inclusion of the Cultural Formulation Interview (CFI) in the DSM-5 has been viewed as a promising development for the inclusion of cultural factors in diagnosis and treatment of mental illness. In this study, we assess the appropriateness, acceptability, and clinical utility of the CFI among outpatients in a Mexican psychiatric hospital. Our assessment included observations of psychiatric residents' application of the CFI with 19 patients during routine outpatient visits, along with pre- and post-CFI interviews to determine providers' and patients' views of the CFI. The CFI was generally well received by providers and patients, viewed as a way of building trust and increasing providers' understanding of contextual factors influencing mental illness, such as social support. However, the CFI questions specifically related to "culture" were of limited effect and both patients and providers did not view them as useful. We discuss implications for the clinical assessment of cultural factors influencing mental health and illness and for the incorporation of the CFI in Mexican clinical settings.
Assuntos
Assistência à Saúde Culturalmente Competente/normas , Manual Diagnóstico e Estatístico de Transtornos Mentais , Entrevista Psicológica/normas , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Adulto , Antropologia Médica , Feminino , Hospitais Psiquiátricos , Humanos , Masculino , Serviços de Saúde Mental/organização & administração , México , Pessoa de Meia-Idade , Pacientes Ambulatoriais/psicologia , Apoio Social , Adulto JovemRESUMO
Systematic review and meta-analysis of literature were conducted examining the effectiveness of the National Institute for Child Health and Human Development Investigative Interview Protocol in improving the quality of child forensic interviews. Online databases were searched for journal articles published between the years 2000 and 2013. Measures of interview quality were the type of interviewer utterances and the amount of information provided by children. Five studies met criteria for inclusion in the meta-analysis. Weighted mean of the effect sizes was calculated for each outcome measure. Protocol interviews had more invitations (g = 1.60) and fewer option-posing (g = -.95) and suggestive prompts (g = -.63) than standard interviews. Children interviewed by the protocol provided more central details (g = .90) in response to invitations than controls. Meta-analyses of a subset of preschool children samples revealed that protocol interviews had more invitations (g = 1.46), fewer suggestive prompts (g = -.61), and fewer option-posing prompts (g = -1.05) than controls. Findings corroborate results from previous studies that suggested the benefits of the protocol on the interviewers' performance and on children's informativeness. However, protocol did not show the same performance with regard to preschool children.
Assuntos
Abuso Sexual na Infância/psicologia , Entrevista Psicológica/normas , National Institute of Child Health and Human Development (U.S.)/normas , Relatório de Pesquisa/normas , Adolescente , Criança , Pré-Escolar , Humanos , Revisões Sistemáticas como Assunto , Estados UnidosRESUMO
O suporte materno pode funcionar como um moderador dos efeitos do abuso sexual no microssistema familiar das vítimas, maximizando as chances de ajustamento psicológico nestes contextos. Este estudo objetivou caracterizar o suporte materno de cinco mães de meninas vítimas de abuso sexual. Foram avaliadas as seguintes dimensões de suporte materno: acreditar na vítima, suporte emocional, e ação protetiva. Por meio das entrevistas, observou-se que a falta de credibilidade inicial das participantes em relação ao abuso sexual de suas filhas, não afetou as ações protetivas. Houve o relato de mudanças nas práticas maternas após a descoberta do abuso sexual. Discute-se a sobrecarga emocional destas cuidadoras, a manutenção do segredo acerca do abuso sexual e a importância das estratégias de intervenção familiar.
The maternal support can act as a moderator of the effects of sexual abuse in the family microsystem victims, maximizing the chances of psychological adjustment in these contexts. This study aimed to characterize the maternal support of five mothers of sexually abused girls. The following dimensions of maternal support were considered: believe the victim, emotional support, and protective action. Through the interviews, observed that the initial lack of credibility of the participants in relation to the sexual abuse of their daughters, did not affect the protective actions. There was the report of changes in maternal practices after the discovery of sexual abuse. The emotional burden of these caregivers, the maintenance of the secrecy about sexual abuse, and the importance of family intervention strategies are discussed.
El apoyo de la madre puede actuar como moderador de los efectos del abuso sexual en las víctimas de microsistemas familiares, maximizando las posibilidades de ajuste psicológico en estos contextos. Este estudio tuvo como objetivo caracterizar el apoyo materno de cinco madres de niñas víctimas de abuso sexual. Se consideraron las siguientes dimensiones del apoyo materno: creer en la víctima, el apoyo emocional y la acción protectora. A través de las entrevistas, se observó que la falta inicial de credibilidad de los participantes en relación con el abuso sexual de sus hijas, no afectó a las acciones de protección. Ha habido informes de cambios en las prácticas maternas después del descubrimiento de los abusos sexuales. Se discute la carga emocional de estos cuidadores, el mantenimiento del secreto sobre el abuso sexual y la importancia de las estrategias de intervención familiar.
Assuntos
Humanos , Feminino , Criança , Adulto , Abuso Sexual na Infância , Relações Mãe-Filho/psicologia , Entrevista Psicológica/normasRESUMO
OBJECTIVES: To investigate the psychometric properties of the Executive Interview (EXIT) and Quick EXIT in community dwelling older adults. DESIGN: Secondary analysis of data obtained as part of a longitudinal study of cognitive function in late-life depression. SETTING: A university hospital. PARTICIPANTS: Community-dwelling adults (N = 422), aged 59 years and older, with current or recent history of non-psychotic unipolar major depression, and never-depressed comparison subjects. MEASUREMENTS: The EXIT and other measures of executive control functions (ECF), non-executive cognitive domains, and global cognitive function. We calculated Quick EXIT scores from the EXIT. RESULTS: The EXIT demonstrated high inter-rater reliability (Intraclass correlation coefficient = 0.978, F(7, 21) = 174.85, p <0.001), and both the EXIT and Quick EXIT demonstrated moderate internal consistency (α = 0.66 and α = 0.68, respectively). Both tests also demonstrated acceptable convergent validity against several standard tests of ECF (rs -0.399 to 0.322, except for the Trail Making Test B, where rs was 0.057 to 0.063) as well as against measures of multifactorial cognitive function (rs -0.432 to 0.491). Both tests, however, demonstrated inconsistent discriminant validity against a variety of standard non-ECF tests (rs -0.013 to 0.376). CONCLUSIONS: Both the EXIT and the Quick EXIT have adequate reliability and appear to require ECF in this population. However, both the EXIT and the Quick EXIT also reflect non-ECF domains. The EXIT and Quick EXIT should be considered to be measures of global cognitive function rather than pure ECF measures. Given similar reliability and validity, the Quick EXIT is recommended clinically as it is briefer and less burdensome than the full EXIT.
Assuntos
Envelhecimento/fisiologia , Transtornos Cognitivos/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Função Executiva/fisiologia , Entrevista Psicológica/normas , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Psicometria/instrumentação , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To evaluate the effectiveness of brief motivational interviewing and an educational brochure when delivered in emergency room to reduce alcohol abuse and related problems among adolescents and young adults. METHOD: A randomized single-blind clinical trial with a three-month follow-up was carried out at three emergency rooms from October 2004 to November 2005; subjects assessed were 16-25 years old treated for alcohol related events up to 6 hours after consumption. Socio-demographic data, quantity, frequency and negative consequences of alcohol consumption, motivation to change habits and future risk perception were evaluated. Statistical analysis was performed on subjects who completed follow-up (completers). ANCOVA model was used to analyze the difference between the intervention groups with statistical significance level α = 5% and confidence interval (CI) of 95%. RESULTS: 186 subjects formed the initial sample, being 175 included and randomized to the educational brochure group (n = 88) or motivational interviewing group (n = 87). Follow-up assessment was performed in 85.2% of the sample. No significant difference between groups was observed. However, significant reductions (p < 0.01) in related problems and alcohol abuse were found in both groups. CONCLUSION: In this sample a reduction of alcohol use and related problems was observed. Preliminary data indicate that controlled clinical trials with motivational interviewing, educational brochure and nonintervention should be of future interest among Brazilian adolescent populations.
Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Entrevista Psicológica/métodos , Motivação , Folhetos , Educação de Pacientes como Assunto/métodos , Adolescente , Adulto , Transtornos Relacionados ao Uso de Álcool/psicologia , Alcoolismo , Brasil , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Entrevista Psicológica/normas , Masculino , Método Simples-Cego , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: To evaluate the effectiveness of brief motivational interviewing and an educational brochure when delivered in emergency room to reduce alcohol abuse and related problems among adolescents and young adults. METHOD: A randomized single-blind clinical trial with a three-month follow-up was carried out at three emergency rooms from October 2004 to November 2005; subjects assessed were 16-25 years old treated for alcohol related events up to 6 hours after consumption. Socio-demographic data, quantity, frequency and negative consequences of alcohol consumption, motivation to change habits and future risk perception were evaluated. Statistical analysis was performed on subjects who completed follow-up (completers). ANCOVA model was used to analyze the difference between the intervention groups with statistical significance level α = 5 percent and confidence interval (CI) of 95 percent. RESULTS: 186 subjects formed the initial sample, being 175 included and randomized to the educational brochure group (n = 88) or motivational interviewing group (n = 87). Follow-up assessment was performed in 85.2 percent of the sample. No significant difference between groups was observed. However, significant reductions (p < 0.01) in related problems and alcohol abuse were found in both groups. CONCLUSION: In this sample a reduction of alcohol use and related problems was observed. Preliminary data indicate that controlled clinical trials with motivational interviewing, educational brochure and nonintervention should be of future interest among Brazilian adolescent populations.
OBJETIVO: Avaliar a efetividade da entrevista motivacional breve e de uma brochura educativa quando aplicadas em prontos-socorros para reduzir o abuso e problemas relacionados ao álcool entre os jovens. MÉTODO: Um ensaio clínico randomizado simples-cego com três meses de seguimento foi realizado em três prontos-socorros de outubro de 2004 a novembro de 2005, com indivíduos de 16-25 anos tratados por eventos relacionados ao álcool com até 6 horas após o consumo. Dados sociodemográficos, quantidade, frequência e consequências negativas, motivação para mudanças de hábitos e percepção para riscos do consumo de álcool foram avaliados. A análise estatística foi realizada em indivíduos que completaram o seguimento (completados). Modelo de ANCOVA foi utilizado para analisar a diferença entre os grupos de intervenção, com nível de significância estatística α = 5 por cento e intervalo de confiança (IC) de 95 por cento. RESULTADOS: 186 indivíduos formaram a amostra inicial, sendo n = 175 incluídos e randomizados para brochura educativa (n = 88) ou grupo entrevista motivacional breve (n = 87). O seguimento de avaliação foi realizado em 85,2 por cento da amostra. Não foi observada diferença significativa entre os grupos. No entanto, uma redução significativa (p < 0,01) em problemas relacionados eo abuso de álcool foram encontrados em ambos os grupos. CONCLUSÃO: Nesta amostra, a redução do abuso de álcool e problemas relacionados foi observada. Dados preliminares indicam que os ensaios clínicos controlados com entrevista motivacional breve, brochura educativa e não-intervenção deveriam ser de futuro interesse entre a população adolescente brasileira.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Entrevista Psicológica/métodos , Motivação , Folhetos , Educação de Pacientes como Assunto/métodos , Transtornos Relacionados ao Uso de Álcool/psicologia , Alcoolismo , Brasil , Serviço Hospitalar de Emergência , Seguimentos , Entrevista Psicológica/normas , Inquéritos e Questionários , Método Simples-Cego , Fatores SocioeconômicosRESUMO
This article concerns the first phase of the cross-cultural equivalence of Section A in the Cambridge Examination for Mental Disorders of the Elderly-Revised Version (CAMDEX-R), a clinical interview for dementia diagnosis. Evaluating conceptual and item equivalencies involved a literature review and expert groups. Semantic equivalence involved translations of the original into Portuguese and back-translations, with analysis of the versions and the original text; meetings with experts; discussions with 52 elders using the focus group technique; further meeting with experts; pretesting on 35 elders; and elaboration of the final version. For the reliability analysis, the version was applied to 160 patients. Inter-observer reliability was nearly perfect in all sub-sections of present state and in individual items of past medical history. Test-retest reliability was moderate or higher in the sub-sections and substantial or nearly perfect in 70% of the items in past history. The Brazilian version shows satisfactory equivalence to the original and good reliability levels.
Assuntos
Demência/diagnóstico , Avaliação Geriátrica/métodos , Entrevista Psicológica/normas , Traduções , Idoso , Idoso de 80 Anos ou mais , Brasil , Comparação Transcultural , Características Culturais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes , Fatores SocioeconômicosRESUMO
The demobilisation of guerrillas and paramilitaries in Colombia, also known as irregular armed groups, has raised the question among mental health professionals as to whether ex-combatants who have had repeated exposure to stressful events might meet the requirements for posttraumatic stress disorder (PTSD). Upon arrival at a psychiatric clinic in Bogotá, 76 patients were evaluated by a group of mental health professionals with experience in this diagnosis. Contrary to clinicians' expectations, there was a conspicuous lack of PTSD among this population. Subsequently, the clinical team administered the Clinician Administered PTSD Scale with 21 of these patients; PTSD was found in 57% of the men. The authors consider various arguments that might explain this discrepancy. Differences between the clinical presentation of PTSD among the ex-combatants and the classic descriptions contained in the DSM-IV-TR may be explained by organisational characteristics of the irregular armed groups. Further research is necessary which focuses on the mental health of populations in the context of political violence, such as those encountered in Colombia.
Assuntos
Entrevista Psicológica/métodos , Militares/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Veteranos/psicologia , Adolescente , Adulto , Colômbia/epidemiologia , Comorbidade , Escolaridade , Humanos , Entrevista Psicológica/normas , Masculino , Estado Civil , Pessoa de Meia-Idade , Política , Pobreza , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Adulto JovemRESUMO
OBJECTIVES: The Schedule for the Assessment of Insight - Expanded Version consists of 11 items that encompass: awareness of having a mental illness, ability to rename psychotic phenomena as abnormal, and compliance with treatment. The objective of the study was to evaluate the inter-rater reliability and to study the factorial structure of the Brazilian version of the instrument. METHOD: The Brazilian version of the Schedule for the Assessment of Insight - Expanded Version was used for the assessment of insight of 109 psychotic inpatients, 60 of whom had the interview tape-recorded in order to be scored by an independent evaluator. Intraclass correlation coefficient (ICC) was adopted as the inter-rater reliability coefficient. In the factor analysis, principal components analysis and Varimax rotation were adopted. RESULTS: Inter-rater reliability coefficients from good to excellent were found for the individual items of the Schedule for the Assessment of Insight - Expanded Version with ICC values ranging from 0.54 to 0.82. Regarding the total score, inter-rater reliability was excellent, with ICC = 0.90. A factorial structure similar to the one obtained by the original version of the Schedule for the Assessment of Insight - Expanded Version was found, with 3 factors accounting for 71.72 percent of variance. CONCLUSION: In the Brazilian context, the Schedule for the Assessment of Insight - Expanded Version presented good inter-rater reliability and factorial structure compatible to the insight dimensions that are intended to be evaluated.
OBJETIVOS: O Schedule for the Assessment of Insight - Expanded Version é constituído por 11 itens que abordam: reconhecimento de se ter um transtorno mental, capacidade de renomear fenômenos psicóticos como anormais e adesão ao tratamento. O objetivo do estudo foi avaliar a confiabilidade entre avaliadores e estudar a estrutura fatorial da versão brasileira do Schedule for the Assessment of Insight - Expanded Version. MÉTODO: A versão brasileira do Schedule for the Assessment of Insight - Expanded Version foi utilizada na avaliação de 109 pacientes psicóticos internados, dos quais 60 tiveram a entrevista gravada para atribuição de escores por avaliador independente. O coeficiente de correlação intraclasse (ICC) foi utilizado na avaliação da confiabilidade entre avaliadores. Para a análise fatorial foram adotadas análise de componentes principais e rotação varimax. RESULTADOS: A confiabilidade entre avaliadores para os itens do Schedule for the Assessment of Insight - Expanded Version encontrada esteve entre boa e excelente, com ICC variando de 0,54 a 0,82; para o escore total foi excelente, com ICC = 0,90. Uma estrutura fatorial semelhante à obtida para a versão original do Schedule for the Assessment of Insight - Expanded Version foi encontrada, com três fatores explicando 71,72 por cento da variação. CONCLUSÃO: No contexto brasileiro, o Schedule for the Assessment of Insight - Expanded Version apresentou boa confiabilidade entre avaliadores e estrutura fatorial compatível com as dimensões do insight que pretende avaliar.
Assuntos
Adulto , Feminino , Humanos , Masculino , Conscientização , Entrevista Psicológica/métodos , Entrevista Psiquiátrica Padronizada/normas , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Análise de Variância , Brasil , Entrevista Psicológica/normas , Idioma , Variações Dependentes do Observador , Cooperação do Paciente , Psicometria , Reprodutibilidade dos Testes , Esquizofrenia/diagnóstico , TraduçãoRESUMO
OBJECTIVES: The Schedule for the Assessment of Insight - Expanded Version consists of 11 items that encompass: awareness of having a mental illness, ability to rename psychotic phenomena as abnormal, and compliance with treatment. The objective of the study was to evaluate the inter-rater reliability and to study the factorial structure of the Brazilian version of the instrument. METHOD: The Brazilian version of the Schedule for the Assessment of Insight - Expanded Version was used for the assessment of insight of 109 psychotic inpatients, 60 of whom had the interview tape-recorded in order to be scored by an independent evaluator. Intraclass correlation coefficient (ICC) was adopted as the inter-rater reliability coefficient. In the factor analysis, principal components analysis and Varimax rotation were adopted. RESULTS: Inter-rater reliability coefficients from good to excellent were found for the individual items of the Schedule for the Assessment of Insight - Expanded Version with ICC values ranging from 0.54 to 0.82. Regarding the total score, inter-rater reliability was excellent, with ICC = 0.90. A factorial structure similar to the one obtained by the original version of the Schedule for the Assessment of Insight - Expanded Version was found, with 3 factors accounting for 71.72% of variance. CONCLUSION: In the Brazilian context, the Schedule for the Assessment of Insight - Expanded Version presented good inter-rater reliability and factorial structure compatible to the insight dimensions that are intended to be evaluated.
Assuntos
Conscientização , Entrevista Psicológica/métodos , Entrevista Psiquiátrica Padronizada/normas , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Adulto , Análise de Variância , Brasil , Feminino , Humanos , Entrevista Psicológica/normas , Idioma , Masculino , Variações Dependentes do Observador , Cooperação do Paciente , Psicometria , Reprodutibilidade dos Testes , Esquizofrenia/diagnóstico , TraduçãoRESUMO
OBJECTIVE: To study the concurrent validity of the Brazilian Composite International Diagnostic Interview 2.1 using as gold standard the clinical diagnoses based on the ICD-10 criteria and the Longitudinal, Expert, All Data (LEAD) procedure. METHOD: The sample was composed of 185 subjects selected at psychiatric hospitals, psychiatric outpatient units, the community, and primary care services. These individuals were intentionally selected according to 9 diagnostic groups. INSTRUMENTS: Composite International Diagnostic Interview (CIDI-core) version 2.1 (paper-and-pencil) administered by 16 trained interviewers. ANALYSIS: concurrent validity of diagnoses of the Composite International Diagnostic Interview 12-month. RESULTS: Values found for sensitivity and specificity in each diagnosis were: alcohol-related disorders (79.5%/97.2%); psychoactive substance-related disorders (77.3%/100%); schizophrenia and other psychotic disorders (28.6%/93.9%); manic episode and bipolar affective disorder (38.9%/96.4%); depressive disorder (82.5%/ 93.8%); phobic-anxiety disorder (80.6%/93.5%); obsessive-compulsive disorder (18.2%/98.9%); somatoform disorder (41.7%/90.8%); eating disorder (45.5%/100.0%). CONCLUSION: The Composite International Diagnostic Interview proved to be valid for diagnoses of alcohol-related disorders, psychoactive substance-related disorders, depressive disorder and phobic-anxiety disorder. The probable explanations for the poor performance for the other diagnoses were: necessity of some clinical judgement by the lay interviewer; difficulty to use the Probe Flow Chart; interviewees' difficulty of understanding; and lack of mechanisms to certify the veracity of the information.
Assuntos
Manual Diagnóstico e Estatístico de Transtornos Mentais , Entrevista Psicológica/normas , Transtornos Mentais/diagnóstico , Serviços de Saúde Mental , Adolescente , Adulto , Idoso , Brasil , Comparação Transcultural , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Feminino , Humanos , Masculino , Transtornos Mentais/classificação , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/diagnóstico , Reprodutibilidade dos Testes , Esquizofrenia/diagnóstico , Sensibilidade e Especificidade , Transtornos Somatoformes/diagnóstico , TraduçõesRESUMO
OBJECTIVE: To study the concurrent validity of the Brazilian Composite International Diagnostic Interview 2.1 using as gold standard the clinical diagnoses based on the ICD-10 criteria and the Longitudinal, Expert, All Data (LEAD) procedure. METHOD: The sample was composed of 185 subjects selected at psychiatric hospitals, psychiatric outpatient units, the community, and primary care services. These individuals were intentionally selected according to 9 diagnostic groups. Instruments: Composite International Diagnostic Interview (CIDI-core) version 2.1 (paper-and-pencil) administered by 16 trained interviewers. Analysis: concurrent validity of diagnoses of the Composite International Diagnostic Interview 12-month. RESULTS: Values found for sensitivity and specificity in each diagnosis were: alcohol-related disorders (79.5 percent/97.2 percent); psychoactive substance-related disorders (77.3 percent/100 percent); schizophrenia and other psychotic disorders (28.6 percent/93.9 percent); manic episode and bipolar affective disorder (38.9 percent/96.4 percent); depressive disorder (82.5 percent/ 93.8 percent); phobic-anxiety disorder (80.6 percent/93.5 percent); obsessive-compulsive disorder (18.2 percent/98.9 percent); somatoform disorder (41.7 percent/90.8 percent); eating disorder (45.5 percent/100.0 percent). CONCLUSION: The Composite International Diagnostic Interview proved to be valid for diagnoses of alcohol-related disorders, psychoactive substance-related disorders, depressive disorder and phobic-anxiety disorder. The probable explanations for the poor performance for the other diagnoses were: necessity of some clinical judgement by the lay interviewer; difficulty to use the Probe Flow Chart; interviewees' difficulty of understanding; and lack of mechanisms to certify the veracity of the information.
OBJETIVO: Validação concorrente da versão brasileira do Composite International Diagnostic Interview 2.1, utilizando como padrão ouro o diagnóstico médico baseado nos critérios diagnósticos da CID-10 e critérios Longitudinal, Experts Clinicians, All Data (LEAD). MÉTODO: Amostra composta por 185 indivíduos procedentes de hospitais psiquiátricos, ambulatórios de especialidades psiquiátricas, serviços comunitários e atenção primária à saúde, selecionados intencionalmente segundo nove grupos diagnósticos. Instrumentos: CIDI 2.1 (lápis e papel), versão para diagnósticos ao longo da vida, aplicado por 16 entrevistadores treinados. Análise: validade concorrente dos diagnósticos do Composite International Diagnostic Interview no último ano. RESULTADOS: Os valores encontrados de sensibilidade e especificidade foram: transtornos decorrentes do uso de álcool (79,5 por cento/97,2 por cento); transtornos decorrentes do uso de substâncias psicoativas (77,3 por cento/100 por cento); esquizofrenia e outros transtornos psicóticos (28,6 por cento/93,9 por cento); episódio maníaco e transtorno afetivo bipolar (38,9 por cento/96,4 por cento); transtorno depressivo (82,5 por cento/93,8 por cento); transtorno fóbico-ansioso (80,6 por cento/93,5 por cento); transtorno obsessivo-compulsivo (18,2 por cento/98,9 por cento); transtorno somatoforme (41,7 por cento/90,8 por cento); e transtorno alimentar (45,5 por cento/100,0 por cento). CONCLUSÃO: O Composite International Diagnostic Interview mostrou-se válido para os diagnósticos de transtornos decorrentes do uso de álcool e substâncias psicoativas, transtorno depressivo e transtorno fóbico-ansioso. As prováveis explicações para o pior desempenho nos demais diagnósticos foram: necessidade de algum julgamento clínico do entrevistador leigo; dificuldade no manuseio do Diagrama de Especificação de Resposta; dificuldade de compreensão dos entrevistados; e falta de mecanismos para atestar a veracidade das informações.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Entrevista Psicológica/normas , Transtornos Mentais/diagnóstico , Serviços de Saúde Mental , Brasil , Comparação Transcultural , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos Mentais/classificação , Serviços de Saúde Mental/normas , Serviços de Saúde Mental/estatística & dados numéricos , Transtorno Obsessivo-Compulsivo/diagnóstico , Reprodutibilidade dos Testes , Esquizofrenia/diagnóstico , Sensibilidade e Especificidade , Transtornos Somatoformes/diagnóstico , TraduçõesRESUMO
OBJECTIVE: To present the translation and validation of the Brief Social Phobia Scale for use in Brazilian Portuguese, to develop a structured interview guide in order to systemize its use and to perform a preliminary study of inter-rater reliability. METHOD: The instrument was translated and adapted to Portuguese by specialists in anxiety disorders and rating scales. A structured interview guide was created with the aim of covering all of the items of the instrument and grouping them into six categories. Specialists in mental health evaluated the guide. These professionals also watched the videotaped interviews of patients with and without social anxiety disorders, and, based on the interview guide, they rated the scale to evaluate its reliability. RESULTS: No semantic or linguistic adjustments were needed. For the complete scale, the general evaluation showed a percentage of agreement of 0.84 and intraclass coefficient of 0.91. The mean inter-rater correlation was 0.84. CONCLUSIONS: The Portuguese-language version of the Brief Social Phobia Scale is available for use in the Brazilian population, with rather acceptable indicators of inter-rater reliability. The interview guide was useful in providing these values. Further studies are needed in order to improve the reliability and to study other psychometric properties of the instrument.
Assuntos
Transtornos Fóbicos , Inquéritos e Questionários/normas , Traduções , Comparação Transcultural , Humanos , Entrevista Psicológica/normas , Psicometria/normas , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: To present the translation and validation of the Brief Social Phobia Scale for use in Brazilian Portuguese, to develop a structured interview guide in order to systemize its use and to perform a preliminary study of inter-rater reliability. METHOD: The instrument was translated and adapted to Portuguese by specialists in anxiety disorders and rating scales. A structured interview guide was created with the aim of covering all of the items of the instrument and grouping them into six categories. Specialists in mental health evaluated the guide. These professionals also watched the videotaped interviews of patients with and without social anxiety disorders, and, based on the interview guide, they rated the scale to evaluate its reliability. RESULTS: No semantic or linguistic adjustments were needed. For the complete scale, the general evaluation showed a percentage of agreement of 0.84 and intraclass coefficient of 0.91. The mean inter-rater correlation was 0.84. CONCLUSIONS: The Portuguese-language version of the Brief Social Phobia Scale is available for use in the Brazilian population, with rather acceptable indicators of inter-rater reliability. The interview guide was useful in providing these values. Further studies are needed in order to improve the reliability and to study other psychometric properties of the instrument.
OBJETIVO: Apresentar a tradução e validação da Brief Social Phobia Scale para o português, um roteiro de perguntas-guia para sistematizar sua aplicação e o estudo preliminar da confiabilidade inter-avaliadores. MÉTODO: O instrumento foi traduzido e adaptado para o português por especialistas em transtornos de ansiedade e escalas de avaliação. Um roteiro de perguntas-guia foi elaborado de modo a abranger todos os itens do instrumento, agrupando-os em seis categorias. O roteiro foi submetido à avaliação de profissionais de saúde mental. Tais profissionais também assistiram a entrevistas gravadas em videotape de pacientes com e sem transtorno de ansiedade social, as quais tiveram como referência o roteiro para pontuar a escala para o cálculo da confiabilidade. RESULTADOS: Não foram necessárias reformulações e adaptações semânticas e lingüísticas. Para a escala total, a concordância geral foi 0.84 e o coeficiente de correlação intraclasse 0.91. O nível médio de concordância dos avaliadores foi 0.84. CONCLUSÕES: a versão para o português está disponível para uso na população brasileira, apresentando indicadores preliminares de confiabilidade inter-avaliadores bastante aceitáveis, sendo que o uso do roteiro de perguntas-guia foi bastante útil para favorecer tais valores. Futuros estudos são necessários para aprimorar o valor desta e das demais propriedades psicométricas do instrumento.
Assuntos
Humanos , Transtornos Fóbicos , Inquéritos e Questionários/normas , Traduções , Comparação Transcultural , Entrevista Psicológica/normas , Psicometria/normas , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: This population-based study aimed to compare the prevalence rates of social phobia using DSM-III-R and CID-10, based on the Composite International Diagnostic Interview (CIDI), in a Brazilian community. METHODS: This survey was carried out in a representative sample of 1,041 residents from Bambuí, Minas Gerais, Brazil (attrition rate = 14.7%). The Brazilian version of the CIDI was used. One-month, one-year and lifetime social phobia prevalence rates were estimated, employing the DSM-III-R and ICD-10 classifications, using the CIDI computer program. RESULTS: One-month, one-year, and life prevalence rates of social phobia, based on the DSM-III-R (7.9, 9.0 and 11.7% respectively) were higher than those based on the ICD-10 (4.7, 5.2 and 6.7% respectively; p < 0.01 for all). CONCLUSION: Our results reinforce the hypothesis that the prevalence of social phobia is higher when based on the DSM-III-R compared to the ICD-10 classification.
Assuntos
Entrevista Psicológica/métodos , Transtornos Fóbicos/diagnóstico , Adolescente , Adulto , Brasil/epidemiologia , Diagnóstico por Computador , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Classificação Internacional de Doenças/normas , Entrevista Psicológica/normas , Masculino , Transtornos Fóbicos/epidemiologia , Prevalência , Fatores SexuaisRESUMO
OBJETIVO: Este estudo populacional visa comparar estimativas de prevalência de fobia social empregando-se a CID-10 e a DSM-III-R em uma comunidade brasileira. MÉTODOS: O levantamento foi realizado em uma amostra representativa de 1.041 residentes de Bambuí, Minas Gerais, Brasil (perda = 14,7%). Foi utilizada a versão brasileira da Composite International Diagnostic Interview (CIDI). As prevalências de 1 mês, 1 ano e vida foram estimadas empregando-se as classificacões CID-10 e DSM-III-R, utilizando-se o programa de computador da CIDI. RESULTADOS: As prevalências de 1 mês, 1 ano e vida da fobia social, baseadas na DSM-III-R (7,9, 9,0 e 11,7% respectivamente) foram mais elevadas que aquelas baseadas na CID-10 (4,7, 5,2 e 6,7%, respectivamente; p < 0,01 para todos). CONCLUSAO: Nossos resultados reforcam a hipótese de que as taxas de prevalência de fobia social são mais elevadas quando baseadas na DSM-III-R em comparacão com a CID-10.
Assuntos
Adolescente , Adulto , Humanos , Masculino , Feminino , Manual Diagnóstico e Estatístico de Transtornos Mentais , Classificação Internacional de Doenças , Entrevista Psicológica/métodos , Transtornos Fóbicos/diagnóstico , Brasil/epidemiologia , Diagnóstico por Computador , Classificação Internacional de Doenças/normas , Entrevista Psicológica/normas , Transtornos Fóbicos/epidemiologia , Prevalência , Fatores SexuaisRESUMO
INTRODUCTION: Previous studies have suggested that lack of insight into mental disorder can be an important predicting factor involving the course of psychotic disorders mainly regarding compliance with treatment. The Scale to Assess Unawareness of Mental Disorder--SUMD is a semi-structured open interview that evaluates global insight, insight into illness and insight into symptoms. The SUMD has shown good reliability and validity and has demonstrated certain advantages over previous measures of insight, suggesting the usefulness of a multidimensional view of this complex concept. OBJECTIVE: The aim of this study is to translate, adapt and test the reliability of the SUMD in schizophrenic patients. METHODS: This study involved 35 schizophrenic patients according to the DSM-IV criteria, who where under treatment in the Schizophrenia Program of the Federal University of São Paulo. Two independent examiners conducted the reliability study simultaneously. RESULTS: The results demonstrated that the SUMD achieved a good intraclass reliability coefficients between investigators--ICC ranged from 0.55 to 0.97--for the general items to assess awareness of mental disorder and 0.56 to 0.98--for the symptoms items. DISCUSSION: These coefficients were similar to those found by the researchers who developed this scale. The SUMD scale has proven to be easily applied and may be deemed an useful instrument with good psychometrics capacities in researches involving schizophrenic subjects.
Assuntos
Conscientização , Conhecimentos, Atitudes e Prática em Saúde , Entrevista Psicológica/normas , Escalas de Graduação Psiquiátrica/normas , Psicologia do Esquizofrênico , Adulto , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Esquizofrenia , TraduçõesRESUMO
INTRODUÇAO: Estudos sugerem que a falta de insight para a doença mental pode ser um fator preditivo de mau prognóstico no curso dos transtornos psicóticos, principalmente em relação à adesão ao tratamento. A Escala para Avaliar a Ausência de Noção do Transtorno Mental - SUMD é uma entrevista aberta semi-estruturada que avalia o insight global do paciente, para a doença e para seus sintomas. A SUMD tem demonstrado boa confiabilidade e validade devido a sua característica multidimensional e, também, apresentado vantagens em relação a outros instrumentos que avaliam o insight. OBJETIVO: O objetivo deste estudo foi traduzir, adaptar e testar a confiabilidade da SUMD em pacientes com esquizofrenia. MÉTODOS: Foram avaliados 35 pacientes com diagnóstico de esquizofrenia pelo DSM-IV, do Programa de Esquizofrenia da UNIFESP/EPM, através da SUMD, por dois entrevistadores independentes. RESULTADOS: Os resultados do estudo de confiabilidade demonstraram que a SUMD apresentou bons coeficientes de confiabilidade intraclasse entre os investigadores, com coeficientes variando entre 0,55 e 0,97 para os itens gerais e de 0,56 a 0,98 para os itens de sintomas específicos. DISCUSSAO: Estes coeficientes foram similares aos encontrados pelos investigadores que desenvolveram a escala. A SUMD mostrou ser de fácil aplicação, demonstrando ser um instrumento útil e com boas propriedades psicométricas na avaliação do insight em pacientes com esquizofrenia em nosso meio.