Reliability and Validity of the Korean Version of GMS-AGECAT / 신경정신의학

OBJECTIVES: This study aims to confirm the reliability and validity of the GMS-AGECAT(Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy in a Korean elderly population. METHODS: Translation committee developed Korean version GMS translating GMS-A3 after preliminary studies. Few changes from the original English version were necessary. A random sample(N= 1256 of the elderly(65+ years in Asan, community was assessed for diagnostic validity. A two-phase study was designed: Korean version of GMS-AGECAT, MMSE and GDS rated by lay interviewer and clinical assessment by psychiatrists according to DSM-IV. A consecutive hospital sample(N=28 of the elderly(65+ years admitted in Hangang Sacred Heart Hospital was assessed for reliability, concurrent & procedural validity. RESULTS: Reliability coefficients of GMS-AGECAT diagnosis were Inter-rater kappa 0.78 and test-retest kappa 0.56. Correlation coefficients for concurrent validity were 0.76 with MMSE and 0.73 with GDS. Procedural validity of psychiatrist's GMS-AGECAT diagnosis and lay-interviewers' were as follow: case/ no case distinction sensitivity 95.5%, specificity 75%; organicity distinction sensitivity 100%, specificity 83.3% and depression distinction, sensitivity 92.3%, specificity 100%. Diagnostic validity of DSM-IV diagnoses and GMS-AGECAT diagnoses were: case/ no case distinction sensitivity 92.7%, specificity 81%, dementia distinction sensitivity 77.3%, specificity 92.1% and depression distinction sensitivity 83.6%, specificity 84.1%. CONCLUSIONS: This study confirms the reliability and validity of the GMS-AGECAT in Korean elderly. Korean version GMS can be used in the international comparison studies.

Development and Validation of DIS-IV, Korean Version / 신경정신의학

OBJECTIVE: Appearance of DSM-IV has influenced greatly on the nosological classification of mental disorder, not considered as revised one of DSM-III-R but a new criteria. DIS-IV has been developed after revision of DIS-III in consideration of various changes in DSM-IV. This study is to develop and validate the DIS-IV, Korean version to activate Korean psychiatric research much more and to modivate more frequent international collaborative study. METHOD: Translation committee produced DIS-IV, Korean version through all the procedures of translation, back-translation, confirmation of retained original meaning of the English version, adaptation to Korean linguistic usage and preliminary study. Four medical students were trained during DIS-IV training course that retained the same contents and methods as of Washington University. Inter-rater reliability was measured by comparison between two diagnoses made from two interviewer who rated one patient at the same time. Procedural validity was measured by comparison between lay-interviewer's diagnosis and psychiatrist's diagnosis which were made after independent DIS-IV using interview. Subjects were 124 patients who were being treated at two University Hospital and National Forensic Psychiatric Hospital between January, 2000 and August, 2000. RESULTS: Average kappa value of inter-rater reliability was 0.74. Diagnoses showing over 0.7 in kappa value were bipolar I disorder, generalized anxiety disorder, depressive disorder, obsessive-compulsive disorder, oppositional defiant disorder, pain disorder, pathological gambling, post-traumatic stress disorder, specific phobia and almost all substance use disorder or substance- related disorder. Procedural validity, that compared lay-interviewer's diagnosis and psychiatrist's diagnosis, were as follows;For all diagnoses, sensitivity, specificity and kappa were 67.6%, 98.3% and 0.69. For diagnoses of substance use disorder or substance- related disorder, sensitivity, specificity and kappa were 79%, 98% and 0.77. For other diagnoses except substance use disorder or substance- related disorder, sensitivity, specificity and kappa were 60.5%, 98% and 0.64. This results are almost at the same level as that of Robins and her colleagues who first reported reliability and validity of DIS. CONCLUSION: We think that DIS-IV, Korean version has higher reliability and validity. It is very important that diagnoses of substance use disorder and substance-related disorder can be made reliably and validly by this instrument. We expect that it can help to improve diagnosability of mental disorder, activate clinical research and increase international scientific communication.

Comparison Study of Quality of Life in Depressed, Demented and Normal Elderly

The elderly people are often afflicted with chronic illnesses of which depression and dementia comprise substantial proportion. The authors tried to figure out the impact of depression and dementia on the quality of life of elderly. 1,300 community residents over 65 years of age were selected by random sampling. Using Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy, the authors selected 3 groups of subjects, namely dementia group (N=113), depression group (N=157), normal control group (N=289). The 3 groups of subjects were examined with General Health Questionnaire 12-Quality of Life, Geriatric Depression Scale, Mini-Mental State Exam-K, and Physical Self-Maintenance Scale. The results were compared between groups and the correlations of each scales were examined. The quality of life was lower in the older, female, lower educational groups. The quality of life was significantly lower in dementia group and depression group than in normal elderly group. The subjective quality of life of depressed elderly got lower with increasing severity of depression. Demented elderly had low quality of life but no correlation was found between subjective quality of life and severity of depression. The score of Mini-Mental State Exam-K was found to have significant correlation with the quality of life in demented group. The quality of life of normal elderly and those with dementia had significant correlation with Physical Self-Maintenance Scale. Conclusively, the quality of life was decreased in both normal elderly group and dementia group. The severity of depressive symptoms were correlated with the decrease of quality of life in depression group, whereas the degree of cognitive impairment had significant correlation with quality of life in dementia group. Therefore, the subjective quality of life must be considered in the treatment of the depression and dementia, and further study about the relation between psychopathology and the various aspects of living and the quality of life in the elderly is needed.