Stress and Adjustment Disorder Section of WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN)--Thai version: validity and reliability study.

OBJECTIVES: To determine the validity and reliability of the Thai version of the Stress and Adjustment Disorder section of WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN) version 2.1. MATERIAL AND METHOD: The SCAN interview version 2.1 Stress and Adjustment Disorder section was translated into Thai and its content validity tested by back translation. The linguistic clarity of the psychiatric schedules for Thais from the country's four regions was tested by psychiatrists competent in the use of the schedules and aware of their underlying objectives. The reliability of SCAN: Stress and Adjustment Disorder section was tested between June and November 2006 on 30 participants, including 18 patients with stress-related disorders (adjustment disorder post-traumatic stress disorder, acute stress reaction) and 12 normal volunteers. RESULTS: Based on reactions from the sample and consultations from competent psychiatrists, content validity was established The duration of interviews for the Stress and Adjustment Disorder section averaged 17.92 min (25.59 for patients with stress-related disorders and 6.41 for normal subjects). The respective mean inter- and intra-rater reliability kappa was 0.90 (SD = 0.12) and 0.94 (SD = 0.09). A respective 77.05% and 85.26% of the items reached a substantial to almost perfect level of inter- and intra-rater agreement. CONCLUSION: The Stress and Adjustment Disorder section of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version) is demonstrably an effective tool for diagnosing stress-related disorders among Thais.

Validity and reliability of WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN)-Thai version: Cognitive Impairment or Decline Section.

OBJECTIVE: To determine the validity and reliability of the Thai version of the Cognitive Impairment or Decline section of WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN) version 2.1. MATERIAL AND METHOD: The SCAN interview version 2.1 Cognitive Impairment or Decline Section was translated into Thai and its content validity tested by back translation. Psychiatrists competent in the use of the schedules and aware of their underlying objectives tested the linguistic clarity of the psychiatric schedules for Thais from the country's four regions. The reliability of SCAN: Cognitive Impairment or Decline Section was tested between June and November 2005 on 30 participants, including 15 patients with cognitive impairment and 15 normal volunteers. RESULTS: Based on reactions from Thais and consultations from competent psychiatrists, content validity was indeed established. The duration of interviews for the Cognitive Impairment or Decline Section averaged 48.99 min (59.71 for patients with cognitive impairment and 33.77 for normal subjects). The respective mean inter- and intra-rater reliability kappa was 0.72 (SD = 0.31) and 0.78 (SD = 0.23). The reliability of the majority of items reached a substantial to almost perfect level; however, three items (3.66%) had poor and nine (6.67%) only slight inter-rater agreement. Some items needed clarification of the scoring method. The respective inter- and intra-rater reliability of the continuous data was 0.93 and 0.96. CONCLUSION: The Cognitive Impairment or Decline Section of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version) is demonstrably an effective tool for diagnosing cognitive impairment disorders among Thais.

Validity and reliability study of the Thai version of WHO schedules for clinical assessment in neuropsychiatry: sections on psychotic disorders.

OBJECTIVE: To determine the validity and reliability of the Thai version of the WHO Psychotic Disorders Sections of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Version 2.1 MATERIAL AND METHOD: The SCAN interview version 2.1 Psychotic Symptoms Sections (Section 16: Perceptual disorders other than hallucinations, Section 17: Hallucinations, Section 18: Experiences of thought disorder and replacement of will, and Section 19: Delusions) were translated into Thai. The content validity of the translation was established by comparing a back-translation of the Thai version to the English original. Whenever inconsistencies were encountered, the Thai version was adapted to convey the meaning of the original. The revised Thai version was then field-tested in 4 regions (Suanprung Psychiatric Hospital, Jitavejkhonkaen Hospital, Srithanya Hospital and Suansaranrom Psychiatric Hospital, each place comprised 20 volunteers ) for comprehensibility of the relatively technical language. Between October 2004 and July 2006, thirty persons were recruited for the reliability study (16 males; 14 females). Sixteen persons were schizophrenic patients (9 males; 7 females) and 14 (7 males; 7 females) were normal persons or nonpsychotic psychiatric patients. Education and occupations varied widely. The subjects were interviewed by a psychiatrist competent in using the Thai version of SCAN and these interviews were recorded on video for later re-rating. RESULTS: Based on the response from Thai subjects and consultations with competent psychiatrists, content validity was established The time taken to interview a schizophrenic patient averaged 140.2 +/- 36.0 minutes (range, 75-193) vs. 81.9 +/- 25.9 minutes (range, 48-124) for a comparison subject. The respective mean +/- SD of inter-rater reliability (kappa) of Section 16, 17, 18 and 19 was 0.66 +/- 0.17, 0.71 +/- 0.16, 0. 70 +/- 0.22 and 0.64 +/- 0.23. Some items in some sections had 100 percent agreement between raters. The respective intra-rater reliability was 0.65 +/- 0. 11, 0. 74 +/- 0.17, 0.86 +/- 0.17 and 0.80 +/- 0.18. Some sections had items with 100 percent agreement from the same rater even when rated 2 weeks apart. More than half of the items in each section had kappa values, both inter-rater and intra-rater, at least in substantial level. CONCLUSION: The Thai version of the Psychotic Disorders Sections of SCAN version 2.1 proved to be a valid and reliable tool for assessing psychotic symptoms among Thais.

The incidence of clozapine-induced leukopenia in patients with schizophrenia at Srinagarind Hospital.

OBJECTIVE: Define the incidence of clozapine-induced leukopenia, neutropenia, and agranulocytosis in patients with schizophrenia at Srinagarind Hospital. MATERIAL AND METHOD: A descriptive study was done by retrospective reviews of the medical records of schizophrenic outpatients at psychiatric clinic in Srinagarind Hospital who had received clozapine from January 1st, 2003 to December 31st, 2005. The demographic data, incidence rate, and incidence density of leukopenia, neutropenia, and agranulocytosis were collected. RESULTS: One hundred and seventeen medical records were reviewed, 65 patients met the inclusion criteria. One patient developed neutropenia. The incidence rate of neutropenia was 1.5% and the incidence density of neutropenia was 0.01/year. No leukopenia or agranulocytosis was found in the present study. The complete blood counts were not obtained regularly due to the problems of patient's adherence and variations in practice among the physicians. CONCLUSION: Neutropenia is uncommon. No leukopenia and agranulocytosis were found. According to variations of incidence reports among different studies, the monitoring of white blood count should be continued.

The validity and reliability of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version): anxiety disorders section.

BACKGROUND: Anxiety disorders are some of the most prevalent psychiatric disorders, have early onset, are chronic and can cause functional impairment. It is, therefore, crucial to establish an accurate diagnosis for treatment and research purposes. OBJECTIVE: To test the validity and reliability of the W.H.O. Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version): Anxiety Disorders Section. MATERIAL AND METHOD: The linguistic clarity of the psychiatric schedules for Thais was tested by psychiatrists from the country's four regions. The psychiatrists were competent in the use of the schedules and their underlying objectives. Then between October 2004 and August 2005, Reliability of SCAN: anxiety disorder section was tested among 30 participants, including patients with anxiety disorders and normal volunteers. RESULTS: Based on reactions from Thais and consultations from competent psychiatrists, content validity was established. The duration of interviews for anxiety disorders section averaged 45.1 min (SD = 13.5). The reliability determined by Cohen's kappa coefficient for the 83 items that related to anxiety disorders in the SCAN were in Section 3, 4, 5. This overall inter-rater reliability was 0.79 (SD = 0.22), which were in substantial level of agreement. The overall intra-rater reliability was rated by the same psychiatrist 2 weeks apart. The result was 0.84 (SD = 0.21), which was near perfect agreement. There were three items (3.6%) of fair agreement and five items (6%) of moderate agreement that were caused from discrepancy of item definitions and the subjectivity of raters. CONCLUSION: The Anxiety Disorders Sections of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version) were an effective tool for assessing symptoms of anxiety disorders among Thais.

Inter- and intra-rater reliability of the Thai version of SCAN: Use of Alcohol and Use of Tobacco Section.

OBJECTIVE: To assess inter and intra rater reliability of the Thai version of Use of Alcohol and Use of Tobacco Section of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN). MATERIAL AND METHOD: Fifteen alcohol and/or tobacco dependence patients and fifteen controls with ages of > or = 18 years were recruited from October 2003 to August 2004 at Srinagarind Hospital. One psychiatrist interviewed and first rated under video-recording, then re-rated two weeks later. Another psychiatrist rated independently by looking at the videotapes for inter-rater reliability testing. RESULTS: The intra-rater kappa was 'excellent' for both sections. The inter-rater kappa for all items of "tobacco use" were 'excellent' (mean kappa = 0.84), and 'good' (mean kappa = 0.66) for the "alcohol use". Items of dependence had 'good' kappa (mean kappa = 0.73-0.95), except items of 'activities limitation (interest neglect)' and 'use despite knowledge of psychological/physical problems (continued use)' was 'fair' (mean kappa 062-0.49). The poor kappa (mean kappa = 0.17-0.38) was found in the item of 'physical and mental health problems due to drinking'. CONCLUSION: Thai SCAN provided reliable inter-rater diagnostic information for alcohol and tobacco dependence, but fair reliability for alcohol abuse. Improve understanding of the item concepts, better validity in questioning; giving examples of the focus symptoms, and frequent discussion about the respondent's answers, might improve overall validity and reliability.

Validity and reliability study of the Thai version of WHO SCAN: somatoform and dissociative symptoms section.

OBJECTIVES: To determine the validity and reliability of the Thai version of the WHO Somatoform and Dissociative Symptoms Section of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Version 2.1 MATERIAL AND METHOD: The SCAN interview version 2.1 Somatoform and Dissociative Symptoms Section was translated into Thai. The content validity of the translation was verified by comparing a back-translation (to English) of the Thai version to the English original. Whenever inconsistencies were encountered, the Thai version was adapted so that it correctly conveyed the meaning of the original English version. The revised Thai version was then field-tested nationwide for the comprehensibility of the relatively technical language. Between October 2003 and August 2004, 30 persons were recruited for the reliability study (16 males; 14 females) Fifteen subjects had somatoform disorders and 15 were normal. The number of years of formal education varied widely and occupations were diverse. Subjects were interviewed by a psychiatrist competent in using the Thai version of SCAN. The interviews were recorded on video so that the material could be rerated. RESULTS: Based on the response from Thai subjects and consultations with competent psychiatrists, the content validity was established. The time taken to interview a somatoform patient averaged 57.1 +/- 12.1 minutes while it was 42.1 +/- 13.9 minutes for a normal subject. The inter-rater reliability (kappa) of the 113 Items were: 0.81-1.0, 0.61-0.80 and 0. 00-0.20 in 49.6, 30.0 and 8.9 percent, respectively. Kappas could not be calculated for 11.5% of the Items. The intra-rater reliabilities were. 0.81-1.0, 0.61-0.80 and 0.00-0.20 in 54.9, 26.5 and 2.7 percent, respectively. Kappas could not be calculated for 15.9% of the Items. CONCLUSION: The Thai version of the Somatoform and Dissociative Symptoms Section of SCAN version 2.1 proved to be a valid and reliable tool for assessing somatoform and dissociative symptoms among Thai speakers.

The validity and reliability of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version): Mood Disorders Section.

BACKGROUND: Mood disorders are one of the most prevalent psychiatric disorders that have early onset, are chronic and can cause functional impairment. It is therefore crucial to establish an accurate diagnosis for treatment and research purposes. OBJECTIVES: The authors aimed to test the validity and reliability of the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN Thai Version): Mood Disorders Section. MATERIAL AND METHOD: First, psychiatrists competent in the use of the schedules and their underlying objectives tests the linguistic clarity of the Thai psychiatric schedules in four regions of the country. Then between October 2003 and August 2004, Reliability of SCAN: mood disorder section was tested among 30 participants, including mood disordered patients and normal volunteers. RESULTS: Based on reactions from Thais and consultations from competent psychiatrists, content validity was established. The duration of interviews for the mood disorder sections averaged 63.6 min (SD = 17.1). The inter- and intra-rater reliability kappa were 0.80 (0.77-0.83) and 0.86 (0.84-0.88), respectively. The reliability of the majority of items reached substantial to almost perfect agreement; however, 1 item (1%) had only slight agreement and 15 items (12%) had moderate agreement, and needed clarification of the scoring method CONCLUSION: The Mood Disorders Sections of the WHO Neuropsychiatry Schedules for Clinical Assessment (SCAN Thai Version) were effective tools for diagnosing mood disorders among Thais.