ABSTRACT
BACKGROUND: Accurate assessment of suicidality is of major importance. We aimed to evaluate trained clinicians' ability to assess suicidality against a structured assessment made by trained raters. METHOD: Treating clinicians classified 218 adolescent psychiatric outpatients suffering from a depressive mood disorder into three classes: 1-no suicidal ideation, 2-suicidal ideation, no suicidal acts, 3-suicidal or self-harming acts. This classification was compared with a classification with identical content derived from the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) made by trained raters. The convergence was assessed by kappa- and weighted kappa tests. RESULTS: The clinicians' classification to class 1 (no suicidal ideation) was 85%, class 2 (suicidal ideation) 50%, and class 3 (suicidal acts) 10% concurrent with the K-SADS evaluation (gamma2 = 37.1, df 4, p = 0.000). Weighted kappa for the agreement of the measures was 0.335 (CI = 0.198-0.471, p < 0.0001). The clinicians under-detected suicidal and self-harm acts, but over-detected suicidal ideation. CONCLUSION: There was only a modest agreement between the trained clinicians' suicidality evaluation and the K-SADS evaluation, especially concerning suicidal or self-harming acts. We suggest a wider use of structured scales in clinical and research settings to improve reliable detection of adolescents with suicidality.
Subject(s)
Depressive Disorder/diagnosis , Inservice Training , Mass Screening/statistics & numerical data , Personality Assessment/statistics & numerical data , Self-Injurious Behavior/diagnosis , Suicide Prevention , Suicide, Attempted/prevention & control , Adolescent , Ambulatory Care , Depressive Disorder/psychology , Female , Finland , Humans , Interview, Psychological , Male , Psychometrics/statistics & numerical data , Reproducibility of Results , Self-Injurious Behavior/psychology , Suicide/psychology , Suicide, Attempted/psychologyABSTRACT
The movement disturbances and brain imaging findings in Asperger's disorder (AD) suggest a dopaminergic deficit in movement regulation. Movement disorders of different etiologies have been quantified and specified with actometry. We compared 10 AD patients with 10 healthy controls, measuring their rest-activities by actometry. The lower limb motor activity was significantly higher in the AD group. They also displayed a rhythmic, periodic movement pattern similar to akathisia. These findings suggest a hypothesis of idiopathic akathisia and a special sensitivity to adverse effects of neuroleptic drugs.
Subject(s)
Asperger Syndrome/epidemiology , Lower Extremity/physiopathology , Restless Legs Syndrome , Adolescent , Adult , Aged , Asperger Syndrome/diagnosis , Diagnostic and Statistical Manual of Mental Disorders , Electrophysiology/instrumentation , Female , Humans , Male , Middle Aged , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/epidemiology , Restless Legs Syndrome/physiopathology , Severity of Illness IndexABSTRACT
An objective marker of restless legs syndrome (RLS) is needed for developing diagnostic tools and monitoring symptoms. Actometric ambulatory monitoring of 15 RLS patients and 15 healthy controls was undertaken in order to differentiate between RLS-related motor symptoms and normal motor activity. Nocturnal lower-limb activity per minute differentiated and discriminated between groups with no overlap, whereas the periodic limb movement index and the controlled rest activity during sitting showed less discriminative power. The naturalistic recording of nocturnal activity by actometry may prove useful for assessing the severity of RLS and for finding an objective marker to support the diagnosis of RLS.
