Different cutoff points for different trimesters? The use of Edinburgh Postnatal Depression Scale and Beck Depression Inventory to screen for depression in pregnant Taiwanese women.

OBJECTIVE: Validating self-reported questionnaires to detect depression during pregnancy, compared to depression during postpartum, has gained much less attention. Furthermore, it is unknown whether it is appropriate to use the same cutoff point to detect depression on different trimesters of pregnancy. The aims of this study, conducted in pregnant Taiwanese women, were: (a) to validate the Taiwanese version of the Edinburgh Postnatal Depression Scale (EPDS-T) and the second edition of the Beck Depression Inventory (BDI-II); (b) to compare the EPDS-T and the BDI-II on their validity in detecting depression; and (c) to determine if these scales have different cutoff points in detecting major depressive disorder for different trimesters. METHOD: One hundred eighty-five pregnant Taiwanese women who completed the EPDS-T and the BDI-II were interviewed by psychiatrists with the structural interview Mini-International Neuropsychiatric Interview (MINI) to establish a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of major depressive disorder. We analyzed and compared the sensitivity, specificity and validity of the EPDS-T and the BDI-II against the MINI diagnosis on the second and third trimesters. RESULTS: We identified 12/13 as the optimal cutoff of the EPDS-T, at which the sensitivity of the scale was 83% and the specificity was 89%. The optimal cutoff of the BDI-II was 11/12, at which the sensitivity of the scale was 74% and the specificity was 83%. The area under the curve of the receiver operating characteristic analysis was 0.92 for the EPDS-T and 0.84 for the BDI. There exist different optimal cutoff points of the EPDS-T for detecting major depression during different trimesters: 13/14 for the second trimester and 12/13 for the third trimester. No different optimal cutoff point for the BDI-II was found for different trimesters. CONCLUSION: The EPDS-T has satisfactory sensitivity and specificity and better validity than the BDI-II for detecting major depressive disorder during pregnancy in pregnant Taiwanese women. We suggest that more studies with larger sample sizes be performed to confirm if there exist different cutoff points in detecting depression for different trimesters of gestation.

Fine-tuning risperidone dosage for acutely exacerbated schizophrenia: clinical determinants.

RATIONALE: Risperidone doses for acute schizophrenia were rather high in most recent studies. OBJECTIVES: We tested a hypothesis that fine-tuning risperidone dosage to relieve side effects still yields efficacy. Clinical factors influencing the dosing were also determined. METHODS: One hundred and forty-six schizophrenia inpatients with acute exacerbation entered a prospective, 6-week, repeated measures study. Risperidone doses were titrated to 6 mg/day (if tolerable) within 7 days, but were lowered thereafter if adverse reactions appeared. Efficacy and safety were measured biweekly. RESULTS: Forty-eight patients tolerated the 6-mg/day target dose well, while the other 98 received lower final doses (mean+/-SD=3.4+/-0.9 mg/day) to curtail adverse effects. At endpoint, 64.3% of the low-dose patients and 43.8% of the high-dose subjects responded to treatment [>/=20% reduction in the Positive and Negative Syndrome Scale (PANSS) total score] ( P=0.018). In detail, the low-dose individuals were significantly superior in percentage changes in the PANSS total and general-subscale scores at endpoint. The low-dose group also tended to improve more (albeit statistically insignificantly) in the PANSS positive and negative subscales and other efficacy measures. Compared to the patients with undifferentiated subtype, those with disorganized subtype received higher dosage by 0.90 mg/day, after controlling for other variables ( P=0.008). Paranoid subtype was similar to undifferentiated subtype in drug doses. Patients with longer illness duration also showed a trend to use higher dosage ( P=0.078). CONCLUSIONS: These findings suggest that dosage adjustment to diminish side effects does not compromise risperidone response and that disorganized patients and perhaps patients with longer illness duration are prone to receive larger doses.