The Brown Assessment of Beliefs Scale: reliability and validity.

OBJECTIVE: The authors developed and evaluated the reliability and validity of the Brown Assessment of Beliefs Scale, a clinician-administered seven-item scale designed to assess delusions across a wide range of psychiatric disorders. METHOD: The authors developed the scale after reviewing the literature on the assessment of delusions. Four raters administered the scale to 20 patients with obsessive-compulsive disorder (OCD), 20 patients with body dysmorphic disorder, and 10 patients with mood disorder with psychotic features. Audiotaped interviews of scale administration conducted by one rater were independently scored by the other raters to evaluate interrater reliability. The scale was administered to 27 patients twice to determine test-retest reliability. Other insight instruments as well as scales that assess symptom severity were administered to assess convergent and discriminant validity. Sensitivity to change was assessed in a multicenter treatment study of sertraline for OCD. RESULTS: Interrater and test-retest reliability for the total score and individual item scores was excellent, with a high degree of internal consistency. One factor was obtained that accounted for 56% of the variance. Scores on the Brown Assessment of Beliefs Scale were not correlated with symptom severity but were correlated with other measures of insight. The scale was sensitive to change in insight in OCD but was not identical to improvement in severity. CONCLUSIONS: The Brown Assessment of Beliefs Scale is a reliable and valid instrument for assessing delusionality in a number of psychiatric disorders. This scale may help clarify whether delusional and nondelusional variants of disorders constitute the same disorder as well as whether delusionality affects treatment outcome and prognosis.

Case study: body dysmorphic disorder in adolescents.

Body dysmorphic disorder, an often-secret preoccupation with an imagined or slight defect in appearance, is an underrecognized disorder that is unknown to many clinicians. This disorder has gone virtually unmentioned in the adolescent literature, despite the fact that it often occurs during adolescence. Body dysmorphic disorder is more common than is realized and causes significant distress and impairment in functioning. This report presents four cases of adolescents with body dysmorphic disorder, all of who responded to a serotonin reuptake inhibitor. The clinical features of body dysmorphic disorder are reviewed, as are available data on the treatment of this distressing and often-disabling disorder.

Pediatric limb amputation: aspects of coping and psychotherapeutic intervention.

This paper addresses the assessment of and intervention with pediatric patients undergoing limb amputation. A multicomponent treatment package is advocated including the use of play and cognitive-behavioral strategies to enhance coping and adjustment to the loss of a limb.

Suicidal adolescents. How to help them before it's too late.

Primary care physicians should interview and assess troubled adolescent patients for level of suicidal intent. Several practical interventions by the physician can help adolescents with vague suicidal ideation who are not at high risk. Follow-up by the primary care physician is necessary, with continued monitoring to detect increases in the severity of either depression or suicidal thoughts. The emotional support of the family is essential in limiting risk for completion of suicide. If family support is inadequate, other support must be obtained. However, psychiatric referral is indicated for patients exhibiting a high risk of suicide, as indicated by: (1) clearly expressed suicidal intent, (2) an overt plan for suicide with means to carry out the plan, (3) previous suicide attempt(s), and (4) suicidal ideation judged to be high or accompanied by psychosis, substance abuse, or past suicidal behavior.

Bulimia nervosa. Uncovering a secret disorder.

Bulimia nervosa is a common eating disorder among women. Sociocultural and interpersonal pressures are thought to be highly influential in the development of the syndrome. An association with depression has also been suggested. Recognizing bulimia nervosa is usually difficult, because patients are hesitant to reveal their symptoms. If the condition is diagnosed early in its course, the prognosis is more favorable. Use of tricyclic antidepressants and psychotherapy is the accepted treatment regimen.