The Rater Applied Performance Scale: development and reliability.

Previous studies of rater performance and interrater reliability have used passive scoring tasks such as rating patients from a videotaped interview. Little is known, however, about how well raters conduct assessments on real patients or how reliably they apply scoring criteria during actual assessment sessions. With growing recognition of the importance of monitoring and review of actual evaluation sessions, there is need for a systematic approach to quantify raters' applied performance. The Rater Applied Performance Scale (RAPS) measures six dimensions of rater performance (adherence, follow-up, clarification, neutrality, rapport, and accuracy) based on reviews of audiotaped or videotaped assessment sessions or on live monitoring of assessment sessions. We tested this new scale by having two reviewers rate 20 Hamilton Depression Scale rating sessions ascertained from a multi-site depression trial. We found good internal consistency for the RAPS. Interrater (i.e. inter-reviewer) reliability was satisfactory for RAPS total score ratings. In addition, RAPS ratings correlated with quantitative measures of scoring accuracy based on independent expert ratings. Preliminary psychometric data suggest that the RAPS may be a valuable tool for quantifying the performance of clinical raters. Potential applications of the RAPS are considered.

High-potency benzodiazepines: recent clinical results.

As high-potency benzodiazepines, essentially alprazolam, clonazepam, and lorazepam, have been used to treat anxiety disorders for almost 2 decades, most efficacy and safety data appeared several years ago. The release of new formulations of 2 of them, clonazepam and alprazolam, invites review of these broadly effective anxiolytics. Clonazepam has recently become available in a lyophilized wafer that disintegrates when exposed to saliva and enhances ease of administration without altering its pharmacology, as shown by bioequivalence studies. Two U.S. multicenter trials carried out in the 1990s, among others, have provided strong confirmatory evidence for the use of clonazepam in panic disorder. Other recently published data on clonazepam pertain to its use as augmentation therapy with selective serotonin reuptake inhibitors and in the prevention of recurrences of major depressive disorder. A new, extended-release formulation of alprazolam now allows for once-daily rather than t.i.d. or q.i.d. dosing. With extended release, the blood drug concentrations of alprazolam remain within the therapeutic window for several hours, which should reduce fluctuation in therapeutic effect and curb the clock-watching phenomenon between doses. The literature concerning the use of this new formulation of alprazolam in panic disorder is reviewed.