Development and validation of the Bush-Francis Catatonia Rating Scale - Brazilian version.

OBJECTIVE:: This article aims to describe the adaptation and translation process of the Bush-Francis Catatonia Rating Scale (BFCRS) and its reduced version, the Bush-Francis Catatonia Screening Instrument (BFCSI) for Brazilian Portuguese, as well as its validation. METHODS:: Semantic equivalence processes included four steps: translation, back translation, evaluation of semantic equivalence and a pilot-study. Validation consisted of simultaneous applications of the instrument in Portuguese by two examiners in 30 catatonic and 30 non-catatonic patients. RESULTS:: Total scores averaged 20.07 for the complete scale and 7.80 for its reduced version among catatonic patients, compared with 0.47 and 0.20 among non-catatonic patients, respectively. Overall values of inter-rater reliability of the instruments were 0.97 for the BFCSI and 0.96 for the BFCRS. CONCLUSION:: The scale's version in Portuguese proved to be valid and was able to distinguish between catatonic and non-catatonic patients. It was also reliable, with inter-evaluator reliability indexes as high as those of the original instrument.

Development and validation of the Bush-Francis Catatonia Rating Scale - Brazilian version / Desenvolvimento e validação da versão brasileira da escala de classificação de Bush-Francis para catatonia

ABSTRACT Objective: This article aims to describe the adaptation and translation process of the Bush-Francis Catatonia Rating Scale (BFCRS) and its reduced version, the Bush-Francis Catatonia Screening Instrument (BFCSI) for Brazilian Portuguese, as well as its validation. Methods: Semantic equivalence processes included four steps: translation, back translation, evaluation of semantic equivalence and a pilot-study. Validation consisted of simultaneous applications of the instrument in Portuguese by two examiners in 30 catatonic and 30 non-catatonic patients. Results: Total scores averaged 20.07 for the complete scale and 7.80 for its reduced version among catatonic patients, compared with 0.47 and 0.20 among non-catatonic patients, respectively. Overall values of inter-rater reliability of the instruments were 0.97 for the BFCSI and 0.96 for the BFCRS. Conclusion: The scale's version in Portuguese proved to be valid and was able to distinguish between catatonic and non-catatonic patients. It was also reliable, with inter-evaluator reliability indexes as high as those of the original instrument.

RESUMO Objetivo: O artigo tem como objetivo descrever o processo de tradução e adaptação da Escala de Catatonia Bush-Francis (ECBF) e de sua versão reduzida (ICBF) para o Português, bem como sua validação. Métodos: O processo de equivalência semântica foi realizado em quatro passos: tradução, retro-tradução, avaliação da equivalência semântica e estudo-piloto. A validação consistiu em aplicações dos instrumentos em português simultâneas por dois avaliadores em 30 pacientes com catatonia e 30 pacientes sem catatonia. Resultados: Média dos escores totais em pacientes catatônicos foi de 20,07 para a versão completa e 7,80 para versão reduzida, contra 0,47 e 0,20 em pacientes não-catatônicos respectivamente. Valores gerais para confiabilidade inter-observador dos instrumentos foi de 0,97 para ICBF e 0,96 para ECBF. Conclusão: A versão em Português da escala provou ser válida e capaz de diferenciar pacientes catatônicos daqueles sem catatonia. Também mostrou ser confiável, com índices inter-avaliadores tão altos quanto no instrumento original.

Insight Across the Different Mood States of Bipolar Disorder.

In bipolar disorder, levels of insight vary as a function of the mood state and appear to influence pharmacology compliance, quality of life, the presence of suicidal ideations, and aggressive behavior. To establish a comparison among different mood states in bipolar with regard to level of insight. Forty-eight patients were evaluated in different affective states (i.e., euthymia, mania, depression, and mixed state). Identifying information, sociodemographic data, and clinical records were recorded. The following scales were applied: Hamilton Depression Scale, Young Mania Rating Scale, Positive and Negative Syndrome Scale positive symptoms subscale, and Global Assessment of Functioning and Clinical Global Impressions Scale for use in bipolar disorder. Insight was evaluated using items 11 and 17 of the Young Mania Rating Scale and Hamilton Depression Scale, respectively. Insight in bipolar disorder was found to be more compromised during manic phases and mixed episodes than during periods of depression or euthymia. The factors associated with lower levels of insight were the following: shorter illness duration, older age, and greater severity in mania; the female gender and older age in depression; and shorter illness duration and more severe depressive symptoms in mixed episodes. In the same individual, levels of insight vary as a function of the affective state over the course of bipolar disorder and appear to be influenced by several clinical variables.

The reliability of self-assessment of affective state in different phases of bipolar disorder.

Some studies have indicated that the capacity of self-assessment of affective state is more compromised during mania than during depression. In the present study, we investigated whether the reliability of self-assessment in bipolar disorder varies as a function of actual affective state (i.e., euthymia, mania, or depression). Sixty-five patients with a diagnosis of type I and type II bipolar disorder were evaluated with regard to the occurrence of an affective syndrome using the Clinical Global Impressions Scale for use in bipolar illness, the Positive and Negative Syndrome Scale, and the Global Assessment of Functioning scale. In parallel, we applied the Analog Visual Mood Scale, a self-assessment tool to evaluate mood changes. The same individual prospectively completed the self-assessment scale in different affective states. During depression, the patients' evaluation was significantly different from when they were in manic or euthymic mood states. However, when in mania, the patients evaluated their mood state similarly to when they were euthymic. The bipolar patients in mania but not in depression did not reliably evaluate themselves with regard to their affective state.

Increased energy/activity, not mood changes, is the core feature of mania.

BACKGROUND: In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, the occurrence of increased energy/activity and elation of mood or irritability became necessary symptoms for the diagnosis of an episode of mania or hypomania. OBJECTIVE: To evaluate whether increases in energy/activity or mood changes represent the core feature of the manic syndrome. METHODS: The symptomatology of 117 hospitalized patients with bipolar mania was evaluated using the Schedule for Affective Disorders and Schizophrenia-Changed version (SADS-C). Based on six items of the SADS-S related to mania, a Confirmatory Factor Analysis (CFA) was performed. An Item Response Theory (IRT) analysis was used to identify how much each symptom informs about the different levels of severity of the syndrome. RESULTS: According to the CFA, the item "increased energy" was the symptom with the highest factorial loadings, which was confirmed by the IRT analysis. Thus, increased energy was the alteration most correlated with the total severity of manic symptoms. Additionally, the analysis of the Item Information Function revealed that increased energy was correlated with the larger amplitude of severity levels compared with the other symptoms of mania. LIMITATIONS: Only six manic symptoms were considered. The sample might not be representative because the patients were evaluated while presenting peak symptom severity. CONCLUSIONS: Increased energy/activity is a more important symptom for a diagnosis of mania than mood changes and represents the core feature of this syndrome.

Lamotrigine as an adjuvant treatment for acute bipolar depression: a Brazilian naturalistic study

Lamotrigine is indicated according to several recent treatment guidelines as a first-line medication for the treatment of bipolar depression. However, its efficacy in acute bipolar depression has not been well established. In the present naturalistic study, patients with bipolar depression (n = 20), predominantly bipolar type I, were treated with lamotrigine in addition to their prior treatment for 8 weeks. The Young Mania Rating Scale (YMRS), 17-item Hamilton Rating Scale for Depression (HAM-D-17), and Clinical Global Impressions-Bipolar Disorder (CGI-BD) scale were applied at baseline, week 4, and week 8. With regard to the primary measure of efficacy, mean total HAM-D-17 scores significantly decreased (p < .01) at the end of treatment. Eight patients (40%) exhibited a positive response (i.e., at least a 50% reduction of baseline scores). Additionally, eight (40%) and 11 (55%) patients exhibited complete remission, reflected by HAM-D-17 and CGI-BP scores, respectively. Episodes of switching to mania or hypomania occurred in five patients (25%). No skin rash or any other significant adverse events were reported. Our results indicate that the addition of lamotrigine to a mood stabilizer can be useful in the treatment of acute depressive episodes in bipolar I disorder.

Lamotrigine as an adjuvant treatment for acute bipolar depression: a Brazilian naturalistic study

Lamotrigine is indicated according to several recent treatment guidelines as a first-line medication for the treatment of bipolar depression. However, its efficacy in acute bipolar depression has not been well established. In the present naturalistic study, patients with bipolar depression (n = 20), predominantly bipolar type I, were treated with lamotrigine in addition to their prior treatment for 8 weeks. The Young Mania Rating Scale (YMRS), 17-item Hamilton Rating Scale for Depression (HAM-D-17), and Clinical Global Impressions-Bipolar Disorder (CGI-BD) scale were applied at baseline, week 4, and week 8. With regard to the primary measure of efficacy, mean total HAM-D-17 scores significantly decreased (p < .01) at the end of treatment. Eight patients (40%) exhibited a positive response (i.e., at least a 50% reduction of baseline scores). Additionally, eight (40%) and 11 (55%) patients exhibited complete remission, reflected by HAM-D-17 and CGI-BP scores, respectively. Episodes of switching to mania or hypomania occurred in five patients (25%). No skin rash or any other significant adverse events were reported. Our results indicate that the addition of lamotrigine to a mood stabilizer can be useful in the treatment of acute depressive episodes in bipolar I disorder.(AU)

Mood self-assessment in bipolar disorder: a comparison between patients in mania, depression, and euthymia.

BACKGROUND: Some studies indicate that mood self-assessment is more severely impaired in patients with bipolar disorder in a manic episode than in depression. OBJECTIVES: To investigate variations in mood self-assessment in relation to current affective state in a group of individuals with bipolar disorder. METHODS: A total of 165 patients with a diagnosis of bipolar disorder type I or type II had their affective state assessed using the Clinical Global Impressions Scale for use in bipolar illness (CGI-BP), the Positive and Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF). In addition, participants completed a self-report visual analog mood scale (VAMS). Patients were divided into three groups (euthymia, mania, and depression) and compared with regard to VAMS results. RESULTS: Manic patients rated their mood similarly to patients in euthymia in 14 out of 16 items in the VAMS. By contrast, depressed patients rated only two items similarly to euthymic patients. CONCLUSION: Patients with bipolar disorder in mania, but not those in depression, poorly evaluate their affective state, reinforcing the occurrence of insight impairment in the manic syndrome.

Mood self-assessment in bipolar disorder: a comparison between patients in mania, depression, and euthymia / Autoavaliação do estado de humor no transtorno bipolar: uma comparação entre pacientes em mania, depressão, e eutimia

BACKGROUND: Some studies indicate that mood self-assessment is more severely impaired in patients with bipolar disorder in a manic episode than in depression. OBJECTIVES: To investigate variations in mood self-assessment in relation to current affective state in a group of individuals with bipolar disorder. METHODS: A total of 165 patients with a diagnosis of bipolar disorder type I or type II had their affective state assessed using the Clinical Global Impressions Scale for use in bipolar illness (CGI-BP), the Positive and Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF). In addition, participants completed a self-report visual analog mood scale (VAMS). Patients were divided into three groups (euthymia, mania, and depression) and compared with regard to VAMS results. RESULTS: Manic patients rated their mood similarly to patients in euthymia in 14 out of 16 items in the VAMS. By contrast, depressed patients rated only two items similarly to euthymic patients. CONCLUSION: Patients with bipolar disorder in mania, but not those in depression, poorly evaluate their affective state, reinforcing the occurrence of insight impairment in the manic syndrome

CONTEXTO: Alguns estudos indicam que a capacidade de autoavaliação do estado de humor está mais comprometida em pacientes com transtorno bipolar na mania do que na depressão. OBJETIVO: Estudar variações na autoavaliação do humor em relação ao estado afetivo atual em indivíduos com transtorno bipolar. MÉTODO: Um total de 165 pacientes com diagnóstico de transtorno bipolar tipo I ou tipo II tiveram seu estado afetivo avaliado utilizando os instrumentos Clinical Global Impressions Scale for use in bipolar illness (CGI-BP), Positive and Negative Syndrome Scale (PANSS) e Global Assessment of Functioning (GAF). Além disso, foi aplicada um instrumento de autoavaliação, a escala visual analógica do humor (EVAH). Os pacientes foram divididos em três grupos (eutimia, mania e depressão) e comparados quanto aos resultados da EVAH. RESULTADOS: Dos 16 itens da EVAH, 14 foram avaliados pelos pacientes em mania de forma semelhante aos pacientes em eutimia. Em contraste, em apenas dois itens, os deprimidos mostraram escores semelhantes aos eutímicos. CONCLUSÃO: Pacientes bipolares em mania, mas não os deprimidos, avaliam de forma não fidedigna seu estado afetivo, o que reforça o comprometimento do insight na síndrome maníaca