Interrater reliability and coding guide for nonpsychotic formal thought disorder.

Reliable and valid assessment of abnormal speech patterns may enable earlier recognition of nonpsychotic disorders through characteristic speech patterns. This study sought to establish interrater reliability using a standardized guide for scoring. A scoring guide defining 27 elements (e.g., inappropriate self-reference, simple loss of goal, circumstantiality) of disordered thought was developed. The seminal work of Andreasen's and Holzman's groups provided 12 elements, and 15 new elements were suggested by clinical literature. Audiotaped interviews with 12 psychiatric inpatients, adults of both sexes and various ages hospitalized for acute management of nonpsychotic psychiatric disorders, provided speech samples for observation of disordered thought by two independent raters. Using the guide's definitions and accompanying examples of elements of disordered thought, reliability in scoring was high (kappa of .85 for agreement on the presence of any abnormal speech element and kappa values from .66 to 1.00 for agreement on the presence of individual elements).

What does the Keane PTSD scale of the MMPI measure? Repeated measurements in a group of patients with major depression.

We looked at a group of depressed patients in a treatment study, none of whom by study design had Posttraumatic Stress Disorder (PTSD). High scores on the PTSD (PK) scale could only be due to factors other than PTSD. Despite the absence of PTSD, we observed an extremely high false positive rate in a group given the MMPI on multiple occasions. 92% of the subjects had at least one T score at or above 65 on the PK scale. 44% of the men and the women had at least one score at or above the more conservative cutoff (a raw score of 28) recommended by Lyons and Keane. The PK scale is sensitive to depression as well as anxiety and PTSD. The PK scale showed multiple high correlations with clinical and validity scales. It was concluded, in agreement with Miller, Goldberg, and Streiner (1995) and Moody and Kish (1989), that the PK scale is primarily a measure of general dysphoria. In populations with considerable psychopathology, the PK scale does not appear to discriminate between patients with and without PTSD.

Concurrent and Close Temporal Administration of Lithium and ECT.

The clinical effects of concurrent and close temporal administration of electroconvulsive therapy (ECT) and lithium (Li) were investigated by chart review. Three groups of patients were compared on the basis of ECT-related complications, total length of hospital stay (LOS), and post-ECT hospital stay. The groups consisted of patients administered concurrent ECT and Li (n = 27); patients administered Li within 24 h prior to ECT or within 48 h post-ECT (n = 49); and patients administered ECT without concurrent or close temporal administration of Li (n = 100). Prolonged or severe post-ECT confusion was significantly associated with close timing of administration of Li relative to the ECT course. The groups did not differ in the number of complications or the total LOS, although the post-ECT LOS was significantly longer in the group administered Li in close temporal association with ECT. These data suggest that caution should be exercised in the combined use of these treatment modalities.