Objectives: The primary objective of this research was to inform the criterion validity of the single self-report depression screening question in the interRAI-Contact Assessment (CA) against the validated Depression Rating Scale (DRS) in the RAI-Home Care (HC) instrument. To achieve this objective, two overarching research questions were addressed: 1) What is the DRS cut-point best suited for the detection of a possible depressed mood state?; and 2) What are the consistencies in the prevalence rates of the CA’s single self-report depression question and the HC’s DRS detection measure? A secondary objective of this research was to explore the relationships of multiple depression-related outcomes with selected possible predictor variables to indirectly aid in the identification of a possible depressed mood state. Methods: Four datasets were obtained from the interRAI organization to inform this research. Three datasets, which house and concurrently administer both the self-report item and the DRS, were used to determine the best-suited DRS detection threshold through both univariate and bivariate analyses. The validity of the CA’s self-report item was informed through bivariate analyses with the HC’s DRS measure using the phi-correlation and the c statistic from the bivariate logistic regression model. Spearman and point biserial correlations and bivariate logistic regression modeling informed the relationships of the possible predictor variables with the depression-related outcomes. Results: The DRS one-plus threshold was determined to be the cut-point best-suited for the detection of a possible depressed mood state. Several predictor variables proved statistically significant but were not consistent across the three datasets. The CA’s single question did not evidence a strong association with the HC’s DRS measure. Conclusions: According to the resulting significance of the predictor variables, the experience and expression of depression across the three explored samples differ; the results from one sample cannot be generalized to explain the experience of the other samples. The DRS one-plus threshold is supported for the detection of a possible depressed mood state. However, the validity of the single self-report question in comparison to the DRS measure cannot be supported with the study’s results. However, due to recognized study limitations, the overall validity of the measure is not conclusive. Future research directions are recommended.

Objectives: The primary objective of this research was to inform the criterion validity of the single self-report depression screening question in the interRAI-Contact Assessment (CA) against the validated Depression Rating Scale (DRS) in the RAI-Home Care (HC) instrument. To achieve this objective, two overarching research questions were addressed: 1) What is the DRS cut-point best suited for the detection of a possible depressed mood state?; and 2) What are the consistencies in the prevalence rates of the CA’s single self-report depression question and the HC’s DRS detection measure? A secondary objective of this research was to explore the relationships of multiple depression-related outcomes with selected possible predictor variables to indirectly aid in the identification of a possible depressed mood state. Methods: Four datasets were obtained from the interRAI organization to inform this research. Three datasets, which house and concurrently administer both the self-report item and the DRS, were used to determine the best-suited DRS detection threshold through both univariate and bivariate analyses. The validity of the CA’s self-report item was informed through bivariate analyses with the HC’s DRS measure using the phi-correlation and the c statistic from the bivariate logistic regression model. Spearman and point biserial correlations and bivariate logistic regression modeling informed the relationships of the possible predictor variables with the depression-related outcomes. Results: The DRS one-plus threshold was determined to be the cut-point best-suited for the detection of a possible depressed mood state. Several predictor variables proved statistically significant but were not consistent across the three datasets. The CA’s single question did not evidence a strong association with the HC’s DRS measure. Conclusions: According to the resulting significance of the predictor variables, the experience and expression of depression across the three explored samples differ; the results from one sample cannot be generalized to explain the experience of the other samples. The DRS one-plus threshold is supported for the detection of a possible depressed mood state. However, the validity of the single self-report question in comparison to the DRS measure cannot be supported with the study’s results. However, due to recognized study limitations, the overall validity of the measure is not conclusive. Future research directions are recommended.

BACKGROUND: Major Depressive Disorder (MDD) is a common mental health illness, characterized by persistent feelings of sadness, diminished interests, guilt, low-self esteem, and disturbances in sleep and appetite. A significant percentage of patients with MDD are treatment resistant. Electroconvulsive Therapy (ECT) is a biological procedure utilized for treatment resistant illnesses. Diagnosis and clinical conditions primarily dictate when ECT is the appropriate treatment modality for an individual. Circumstances requiring rapid clinical response, risks affiliated with alternative treatments, resistance to pharmacotherapy, and medical history are all factors that designate ECT as the treatment of choice. METHODS: The objective of this systematic review was to examine how different anesthetics or combinations of agents affect ECT’s therapeutic efficacy in depressed, adult patients. Electroencephalography (EEG) and motor seizure durations and Hamilton Depression Rating Scale (HDRS) scores were used as primary measures of clinical outcomes. Two rounds of literature searches were conducted in the PubMed, Web of Science, and Google Scholar databases to identify randomized controlled trials and crossover trials that examined the effects of different intravenous sedatives and hypnotic agents on ECT. Two reviewers independently evaluated the internal validity and quality of studies, extracted data, and analyzed statistics. Utilizing all relevant data, standardized mean differences (SMD) with 95% confidence intervals (CIs), and heterogeneity measures were calculated. Ten studies with 373 participants were included. RESULTS: Thiopental only anesthesia was associated with longer EEG seizure duration when compared to propofol only treatment. The pooled effect size from studies with propofol anesthesia also suggests that this agent is associated with shorter seizure durations. If assessed individually with thiopental, the combination of ketamine and thiopental is correlated with increased motor as well as EEG seizure durations. When pooled; however, studies with patient groups assigned to anesthesia consisting of ketamine and another primary agent do not show significant differences either in EEG or motor seizure durations. Additionally, no difference exists in HDRS score reductions between propofol and methohexital. Of note; however, ketamine combined with either propofol or thiopental had significantly greater decreases in HDRS scores. CONCLUSION: Choice of anesthetic should be determined based on anticipated clinical outcome, adverse effect profile, reemergence, and patient preference. If long seizures are preferred, thiopental may be a reasonable option. However, if significantly larger decreases in depression score are preferred, then the combinations of ketamine and propofol or ketamine and thiopental appear to be the therapies of choice. Small sample sizes and insufficient clinical data limit the interpretations of these variables that determine therapeutic efficacy. Larger randomized control trials and crossover trials would provide greater insight into the optimal use of intravenous anesthetic agents with minimal adverse effects.

Introdução: Comparados com pacientes bipolares com episódios maníacos/hipomaníacos e depressivos, os que apresentam estados mistos tendem a curso mais grave da doença, início mais precoce, ocorrência mais frequente de sintomas psicóticos, maior risco de suicídio, altas taxas de comorbidade e tempo maior para remissão. Portanto, medidas objetivas de avaliação desses estados são necessárias. Objetivo:Avaliar a concordância entre três pares formados por uma de três escalas de mania (Young Mania Rating Scale (YMRS), Bech-Rafaelsen Mania Scale (BRMS) ou Clinician-Administered Rating Scale for Mania (CARS-M)) e uma de depressão (21-item Hamilton Depression) na avaliação da resposta a estabilizadores do humor em pacientes mistos. Método:Sessenta e oito (n=68) consecutivos pacientes ambulatoriais bipolares Tipo I e II com sintomatologia mista pelo DSM-IV-TR e pelos critérios de Cincinatti foram incluídos nesse estudo aberto de 8 semanas entre 2010 e 2014 foram randomizados para receberem em monoterapia, ácido valproico, carbamazepina ou carbonato de lítio. Resultados: O padrão de resposta (diminuição de, pelo menos, 50% em uma das escalas de mania e na de depressão) foi muito semelhante: 21-HAM-D + YMRS = 22,1%, 21-HAM-D + BRMS = 20,6% e 21-HAM-D + CARS-M = 23,5%; p < 0,368). Os resultados referentes à concordância de resposta revelam valores de kappa bastante altos: 21-HAM-D + YMRS X 21-HAM-D + CARS-M , Kappa = 0,87; 21-HAM-D + YMRS X 21-HAM-D + BRMS, Kappa = 0,78 e 21-HAM-D + CARS-M X 21-HAM-D + BRMS, Kappa = 0,91 (p < 0,001). Conclusões:O presente estudo sugere que qualquer uma das três escalas de mania utilizadas (YMRS, BRMS, CARS-M) pode ser associada à 21-HAM-D na avaliação da resposta em bipolares mistos. / Background: Compared with patients with bipolar disorder who exhibit pure manic/hypomanic or depressive episodes, the presence of mixed mood states is associated with a more severe course of illness, younger age of onset, more frequent ocurrence of psychotic symptoms, major risk of suicide, higher rates of comorbidities and longer time to achieve remission. Therefore, objective avaliation of these states are necessary. Objective: To evaluate the concorccance amog three pairs of three scales (Young Mania Rating Scale (YMRS), Bech-Rafaelsen Mania Scale (BRMS) or Clinician-Administered Rating Scale for Mania (CARS-M)) and a depression scale (21-item Hamilton Depression) in the assessment of response to humor stabizator drugs in mix bipolar patients. Methods: Sixty eight (n=68) consecutive bipolar type I and II outpatients with mixed sitomatology accordint to DSM-IV-TR and Cincinatti Criteria were included in these 8 weeks open-trial, from 2010 through 2014, to, randomly, receive monotherapy valporic acid, carbamazepine or lithium carbonate. Results: The response answer (decrease of, at least 50 %, in one of the mania and depression scales) were very similar: 21-HAM-D + YMRS = 22.1%, 21-HAM-D + BRMS = 20.6% e 21-HAM-D + CARS-M = 23.5%; p < 0,368). The kappa values were : 21-HAM-D + YMRS X 21-HAM-D + CARS-M , Kappa = 0.87; 21-HAM-D + YMRS X 21-HAM-D + BRMS, Kappa = 0.78 e 21-HAM-D + CARS-M X 21-HAM-D + BRMS, Kappa = 0.91 (p < 0,001). Conclusions: The present study suggests that any of the three mania scales used (YMRS, BRMS, CARS-M) may be associated to 21-HAM-D in the assessment of the response o bipolar patients.

Introdução: Comparados com pacientes bipolares com episódios maníacos/hipomaníacos e depressivos, os que apresentam estados mistos tendem a curso mais grave da doença, início mais precoce, ocorrência mais frequente de sintomas psicóticos, maior risco de suicídio, altas taxas de comorbidade e tempo maior para remissão. Portanto, medidas objetivas de avaliação desses estados são necessárias. Objetivo:Avaliar a concordância entre três pares formados por uma de três escalas de mania (Young Mania Rating Scale (YMRS), Bech-Rafaelsen Mania Scale (BRMS) ou Clinician-Administered Rating Scale for Mania (CARS-M)) e uma de depressão (21-item Hamilton Depression) na avaliação da resposta a estabilizadores do humor em pacientes mistos. Método:Sessenta e oito (n=68) consecutivos pacientes ambulatoriais bipolares Tipo I e II com sintomatologia mista pelo DSM-IV-TR e pelos critérios de Cincinatti foram incluídos nesse estudo aberto de 8 semanas entre 2010 e 2014 foram randomizados para receberem em monoterapia, ácido valproico, carbamazepina ou carbonato de lítio. Resultados: O padrão de resposta (diminuição de, pelo menos, 50% em uma das escalas de mania e na de depressão) foi muito semelhante: 21-HAM-D + YMRS = 22,1%, 21-HAM-D + BRMS = 20,6% e 21-HAM-D + CARS-M = 23,5%; p < 0,368). Os resultados referentes à concordância de resposta revelam valores de kappa bastante altos: 21-HAM-D + YMRS X 21-HAM-D + CARS-M , Kappa = 0,87; 21-HAM-D + YMRS X 21-HAM-D + BRMS, Kappa = 0,78 e 21-HAM-D + CARS-M X 21-HAM-D + BRMS, Kappa = 0,91 (p < 0,001). Conclusões:O presente estudo sugere que qualquer uma das três escalas de mania utilizadas (YMRS, BRMS, CARS-M) pode ser associada à 21-HAM-D na avaliação da resposta em bipolares mistos. / Background: Compared with patients with bipolar disorder who exhibit pure manic/hypomanic or depressive episodes, the presence of mixed mood states is associated with a more severe course of illness, younger age of onset, more frequent ocurrence of psychotic symptoms, major risk of suicide, higher rates of comorbidities and longer time to achieve remission. Therefore, objective avaliation of these states are necessary. Objective: To evaluate the concorccance amog three pairs of three scales (Young Mania Rating Scale (YMRS), Bech-Rafaelsen Mania Scale (BRMS) or Clinician-Administered Rating Scale for Mania (CARS-M)) and a depression scale (21-item Hamilton Depression) in the assessment of response to humor stabizator drugs in mix bipolar patients. Methods: Sixty eight (n=68) consecutive bipolar type I and II outpatients with mixed sitomatology accordint to DSM-IV-TR and Cincinatti Criteria were included in these 8 weeks open-trial, from 2010 through 2014, to, randomly, receive monotherapy valporic acid, carbamazepine or lithium carbonate. Results: The response answer (decrease of, at least 50 %, in one of the mania and depression scales) were very similar: 21-HAM-D + YMRS = 22.1%, 21-HAM-D + BRMS = 20.6% e 21-HAM-D + CARS-M = 23.5%; p < 0,368). The kappa values were : 21-HAM-D + YMRS X 21-HAM-D + CARS-M , Kappa = 0.87; 21-HAM-D + YMRS X 21-HAM-D + BRMS, Kappa = 0.78 e 21-HAM-D + CARS-M X 21-HAM-D + BRMS, Kappa = 0.91 (p < 0,001). Conclusions: The present study suggests that any of the three mania scales used (YMRS, BRMS, CARS-M) may be associated to 21-HAM-D in the assessment of the response o bipolar patients.

Introdução: Comparados com pacientes bipolares com episódios maníacos/hipomaníacos e depressivos, os que apresentam estados mistos tendem a curso mais grave da doença, início mais precoce, ocorrência mais frequente de sintomas psicóticos, maior risco de suicídio, altas taxas de comorbidade e tempo maior para remissão. Portanto, medidas objetivas de avaliação desses estados são necessárias. Objetivo:Avaliar a concordância entre três pares formados por uma de três escalas de mania (Young Mania Rating Scale (YMRS), Bech-Rafaelsen Mania Scale (BRMS) ou Clinician-Administered Rating Scale for Mania (CARS-M)) e uma de depressão (21-item Hamilton Depression) na avaliação da resposta a estabilizadores do humor em pacientes mistos. Método:Sessenta e oito (n=68) consecutivos pacientes ambulatoriais bipolares Tipo I e II com sintomatologia mista pelo DSM-IV-TR e pelos critérios de Cincinatti foram incluídos nesse estudo aberto de 8 semanas entre 2010 e 2014 foram randomizados para receberem em monoterapia, ácido valproico, carbamazepina ou carbonato de lítio. Resultados: O padrão de resposta (diminuição de, pelo menos, 50% em uma das escalas de mania e na de depressão) foi muito semelhante: 21-HAM-D + YMRS = 22,1%, 21-HAM-D + BRMS = 20,6% e 21-HAM-D + CARS-M = 23,5%; p < 0,368). Os resultados referentes à concordância de resposta revelam valores de kappa bastante altos: 21-HAM-D + YMRS X 21-HAM-D + CARS-M , Kappa = 0,87; 21-HAM-D + YMRS X 21-HAM-D + BRMS, Kappa = 0,78 e 21-HAM-D + CARS-M X 21-HAM-D + BRMS, Kappa = 0,91 (p < 0,001). Conclusões:O presente estudo sugere que qualquer uma das três escalas de mania utilizadas (YMRS, BRMS, CARS-M) pode ser associada à 21-HAM-D na avaliação da resposta em bipolares mistos. / Background: Compared with patients with bipolar disorder who exhibit pure manic/hypomanic or depressive episodes, the presence of mixed mood states is associated with a more severe course of illness, younger age of onset, more frequent ocurrence of psychotic symptoms, major risk of suicide, higher rates of comorbidities and longer time to achieve remission. Therefore, objective avaliation of these states are necessary. Objective: To evaluate the concorccance amog three pairs of three scales (Young Mania Rating Scale (YMRS), Bech-Rafaelsen Mania Scale (BRMS) or Clinician-Administered Rating Scale for Mania (CARS-M)) and a depression scale (21-item Hamilton Depression) in the assessment of response to humor stabizator drugs in mix bipolar patients. Methods: Sixty eight (n=68) consecutive bipolar type I and II outpatients with mixed sitomatology accordint to DSM-IV-TR and Cincinatti Criteria were included in these 8 weeks open-trial, from 2010 through 2014, to, randomly, receive monotherapy valporic acid, carbamazepine or lithium carbonate. Results: The response answer (decrease of, at least 50 %, in one of the mania and depression scales) were very similar: 21-HAM-D + YMRS = 22.1%, 21-HAM-D + BRMS = 20.6% e 21-HAM-D + CARS-M = 23.5%; p < 0,368). The kappa values were : 21-HAM-D + YMRS X 21-HAM-D + CARS-M , Kappa = 0.87; 21-HAM-D + YMRS X 21-HAM-D + BRMS, Kappa = 0.78 e 21-HAM-D + CARS-M X 21-HAM-D + BRMS, Kappa = 0.91 (p < 0,001). Conclusions: The present study suggests that any of the three mania scales used (YMRS, BRMS, CARS-M) may be associated to 21-HAM-D in the assessment of the response o bipolar patients.