Gabriele Sani1, Paul A Vöhringer2, Sergio A Barroilhet3, Alexia E Koukopoulos4, S Nassir Ghaemi5. 1. NeSMOS Department, Sapienza University of Rome, Italy; Department of Psychiatry, Tufts Medical Center, Boston, MA, USA; Centro Lucio Bini, Rome, Italy; Tufts University School of Medicine, USA. Electronic address: gabriele.sani@uniroma1.it. 2. Department of Psychiatry, Tufts Medical Center, Boston, MA, USA; Psychiatry Department, Hospital Clinico University of Chile, Chile; Millenium Institute for Depression and Personality Research, Ministry of Economy, Macul, Santiago, Chile; Tufts University School of Medicine, USA. 3. Department of Psychiatry, Tufts Medical Center, Boston, MA, USA; University of Chile, Chile; Tufts University School of Medicine, USA. 4. Centro Lucio Bini, Rome, Italy; Umberto I Hospital, Psychiatry Department, Rome, Italy. 5. Tufts University School of Medicine, USA; Department of Psychiatry, Harvard Medical School, USA; Translational Medicine-Neuroscience, Novartis Institutes of Biomedical Research, Cambridge, MA, USA.
Abstract
BACKGROUND: It has been proposed that the broad major depressive disorder (MDD) construct is heterogenous. Koukopoulos has provided diagnostic criteria for an important subtype within that construct, "mixed depression" (MxD), which encompasses clinical pictures characterized by marked psychomotor or inner excitation and rage/anger, along with severe depression. This study provides psychometric validation for the first rating scale specifically designed to assess MxD symptoms cross-sectionally, the Koukopoulos Mixed Depression Rating Scale (KMDRS). METHODS: 350 patients from the international mood network (IMN) completed three rating scales: the KMDRS, Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS). KMDRS' psychometric properties assessed included Cronbach's alpha, inter-rater reliability, factor analysis, predictive validity, and Receiver Operator Curve analysis. RESULTS: Internal consistency (Cronbach's alpha = 0.76; 95% CI 0.57, 0.94) and interrater reliability (kappa = 0.73) were adequate. Confirmatory factor analysis identified 2 components: anger and psychomotor excitation (80% of total variance). Good predictive validity was seen (C-statistic = 0.82 95% CI 0.68, 0.93). Severity cut-off scores identified were as follows: none (0-4), possible (5-9), mild (10-15), moderate (16-20) and severe (> 21) MxD. LIMITATIONS: Non DSM-based diagnosis of MxD may pose some difficulties in the initial use and interpretation of the scoring of the scale. Moreover, the cross-sectional nature of the evaluation does not verify the long-term stability of the scale. CONCLUSIONS: KMDRS was a reliable and valid instrument to assess MxD symptoms.
BACKGROUND: It has been proposed that the broad major depressive disorder (MDD) construct is heterogenous. Koukopoulos has provided diagnostic criteria for an important subtype within that construct, "mixed depression" (MxD), which encompasses clinical pictures characterized by marked psychomotor or inner excitation and rage/anger, along with severe depression. This study provides psychometric validation for the first rating scale specifically designed to assess MxD symptoms cross-sectionally, the Koukopoulos Mixed Depression Rating Scale (KMDRS). METHODS: 350 patients from the international mood network (IMN) completed three rating scales: the KMDRS, Montgomery-Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS). KMDRS' psychometric properties assessed included Cronbach's alpha, inter-rater reliability, factor analysis, predictive validity, and Receiver Operator Curve analysis. RESULTS: Internal consistency (Cronbach's alpha = 0.76; 95% CI 0.57, 0.94) and interrater reliability (kappa = 0.73) were adequate. Confirmatory factor analysis identified 2 components: anger and psychomotor excitation (80% of total variance). Good predictive validity was seen (C-statistic = 0.82 95% CI 0.68, 0.93). Severity cut-off scores identified were as follows: none (0-4), possible (5-9), mild (10-15), moderate (16-20) and severe (> 21) MxD. LIMITATIONS: Non DSM-based diagnosis of MxD may pose some difficulties in the initial use and interpretation of the scoring of the scale. Moreover, the cross-sectional nature of the evaluation does not verify the long-term stability of the scale. CONCLUSIONS: KMDRS was a reliable and valid instrument to assess MxD symptoms.
Authors: Islam Shahin; Caterina Del Mar Bonnin; Elsayed Saleh; Khaled Helmy; Usama M Youssef; Eduard Vieta Journal: Neuropsychiatr Dis Treat Date: 2020-09-28 Impact factor: 2.570
Authors: Ludovico Mineo; Alessandro Rodolico; Giorgio Alfredo Spedicato; Andrea Aguglia; Simone Bolognesi; Carmen Concerto; Alessandro Cuomo; Arianna Goracci; Giuseppe Maina; Andrea Fagiolini; Mario Amore; Eugenio Aguglia Journal: Eur Psychiatry Date: 2022-05-31 Impact factor: 7.156