The improved Clinical Global Impression Scale (iCGI): development and validation in depression

Alane Kadouri, Emmanuelle Corruble, Bruno Falissard, Alane Kadouri, Emmanuelle Corruble, Bruno Falissard

Abstract

Background: The Clinical Global Impression scale (CGI) is frequently used in medical care and clinical research because of its face validity and practicability. This study proposes to improve the reliability of the Clinical Global Impression (CGI) scale in depressive disorders by the use of a semi-standardized interview, a new response format, and a Delphi procedure.

Methods: Thirty patients hospitalised for a major depressive episode were filmed at T1 (first week in hospital) and at T2 (2 weeks later) during a 5' specific interview. The Hamilton Depressive Rating Scale and the Symptom Check List were also rated. Eleven psychiatrists rated these videos using either the usual CGI response format or an improved response format, with or without a Delphi procedure.

Results: The new response format slightly improved (but not significantly) the interrater agreement, the Delphi procedure did not. The best results were obtained when ratings by 4 independent raters were averaged. In this situation, intraclass correlation coefficients were about 0.9.

Conclusion: The Clinical Global Impression is a useful approach in psychiatry since it apprehends patients in their entirety. This study shows that it is possible to quantify such impressions with a high level of interrater agreement.

References

    1. Guy W. Clinical Global Impression. ECDEU Assessment Manual for Psychopharmacology, revised National Institute of Mental Health, Rockville, MD. 1976.
    1. Spearing MK, Post RM, Leverich GS, Brandt D, Nolen W. Modification of the clinical global Impression scale for use in bipolar illness (BP): the CGI-BP. Psychiatry Research. 1997;73:159–171. doi: 10.1016/S0165-1781(97)00123-6.
    1. Leon AC, Shear K, Klerman GL, Portera L, Rosenbaum JF, Goldenberg I. A comparison of Symptom Determinants of patient and clinical global ratings in patients with panic disorder and depression. J Clin Psychopharmacol. 1993;13:327–331. doi: 10.1097/00004714-199310000-00005.
    1. Haro JM, Kamath SA, Ochoa S, Novick D, Rele K, Fargas A, Rodriguez MJ, Rele R, Orta J, Kharbeng A, Araya S, Gervin M, Alonso J, Mavreas V, Lavrentzou E, Liontos N, Gregor K, Jones PB, on behalf of the SOHO Study Group The global impression-schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia. Acta Psychiatrica Scandinavica. 2003;107 (suppl. 416):16–23. doi: 10.1034/j.1600-0447.107.s416.5.x.
    1. Bech P. Rating scales for affective disorders: their validity and consistency. Acta Psychiatrica Scandinavica. 1981;S295:11–93.
    1. Lecrubier Y. Séminaire de Psychiatrie Biologique. Vol. 26. Paris, Rhône-Poulenc- Rorer; 1996. Avantages et limites de la quantification des symptômes dépressifs.
    1. Guelfi JD. Clinical research in psychopharmacology: new standards for drug development. An application to antidepressants. Psychiatrie et Psychobiologie. 1990;5:289–294.
    1. Prien RF, Levine J. Research and methodological issues for evaluating the thérapeutic effectiveness of antidepressant drugs. Psychopharmacol Bulletin. 1984;20:250–257.
    1. Cicchetti DV, Prusoff BA. Reliability of depression and associated clinical symptoms. Arch Gen Psychiatry. 1983;40:987–990.
    1. Jones J, Hunter D. Consensus methods for medical and health services research. BMJ. 1995;311:376–380.
    1. Graham B, Regehr G, Wright JG. Delphi as a method consensus for diagnostic criteria. J Clin Epidemiol. 2003;56:1150–1156. doi: 10.1016/S0895-4356(03)00211-7.
    1. Fink A, Losecoff J, Chassin M, Brook RH. Consensus methods: characteristic and guidelines for use. Am J Public Health. 1984;74:376–380.
    1. Miller GA. the magical number seven, plus or minus two: some limits on our capacity for processing information. Psychol rev. 1956;63:81–97. doi: 10.1037/h0043158.
    1. Preston CC, Colman AM. Optimal number of response categories in rating scales: reliability, validity, discriminating power, and respondent preferences. Acta Psychologica. 1999;104:1–15. doi: 10.1016/S0001-6918(99)00050-5.
    1. Cox EP. The optimal number of response alternatives for a scale: a review. Journal of marketing research. 1980;15:261–257.
    1. Minkowsky E. Le temps vécu. Quadriges / presses universitaire de France 1995.
    1. Rûmke HC. la différence clinique à l'intérieur du groupe des schizophrènes. L'evolution psychiatrique. 1958;23:525–538.
    1. Buytendijk FJJ. Textes et études philosophiques. Desclée de Brouwer 1952. Phénoménologie de la rencontre.
    1. Tellenbach H. Psychiatrie ouverte. Presse Universitaire de France 1968. Goût et atmosphère.
    1. Gupta M. The Impact of "Phenomenology" on North American Psychiatric Assessment. Philosophy, Psychiatry & Psychology. 2002;9:73–85. doi: 10.1353/ppp.2003.0009.
    1. American-Psychiatric-Association . Diagnostic and Statistical Manual of mental Disorders. Washington DC, ; 1984.
    1. Shrout PE, Fleiss JL. intraclass correlations uses in assessing rater reliability. Psychological Bull. 1979;86:420–428. doi: 10.1037/0033-2909.86.2.420.
    1. Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. 2nd ed.Oxford medical publications. Oxford, ; 1994.
    1. Norman GR, Stradford P, Regehr G. Methodological problems in the retrospective computation of responsiveness to change: the lesson of Chronbach. J Clin Epidemiol. 1997;50:869–879. doi: 10.1016/S0895-4356(97)00097-8.
    1. R [computer program]. Version 1.9.1. , ; 2002.
    1. Cicchetti DV, Sparrow SS. Developing criteria for establishing the interrater reliability of specific item in a given inventory: Applications to the assessment of adaptive behavior. Am J Ment Defic. 1981;86:127–137.
    1. Fermanian J. The degree of concordance between observers. The quantitative case. Revue d'épidémiologie et de santé publique. 1984;32:408–413.
    1. Schene AH, Koeter M, Wijngaarden BV. Methodology of a multi-site reliability study. Br J Psychiatry. 2000;177(suppl 30):15–20. doi: 10.1192/bjp.177.39.s15.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa