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Per Bech - One of the best experts on this subject based on the ideXlab platform.
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Olanzapine plasma level in relation to antimanic effect in the acute therapy of manic states.
Nordic Journal of Psychiatry, 2009Co-Authors: Per Bech, Marianne Gex-fabry, Jean-michel Aubry, Sophie Favre, Gilles BertschyAbstract:The aim of this study was to evaluate internal as well as external validity of the two most frequently used Mania Scales, the Young Mania Rating Scale (YMRS) and the Bech–Rafaelsen Mania Scale (MAS), in patients with DSM-IV Mania. Mokken analysis was used to evaluate internal validity in which a coefficient of homogeneity of 0.40 or higher indicates that the total score is a sufficient statistic. The external validity was evaluated by plasma-level relationship of olanzapine. In total, 20 patients with DSM-IV Mania were analysed, and the coefficient of homogeneity was acceptable for the MAS, but not for the YMRS. In a subgroup of females who over 2 weeks had received a fixed dose of 20 mg olanzapine daily, a significant association was found between MAS scores and plasma levels, but this association was not obtained with the YMRS. In conclusion, the MAS was found superior to the YMRS in regard to both internal and external validity.
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The Bech-Rafaelsen Mania Scale in Clinical Trials of Therapies for Bipolar Disorder
CNS Drugs, 2002Co-Authors: Per BechAbstract:Over the last two decades the Bech-Rafaelsen Mania Scale (MAS) has been used extensively in trials that have assessed the efficacy of treatments for bipolar disorder. The extent of its use makes it possible to evaluate the psychometric properties of the Scale according to the principles of internal validity, reliability, and external validity. Studies of the internal validity of the MAS have demonstrated that the simple sum of the 11 items of the Scale is a sufficient statistic for the assessment of the severity of manic states. Both factor analysis and latent structure analysis (the Rasch analysis) have been used to demonstrate this. The total score of the MAS has been standardised such that scores below 15 indicate hypoMania, scores around 20 indicate moderate Mania, and scores around 28 indicate severe Mania. The inter-observer reliability has been found to be high in a number of studies conducted in various countries. The MAS has shown an acceptable external validity, in terms of both sensitivity and responsiveness. Thus, the MAS was found to be superior to the Clinical Global Impression Scale with regard to responsiveness, and sensitivity has been found to be adequate, with the MAS able to demonstrate large drug-placebo differences. Based on pretreatment scores, trials of antimanic therapies can be classified into: (i) ultrashort (1 week) therapy of severe Mania; (ii) short-term therapy (3 to 8 weeks) of moderate Mania; (iii) short-term therapy of hypomanic or mixed bipolar states; and (iv) long-term (12 months) therapy of bipolar states. The responsiveness of MAS is such that the Scale has been able to demonstrated that typical antipsychotics are effective as an ultrashort therapy of severe Mania; that lithium and anticonvulsants are effective in the short-term therapy of moderate Mania; and that atypical antipsychotics, electroconvulsive therapy (ECT) and transcranial magnetic stimulation seem to have promising effects in the short-term therapy of moderate Mania. In contrast, the Scale has been used to demonstrate that calcium antagonists (e.g. verapamil) are ineffective in the treatment of Mania. MAS has also been used to add to the literature on the evidence-based effect of lithium as a short-term therapy for hypoMania or mixed bipolar states and as a long-term therapy of bipolar states.
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the bech rafaelsen Mania Scale in clinical trials of therapies for bipolar disorder a 20 year review of its use as an outcome measure
CNS Drugs, 2002Co-Authors: Per BechAbstract:Over the last two decades the Bech-Rafaelsen Mania Scale (MAS) has been used extensively in trials that have assessed the efficacy of treatments for bipolar disorder. The extent of its use makes it possible to evaluate the psychometric properties of the Scale according to the principles of internal validity, reliability, and external validity. Studies of the internal validity of the MAS have demonstrated that the simple sum of the 11 items of the Scale is a sufficient statistic for the assessment of the severity of manic states. Both factor analysis and latent structure analysis (the Rasch analysis) have been used to demonstrate this. The total score of the MAS has been standardised such that scores below 15 indicate hypoMania, scores around 20 indicate moderate Mania, and scores around 28 indicate severe Mania. The inter-observer reliability has been found to be high in a number of studies conducted in various countries. The MAS has shown an acceptable external validity, in terms of both sensitivity and responsiveness. Thus, the MAS was found to be superior to the Clinical Global Impression Scale with regard to responsiveness, and sensitivity has been found to be adequate, with the MAS able to demonstrate large drug-placebo differences. Based on pretreatment scores, trials of antimanic therapies can be classified into: (i) ultrashort (1 week) therapy of severe Mania; (ii) short-term therapy (3 to 8 weeks) of moderate Mania; (iii) short-term therapy of hypomanic or mixed bipolar states; and (iv) long-term (12 months) therapy of bipolar states. The responsiveness of MAS is such that the Scale has been able to demonstrated that typical antipsychotics are effective as an ultrashort therapy of severe Mania; that lithium and anticonvulsants are effective in the short-term therapy of moderate Mania; and that atypical antipsychotics, electroconvulsive therapy (ECT) and transcranial magnetic stimulation seem to have promising effects in the short-term therapy of moderate Mania. In contrast, the Scale has been used to demonstrate that calcium antagonists (e.g. verapamil) are ineffective in the treatment of Mania. MAS has also been used to add to the literature on the evidence-based effect of lithium as a short-term therapy for hypoMania or mixed bipolar states and as a long-term therapy of bipolar states.
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dimensionality responsiveness and standardization of the bech rafaelsen Mania Scale in the ultra short therapy with antipsychotics in patients with severe manic episodes
Acta Psychiatrica Scandinavica, 2001Co-Authors: Per Bech, P C Baastrup, E De Bleeker, R RopertAbstract:Objective: Typical antipsychotics have their indication in the ultra-short (first week) treatment of severe episodes of Mania. In this setting the Bech–Rafaelsen Mania Scale (MAS) was psychometrically compared with the Clinical Global Impression Scale (CGI) to assess its ability to measure response. Method: Ratings on patients with marked to severe Mania (n=80) who participated in the clinical trials to evaluate the ultra-short antimanic effect of zuclopenthixol acetate were assessed. The MAS was analysed for internal validity (total score a sufficient statistic) and for external validity. Results: The MAS was shown to have a high internal validity showing onset of action already after days of treatment. After 6 days of treatment 53% of the patients responded according to the MAS but only 30% according to the CGI. The difference was statistically significant. Conclusion: The MAS has been found to be a valid Scale to measure early onset of action and response in the ultra-short antimanic treatment with typical antipsychotics.
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the bech rafaelsen Mania Scale mas
1996Co-Authors: Per BechAbstract:The DSM-IV criteria for Mania: If A2 is scored higher than A1, a manic classification requires at least four B items. If A1 is scored higher than A2, only three B items are needed.
Sophia Frangou - One of the best experts on this subject based on the ideXlab platform.
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child behavior checklist Mania Scale cbcl ms development and evaluation of a population based screening Scale for bipolar disorder
PLOS ONE, 2013Co-Authors: Efstathios Papachristou, Johannes Ormel, Marinos Kyriakopoulos, Maria Reinares, Albertine J Oldehinkel, Abraham Reichenberg, Sophia FrangouAbstract:CONTEXT: Early identification of Bipolar Disorder (BD) remains poor despite the high levels of disability associated with the disorder. OBJECTIVE: We developed and evaluated a new DSM orientated Scale for the identification of young people at risk for BD based on the Child Behavior Checklist (CBCL) and compared its performance against the CBCL-Pediatric Bipolar Disorder (CBCL-PBD) and the CBCL-Externalizing Scale, the two most widely used Scales. METHODS: The new Scale, CBCL-Mania Scale (CBCL-MS), comprises 19 CBCL items that directly correspond to operational criteria for Mania. We tested the reliability, longitudinal stability and diagnostic accuracy of the CBCL-MS on data from the TRacking Adolescents' Individual Lives Survey (TRAILS), a prospective epidemiological cohort study of 2230 Dutch youths assessed with the CBCL at ages 11, 13 and 16. At age 19 lifetime psychiatric diagnoses were ascertained with the Composite International Diagnostic Interview. We compared the predictive ability of the CBCL-MS against the CBCL-Externalising Scale and the CBCL-PBD in the TRAILS sample. RESULTS: The CBCL-MS had high internal consistency and satisfactory accuracy (area under the curve = 0.64) in this general population sample. Principal Component Analyses, followed by parallel analyses and confirmatory factor analyses, identified four factors corresponding to distractibility/disinhibition, psychosis, increased libido and disrupted sleep. This factor structure remained stable across all assessment ages. Logistic regression analyses showed that the CBCL-MS had significantly higher predictive ability than both the other Scales. CONCLUSIONS: Our data demonstrate that the CBCL-MS is a promising screening instrument for BD. The factor structure of the CBCL-MS showed remarkable temporal stability between late childhood and early adulthood suggesting that it maps on to meaningful developmental dimensions of liability to BD.
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child behaviour checklist Mania Scale cbcl ms development and validation among a non clinical pediatric population
F1000Research, 2012Co-Authors: Efstathios Papachristou, Johannes Ormel, Marinos Kyriakopoulos, Maria Reinares, Albertine J Oldehinkel, Abraham Reichenberg, Sophia FrangouAbstract:previously developed that aim to capture the Mania phenotype, however they have limited potential as screening instruments in non-clinical populations. The goal of this study was to investigate the psychometric properties as well specificity and sensitivity rates of a new Mania CBCLsubScale developed using the same methodology as the originally defined for DSM-oriented subScale development by Achenbach et al. (2003). METHODS: An expert panel identified 19 items from the CBCL 6-18 that map onto the DSM-IV criteria for Mania. We then tested the validity and reliability of this subScale, the CBCL-Mania Scale (CBCL-MS), on data from TRAILS (TRacking Adolescents’ Individual Lives Survey). TRAILS is a prospective epidemiological study of a cohort of 1240 Dutch adolescents who were assessed with the full CBCL at age 16 and were administered the Composite International Diagnostic Interview (CIDI) at age 18. Thirty-nine cases meeting criteria for Mania were identified using CIDI.
Efstathios Papachristou - One of the best experts on this subject based on the ideXlab platform.
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child behavior checklist Mania Scale cbcl ms development and evaluation of a population based screening Scale for bipolar disorder
PLOS ONE, 2013Co-Authors: Efstathios Papachristou, Johannes Ormel, Marinos Kyriakopoulos, Maria Reinares, Albertine J Oldehinkel, Abraham Reichenberg, Sophia FrangouAbstract:CONTEXT: Early identification of Bipolar Disorder (BD) remains poor despite the high levels of disability associated with the disorder. OBJECTIVE: We developed and evaluated a new DSM orientated Scale for the identification of young people at risk for BD based on the Child Behavior Checklist (CBCL) and compared its performance against the CBCL-Pediatric Bipolar Disorder (CBCL-PBD) and the CBCL-Externalizing Scale, the two most widely used Scales. METHODS: The new Scale, CBCL-Mania Scale (CBCL-MS), comprises 19 CBCL items that directly correspond to operational criteria for Mania. We tested the reliability, longitudinal stability and diagnostic accuracy of the CBCL-MS on data from the TRacking Adolescents' Individual Lives Survey (TRAILS), a prospective epidemiological cohort study of 2230 Dutch youths assessed with the CBCL at ages 11, 13 and 16. At age 19 lifetime psychiatric diagnoses were ascertained with the Composite International Diagnostic Interview. We compared the predictive ability of the CBCL-MS against the CBCL-Externalising Scale and the CBCL-PBD in the TRAILS sample. RESULTS: The CBCL-MS had high internal consistency and satisfactory accuracy (area under the curve = 0.64) in this general population sample. Principal Component Analyses, followed by parallel analyses and confirmatory factor analyses, identified four factors corresponding to distractibility/disinhibition, psychosis, increased libido and disrupted sleep. This factor structure remained stable across all assessment ages. Logistic regression analyses showed that the CBCL-MS had significantly higher predictive ability than both the other Scales. CONCLUSIONS: Our data demonstrate that the CBCL-MS is a promising screening instrument for BD. The factor structure of the CBCL-MS showed remarkable temporal stability between late childhood and early adulthood suggesting that it maps on to meaningful developmental dimensions of liability to BD.
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child behaviour checklist Mania Scale cbcl ms development and validation among a non clinical pediatric population
F1000Research, 2012Co-Authors: Efstathios Papachristou, Johannes Ormel, Marinos Kyriakopoulos, Maria Reinares, Albertine J Oldehinkel, Abraham Reichenberg, Sophia FrangouAbstract:previously developed that aim to capture the Mania phenotype, however they have limited potential as screening instruments in non-clinical populations. The goal of this study was to investigate the psychometric properties as well specificity and sensitivity rates of a new Mania CBCLsubScale developed using the same methodology as the originally defined for DSM-oriented subScale development by Achenbach et al. (2003). METHODS: An expert panel identified 19 items from the CBCL 6-18 that map onto the DSM-IV criteria for Mania. We then tested the validity and reliability of this subScale, the CBCL-Mania Scale (CBCL-MS), on data from TRAILS (TRacking Adolescents’ Individual Lives Survey). TRAILS is a prospective epidemiological study of a cohort of 1240 Dutch adolescents who were assessed with the full CBCL at age 16 and were administered the Composite International Diagnostic Interview (CIDI) at age 18. Thirty-nine cases meeting criteria for Mania were identified using CIDI.
Maria Reinares - One of the best experts on this subject based on the ideXlab platform.
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child behavior checklist Mania Scale cbcl ms development and evaluation of a population based screening Scale for bipolar disorder
PLOS ONE, 2013Co-Authors: Efstathios Papachristou, Johannes Ormel, Marinos Kyriakopoulos, Maria Reinares, Albertine J Oldehinkel, Abraham Reichenberg, Sophia FrangouAbstract:CONTEXT: Early identification of Bipolar Disorder (BD) remains poor despite the high levels of disability associated with the disorder. OBJECTIVE: We developed and evaluated a new DSM orientated Scale for the identification of young people at risk for BD based on the Child Behavior Checklist (CBCL) and compared its performance against the CBCL-Pediatric Bipolar Disorder (CBCL-PBD) and the CBCL-Externalizing Scale, the two most widely used Scales. METHODS: The new Scale, CBCL-Mania Scale (CBCL-MS), comprises 19 CBCL items that directly correspond to operational criteria for Mania. We tested the reliability, longitudinal stability and diagnostic accuracy of the CBCL-MS on data from the TRacking Adolescents' Individual Lives Survey (TRAILS), a prospective epidemiological cohort study of 2230 Dutch youths assessed with the CBCL at ages 11, 13 and 16. At age 19 lifetime psychiatric diagnoses were ascertained with the Composite International Diagnostic Interview. We compared the predictive ability of the CBCL-MS against the CBCL-Externalising Scale and the CBCL-PBD in the TRAILS sample. RESULTS: The CBCL-MS had high internal consistency and satisfactory accuracy (area under the curve = 0.64) in this general population sample. Principal Component Analyses, followed by parallel analyses and confirmatory factor analyses, identified four factors corresponding to distractibility/disinhibition, psychosis, increased libido and disrupted sleep. This factor structure remained stable across all assessment ages. Logistic regression analyses showed that the CBCL-MS had significantly higher predictive ability than both the other Scales. CONCLUSIONS: Our data demonstrate that the CBCL-MS is a promising screening instrument for BD. The factor structure of the CBCL-MS showed remarkable temporal stability between late childhood and early adulthood suggesting that it maps on to meaningful developmental dimensions of liability to BD.
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child behaviour checklist Mania Scale cbcl ms development and validation among a non clinical pediatric population
F1000Research, 2012Co-Authors: Efstathios Papachristou, Johannes Ormel, Marinos Kyriakopoulos, Maria Reinares, Albertine J Oldehinkel, Abraham Reichenberg, Sophia FrangouAbstract:previously developed that aim to capture the Mania phenotype, however they have limited potential as screening instruments in non-clinical populations. The goal of this study was to investigate the psychometric properties as well specificity and sensitivity rates of a new Mania CBCLsubScale developed using the same methodology as the originally defined for DSM-oriented subScale development by Achenbach et al. (2003). METHODS: An expert panel identified 19 items from the CBCL 6-18 that map onto the DSM-IV criteria for Mania. We then tested the validity and reliability of this subScale, the CBCL-Mania Scale (CBCL-MS), on data from TRAILS (TRacking Adolescents’ Individual Lives Survey). TRAILS is a prospective epidemiological study of a cohort of 1240 Dutch adolescents who were assessed with the full CBCL at age 16 and were administered the Composite International Diagnostic Interview (CIDI) at age 18. Thirty-nine cases meeting criteria for Mania were identified using CIDI.
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Tratamiento del trastorno bipolar II con lamotrigina
Actas Espanolas De Psiquiatria, 2003Co-Authors: Eduard Vieta, Maria Reinares, Anabel Martínez-arán, Goikolea M, Antonio Benabarre, Carla Torrent, Mercè Comes, F. Colom, Gemma Parramon, Barbara CorbellaAbstract:INTRODUCTION: This study analyzes the effectiveness and safety of lamotrigine in the treatment of bipolar II disorder. Patients and methods. Seventeen patients with DSM-IV bipolar II disorder with a history of poor response to lithium or other mood-stabilizers gave their consent to be treated with lamotrigine. Th ey we re followed-up for 6 months and assessed with the Young Mania Scale (YMRS), Hamilton Depression Rating Scale (HDRS-17) and the modified version of the Global Clinic Impresion Scale for Bipolar Disorder ( CG I-BP-M). RESULTS: Twelve patients completed the study. Three patients dropped out due to side effects (two because of mild rash, which vanished after treatment was discontinued and one because of vomiting) and two due to lack of efficacy. The mean dose of lamotrigine for patients completing the study was 202.1 64.4 mg/day. There was a significant improvement in HDRS-17 scores (p= 0.004) and the depressive (p=0.002) and overall (p= 0.002) subScales of the CGI-BP-M. CONCLUSIONS: This study confirms previous findings concerning the antidepressant profile of lamotrigine and its potential effectiveness in bipolar II disorder.
Jeanmichel Azorin - One of the best experts on this subject based on the ideXlab platform.
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young Mania rating Scale how to interpret the numbers determination of a severity threshold and of the minimal clinically significant difference in the emblem cohort
International Journal of Methods in Psychiatric Research, 2013Co-Authors: Michael Lukasiewicz, Catherine Reed, Stephanie Gerard, Adeline Besnard, Bruno Falissard, Elena Perrin, Helene Sapin, Mauricio Tohen, Jeanmichel AzorinAbstract:The aim of this analysis was to identify Young Mania Rating Scale (YMRS) meaningful benchmarks for clinicians (severity threshold, minimal clinically significant difference [MCSD]) using the Clinical Global Impressions Bipolar (CGI-BP) Mania Scale, to provide a clinical perspective to randomized clinical trials (RCTs) results. We used the cohort of patients with acute manic/mixed state of bipolar disorders (N = 3459) included in the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) study. A receiver-operating characteristic analysis was performed on randomly selected patients to determine the YMRS optimal severity threshold with CGI-BP Mania score ≥ “Markedly ill” defining severity. The MCSD (clinically meaningful change in score relative to one point difference in CGI-BP Mania for outcome measures) of YMRS, was assessed with a linear regression on baseline data. At baseline, YMRS mean score was 26.4 (±9.9), CGI-BP Mania mean score was 4.8 (±1.0) and 61.7% of patients had a score ≥ 5. The optimal YMRS severity threshold of 25 (positive predictive value [PPV] = 83.0%; negative predictive value [NPV] = 66.0%) was determined. In this cohort, a YMRS score of 20 (typical cutoff for RCTs inclusion criteria) corresponds to a PPV of 74.6% and to a NPV of 77.6%, meaning that the majority of patients included would be classified as severely ill. The YMRS minimal clinically significant difference was 6.6 points. Copyright © 2013 John Wiley & Sons, Ltd.