Rating Scales and Safety Measurements in Bipolar Disorder

Rating Scales and Safety Measurements in Bipolar Disorder

Article

Psychopharmacol Bull: Vol. 47 · No. 3 2017; 47(3) p77–109

Summary of the research

            In advanced practice nursing research, each subject is provided with a statement and purpose and the expected duration of the study. For instance, the subject in clinical nursing should understand which research activities are associated with nursing activities and those which are routine nursing interventions. It is vital during the research that the subject obtains informed consent from human subjects so they can be able to conduct ethical research. However, the research may face ethical issues such as scientific misconduct and the use of animals in the research.

This study purposes to evaluate the measurement variable used with bipolar disorder. Thorough research was done on the topic though it is not sufficient to make conclusions. The quantitative and qualitative methods of research were used.

Statistical analysis was done, questionnaires were given out to respondents, and three semi-structured interviews were conducted. The mood disorder questionnaire, hypomania checklist, and mania rating scale are the measurement instrument used in the study. The types of measurements used to gather data were databases, medical data registries, and clinical Heparin-Induced Thrombocytopenia (HIT). These measurement methods were effective for the study.

According to research by the psychopharmacology bulletin (2017), the measurement for validity helps healthcare professionals evaluate and understand the clinical evidence for the treatment of the bipolar disorder. The article uses rating scales on bipolar disorders as a form of scales of measurement. The rating scales were tested for reliability and validity. The article addresses the valid and reliable rating scales in bipolar disorder.

Research Method

Qualitative and quantitative methods of research were both used in the study. Statistical analysis was done. Questionnaires were administered to the different respondents, and three semi-structured face-to-face interviews were conducted. A random sample was used in the study.

Quality of Life Enjoyment and Satisfaction Questionnaires and mood disorder questionnaires were given to different patients, and they inquired about the mood, physical health, social and family relationships, leisure activities, and work (VanFosson et al., 2016). The interviews were conducted using the Positive and Negative Syndrome Scale (PANSS). PANSS consists of 30 items ranging from positive scale, negative scale, and general psychopathology. The positive items include hallucinatory behavior, delusions, excitement, grandiosity, conceptual disorganization, hostility, and suspiciousness (Munkholm, 2015). Items on the negative scale are poor rapport, blunted affect. Passive-apathetic social withdrawal, emotional withdrawal, difficulty in abstract thinking, stereotyped thinking, and lack of spontaneity and flow of conversation (Bull, 2017). Items on the general psychopathology scale include uncooperativeness, feeling of guilt, anxiety, motor retardation, somatic concern, tension, depression, disorientation, mannerisms and posturing, active social avoidance, poor impulse control, preoccupation, lack of judgment and insight and disturbance of volition. PANSS was adopted from the previous psychopathology scales. This scale involves a clinical interview and any supporting information from the patient. The interviewer is responsible for rating the severity of the symptoms (Poletti et al., 2015).

Types of measurement used to gather and analyze the data

Data was collected and gathered from databases with medical patients with bipolar diseases or related cases, medical data registries, and clinical Heparin-Induced Thrombocytopenia (HIT). A rating scale was used as a measurement to collect and analyze data. The mood disorder questionnaire, hypomania checklist, and mania rating scale are the measurement instrument used in the study. The rating scales include Montgomery-asberg depression rating scale, young mania rating scale, a hamilton rating scale for anxiety, a quick inventory of depressive symptomatology – self-report, and a brief psychiatric rating scale.

Montgomery-Asberg Depression Rating Scale

The depressive symptoms and core emotional items measured under the Montgomery asberg depression rating scale are reported sadness, concentration difficulties, inner tension, apparent sadness, suicidal thoughts, inability to feel, pessimistic thoughts, reduced appetite, lassitude, and reduced sleep (Bull, 2017). This rating scale is usually used in clinical trials, and the severity of the items are rated from 0 to 6.

Clinical Global Impression Bipolar Version

Clinical global impression measures the severity of the bipolar disorder illness. The rate in this scale is drawn upon the clinical experience and comparing it with other patients having bipolar disorders (Bull, 2017). This rating is modified to measure the severity of the illness. This method is mainly effective in depressive and manic episodes of bipolar disorder. The National Institute of Mental health came up with this scale, and it is widely used in psychiatry. The range of rating is 1 to 7, and the patient is compared with other patients with the same diagnosis (Poletti et al., 2015).

Young Mania Rating Scale

The young mania rating scale consists of eleven items, and it is designed to analyze the severity of manic symptoms. The scale is always used for mania, and severity ranges from 0 to 6.

Hamilton Rating Scale for Anxiety

The scale has fourteen items; intellect, cardiovascular system, respiratory system, depressed mood, insomnia, somatic general, anxious mood, fears tension, behavior at interview, autonomic system, and genitourinary system(Poletti et al., 2015). This scale depends on the patient report with a scale of 0 to 4.

Quick Inventory of Depressive Symptomatology – Self Report

QIDS- SR has 16 items separate self-reported that go in hand with the nine main symptom domains of DSM-IV MDD (Bull, 2017). The four items of sleep disturbances are waking up too early, falling asleep, sleeping too much, and sleeping during the night. These are the highest individual score for items. Another item is feeling sad. Items associated with appetite and weight are increased appetite, decreased appetite, decreased weight. These items have a score of 6 to 9.  Other items are general interest, view of myself, energy level, concentration/ decision making. Item 15 and 16 pertain psychomotor disturbances are feeling restless and feeling slowed down, and they are the highest item score(Poletti et al., 2015). The patient is usually asked to select a score item that explains their condition for the past seven days.

Brief Psychiatric Rating Scale

BPRS has the following symptom constructs emotional withdrawal, somatic concern, tension, anxiety, conceptual disorganization, mannerism and posturing, feelings of guilt, hallucinatory behavior, hostility, grandiosity, suspiciousness, motor retardation, blunted affect, unusual thought content, and uncooperativeness. This scale is majorly used to measure psychotic and non- psychotic symptoms. Items are rated on a 7- point scale by a psychologist.

Conclusion

The measurement instruments and the measurement methods to collect data were effective for the study. The questionnaires and interviews provided essential data for the study though the data is not sufficient to make conclusions about the research. The rating scale used a measurement variable for bipolar disorder that provided the required data, and it is effective for measurement validity.

Reference

Bull, P. (2017). Rating scales and safety measurements in bipolar disorder and schizophrenia–a reference guide. Psychopharmacology Bulletin, 47(3), 77-109. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546554/

Munkholm, K., Peijs, L., Vinberg, M., & Kessing, L. V. (2015). A composite peripheral blood gene expression measure as a potential diagnostic biomarker in bipolar disorder. Translational psychiatry, 5(8), e614-e614. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4564565/

Poletti, S., Bollettini, I., Mazza, E., Locatelli, C., Radaelli, D., Vai, B., … & Benedetti, F. (2015). Cognitive performances associate with measures of white matter integrity in bipolar disorder. Journal of affective disorders, 174, 342-352. https://europepmc.org/article/med/25553397

Spurlock, D., & Wonder, A. H. (2015). Validity and reliability evidence for a new measure: The evidence-based practice knowledge assessment in nursing. Journal of Nursing Education, 54(11), 605-613. https://www.ncbi.nlm.nih.gov/pubmed/26517071

VanFosson, C. A., Jones, T. L., & Yoder, L. H. (2016). Unfinished nursing care: an important performance measure for nursing care systems. Nursing Outlook, 64(2), 124-136. https://www.ncbi.nlm.nih.gov/pubmed/26850334