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Instrument development in the Italy-USA Collaborative Spectrum Project

  • Paola Rucci (a1) and Jack D. Maser (a2)

Summary

Scope – The Collaborative Spectrum Project aims to define subthreshold and atyical conditions not sufficiently characterized in the current diagnostic nomenclature and for which adequate assessment instruments are not available. This paper reports on the development and validation of new instruments to assess the spectrum of five psychiatric disorders. Design – Three multicenter studies and one single-site study were conducted in Italy to assess the validity and reliability of the five spectrum interviews. Another cross-sectional study to validate the panic-agoraphobia spectrum has been conducted in Pittsburgh. Setting – Outpatients attending various university clinics, university students and, in one Italian study, gym attenders were recruited for the studies. Main outcome measures – Five structured clinical interview to assess the spectrum of panicagoraphobia (SCI-PAS), mood (SCI-MOODS), social phobia (SCI-SHY), and the obsessive-compulsive (SCI-OBS) and eating disorder spectra (SCI-ABS) were administered along with a diagnostic interview and a number of self-report and interviewerrated instruments. Results – All the domains of the interview showed high test-retest reliability (intraclass correlation coefficient >0.61) and satisfactory internal consistency. Mean domain scores were significantly higher in cases than in controls and in patients with the disorder of interest than in patients with other disorders. Convergent validity was satisfactory for panic-agoraphobia, social phobia and obsessive-compulsive spectrum domains. Differences emerged between SCI-ABS and self-report instruments assessing eating disorders. A cut-off score for the panic-agoraphobia spectrum was defined and its clinical validity was tested. Conclusions – The psychometric properties of the five spectrum interviews are very satisfactory, and studies are currently ongoing to test the clinical validity of all the spectra. Subthreshold and atypical symptoms deserve attention in epidemiological investigation.

Scopo – Il Progetto Collaborativo dello Spettro mira a definire condizioni sottosoglia e atipiche non sufficientemente caratterizzate nel DSM-IV e nell'ICD-10, per le quali non sono disponibili adeguati strumenti di valutazione. Scopo di questo articolo è la descrizione delle procedure di sviluppo e validazione degli strumenti per misurare lo spettro di cinque disturbi psichici. Disegno – Sono stati effettuati 4 studi trasversali, di cui 3 multicentrici condotti in Italia, ed uno condotto esclusivamente a Pisa. Un ulteriore studio trasversale di validazione dello spettro del panico-agorafobia è stato condotto a Pittsburgh. Setting – Pazienti ambulatoriali afferenti alle cliniche universitarie, studenti universitari e, in uno degli studi italiani, anche un campione di frequentatori abttuali delle palestre. Principal misure utilizzate – Cinque interviste strutturate per valutare lo spettro del panico-agorafobia (SCI-PAS), dell'umore (SCI-MOODS), della fobia sociale (SCI-SHY), lo spettro ossessivo-compulsìxvo (SCI-OBS) e quello dei disturbi della condotta alimentare (SCI-ABS), unitamente ad una intervista diagnostica e ad una serie di strumenti auto ed eterovalutativi di contenuto analogo ai domini delle interviste. Risultati – Tutti i domini delle interviste hanno mostrato una elevata stabilità temporale (coefficiente di correlazione intraclasse >0.61) ed una soddisfacente consistenza interna. I punteggi medi dei domini sono risultati significativamente più elevati nei casi rispetto ai controlli e, nella quasi totalità dei confronti, nei pazienti con il disturbo di interesse rispetto ad altri disturbi. I confronti con strumenti analoghi per contenuto hanno messo in luce una buona validità concorrente per i domini dello spettro del panico-agorafobia, della fobia sociale e del disturbo ossessivo-compulsivo. Differenze sono emerse tra i domini dello spettro della condotta alimentare ed altri strumenti autovalutativi, verosimilmente legate anche alla forma di somministrazione. E' stata definita e testata clinicamente una soglia per lo spettro del panico-agorafobia nel campione americano. Conclusioni – Le proprietà psicometriche degli strumenti sono molto soddisfacenti e sono in corso studi di validazione clinica. Le condizioni atipiche e sottosoglia richedono attenzione negli studi clinici ed epidemiologici.

Copyright

Corresponding author

Indirizzo per la corrispondenza: Dr. Paola Rucci, Via Sacco 2, 40124 Bologna. Fax: +39-051-421.6814 E-mail: ruccip@msx.upmc.edu

References

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Keywords

Instrument development in the Italy-USA Collaborative Spectrum Project

  • Paola Rucci (a1) and Jack D. Maser (a2)

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