Objective To determine the validity of short Geriatric Depression Scale (GDS) versions for the detection of a major depressive episode according to ICD‐10 criteria for research and DSM‐IV. Design Cross‐sectional evaluation of depressive symptoms in a sample of elderly subjects with short GDS versions. Different GDS cutoff points were used to estimate the sensitivity, specificity, positive predictive value and negative predictive value for the diagnosis of major depressive episode. Internal consistency of the scales was estimated with the Cronbach's alpha coefficient. Setting Mental Health Unit for the Elderly of ‘Santa Casa' Medical School in São Paulo, Brazil. Participants Sixty‐four consecutive outpatients aged 60 or over who met criteria for depressive disorder (current or in remission). Subjects with severe sensory impairment, aphasia or Mini‐Mental State score lower than 10 were excluded from the study. Measurements ICD‐10 Checklist of Symptoms, GDS with 15, 10, 4 and 1 items, Montgomery‐Åsberg Depression Rating Scale (MADRS), ICD‐10 diagnostic criteria for research and DSM‐IV diagnostic criteria. Results The use of the cutoff point 4/5 for the GDS‐15 produced sensitivity and specificity rates of 92.7% and 65.2% respectively, and positive and negative predictive values of 82.6% and 83.3% respectively when ICD‐10 diagnostic criteria for major depressive episode were used as the ‘gold standard'. Similarly, rates of 97.0%, 54.8%, 69.6% and 94.4% were found when DSM‐IV was the comparing diagnostic criteria. Sensitivity, specificity and positive and negative predictive values for the cutoff point 6/7 were 80.5%, 78.3%, 86.8% and 69.2% according to ICD‐10, and 84.8%, 67.7%, 73.7% and 80.8% respectively according to DSM‐IV. Intermediate values were found for the cutoff point 5/6. The best fit for GDS‐10 was the cutoff point 4/5, which produced a sensitivity rate of 80.5%, specificity of 78.3%, positive predictive value of 86.8% and negative predictive value of 60.2% according to ICD‐10 diagnosis of a major depressive episode. Similarly, rates of 84.8%, 67.7%, 73.7% and 80.8% were found when DSM‐IV criteria for major depression were used. GDS‐4 cutoff point of 2/3 was associated with a sensitivity rate of 80.5%, specificity of 78.3%, positive predictive value of 86.8% and negative predictive value of 69.2% when compared to ICD‐10. Again, rates of 84.8%, 67.7%, 73.7% and 80.8% respectively were found when the criteria used were based on DSM‐IV. GDS‐1 had low sensitivity (61.0% and 63.6% for ICD‐10 and DSM‐IV respectively) and negative predictive value (56.7% and 67.6% for ICD‐10 and DSM‐IV respectively), suggesting that this question is of limited clinical utility in screening for depression. GDS‐15 (rho=0.82), GDS‐10 (rho=0.82) and GDS‐4 (rho=0.81) scores were highly correlated with subjects' scores on the MADRS. Reliability coefficients were 0.81 for GDS‐15, 0.75 for GDS‐10 and 0.41 for GDS‐4. Conclusion GDS‐15, GDS‐10 and GDS‐4 are good screening instruments for major depression as defined by both the ICD...

Depressão é problema de saúde frequente entre idosos, embora a identificação desses pacientes seja muitas vezes difícil na prática clínica. Nesse sentido, a avaliação sistemática dos indivíduos nessa faixa etária pode contribuir para melhorar a detecção dos casos de depressão. Este estudo foi desenhado com o objetivo de avaliar a confiabilidade de teste-reteste das versões com 15, 10, 4, e 1 itens da Escala de Depressão em Geriatria (GDS). Foram selecionados 64 indivíduos com 60 ou mais anos de idade atendidos de forma consecutiva nos ambulatórios da Unidade de Idosos do Departamento de Saúde Mental da Santa Casa de São Paulo entre fevereiro e maio de 1998. Todos preenchiam critérios para o diagnóstico de transtorno depressivo (em remissão ou atual) de acordo com a CID-10 e apresentavam escores maiores do que 10 no Mini-Exame do Estado Mental. Eles foram avaliados duas vezes com a GDS-15, sendo as entrevistas conduzidas com intervalo de 48 a 72 horas. Cinquenta e um pacientes aceitaram participar do estudo. A concordância entre os escores de itens individuais da escala foi avaliada pelo coeficiente estatístico Kappa. Estes oscilaram entre 0,04 e 0,49, indicando baixa estabilidade na resposta dos pacientes. Os escores totais da GDS-15 mantiveram-se relativamente estáveis durante o reteste, conforme indicado pelo teste pareado de Wilcoxon (z=1,60; p=0,109), correlação de Spearman (rho=0,86; p<0,001), e Kappa ponderado (Kappa=0,64). O mesmo padrão foi observado para a GDS-10 no teste de Wilcoxon (z=0,85; p=0,402), Spearman (rho=0,81; p<0,001), e Kappa ponderado (Kappa=0,60). O escore total da GDS-4 mostrou variações significativas do teste para o reteste (z=3,75; p<0,001; rho=0,56; p<0,001; Kappa=0,37). Esses resultados indicam que as versões com 1 e 4 ítens apresentam baixos coeficientes de confiabilidade. Isso sugere que essas versões têm utilidade clínica limitada. Por outro lado, a GDS com 15 e 10 iítens pode ser utilizada com relativa confiabilidade na prática clínica, particularmente quando se consideram os escores totais das escalas.

An assessment schedule was used to determine the nature of insight in 91 mixed psychotic patients, and to examine its distribution and associations. While all the components of the schedule intercorrelated significantly, scores for compliance were only weakly related to those for ability to label psychotic phenomena as abnormal. Compliance and illness recognition were related to IQ. Total insight score was inversely correlated, moderately, with a global measure of psychopathology derived from the PSE, and was less in patients involuntarily committed. Age, sex, diagnosis, and the number of previous hospital admissions had little effect. The results support the notion that insight is not a unitary concept.

BackgroundTrials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to determine if daily fluoxetine for 6 months after stroke improves functional outcome in Australasian and Vietnamese patients. MethodsAFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial conducted in 43 hospital stroke units in Australia (n=29), New Zealand (4), and Vietnam (10). Eligible patients were adults with a clinical diagnosis of stroke in the previous 2-15 days and a persisting neurological deficit. Patients were randomised via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20mg or matching placebo for 6 months. Patients, investigators and outcome assessors were masked to the treatment allocation. The primary outcome was functional outcome, measured by the modified Rankin scale (mRS), at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Analyses were according to the patient's treatment allocation. The trial is registered with the ACTRN registry, number 12611000774921. FindingsPowered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation 1280 patients were recruited in Australia (n=532), New Zealand (n=42) and Vietnam (n=706) between 11 January 2013 and 30 June 2019; 642 were allocated fluoxetine and 638 placebo. Adherence to trial medication (mean 167 [SD 48] days) was similar between groups. At 6 months, mRS data were available in 624 (97.2%) patients allocated fluoxetine and 632 (99.1%) placebo. The distribution of mRS categories at 6 months was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0.936, 95% CI 0.762-1.150; p=0.53), and consistent among all pre-defined subgroups. Compared to placebo, patients allocated fluoxetine had more falls (20 [3.12%] vs 7 [1.10%]; p=0.02), bone fractures (19 [2•96%] vs 6 [0.94%]; p=0.01) and epileptic seizures (10 [1.56%] vs 2 [0.31%]; p=0.04) at 6 months. InterpretationFluoxetine 20mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and seizures. These results do not support the use of fluoxetine to improve outcome after stroke.