The Assessment of Symptom Severity and Functional Impairment With <i>DSM-IV</i> Axis V

Smith, G.; Ehmann, Tom; Flynn, Sean W.; MacEwan, G. William; Tee, Karen; Kopala, Lili C.; Thornton, Allen E.; Schenk, Christian; Honer, William G.

doi:10.1176/ps.62.4.pss6204_0411

Cited by 52 publications

(22 citation statements)

References 24 publications

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“…The GAF has been criticized as being unable to distinguish the relative contributions of illness severity and adaptive functioning to overall score (Smith et al, 2011). Its validity has also been questioned.…”

Section: Discussionmentioning

confidence: 99%

Impact of adaptive functioning on readmission to alcohol detoxification among Alaska Native People

Bear

Anderson

Manson

et al. 2014

Drug and Alcohol Dependence

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Background This study examined predictors associated with readmission to detoxification in a sample of adult Alaska Native patients admitted to inpatient alcohol detoxification. Even though Alaska Native people diagnosed with alcoholism have been identified as frequent utilizers of the health care system and at elevated risk of death, little is known about factors associated with readmission to detoxification for this group. Methods We sought to predict readmission using a retrospective cohort study. The sample included 383 adult Alaska Native patients admitted to an inpatient detoxification unit and diagnosed with alcohol withdrawal during 2006 and 2007. Cox proportional hazard modeling was used to estimate unadjusted and adjusted associations with time to readmission within one year. Results Forty-two percent of the patients were readmitted within one year. Global Assessment Functioning (GAF; Axis V in the multi-axial diagnostic system of the Diagnostic and Statistical Manual of Mental Disorders [DSM IV]) score measured at the time of intake was associated with readmission. A one point increase in the GAF score (HR = .96, 95% CL = .94, .99, P = .002) was associated with a four percent decrease in readmission. The results also indicated that the GAF mediated the relationship between readmission and: employment and housing status. Conclusions The GAF measures both illness severity and adaptive functioning, is part of standard behavioral health assessments, and is easy to score. Readmission rates potentially could be decreased by creating clinical protocols that account for differences in adaptive functioning and illness severity during detoxification treatment and aftercare.

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Section: Discussionmentioning

confidence: 99%

Impact of adaptive functioning on readmission to alcohol detoxification among Alaska Native People

Bear

Anderson

Manson

et al. 2014

Drug and Alcohol Dependence

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“…The split version of the GAF was chosen, as advocated by various authors [38, 39], to preserve separate ratings for symptoms and functioning (the regular GAF records only the lowest of these values).…”

Section: Methodsmentioning

confidence: 99%

Experiences, perspectives and priorities of people with schizophrenia spectrum disorders regarding sleep disturbance and its treatment: a qualitative study

Faulkner

Bee

2017

BMC Psychiatry

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BackgroundSleep problems are very common in people with schizophrenia spectrum disorders, and impact negatively on functioning and wellbeing. Research regarding interventions to improve sleep in this population has been lacking. Little is known regarding these patient’s perspectives on sleep problems and their treatment, providing very little foundation on which to develop acceptable and patient-centred treatments.MethodsThis study aims to explore perspectives and priorities of participants with schizophrenia spectrum disorders regarding sleep and sleep disturbance, and their perspectives on existing treatments. An Interpretive Phenomenological Analysis (IPA) study was conducted; data were gathered through in depth interviews with 15 people with schizophrenia spectrum disorders and varying degrees of self-reported sleep disturbance, each case was analysed individually before cross-case comparisons were made.ResultsSleep maintenance and sleep quality were universally valued. Changes to sleep were interpreted as part of a perceived loss of normality relating to diagnosis. Participants differed in the extent of any hopes that sleep would improve. Sleep disturbances were linked to a reduced ability or opportunity to participate in valued activities, and were entangled with self-image due to a wish to be perceived as alert and in control. During difficult times, sleep could be seen as an escape. Concerns were expressed regarding the negative effects of using hypnotics or anti-psychotics to aid sleep, although typically antipsychotics were deemed more acceptable than hypnotics. Concerns regarding barriers to adherence and effectiveness of self-help approaches were common. Non-pharmacological interventions were noted to require a personalised whole-lifestyle approach.ConclusionsThis is the first study to explore sleep perspectives in participants with established schizophrenia spectrum disorders, recruited from a population receiving usual care. Findings re-enforce the importance of considering sleep within recovery focused practice. In developing and adapting interventions routine-based approaches should be considered. Approaches should attempt to make gradual changes more easily perceptible, should support motivation for behaviour change, and should consider the impact of regular psychotropic medications.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1329-8) contains supplementary material, which is available to authorized users.

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“…The scale was designed for simplicity of administration and reliability with minimal training, and the reliability and validity of the measurement are well-established (Goldman, et al, 1992; Hilsenroth, et al, 2000; Smith, et al, 2011; Startup, et al, 2002). The one way random intra-class correlation coefficient (ICC 1, 4) reflecting the reliability of this measurement across the four clinical assessors (three independent interviewers and the treating clinician) in this study was excellent, ICC (1,4) = .81.…”

Section: Methodsmentioning

confidence: 99%

Assessment of Clinical Information

Drill

Nakash

DeFife³

et al. 2015

Journal of Nervous &Amp; Mental Disease

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Adaptive functioning is a key aspect of psychiatric diagnosis and assessment in research and practice. This study compared adaptive functioning validity ratings from Structured Clinical Interviews (SCIDs), symptom-focused structured diagnostic interviews, and Clinical Diagnostic Interviews (CDIs), systematic diagnostic interviews modeling naturalistic clinical interactions focusing on relational narratives. Two hundred forty-five patients (interviewed by two independent interviewers) and their interviewers completed the Clinical Data Form which assesses adaptive functioning and clinical information. Both interviews converged strongly with patient-reports, with no significant differences in validity of the interviews in measuring global and specific domains of adaptive functioning variables. Findings suggest that CDIs provide adaptive functioning data comparable to SCIDs (often considered “gold standard” for assessment but difficult to use in practice), and have important implications for bridging the research-practice gap. By incorporating clinicians’ everyday methods, CDIs yield information that is psychometrically sound for empirical investigation, diagnostically practical, and clinically meaningful and valid.

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The Assessment of Symptom Severity and Functional Impairment With DSM-IV Axis V

Abstract: Findings indicate that GAF ratings for patients with psychosis tend to reflect symptom severity rather than functional impairment. Splitting the GAF into two parts resulted in greater discrimination for this patient group yet retained ease of administration.

Cited by 52 publications

References 24 publications

Impact of adaptive functioning on readmission to alcohol detoxification among Alaska Native People

Impact of adaptive functioning on readmission to alcohol detoxification among Alaska Native People

Experiences, perspectives and priorities of people with schizophrenia spectrum disorders regarding sleep disturbance and its treatment: a qualitative study

Assessment of Clinical Information

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