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Review
. 2015 Nov;132(5):335-44.
doi: 10.1111/acps.12449. Epub 2015 May 27.

Rating scales measuring the severity of psychotic depression

S D Østergaard  1   2 , A J Rothschild  3 , A J Flint  4   5 , B H Mulsant  5   6   7 , E M Whyte  7 , A K Leadholm  8 , P Bech  9 , B S Meyers  10
Affiliations
Review

Rating scales measuring the severity of psychotic depression

S D Østergaard et al. Acta Psychiatr Scand. 2015 Nov.

Abstract

Objective: Unipolar psychotic depression (PD) is a severe and debilitating syndrome, which requires intensive monitoring. The objective of this study was to provide an overview of the rating scales used to assess illness severity in PD.

Method: Selective review of publications reporting results on non-self-rated, symptom-based rating scales utilized to measure symptom severity in PD. The clinical and psychometric validity of the identified rating scales was reviewed.

Results: A total of 14 rating scales meeting the predefined criteria were included in the review. These scales grouped into the following categories: (i) rating scales predominantly covering depressive symptoms, (ii) rating scales predominantly covering psychotic symptoms, (iii) rating scales covering delusions, and (iv) rating scales covering PD. For the vast majority of the scales, the clinical and psychometric validity had not been tested empirically. The only exception from this general tendency was the 11-item Psychotic Depression Assessment Scale (PDAS), which was developed specifically to assess the severity of PD.

Conclusion: In PD, the PDAS represents the only empirically derived rating scale for the measurement of overall severity of illness. The PDAS should be considered in future studies of PD and in clinical practice.

Keywords: affective disorders; depression; psychometrics; psychoses.

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Conflict of interest statement

Declaration of interest

A.J. Rothschild receives grant or research support from Alkermes, AssureRx, Cyberonics, the National Institute of Mental Health, and St Jude Medical, and is a consultant to Allergan, Eli Lilly and Company, GlaxoSmithKline, Omnicare, and Pfizer Inc. Dr. Rothschild has received royalties for the Rothschild Scale for Antidepressant Tachyphylaxis (RSAT)®; Clinical Manual for the Diagnosis and Treatment of Psychotic Depression, American Psychiatric Press, 2009; The Evidence-Based Guide to Antipsychotic Medications, American Psychiatric Press, 2010; and The Evidence-Based Guide to Antidepressant Medications, American Psychiatric Press, 2012. A.J. Flint currently receives grant support from the NIMH, the Canadian Institutes of Health Research, Brain Canada, the Ontario Brain Institute, and Lundbeck and within the past three years has received honoraria from Pfizer Canada. B.H. Mulsant currently receives research funding from Brain Canada, the CAMH Foundation, the Canadian Institutes of Health Research, and the US National Institute of Health (NIH). During the last five years, he also received research support from Bristol-Myers Squibb (medications for a NIH-funded clinical trial), Eli-Lilly (medications for a NIH-funded clinical trial), and Pfizer (medications for a NIH-funded clinical trial). He directly own stocks of General Electric (less than $5,000). E.M. Whyte has received research support from the NIMH, the National Institute of Child Health and Human Development (NICHD), the Department of Defense (DOD) and through a Small Business Innovation Research (SBIR) grant from Fox Learning Systems / National Institute of Neurological Disorders and Stroke (NINDS). B. Meyers receives research support from the NIMH. He is receiving medication donated by Pfizer and Eli Lilly for his NIMH trial. During the last three years he has provided legal consultation to AstraZeneca and research consultation for Forest Laboratories. S.D. Østergaard, A.K. Leadholm and P. Bech declare no conflicts of interest.

Figures

Figure 1
Figure 1. Clinical validity
Left: For a rating scale to be clinically valid, it must map the severity of the syndrome of interest. In the case of psychotic depression, both the psychopathological domains of depression and psychosis must therefore be covered by the items of the rating scale. Right: Furthermore, there must be a high correlation between the rating scale total score and a global evaluation of syndrome severity performed by experienced psychiatrists (“gold-standard”).
Figure 2
Figure 2. Unidimensionality
Unidimensionality: This figure shows a hypothetical six-item rating scale, which is unidimensional because the symptoms represented by the items appear in an orderly fashion as the severity of the syndrome increases, such that scoring on higher prevalence items (less severe items) precedes scoring on lower prevalence items (more severe items). When a rating scale is unidimensional, each individual item adds unique information about the severity of the latent syndrome being rated (represented by the dashed frame) and the total score obtained by adding the individual item score is therefore a valid measure for the severity of the latent syndrome (for instance psychotic depression), provided that the scale is also clinically valid (see figure 1).
See this image and copyright information in PMC

References

    1. Glassman AH, Roose SP. Delusional depression. A distinct clinical entity? Arch Gen Psychiatry. 1981;38:424–427. - PubMed
    1. Charney DS, Nelson JC. Delusional and nondelusional unipolar depression: further evidence for distinct subtypes. Am J Psychiatry. 1981;138:328–333. - PubMed
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