Soledad PSY 314 TEST Critique PDF

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Test Critique on the Altman Self - Rating Mania Scale...

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TEST CRITIQUE: ALTMAN SELF - RATING MANIA SCALE Maricon P. Soledad Final Requirement for PSY 314 A Advance Psychological Assessment August 5, 2021 INTRODUCTION The Altman Self - Rating Scale or ASRM is a self - reported diagnostic scale consisting of 5 items. It is used to assess the presence and severity of manic and hypomanic symptoms, mostly with diagnosed bipolar disorder patients. It was developed by Dr. Edward Altman and colleagues in the year 1997 (Lloyd & Reed, 2018).

PURPOSE AND NATURE OF THE TEST The ASRM may be used in settings dealing with inpatient or outpatient to screen for the presence of and/or severity of manic symptoms for clinical or research purposes. The test is compatible with the criteria of the DSM - IV. It is also found that it significantly correlates with the Clinician - Administered Rating Scale for Mania (CARS - M) and Young Mania Rating Scale (YMRS), it can effectively be used as a screening instrument to facilitate diagnostic assessment in patients with hypomanic symptoms. In regards to the utilization of the test in clinical settings; the ASRM may be used as a psycho-educational tool to help patients in the outpatient settings to recognize and monitor their own symptoms. The self-report measure may be used reliably as a self-report measure of efficacy for patients receiving clinical treatment. The ASRM may be used in combination with self-rating depression scales in assessing mixed states of mania and depression. The ASRM is a brief scale which on average takes 5 minutes and is easy to complete; for it consists only five self - report items, designed to measure the presence and severity of mania. The items are rated on a 5 - point Likert Scale from 0 to 4. The format of the Altman Self - Rating Mania Scale assesses differences in “normal” or baseline levels in five subjective and behavioral areas covering positive mood, self - confidence, sleep patterns, speech patterns & amount, and motor activity. Each of the areas consist of five statements which correspond to scores from 0 through 4; with 0 being unchanged from “normal” or baseline, to 4 being overtly manic thoughts or behaviour. The subject will be asked to choose one statement from each of the five areas that best describes the way he or she has been feeling over the past week.

Please refer to Appendix A for a copy of the test format

as reference (Altman, 1997; Altman, et al., 1997).

In terms of scoring, the ASRM sums items 1 to 5. Total scores range from 0 to 20. A cutoff score of 6 or higher would indicate a high probability of a manic or hypomanic condition; based on a sensitivity rating of 85.5% and a specificity rating of 87.3%. The score of 6 or higher may indicate that there’s a need for treatment and/or further diagnostic workup to confirm a diagnosis of mania or hypomania. The score of 5 or lower is less likely to be associated with significant symptoms of mania. As a self report measure of clinical efficacy, items 1 to 5 should be summed to give a total score, which then may be compared to subsequent total scores during and after treatment. The scores that changes over time is also utilize in determining the efficacy of a particular treatment in clinical setting and to qualify whether there is an increase or decrease of severity in a manic episode (Meyer et al., 2020, Lloyd & Reed, 2018; Altman, 1997).

PRACTICAL AND TECHNICAL EVALUATION The ASRM is a brief yet psychometrically - sound self-rating scale of mania, recommended by the DSM. In constructing the ASRM, the subjects were admitted psychiatric inpatients consecutively over a 3 - year period at the Illinois State Psychiatric Institute. The subjects who completed the ASRM were 105 patients out of the 206 admitted in the institute. The subjects were patients with mixed diagnosis which consists of; 22 schizophrenics, 13 schizoaffectives, 30 major depression, 6 bipolar, depressed, and 34 bipolar. A breakdown and further information of the diagnostic groups is attached in Appendix B. The subjects are diagnosed patients aligned with the criteria of the DSM - IV with information derived by the staff through their hospital records, history of illness and through using Endicott and Spitzer (1978) SADS interview. The selection of the norm group also underwent the proper ethical process, such as informed consent was obtained after complete description was discussed to the patients. The norm group was also filtered by excluding patients who had a recent history of substance abuse, medical problems that are unstable, organic mental syndromes, or presence of symptoms that were severe; like psychosis and thought disorder. They were excluded as to not interfere with their ability to participate in the study. In assessing the reliability of the ASRM, 20 depressed and 10 manic diagnosed patients were asked to rate themselves twice on two separate occasions shortly after admission. In terms of the procedures in clinical assessment, the patients completed the ASRM shortly after admission during a medication washout period averaging 10.9 days. Aside from the ASRM, both the CARS - M and the MRS were administered to be able to measure concurrent validity. The staff who administered the tests were blind to the results of the ASRM. In evaluating the sensitivity of the ASRM to reflect changes in the symptoms following the treatment, 27 out of the 34 manic patients (79%) was able to complete the ASRM, CARS - M, and

MRS again after approximately 4- 5 weeks of pharmacotherapy. The seven bipolar manic patients were lost at follow up due to uncooperative behavior (Atlaman et al, 1997). The five items that were selected was extracted through principal component analysis (PCA) from a group of 14 items that were chosen to reflect 11 symptoms that were considered from the DSM - IV definition of mania, as well as three other psychotic symptoms (auditory, hallucinations, visual hallucinations and delusions). The subsequent analysis reveals that the ASRM’s sum score (i.e., the five item “mania factor” identified in the PCA), could discriminate patients with bipolar disorder who were in manic or mixed state, from patients belonging to other major psychiatric diagnostic groups (schizophrenia, schizoaffective disorder, major depression and bipolar depression). The nine items that remained (irritability, liability of mood, grandiosity, racing thoughts, distractability, poor judgement, auditory hallucinations, visual hallucinations, and delusions) from the group of 14 items considered in the original study of the ASRM did not demonstrate such discriminative ability (Altman et al., 2018). In regards to the psychometric properties of the test it reveals that the scale demonstrates an adequate internal consistency and concurrent validity since the ASRM is comparable to the Clinician - Administered Rating Scale for Mania (CARS - M), Young Mania Rating Scale (YMRS) and the criteria as reflected through the DSM - IV. Although the traditional problems associated with developing self - rating mania scales is present, during the 3 year study period of the ASRM Scale Completion, the study and results showed indication that the ASRM is a reliable and valid patient self-rating mania scale. It garnered a good test - retest reliability on a sample of depressed and manic patients; it has the ability to assess the severity of manic symptoms in patients with mania and it is sensitive to change or improvement following the treatment. The ASRM has been normed across all major diagnostic groups, which includes test - retest reliability on manic and nonmanicpatients, and even assess some manic symptoms that is not covered by the ISS. Compared to other scales, another advantage is that the ASRM is normed on acute and severely distributed manic patients and the practicality of administration as it only consists of five items which will save time and is easy to complete. A disadvantage that was noted is its inability to assess concurrent manic and depressive symptoms, therefore cannot be used to assess depressive features in mixed states (Altman et al., 1997; Altman et al., 2001)

REFERENCE FROM JOURNAL ARTICLES The following are gathered journal articles that tackles the test being critique in this paper; which is the Altman Self - Rating Mania Scale (ASRM). The first one is a study by Altman and his colleagues (2001) where they pursued a comparative evaluation of three self - rating scales for acute mania. The study looked into the comparison of three self - rating mania scales which are the; Internal State Scale (ISS), Self - Report Manic Inventory (SRMI), and the Altman Self - Rating Mania Scale (ASRM). The study was conducted to a group of patients with acute mania. Results garnered from the study reveals that the ASRM and ISS well - being subscale were significantly correlated with CARS - M scores at baseline. In terms of posttreatment scores, it was also significantly decreased for the ASRM. The sensitivities of each scale to be able to correctly identify patients with acute symptoms was at 93% for the ASRM and 33% for its specificity. The ASRM together with the SRMI were seen to be more sensitive compared to the ISS in screening patients with acute mania. The study discussed that the poor specificity of the ASRM at baseline was mostly due to the classification of 8 out of 11 patients with mild/hypomanic symptoms. At posttreatment if it is to use a clinically more appropriate CARS-M cut off of ≤ 7, then the specificity for the ASRM would be much higher. Basically the study pointed out that it can be argued that low baseline specificity is less important for screening purposes, therefore would further mean that the usefulness of ASRM in effectively screening and outcome measure for acute mania is not compromised. It was concluded in the study that the results reveals the ASRM performed best in terms of utilizing self - report to assess severity, screening for acute symptoms or in measuring outcome in bipolar patients. Meyer and his colleagues (2020) also conducted a study that included the ASRM. They pursued a systematic review on existing self - rating of acute manic symptoms in adults and looked into whether are these reliable and valid. The conclusion of the review states that the ASRM together with the ISS and SRMI are promising self - rating tools for (hypo)mania that are utilized in clinical contexts. However, there was a need for further studies to further validate the measures. In example, looking into their associations between each other and sensitivity to change, especially if they were meant to be outcome measures in studies. The study retrieved and reviewed 9 studies that used the ASRM. The review compilation revealed that the internal consistency was satisfactory (.7) in both time point, test - retest reliability was at .25. This was compared to the original psychometric validation of the ASRM. The convergent validity of the ASRM was also reviewed in the study by different studies. The ASRM’s convergent validity to the YMRS ranged from .40 in participants with bipolar disorder and .72 for inpatient psychiatric patients. A result of the study by Ng et al. (2013) may suggests that the instruments may differ in its ability in detecting mood changes over time, or reflect differing views of the current state of the person over time when self - reported or evaluated by a clinician. The scores from the ASRM, SRMI and ISS scales correlate positively and indicated that there is evidence

of convergent validity. In conclusion the ASRM could detect differences in performance related to the presence of absence of insight which suggests that it could be used in a variety of setting and illness severity. The three scales reviewed which includes the ASRM does possess some data in terms of reliability and validity, however it was pointed out that further studies when using them as variables should try to incorporate additional measures in order to assess the psychometric and diagnostic properties in their studies (Meyers et al., 2020; Ng et al., 2013; Strange et al., 2013; Huang, et al., 2003, Brown et al., 2000; Altman et al., 1997). Kim and Kwon (2017) aimed to examine the reliability and validity of the Korean Altman Self - Rating Mania Scale (K - ASRM) in a large sample of Korean non - clinical undergraduates. The participants gathered, filled out the K - ASRM and other self - report questionnaires that assesses bipolarity, mood symptoms and affect. In examining the psychometric properties, reliability test, exploratory factor analysis and correlation analysis were conducted. The results of the study indicated there was adequate reliability of the K - ASRM garnering a Cronbachs ɑ = .73 and item-to-total correlation .53 - .78. The exploratory factor analysis was able to yield one factor of mania. The Korean Altman Self Rating Mania scale was able to demonstrate a significant association with measures of hypomanic personality, lifetime history of hypomanic symptoms and was significantly correlated with positive affect, negative affect and depressive symptoms. In conclusion the results suggest preliminary possibility that the K-ASRM can be used as a self - rating tool for mania in Korea and also future directions for further validation. Mas and colleagues (2005) translated, adapted and validated in the Spanish environment the Altman Self - Rating Scale for Mania (ASRM) in order to fulfill the need for a self - rating of mania in their environment. The ASRM was translated and a back translation also underwent with the process. The original authors of the ASRM sent the original scale. The researchers administered the scale to a sample of 74 patients diagnosed with bipolar disorder which they divided into two groups; one consisting of patient with acute mania while the other constituted by asymptomatic patients.The Clinician Administered Rating Scale for Mania (CARS - M) and the Numeric Evaluation Scale (NES) was concurrently applied. The results revealed high internal consistency with high and significant correlation with the mania sub - scale for CARS - M and NES. Very significant differences were noted between the two groups in the scale score. The ROC curve indicated there was an excellent adjustment of the scale, when discriminating among bipolar patients with and without manic symptoms. Through the factorial analysis, it provided a single factor that accounts for 62% of the total variance. It was concluded that the ASRM is shown to be reliable and valid as a self - rating instrument in assessing manic symptoms presence and intensity. The researchers indicated that it makes it possible to carry out simple and quick assessments to the patient’s state and can be utilized for research as clinical objectives and also as an instrument for screening.

ASRM UPDATES AND PROGRESS

ASRM - 11 & ASRM - 14 Altman and Ostergaard (2018) discussed that since the original publication of ASRM, its utilization has increased in both the clinical and research settings. It has also been included in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM - V) as an emergent measure; which I’ll be discussing in the next part of this section. At present the ASRM has been translated into 10 languages, however despite the increased interest and use of the ASRM; the one major criticism exists, stating that it is not a comprehensive self - report measure of mania. Upon the authors receiving numerous requests for a complete self - report measure, Altman and his colleagues decided to create the 11 item version that focus exclusively on the 11 symptoms of mania considered in the DSM - IV; and the 14 item version that includes three items for psychosis. Compared to the 5 versions, the ASRM - 11 and ASRM - 14 allows for a more comprehensive approach in assessing mania without substantially increasing the time to complete and score the scale. The authors hope that the field will subject the ASRM - 11 and ASRM - 14 to further validation and explore use for the scales in the practice of research and clinical approaches.

The wording of

the ASRM - 11 and ASRM - 14 have been changed slightly compared to the original version in 1997. The copy is available online with the link provided in the Appendix C.

DSM - 5 Level 2 - Mania - Adult Measure The ASRM has been included in the Diagnostic Statistical Manual of Mental Disorders 5th Edition (DSM - V) as an emergent measure which needs to be additionally followed up study which confirms its utility in various settings. The American Psychological Association is offering a number of these emerging measures for further research and clinical evaluation; which are patient assessment measures that are developed to be administered at the initial patient interview and to monitor treatment progress. They are utilized in research and evaluation as potentially useful tools that will help enhance clinical - decision making, but it is not to be used as the sole basis for making a clinical diagnosis. The instructions, scoring information and interpretation guidelines are provided for further background information, which can be found in DSM - 5. The APA is urging clinicians and researchers to provide further data on the instruments’ usefulness in characterizing patient status an improving patient at care. This includes the ASRM; the DSM - 5 level 2 Mania - Adult Measure, a copy is provided which can be found in Appendix D.

SUMMARY The Altman Self - Rating Mania Scale (ASRM) was originally published in 1997 and is a self rated measure that aims to assess the severity of manic symptoms. The measure consists of 5 symptom items that consists of; elevated mood, increased self - esteem, decreased need for sleep, pressured speech, and psychomotor agitation which are rated by the patients through endorsement of one of the five statements ranging from 0 (symptom not present) to 4 (symptom present in a severe degree) (Altman, 2018). It is seen over the years that the ASRM is a psychometrically sound test; which the clinical and research settings have shown great interest and an increased of its utilization. Despite the usage of the test for its practicality and brief administration, like any other test, it faces criticisms like the need for a comprehensive self - report measure of mania. That’s why in the present, a population of researchers and professionals are helping to improve the emerging measure; which includes the original authors and professionals within the APA. On a personal note, after reading and reviewing the components of the test and scanning through the other researches I have gathered, I believe in the test’s potential. I look forward to the further improvements and additional studies that tackles the usage of the ASRM.

RERENCES

Altman EG, Hedeker DR, Janicak PG, Peterson JL, Davis JM. (1994): The Clinician-Administered Rating Scale for Mania (CARS-M): Development, reliability and validity. Biolpsychiatry 36:124-134. Altman, E., Hedeker, D., Peterson, JL., Davis JM (1997): The Altman Self-Rating Mania Scale. Biol Pychiatry 42:948–955. American Psychiatric Association (1994): Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Press. Altman, E. G., & Østergaard, S. D. (2018). The 11-item and 14-item versions of the Altman Self-Rating Mania Scale (ASRM). Acta Psychiatrica Scandinavica. doi:10.1111/acps.12988 Bin-Na, K. & Seok-Man, K. (2017). Initial Psychometric Properties of the Korean Altman Self - Rating Mania Scale: Preliminary Validation Study in a Non-Clinical Sample. Retrieved from: https://doi.org/10.4306/pi.2017.14.5.562 Brown ES, Bauer MS, Suppes T, Khan DA, Carmody T. Comparison of the Internal State Scale to clinician-administered scales in asthma patients receiving corticosteroid therapy. Gen Hosp Psychiatry. 2000;22(3):180-183. Huang C-L, Yang Y-K, Chen M, Lee I-H, Yeh T-L, Yang M-J. Patient and family-rated scale for bipolar disorder symptoms: Internal State Scale. Kaohsiung J Med Sci. 2003;19(4):170-175 Mas, A., Rodrigo, B., Garcia, JM., Livianos, A. & Moreno, R. (2005). Translation and Adaptation in the Spanish environment of the Altman Self - Rating Mania Scale. Retrieved from https://europepmc.org/ar...