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PubMed2000

Early dobutamine echocardiography predicts improvement in regional and global left ventricular function after reperfused acute myocardial infarction without residual stenosis of the infarct-related artery.

BACKGROUND: The accuracy of dobutamine echocardiography (DE) early after reperfused acute myocardial infarction (AMI) without residual stenosis of the infarct-related artery is unknown. The objective of this study was to assess whether in reperfused AMI DE can predict early as well as late regional and global spontaneous functional recovery. METHODS: DE was performed in 157 patients (61 +/- 11 years; 33 women) 3 days after AMI treated with successful direct percutaneous transluminal coronary angioplasty (Thrombolysis in Myocardial Infarction flow grade 3, residual stenosis <30%). All patients underwent 2-dimensional echocardiography and coronary angiography at 1 month and 145 (92%) at 6 months. RESULTS: Patency and restenosis rate were similar between those who did and did not respond to DE. DE showed a high accuracy in predicting both early and late regional functional recovery (86% and 81%, respectively). DE accuracy in predicting early and late reversible dysfunction was also high on a patient-by-patient analysis (89% and 87%). In DE responders left ventricular ejection fraction increased from 44% +/- 9% at baseline to 57% +/- 9% at 6 months (P <.00005), whereas only a slight, although significant improvement was found in nonresponders (from 40% +/- 10% to 44% +/- 12%; P =.03). A significant correlation was found between the number of dobutamine-responder segments and the magnitude of their functional improvement at peak dobutamine and changes in ejection fraction (r =.72; P <.000001; r =.68, P <.000001, respectively). CONCLUSIONS: These data indicate that in patients with AMI in whom anterograde flow is fully restored without residual stenosis, DE can predict the recovery of regional function and whether a relevant change in ejection fraction will occur at early and late follow-up.

Angioplasty, Balloon, Coronary↗

PubMedDate not supplied

MRI assessment of ventricular function.

Cine-MRI is a robust non invasive technique able to assess regional and global systolic function of both ventricles. Conventinal cine-MRI was used for LV global function parameters both on horizontal long axis and vertical long axis, applying area-length methods, as in echocardiography. Recent developments of segmented k-space techniques allowed breath-held cine-MRI, making possible a rapid acquisition of the entire ventricles, both left and right. Using the Simpson's rule volumes are estimated with high accuracy, without any geometrical assumption; this method is considered gold standard for global function assessment. Regional function is studied by cine-MRI both qualitatively and quantitatively, as it represents the best technique in defining endo- and epi-cardial borders. The ability of quantify wall thickness and wall thickening makes cine-MRI highly suitable for stress-imaging, both in ischemia detection and viability assessment. Tagging is a novel technique, able to assess the complex mechanism of myocardial contraction and to quantify myocardial strain. Finally MRI is also able to assess diastolic function with phase velocity mapping.

Exercise Test↗

PubMed2001

Global assessment of functioning following assertive community treatment in Edmonton, Alberta: a longitudinal study.

OBJECTIVE: To examine longitudinally the effects of Assertive Community Treatment (ACT) on Global Assessment of Functioning (GAF) scores in Edmonton, Alberta. METHODS: We acquired GAF scores for all clients at initial registration in the ACT program and at subsequent 18- and 36-month time points while in ACT. We analyzed both the entire ACT cohort and separate diagnostic groups. RESULTS: We obtained baseline and follow-up GAF scores for 411 clients, of whom the largest diagnostic group suffered from schizophrenia (n = 189), followed by bipolar disorder (n = 98). Collapsed across all groups, GAF scores significantly improved at both 18 (P < 0.0001) and 36 months (P < 0.0001). By group, at 18-month follow-up, significant improvements were seen in patients with delusional disorder (P < 0.05), dysthymia (P < 0.05), schizoaffective disorder (P < 0.05), and schizophrenia (P < 0.001). This was also seen at 36-month follow-up, with the addition of significant improvements in those with bipolar disorder (P < 0.05). Those patients with major affective disorder or psychosis not otherwise specified (NOS) did not show significant improvements over time. Regardless of diagnosis, those clients with baseline GAF scores of < or = 40 significantly improved at both 18-month (P < 0.0001) and 36-month (P < 0.0001) follow-up, while those with baseline GAF scores above 40 did not show significant improvement. CONCLUSIONS: GAF scores improved at 18- and 36-month follow-up from enrolment in an ACT program. Groups with different diagnoses and levels of functioning at time of enrolment may not benefit to the same degree.

Activities of Daily Living↗

PubMedDate not supplied

Comparison of regional and global left ventricular function by serial echocardiograms after reperfusion in acute myocardial infarction.

Fifty patients undergoing successful reperfusion therapy (percutaneous transluminal coronary angioplasty 20, thrombolysis 10, combined 20) for acute myocardial infarction were evaluated with serial two-dimensional echocardiograms performed early (less than 24 hours, mean 8 hours) and late (greater than 3 days, mean 6 days) after presentation. Treatment occurred within 12 hours of the onset of symptoms with most patients achieving reperfusion in less than 6 hours (mean 4.7 hours) from the onset of pain. Reperfusion was demonstrated short-term by angiography in 42 of 50 patients (84%). Four patients had clinical signs of reperfusion and subsequent angiographic confirmation. An additional four patients with "stuttering" infarct courses were treated late by percutaneous transluminal coronary angioplasty. Echocardiograms were analyzed for global performance by calculation of fractional area change at the papillary muscle level and ejection fraction (biplane Simpson's rule) in 18 patients in whom this analysis could be performed. Measurements of regional function included fractional shortening at the base (n = 37), regional wall motion index (n = 50) and percent of normal functioning myocardium (n = 50). Overall there was a significant improvement in regional wall scores and percent of functioning myocardium (regional wall motion index 1.73 to 1.43, p less than 0.001 and percent of functioning myocardium 0.61 to 0.70, p less than 0.001) but only a trend toward improvement when global function was assessed by ejection fraction (0.42 to 0.48, p less than 0.14).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2005

Comparison of segmental and global systemic ventricular function at rest and during dobutamine stress between patients with transposition and congenitally corrected transposition.

The aim of the study was to evaluate segmental and global right ventricular function at rest and during stress in patients having a systemic morphologically right ventricle. We studied 17 patients after atrial correction for transposition, 13 with congenitally corrected transposition, and 11 age-matched controls using cardiovascular magnetic resonance at rest and during stress with dobutamine given at 15 micrograms per kilogram per minute. Blood was drawn to obtain levels of brain natriuretic peptide. Right ventricular ejection fraction was calculated, and wall-motion and wall-thickening were assessed, in 4 segments of a midventricular slice. The findings for the systemic right ventricle were compared to the left ventricle in controls. Patients with transposition showed a decreased ejection fraction at rest (57 percent versus 69 percent, p equal to 0.005), decreased wall motion of the anterior, lateral and septal wall (p less than 0.01, p less than 0.01, and p less than 0.01) and decreased thickening of the lateral wall (p less than 0.01). Patients with congenitally corrected transposition showed normal ejection fraction, wall thickening, and wall motion at rest. During dobutamine stress, we found no significant differences in wall motion and thickening between the two groups. Ejection fraction, also increased to comparable values during stress, at 67 percent versus 66 percent, p not being significant. In both groups, we observed similarly increased levels of brain natriuretic peptide (p equal to 0.02 and 0.03, respectively). We conclude that only patients with transposition showed segmental wall motion and wall thickening abnormalities at rest. After dobutamine stress, however, segmental and global right ventricular dysfunction was similar in both groups.

Adolescent↗

PubMed1999

Gender differences in living skills and global assessment of functioning among outpatients with schizophrenia.

OBJECTIVE: The aims of this paper are to study skills in personal and domestic activities, and their associations with Global Assessment of Functioning (GAF) scale scores among outpatients with schizophrenia, and to study the impact of depressive mood on functional capacity in schizophrenia. METHOD: Three hundred and two outpatients with DSM-III-R schizophrenia completed the 13-item Beck Depression Inventory (BDI) and a questionnaire relating to their sociodemographic characteristics, and living and working conditions. Staff members completed the GAF scale and a questionnaire relating to the patient's medical history and current treatment. This questionnaire also included the staff's assessments on patient's skills in six personal or domestic activities (personal hygiene, homemaking, management of financial affairs, shopping, decision-making, getting about). RESULTS: Fifty-six percent of men and 33% of women (p < 0.001) with schizophrenia did not have independent skills in at least one personal or domestic activity but there was no difference in the mean GAF score between men and women. In men, the GAF score was independently and positively associated with all living skills studied and in women with homemaking, management of financial affairs, and decision-making, respectively. The BDI scores were not independently associated with functioning in personal and domestic activities except with getting about in women. CONCLUSIONS: The GAF scale is a simple and time-saving measure for assessing overall living skills among outpatients with schizophrenia. However, assessments on the GAF scale may be biased towards poor functioning in women. Moreover, psychosocial functioning and depression should be evaluated separately.

Activities of Daily Living↗

PubMed1992

Hemodynamic effects of oral amiodarone on left ventricular function before and after global ischemia.

We evaluated the hemodynamic effects of amiodarone on left ventricular (LV) function after global ischemia. Amiodarone was administered orally at 15 mg/kg/day for an average of 28 days to a group of 10 dogs. The concentration of amiodarone in serum and LV myocardium was 0.40 +/- 0.24 micrograms/ml and 44 +/- 27.0 micrograms/g, respectively. This experimental group and a control group of 10 dogs each underwent 120 min of aortic cross-clamping with cold crystalloid cardioplegia resulting in an average myocardial temperature of 15 degrees C. LV function measurements by pulse-transit sonomicrometry and Millar solid-state micromanometers were processed by a minicomputer. Compared to the nontreated control group, oral amiodarone for 28 days produced depression of LV contractility which was reflected by lower slope of the end-systolic pressure-volume relation (Evmax), percentage shortening of segment length, left ventricular pressure-segment length loop area, and slope of the end-systolic pressure-segment length relation (Esmax). After ischemia, percentage recovery of LV global function (Evmax and mean velocity of circumferential fiber shortening) and regional function (Esmax) was significantly better in the amiodarone group than in the control group. We conclude that oral amiodarone for 28 days results in a depression of LV contractility but the combination of amiodarone and ischemia does not act synergistically to further depress postischemic LV function.

Administration, Oral↗

PubMed1985

Acute effects of sublingual nifedipine on segmental and global left ventricular function in coronary artery disease; an angiographic study.

In 12 patients with significant coronary artery disease (CAD) segmental and global left ventricular (LV) function was studied by quantitative cineventriculography before and 5 min after sublingual administration of 20 mg nifedipine (N). Significant increase of mean relative hemiaxes shortening of inferior (24 +/- 10%----38 +/- 13%) and apical (31 +/- 10%----42 +/- 14%) wall segments, as well as improvement of ejection fraction (61 +/- 14%----75 +/- 14%), mean circumferential fiber shortening velocity (1.05 +/- 0.46 ccf/s----1.41 +/- 0.47 ccf/s) and end-systolic volume (57 +/- 26 ml----37 +/- 27 ml) of the LV were found after administration of N. The highest increase of segmental contraction (28 +/- 11%----44 +/- 16%; p less than 0.001) was noted in 20 noninfarcted wall segments, perfused by significantly stenosed coronary arteries. No significant improvement could be detected in 6 infarcted segments. A second group consisting of 12 patients with CAD showed a significant reduction of the aortic end-diastolic pressure (89 +/- 9 mm Hg----79 +/- 7 mm Hg; p less than 0.001) but no significant change of isovolumic contractility indices and heart rate was observed after N administration. The study suggests that acute improvement of LV function, found 5 min after sublingual administration of N, is mainly due to improved contraction of ischemic myocardial wall segments. Among different possible reasons for this improvement LV afterload reduction after N administration seems to be the most important one.

Administration, Oral↗

PubMed1992

Effects of surgical stress and volatile anesthetics on left ventricular global and regional function in patients with coronary artery disease. Evaluation by computer-assisted two-dimensional quantitative transesophageal echocardiography.

We investigated the effects of halothane, enflurane, and isoflurane on central hemodynamics and left ventricular global and regional function when used to control intraoperative hypertension in 39 patients with coronary artery disease. Left ventricular short-axis, midpapillary images were obtained by transesophageal echocardiography. Using a centerline algorithm, we analyzed left ventricular images for global area ejection fraction (GAEF) and segmental area ejection fraction (SAEF). The SAEF/GAEF ratio was calculated for each of eight segments. Measurements were performed after induction of anesthesia but before skin incision; 1 min after sternotomy; and during administration of the inhaled anesthetic. The increase in arterial blood pressure during sternotomy was due to an increase in vascular resistance accompanied by increases in heart rate and filling pressures while GAEF decreased. No changes in the SAEF/GAEF ratio appeared during sternotomy. The inhaled anesthetics restored arterial blood pressure by a similar decrease in vascular resistance. Isoflurane caused an increase in cardiac index that was not seen with halothane or enflurane (halothane vs isoflurane, P < 0.05). The GAEF was decreased by halothane but unaffected by isoflurane and enflurane (halothane vs enflurane; P < 0.05). Isoflurane induced a decrease in the SAEF/GAEF ratios of two segments corresponding to the inferolateral wall of the left ventricle that was, in one of these segments, significantly more pronounced compared with both halothane and enflurane. Halothane or enflurane did not cause any change in regional wall motion. We conclude that isoflurane is more likely to cause regional wall motion changes than halothane or enflurane in patients with coronary artery disease.

Adult↗

PubMed2001

Global and regional functional measurements with gated FDG PET in comparison with left ventriculography.

The purpose of this study was to validate the measurement of global and regional left ventricular cardiac function with ECG-gated fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) by comparison with the corresponding indices from X-ray left ventriculography (LVG). Twenty-six patients (23 men, 3 women, mean age 60.4 years) underwent LVG and ECG-gated (eight frames/cycle) FDG-PET within an interval of 10.2+/-6.8 days. A volumetric sampling approach was used to obtain both global (EF: ejection fraction) and regional [%WT: relative regional count increase from end-diastolic (ED) to end-systolic (ES) phase] functional parameters. The gated PET parameters were compared with the corresponding findings of LVG in seven myocardial segments. EF(gated PET) and EF(LVG) did not differ significantly (30%+/-10% vs 32%+/-10%, P=NS). The two EF values correlated significantly, showing no significant systematic measurement bias [EF(gated PET) = 2.61+0.86 x EF(LVG), R=0.84, P<0.0001]. Inter- and intra-observer reproducibility for EF were R=0.95, P<0.0001 and R=0.92, P<0.0001, respectively. Regional function was evaluated with LVG in 144 myocardial segments comprising 35 normokinetic, 70 hypokinetic and 39 a/dyskinetic segments. Visual analysis of LVG and gated PET correlated significantly (P<0.001), with an overall concordance ratio of 58% (83/144, kappa=0.35). Gated PET overestimated the regional function in 27% (39/144) and underestimated it in 15% (22/144). %WT showed significant differences between each pair of groups (a/dyskinesis, 13.2%+/-9.3%; hypokinesis, 17.1%+/-8.8%; normokinesis, 21.8%+/-10.9%). Inter- and intra-observer reproducibility was significant for %WT (R=0.77, P<0.0001 and R=0.79, P<0.0001, respectively). In conclusion, gated FDG PET permits assessment of global left ventricular cardiac function. In addition, assessment of regional function is feasible using the visual or the quantitative parameters.

Aged↗

PubMed1984

[Comparative statistical study of global and local functional respiratory data in 2 groups of patients with pulmonary or pleural tuberculosis].

Two groups of patients with unilateral tuberculosis, either pulmonary (36 cases) or pleural (75 cases) were studied. The clinical and functional results were compared statistically. These two groups were similar in terms of age, sex, tobacco consumption, the radiological unilaterality of their disease and the global reduction of respiratory function (assessed by VC, FEV1, TPC and TLCO), which can be considered to be essentially due to the local disease. In both groups, the radiological image (extent of the lesion, shape of the lesion) is the only clinical factor statistically related to the functional values. The two groups differ in terms of two functional parameters which reflect different pathophysiological mechanisms in the affected lung. The group with pulmonary tuberculosis presents an obstructive ventilatory syndrome (reduction of the FEV1/VC ratio and increase in the RV/TPC ratio), which reflects the bronchial involvement in the disease. The group with pleural tuberculosis presents a pulmonary distention (increased RV/TPC ratio), which is related to disturbed transmission of the pleural pressure to ventilated alveolar zones. Secondly, in the group with pulmonary tuberculosis, the ventilation and perfusion deficits are equivalent, while in the pleural tuberculosis group, the ventilatory deficit is predominant. Thus the global reduction in ventilatory function which is the same in the two group is caused by fundamentally distinct pathophysiological mechanisms in the two groups of patients.

Adult↗

PubMed1997

Transient global amnesia and functional retrograde amnesia: contrasting examples of episodic memory loss.

We studied 11 patients with transient global amnesia (TGA) and ten patients with functional retrograde amnesia (FRA). Patients with TGA had a uniform clinical picture: a severe, relatively isolated amnesic syndrome that started suddenly, persisted for 4-12 h, and then gradually improved to essentially normal over the next 12-24 h. During the episode, the patients had severe anterograde amnesia for verbal and non-verbal material and retrograde amnesia that typically covered at least two decades. Thirty hours to 42 days after the episode, the patients had recovered completely and performed normally on tests of anterograde and retrograde amnesia. By contrast, patients with FRA had a sudden onset of memory problems that were characterized by severe retrograde amnesia without associated anterograde amnesia and with a clinical presentation that otherwise varied considerably. The episodes persisted from several weeks to more than two years, and some of the patients had not recovered at the time of our last contact with them. The uniform clinical picture of TGA and the variable clinical picture of FRA presumably reflect their respective neurologic ('organic') and psychogenic ('non-organic') aetiologies.

Amnesia↗

PubMed2006

Endothelial function is associated with pulse pressure, pulse wave velocity, and augmentation index in healthy humans.

Arterial stiffness is an independent predictor of mortality and is regulated by a number of factors, including vascular smooth muscle tone. However, the relationship between endothelial function and definitive measures of arterial stiffness and wave reflections has not been described in healthy individuals. Therefore, we tested the hypothesis that endothelial function is inversely correlated with aortic pulse wave velocity (PWV), central pulse pressure, and augmentation index in healthy individuals. Peripheral and central pulse pressure and augmentation index were determined at rest, and global endothelial function was measured using pulse wave analysis and administration of sublingual nitroglycerin and inhaled albuterol. Aortic PWV was also determined at baseline in a subset of 89 subjects. In a separate group of subjects (n=89), aortic PWV was measured and brachial artery flow-mediated dilatation assessed as a measure of conduit artery endothelial function. Global endothelial function was significantly and inversely correlated with aortic PWV (r=-0.69; P<0.001), augmentation index (r=-0.59; P<0.001), and central (r=-0.34; P<0.001) and peripheral pulse pressure (r=-0.15; P=0.03). Moreover, there was a stronger correlation between central rather than peripheral pulse pressure. After adjusting for potential confounders, global endothelial function remained independently and inversely associated with aortic PWV and augmentation index. There was also a significant, inverse relationship between conduit artery endothelial function and aortic PWV (r=0.39, P<0.001), which remained independent after adjusting for confounding factors. In healthy individuals, a decline in endothelial function is associated with increased large artery stiffness, wave reflections, and central pulse pressure.

Administration, Inhalation↗

PubMed1992

[Persistent T-wave inversion in unstable angina: the correlation with the global and regional function of the left ventricle].

The correlation between persistent negative T wave on basal electrocardiogram and coronary anatomy or global and regional left ventricular function was investigated in 34 patients with unstable angina defined as new onset (< 2 months), crescendo or rest angina. The patients with history of previous myocardial infarction, pathological Q waves on electrocardiogram or documented elevation of CPK were excluded. Eighteen patients (group A) showed T wave inversion (> 1 mV) in at least two leads on the basal electrocardiogram, persisting for at least 48 hours before coronary arteriography. In 16 patients (group B) the basal electrocardiogram was normal. Left ventricular volumes and ejection fraction were calculated and the regional systolic wall motion was analyzed using the area method in the 30 degrees right anterior oblique view. Hypokinesis was defined as more than 2 standard deviation below the mean value calculated in 24 normal subjects. No difference was present for age (A: 61 +/- 9 vs B: 57 +/- 9 yrs) and sex distribution. Critical stenoses of at least one coronary artery was documented in all but one patient (in group B). The number of critical stenosis per patient was equal (1.8) in the two groups. Left main coronary artery showed narrowing > 50% in three patients of group A and in two patients of group B.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2002

Naturalistic action impairments in dementia.

Naturalistic actions are everyday tasks (e.g. cooking) that require one to use multiple objects and sequence steps to achieve a goal. Naturalistic action impairment has been attributed to executive dysfunction [Higher cortical functions in man. New York: Basic Books, 1966], semantic knowledge degradation [Brain 111 (1988) 1173], and, more recently, general limitations in cognitive resources [Neuropsychology 12 (1998) 13]. Action impairments were explored in 51 dementia participants with the short form of the multi-level action test (MLAT-S). A clinical neuropsychological test protocol was also administered. Regression analyses including measures of executive functioning, semantic knowledge, and global cognitive functioning showed that global cognitive functioning was the best predictor of MLAT-S errors. Furthermore, task demands significantly influenced the type and frequency of errors, and dementia participants showed a pattern of errors similar to that reported in other clinical populations [Cognitive Neuropsychology 15 (1998) 617; Neuropsychologia 37 (1999) 51; Neuropsychology 12 (1998) 13]. Taken together, the present findings are inconsistent with semantic and executive accounts, but support the limited-capacity resource theory of naturalistic action impairment.

Activities of Daily Living↗

PubMed2000

Chemical strategies for the global analysis of protein function.

As the human genome project nears completion, biological research is entering a new era in which experimental focus will shift from identifying novel genes to determining the function of gene products. Rising to this challenge, several technologies have emerged that aim to characterise genes and/or proteins collectively rather than individually. Of particular interest is a new breed of strategies that employs synthetic chemistry to enrich our understanding of protein function on a global scale.

Animals↗

PubMed2004

Clinical usefulness of ECG-gated 18F-FDG PET combined with 99mTC-MIBI gated SPECT for evaluating myocardial viability and function.

OBJECTIVES: This study sought to evaluate an imaging approach using gated 99mTc-MIBI (MIBI) SPECT and gated 18F-FDG (FDG) PET for assessment of myocardial viability and cardiac function. METHODS: Forty-eight patients (38 men, mean age 68.1 +/- 9.6 years) underwent ECG-gated FDG PET and MIBI SPECT within a week. The baseline diagnoses were coronary artery disease (31), mitral regurgitation (1), paroxysmal arrhythmia (10), and dilated cardiomyopathy (6). The gated FDG PET data were analyzed using pFAST software, and the gated MIBI SPECT data were analyzed using QGS software. Fifteen patients were diagnosed with myocardial infarction, and follow-up study was performed to assess the functional outcome four months later. An improvement in LVEF of >5% was defined as significant. The LV myocardium was divided into 17 segments, and regional defect scores were visually assessed using a 4-point scale for each segment (0 = normal, 1 = mildly reduced, 2 = moderately reduced, 3 = absent). A segment with a greater defect score on MIBI SPECT than on FDG PET was defined as a mismatch. The patients were divided into two groups: those with at least two mismatched segments (MM-group), and those with none or one (M-group). RESULTS: LVEF, EDV and ESV measured by gated FDG PET were highly correlated with those obtained by gated MIBI SPECT (r = 0.848, 0.855 and 0.911, p < 0.0001, respectively). The mean values of LVEF did not differ significantly, but EDV and ESV obtained by gated FDG PET were significantly grater than those obtained by gated MIBI SPECT (p < 0.0001). In 15 patients diagnosed with myocardial infarction, a significant association (p < 0.05) was found between the relative uptake of FDG PET and MIBI SPECT and the functional outcome 4 months later. Global LV function improved in 6 of the 8 patients showing mismatch but in only 1 of the 7 patients with matched defects, resulting in a sensitivity of 86% and specificity of 75%. The overall accuracy to predict global functional outcome was high (80%). CONCLUSION: This imaging approach allows accurate evaluation of myocardial viability. Furthermore, the high correlations of gated FDG PET and gated MIBI SPECT measurements hold promise for the assessment of left ventricular function using gated FDG PET.

Aged↗

PubMed2005

Reliability of global assessment of functioning ratings made by clinical psychiatric staff.

OBJECTIVE: In the Swedish psychiatric care system, systematic follow-up of clinical work with patients is becoming a part of regular service, and a number of care providers are using the Global Assessment of Functioning (GAF) to measure outcomes. This study investigated the reliability of the GAF and analyzed certain factors that affect measurement errors when the scale is used by regular psychiatric staff. METHODS: Eighty-one raters from various psychiatric outpatient clinics rated eight case vignettes. Interrater reliability was assessed by using intraclass correlation coefficients (ICCs), and factors associated with reliability were analyzed by using raters' unique residual values. RESULTS: The results showed that staff who are responsible for assessing first-time patients at outpatient psychiatric clinics and making diagnoses are using the GAF with satisfactory reliability (ICC(1,1)=.81). The factors associated with reliability were raters' subjective attitude toward the GAF and motivation to use the scale and other measurement instruments in psychiatry. CONCLUSIONS: GAF ratings made by an individual rater can be used to measure changes and outcomes at the group level. However, the measurement error is too large for assessment of change for an individual patient, in which case it might be necessary to use several raters. If raters are positively inclined to use rating instruments, measurement errors are minimized and reliability is maximized.

Diagnostic and Statistical Manual of Mental Disord↗