HeRA Collection:

Guidelines for rating Global Assessment of Functioning (GAF).

Sat, 01 Jan 2011 00:00:00 GMT

Title: Guidelines for rating Global Assessment of Functioning (GAF). Authors: Aas, Inge Harald Monrad Abstract: Abstract:; Global Assessment of Functioning (GAF) is a scoring system for the severity of illness in psychiatry. It is used clinically in many countries, as well as in research, but studies have shown several problems with GAF, for example concerning its validity and reliability. Guidelines for rating are important. The present study aimed to identify the current status of guidelines for rating GAF, and relevant factors and gaps in knowledge for the development of improved guidelines.; A thorough literature search was conducted.; Few studies of existing guidelines have been conducted; existing guidelines are short; and rating has a subjective element. Seven main categories were identified as being important in relation to further development of guidelines: (1) general points about guidelines for rating GAF; (2) introduction to guidelines, with ground rules; (3) starting scoring at the top, middle or bottom level of the scale; (4) scoring for different time periods and of different values (highest, lowest or average); (5) the finer grading of the scale; (6) different guidelines for different conditions; and (7) different languages and cultures. Little information is available about how rules for rating are understood by different raters: the final score may be affected by whether the rater starts at the top, middle or bottom of the scale; there is little data on which value/combination of GAF values to record; guidelines for scoring within 10-point intervals are limited; there is little empirical information concerning the suitability of existing guidelines for different conditions and patient characteristics; and little is known about the effects of translation into different languages or of different cultural understanding.; Few studies have dealt specifically with guidelines for rating GAF. Current guidelines for rating GAF are not comprehensive, and relevant points for new guidelines are presented. Theoretical and empirical studies, and international expert panels would be valuable, as well as production of a manual with more information about scoring. Computerised assessment may well be the future.

Global Assessment of Functioning (GAF): properties and frontier of current knowledge.

Fri, 07 May 2010 00:00:00 GMT

Title: Global Assessment of Functioning (GAF): properties and frontier of current knowledge. Authors: Aas, Inge Harald Monrad Abstract: ABSTRACT: BACKGROUND: Global Assessment of Functioning (GAF) is well known internationally and widely used for scoring the severity of illness in psychiatry. Problems with GAF show a need for its further development (for example validity and reliability problems). The aim of the present study was to identify gaps in current knowledge about properties of GAF that are of interest for further development. Properties of GAF are defined as characteristic traits or attributes that serve to define GAF (or may have a role to define a future updated GAF). METHODS: A thorough literature search was conducted. RESULTS: A number of gaps in knowledge about the properties of GAF were identified: for example, the current GAF has a continuous scale, but is a continuous or categorical scale better? Scoring is not performed by setting a mark directly on a visual scale, but could this improve scoring? Would new anchor points, including key words and examples, improve GAF (anchor points for symptoms, functioning, positive mental health, prognosis, improvement of generic properties, exclusion criteria for scoring in 10-point intervals, and anchor points at the endpoints of the scale)? Is a change in the number of anchor points and their distribution over the total scale important? Could better instructions for scoring within 10-point intervals improve scoring? Internationally, both single and dual scales for GAF are used, but what is the advantage of having separate symptom and functioning scales? Symptom (GAF-S) and functioning (GAF-F) scales should score different dimensions and still be correlated, but what is the best combination of definitions for GAF-S and GAF-F? For GAF with more than two scales there is limited empirical testing, but what is gained or lost by using more than two scales? CONCLUSIONS: In the history of GAF, its basic properties have undergone limited changes. Problems with GAF may, in part, be due to lack of a research programme testing the effects of different changes in basic properties. Given the widespread use, research-based development of GAF has not been especially strong. Further research could improve GAF.

Cortisol level predicts executive and memory function in depression, symptom-level predicts psychomotor speed.

Thu, 01 Dec 2005 00:00:00 GMT

Title: Cortisol level predicts executive and memory function in depression, symptom-level predicts psychomotor speed. Authors: Egeland, Jens; Lund, Anders; Landrø, Nils Inge; Rund, Bjørn Rishovd; Sundet, K; Asbjørnsen, A; Mjellem, N; Roness, Atle; Stordal, Kirsten I Abstract: OBJECTIVE: On a group level depression is related to hypercortisolism and to psychomotor retardation, executive dysfunction and memory impairment. However, intra-group heterogeneity is substantial. Why some are impaired while others remain in the normal range, is not clear. The present study aims at discerning the relative contribution of present symptom severity and hypercortisolism to impairment in the three domains of cognition. METHOD: Morning saliva cortisol was measured in 26 subjects with recurrent major depression prior to a neuropsychological examination with tests known to be sensitive to cognitive impairment in depression. RESULTS: Cortisol level correlated with executive dysfunction and post-encoding memory deficits, but not with processing speed. Depression level correlated with processing speed. These patterns remained significant after controlling for confounders through partial correlations. CONCLUSION: The association between cortisol and cognition is not an artifact of psychiatric symptom load. High level of saliva cortisol is associated with aspects of cognition that can be dissociated from psychomotor retardation, which is dependent on symptom load.

Differentiating malingering from genuine cognitive dysfunction using the Trail Making Test-ratio and Stroop Interference scores.

Mon, 01 Jan 2007 00:00:00 GMT

Title: Differentiating malingering from genuine cognitive dysfunction using the Trail Making Test-ratio and Stroop Interference scores. Authors: Egeland, Jens; Langfjaeran, Tone Abstract: Patterns of test performance that are inconsistent with knowledge of brain dysfunction can potentially differentiate between malingering and true impairment among litigants with low scores on neuropsychological tests. In this study possible malingerers (n = 41), impaired (30) or cognitively normal (17) litigants were compared on the Trail Making Test B:A ratio score and Stroop Interference. The majority of possible malingerers had a low TMT-ratio (<2.5) and an inverted Stroop effect, whereas the majority of impaired subjects had a high TMT-ratio and specific Stroop interference. Sensitivity to malingering was 61 and 68 percent, and specificity was 57 and 59 percent. This is too low for valid classification of individuals. However, the combination of both measures increases predictability. The clinician is advised to look for other evidence of malingering in cases of simultaneous low TMT-ratio and inverted Stroop. Patients with high TMT-ratio and Stroop interference, should be thoroughly examined for indications of brain disease.