Wender Utah Rating Scale: Psychometrics, clinical utility and implications regarding the elements of ADHD

Objective: The aim of this study was to assess an electroconvulsive therapy (ECT) rating scale by studying the intraictal electroencephalograph parameters induced by the seizure, and determine the clinical utility of such a scale in terms of time, application and ease of use. Method: This naturalistic study of 55 depressed patients over a 2-year period examined specific parameters of the intraictal electroencephalograph seizure morphology and computer printout, and their association with overall clinical outcome. The rating scale was developed and evaluated in terms of clinical reliability and ease of use. Results: Overall, 1076 individual ECT treatments were given. Using multiple regression analysis, overall seizure adequacy correlated most closely with abrupt seizure endpoint, a high amplitude rhythmic spike and wave phase of >13 s, a seizure energy index of >1000 u, and an electroencephalograph seizure length of > 24 s. ‘Adequate’ overall ratings as determined by the rating scale were shown to correlate significantly with overall clinical improvement. The rating scale had extremely high interrater and test–retest reliability; and was relatively easy to use and time efficient. Conclusions: The use of the rating scale has the potential to help clinicians optimize ECT. While not perfect in any sense, it still gives clinicians good predictive qualities when used as a clinical guide. It is important that larger studies look at all the potential variables that may interact with seizure adequacy and clinical outcome.

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Association between childhood dimensions of attention deficit hyperactivity disorder and adulthood clinical severity of bipolar disorders

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867416642021 ◽

2016 ◽

Vol 51 (4) ◽

pp. 382-392 ◽

Cited By ~ 4

Author(s):

Bruno Etain ◽

M Lajnef ◽

J Loftus ◽

C Henry ◽

A Raust ◽

...

Keyword(s):

Bipolar Disorder ◽

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Rating Scale ◽

Age At Onset ◽

Bipolar Disorders ◽

Clinical Severity ◽

Factorial Structure ◽

Hyperactivity Disorder ◽

Wender Utah Rating Scale

Background: Clinical features of attention deficit hyperactivity disorder can be frequently observed in cases with bipolar disorders and associated with greater severity of bipolar disorders. Although designed as a screening tool for attention deficit hyperactivity disorder, the Wender Utah Rating Scale could, given its factorial structure, be useful in investigating the early history of impulsive, inattentive or mood-related symptoms among patients with bipolar disorders. Methods: We rated the Wender Utah Rating Scale in 276 adult bipolar disorder cases and 228 healthy controls and tested its factorial structure and any associations with bipolar disorder phenomenology. Results: We confirmed a three-factor structure for the Wender Utah Rating Scale (‘ impulsivity/temper’, ‘ inattentiveness’ and ‘ mood/self-esteem’). Cases and controls differed significantly on Wender Utah Rating Scale total score and sub-scale scores ( p-values < 10−5). About 23% of bipolar disorder cases versus 5% of controls were classified as ‘ WURS positive’ (odds ratio = 5.21 [2.73–9.95]). In bipolar disorders, higher Wender Utah Rating Scale score was associated with earlier age at onset, severity of suicidal behaviors and polysubstance misuse; multivariate analyses, controlling for age and gender, confirmed the associations with age at onset ( p = 0.001) and alcohol and substance misuse ( p = 0.001). Conclusion: Adults with bipolar disorders who reported higher levels of childhood symptoms on the Wender Utah Rating Scale presented a more severe expression of bipolar disorders in terms of age at onset and comorbidity. The Wender Utah Rating Scale could be employed to screen for attention deficit hyperactivity disorder but also for ‘ at-risk behaviors’ in adult bipolar disorder cases and possibly for prodromal signs of early onset in high-risk subjects.

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