Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis requires symptoms of both schizophrenia and a mood disorder: either bipolar disorder or depression. The main criterion is the presence of psychotic symptoms for at least two weeks without any mood symptoms. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses.
Bipolar disorder in children, or pediatric bipolar disorder (PBD), is a rare mental disorder in children and adolescents. The diagnosis of bipolar disorder in children has been heavily debated for many reasons including the potential harmful effects of adult bipolar medication use for children. PBD is similar to bipolar disorder (BD) in adults, and has been proposed as an explanation for periods of extreme shifts in mood called mood episodes. These shifts alternate between periods of depressed or irritable moods and periods of abnormally elevated moods called manic or hypomanic episodes. Mixed mood episodes can occur when a child or adolescent with PBD experiences depressive and manic symptoms simultaneously. Mood episodes of children and adolescents with PBD are different from general shifts in mood experienced by children and adolescents because mood episodes last for long periods of time and cause severe disruptions to an individual's life. There are three known forms of PBD: Bipolar I, Bipolar II, and Bipolar Not Otherwise Specified (NOS). The average age of onset of PBD remains unclear, but reported age of onset ranges from 5 years of age to 19 years of age. PBD is typically more severe and has a poorer prognosis than bipolar disorder with onset in late-adolescence or adulthood.
In medicine, a prodrome is an early sign or symptom that often indicates the onset of a disease before more diagnostically specific signs and symptoms develop. It is derived from the Greek word prodromos, meaning "running before". Prodromes may be non-specific symptoms or, in a few instances, may clearly indicate a particular disease, such as the prodromal migraine aura.
The Young Mania Rating Scale (YMRS), developed and popularised by Robert Young and Vincent E Ziegler, is an eleven-item multiple choice diagnostic questionnaire which psychiatrists use to measure the presence and severity of mania and associated symptoms. The scale was originally developed for use in the evaluation of adult patients with bipolar disorder, but has since been adapted for use in pediatric patients. The scale is widely used by clinicians and researchers in the diagnosis, evaluation, and quantification of manic symptomology. It has become the most widely used outcome measure in clinical trials for bipolar disorders, and it is recognized by many regulatory agencies as an acceptable outcome measure despite its age.
The Schedule for Affective Disorders and Schizophrenia (SADS) is a collection of psychiatric diagnostic criteria and symptom rating scales originally published in 1978. It is organized as a semi-structured diagnostic interview. The structured aspect is that every interview asks screening questions about the same set of disorders regardless of the presenting problem; and positive screens get explored with a consistent set of symptoms. These features increase the sensitivity of the interview and the inter-rater reliability of the resulting diagnoses. The SADS also allows more flexibility than fully structured interviews: Interviewers can use their own words and rephrase questions, and some clinical judgment is used to score responses. There are three versions of the schedule, the regular SADS, the lifetime version (SADS-L) and a version for measuring the change in symptomology (SADS-C). Although largely replaced by more structured interviews that follow diagnostic criteria such as DSM-IV and DSM-5, and specific mood rating scales, versions of the SADS are still used in some research papers today.
Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.
The Patient Health Questionnaire (PHQ) is a multiple-choice self-report inventory that is used as a screening and diagnostic tool for mental health disorders of depression, anxiety, alcohol, eating, and somatoform disorders. It is the self-report version of the Primary Care Evaluation of Mental Disorders (PRIME-MD), a diagnostic tool developed in the mid-1990s by Pfizer Inc. The length of the original assessment limited its feasibility; consequently, a shorter version, consisting of 11 multi-part questions - the Patient Health Questionnaire was developed and validated.
Separation anxiety disorder (SAD) is an anxiety disorder in which an individual experiences excessive anxiety regarding separation from home and/or from people to whom the individual has a strong emotional attachment. Separation anxiety is a natural part of the developmental process. It is most common in infants and little children, typically between the ages of six to seven months to three years, although it may pathologically manifest itself in older children, adolescents and adults. Unlike SAD, normal separation anxiety indicates healthy advancements in a child's cognitive maturation and should not be considered a developing behavioral problem.
The Vanderbilt ADHD Diagnostic Rating Scale (VADRS) is a psychological assessment tool for attention deficit hyperactivity disorder (ADHD) symptoms and their effects on behavior and academic performance in children ages 6–12. This measure was developed by Mark L Wolraich at the Oklahoma Health Sciences Center and includes items related to oppositional defiant disorder, conduct disorder, anxiety, and depression, disorders often comorbid with ADHD.
The ADHD Rating Scale (ADHD-RS) is a parent-report or teacher-report inventory created by George J. DuPaul, Thomas J. Power, Arthur D. Anastopoulos, and Robert Reid consisting of 18–90 questions regarding a child's behavior over the past 6 months. The ADHD Rating Scale is used to aid in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children ranging from ages 5–17.
The Hypomania Checklist (HCL-32) is a questionnaire developed by Dr. Jules Angst to identify hypomanic features in patients with major depressive disorder in order to help recognize bipolar II disorder and other bipolar spectrum disorders when people seek help in primary care and other general medical settings. It asks about 32 behaviors and mental states that are either aspects of hypomania or features associated with mood disorders. It uses short phrases and simple language, making it easy to read. The University of Zurich holds the copyright, and the HCL-32 is available for use at no charge. More recent work has focused on validating translations and testing whether shorter versions still perform well enough to be helpful clinically. Recent meta-analyses find that it is one of the most accurate assessments available for detecting hypomania, doing better than other options at recognizing bipolar II disorder.
The Screen for Child Anxiety Related Emotional Disorders (SCARED) is a self-report screening questionnaire for anxiety disorders developed in 1997. The SCARED is intended for youth, 9–18 years old, and their parents to complete in about 10 minutes. It can discriminate between depression and anxiety, as well as among distinct anxiety disorders. The SCARED is useful for generalized anxiety disorder, social anxiety disorder, phobic disorders, and school anxiety problems. Most available self-report instruments that measure anxiety in children look at general aspects of anxiety rather than Diagnostic and Statistical Manual of Mental Disorders (DSM) categorizations. The SCARED was developed as an instrument for both children and their parents that would encompass several DSM-IV and DSM-5 categorizations of the anxiety disorders: somatic/panic, generalized anxiety, separation anxiety, social phobia, and school phobia.
The Weinberg Screen Affective Scale (WSAS) is a free scale designed to screen for symptoms of depression in children and young adults ages 5–21. It can be used as an initial treatment scale and can be used to follow up on treatment efficacy. There are 56 self-report questions that screen for symptoms in 10 major categories of depression: dysphoric mood, low self-esteem, agitation, sleep disturbance, change in school performance, diminished socialization, change in attitude towards school, somatic complaints, loss of usual energy, and unusual change in weight and/or appetite. The scale is based on previously proposed criteria for depression in children. A study looking at the agreement between scales for depression diagnosis found 79.4% agreement between the DSM-III and the WSAS in a sample of 107 children.
The Mood Disorder Questionnaire (MDQ) is a self-report questionnaire designed to help detect bipolar disorder. It focuses on symptoms of hypomania and mania, which are the mood states that separate bipolar disorders from other types of depression and mood disorder. It has 5 main questions, and the first question has 13 parts, for a total of 17 questions. The MDQ was originally tested with adults, but it also has been studied in adolescents ages 11 years and above. It takes approximately 5–10 minutes to complete. In 2006, a parent-report version was created to allow for assessment of bipolar symptoms in children or adolescents from a caregiver perspective, with the research looking at youths as young as 5 years old. The MDQ has become one of the most widely studied and used questionnaires for bipolar disorder, and it has been translated into more than a dozen languages.
The Child Mania Rating Scales (CMRS) is a 21-item diagnostic screening measure designed to identify symptoms of mania in children and adolescents aged 9–17 using diagnostic criteria from the DSM-IV, developed by Pavuluri and colleagues. There is also a 10-item short form. The measure assesses the child's mood and behavior symptoms, asking parents or teachers to rate how often the symptoms have caused a problem for the youth in the past month. Clinical studies have found the CMRS to be reliable and valid when completed by parents in the assessment of children's bipolar symptoms. The CMRS also can differentiate cases of pediatric bipolar disorder from those with ADHD or no disorder, as well as delineating bipolar subtypes. A meta-analysis comparing the different rating scales available found that the CMRS was one of the best performing scales in terms of telling cases with bipolar disorder apart from other clinical diagnoses. The CMRS has also been found to provide a reliable and valid assessment of symptoms longitudinally over the course of treatment. The combination of showing good reliability and validity across multiple samples and clinical settings, along with being free and brief to score, make the CMRS a promising tool, especially since most other checklists available for youths do not assess manic symptoms.
The University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index for DSM-5 is a psychiatric assessment tool used to assess symptoms of PTSD in children and adolescents. This assessment battery includes four measures: the Child/Adolescent Self-Report version; the Parent/Caregiver Report version; the Parent/Caregiver Report version for Children Age 6 and Younger; and a Brief Screen for Trauma and PTSD. Questions may differ among the indexes depending on the target age, however the indexes are identical in format. The target age groups for this assessment are children and adolescents between 7-18 and children age 6 and younger. Versions of the UCLA PTSD Reaction Index for DSM-5 have been translated into many languages, including Spanish, Japanese, Simplified Chinese, Korean, German, and Arabic. The DSM-IV version of the UCLA PTSD Reaction Index Index has been updated for DSM-5.
The General Behavior Inventory (GBI) is a 73-question psychological self-report assessment tool designed by Richard Depue and colleagues to identify the presence and severity of manic and depressive moods in adults, as well as to assess for cyclothymia. It is one of the most widely used psychometric tests for measuring the severity of bipolar disorder and the fluctuation of symptoms over time. The GBI is intended to be administered for adult populations; however, it has been adapted into versions that allow for juvenile populations, as well as a short version that allows for it to be used as a screening test.
The Child PTSD Symptom Scale (CPSS) is a free checklist designed for children and adolescents to report traumatic events and symptoms that they might feel afterward. The items cover the symptoms of posttraumatic stress disorder (PTSD), specifically, the symptoms and clusters used in the DSM-IV. Although relatively new, there has been a fair amount of research on the CPSS due to the frequency of traumatic events involving children. The CPSS is usually administered to school children within school boundaries, or in an off-site location to assess symptoms of trauma. Some, but not all, people experience symptoms after a traumatic event, and in serious cases, these people may not get better on their own. Early and accurate identification, especially in children, of experiencing distress following a trauma could help with early interventions. The CPSS is one of a handful of promising measures that has accrued good evidence for reliability and validity, along with low cost, giving it good clinical utility as it addresses a public health need for better and larger scale assessment.
The Child and Adolescent Symptom Inventory (CASI) is a behavioral rating checklist created by Kenneth Gadow and Joyce Sprafkin that evaluates a range of behaviors related to common emotional and behavioral disorders identified in the Diagnostic and Statistical Manual of Mental Disorders (DSM), including attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, generalized anxiety disorder, social phobia, separation anxiety disorder, major depressive episode, mania, dysthymic disorder, schizophrenia, autism spectrum, Asperger syndrome, anorexia, and bulimia. In addition, one or two key symptoms from each of the following disorders are also included: obsessive-compulsive disorder, specific phobia, panic attack, motor/vocal tics, and substance use. CASI combines the Child Symptom Inventory (CSI) and the Adolescent Symptom Inventory (ASI), letting it apply to both children and adolescents, aged from 5 to 18. The CASI is a self-report questionnaire completed by the child's caretaker or teacher to detect signs of psychiatric disorders in multiple settings. Compared to other widely used checklists for youths, the CASI maps more closely to DSM diagnoses, with scoring systems that map to the diagnostic criteria as well as providing a severity score. Other measures are more likely to have used statistical methods, such as factor analysis, to group symptoms that often occur together; if they have DSM-oriented scales, they are often later additions that only include some of the diagnostic criteria.
