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      The improved Clinical Global Impression Scale (iCGI): development and validation in depression

      research-article
      1 , 2 , 3 , 1 , 2 , 3 , 1 , 2 , 4 ,
      BMC Psychiatry
      BioMed Central

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          Abstract

          Background

          The Clinical Global Impression scale (CGI) is frequently used in medical care and clinical research because of its face validity and practicability. This study proposes to improve the reliability of the Clinical Global Impression (CGI) scale in depressive disorders by the use of a semi-standardized interview, a new response format, and a Delphi procedure.

          Methods

          Thirty patients hospitalised for a major depressive episode were filmed at T1 (first week in hospital) and at T2 (2 weeks later) during a 5' specific interview. The Hamilton Depressive Rating Scale and the Symptom Check List were also rated. Eleven psychiatrists rated these videos using either the usual CGI response format or an improved response format, with or without a Delphi procedure.

          Results

          The new response format slightly improved (but not significantly) the interrater agreement, the Delphi procedure did not. The best results were obtained when ratings by 4 independent raters were averaged. In this situation, intraclass correlation coefficients were about 0.9.

          Conclusion

          The Clinical Global Impression is a useful approach in psychiatry since it apprehends patients in their entirety. This study shows that it is possible to quantify such impressions with a high level of interrater agreement.

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          Most cited references25

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          Diagnostic and statistical manual of mental disorders.

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            Developing criteria for establishing interrater reliability of specific items: applications to assessment of adaptive behavior.

            A set of criteria based upon biostatistical considerations for determining the interrater reliability of specific adaptive behavior items in a given setting was presented. The advantages and limitations of extant statistical assessment procedures were discussed. Also, a set of guidelines for differentiating type of adaptive behavior that are statistically reliable from those that are reliable in a clinical or practical sense was delineated. Data sets were presented throughout in order to illustrate the advantages of recommended statistical procedures over other available ones.
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              Modification of the Clinical Global Impressions (CGI) Scale for use in bipolar illness (BP): the CGI-BP.

              The Clinical Global Impressions Scale (CGI) was modified specifically for use in assessing global illness severity and change in patients with bipolar disorder. Criticisms of the original CGI were addressed by correcting inconsistencies in scaling, identifying time frames for comparison, clarifying definitions of illness severity and change, and separating out assessment of treatment side effects from illness improvement during treatment. A Detailed User's Guide was developed to train clinicians in the use of the new CGI-Bipolar Version (CGI-BP) for rating severity of manic and depressive episodes and the degree of change from the immediately preceding phase and from the worst phase of illness. The revised scale and manual provide a focused set of instructions to facilitate the reliability of these ratings of mania, depression, and overall bipolar illness during treatment of an acute episode or in longer-term illness prophylaxis. Interrater reliability of the scale was demonstrated in preliminary analyses. Thus, the modified CGI-BP is anticipated to be more useful than the original CGI in studies of bipolar disorder.
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                Author and article information

                Journal
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                2007
                6 February 2007
                : 7
                : 7
                Affiliations
                [1 ]Inserm, U669, Paris, France
                [2 ]Univ Paris-Sud and Univ Paris Descartes, UMR-S0669, Paris, France
                [3 ]AP-HP, Hôpital de Bicêtre, Service de Psychiatrie, Le Kremlin-Bicêtre, France
                [4 ]AP-HP, Hôpital Paul Brousse, Département de santé publique, Villejuif, France
                Article
                1471-244X-7-7
                10.1186/1471-244X-7-7
                1802073
                17284321
                35e8ddd5-d981-40e0-9a11-9b487a6ff810
                Copyright © 2007 Kadouri et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 May 2006
                : 6 February 2007
                Categories
                Research Article

                Clinical Psychology & Psychiatry
                Clinical Psychology & Psychiatry

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