In recent studies of the structure of affect, positive and negative affect have consistently emerged as two dominant and relatively independent dimensions. A number of mood scales have been created to measure these factors; however, many existing measures are inadequate, showing low reliability or poor convergent or discriminant validity. To fill the need for reliable and valid Positive Affect and Negative Affect scales that are also brief and easy to administer, we developed two 10-item mood scales that comprise the Positive and Negative Affect Schedule (PANAS). The scales are shown to be highly internally consistent, largely uncorrelated, and stable at appropriate levels over a 2-month time period. Normative data and factorial and external evidence of convergent and discriminant validity for the scales are also presented.

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Development and validation of brief measures of positive and negative affect: The PANAS scales.

Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.

The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research.

This article reports the development and validation of a scale to measure global life satisfaction, the Satisfaction With Life Scale (SWLS). Among the various components of subjective well-being, the SWLS is narrowly focused to assess global life satisfaction and does not tap related constructs such as positive affect or loneliness. The SWLS is shown to have favorable psychometric properties, including high internal consistency and high temporal reliability. Scores on the SWLS correlate moderately to highly with other measures of subjective well-being, and correlate predictably with specific personality characteristics. It is noted that the SWLS is suited for use with different age groups, and other potential uses of the scale are discussed.

The Satisfaction with Life Scale

This article reports the development and validation of a scale to measure global life satisfaction, the Satisfaction With Life Scale (SWLS). Among the various components of subjective well-being, the SWLS is narrowly focused to assess global life satisfaction and does not tap related constructs such as positive affect or loneliness. The SWLS is shown to have favorable psychometric properties, including high internal consistency and high temporal reliability. Scores on the SWLS correlate moderately to highly with other measures of subjective well-being, and correlate predictably with specific personality characteristics. It is noted that the SWLS is Suited for use with different age groups, and other potential uses of the scale are discussed.

The Satisfaction With Life Scale.

Background Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. Methods A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. Results A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. Conclusion The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/410326/ioi60000.pdf

A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7

Groups of patients with principal diagnosis of panic disorder (n = 54) and generalized anxiety disorder (n = 49) were compared on the basis of their comorbidity with other mental disorders. The rates and patterns of comorbidity were similar, except for comorbid simple phobia and past drug abuse. This finding was interpreted as failing to support a notion that there is essential distinction between panic disorder and generalized anxiety disorder.

Comorbidity Rates Do Not Support Distinction between Panic Disorder and Generalized Anxiety Disorder

A series of studies has been carried out using a choice procedure to investigate the reinforcing properties of benzodiazepines in adult volunteer subjects. Amphetamine and other drugs with undisputed dependence potential are clearly preferred by the majority of subjects using this procedure. However, diazepam has not been found to be an effective reinforcer across a range of doses, using various subject populations and under different experimental conditions. In the present study, lorazepam, a benzodiazepine with a shorter half-life than diazepam, was tested. Twelve normal volunteer subjects were tested in 4 separate experiments in which three doses of lorazepam (0.5, 1.0 and 2.0 mg) were each compared to placebo, and in a separate experiment, 1.0 mg lorazepam was compared to 5.0 mg diazepam. Subjects showed no preference between 0.5 mg lorazepam and placebo or between 1.0 mg lorazepam and 5.0 mg diazepam, but at the 1.0 and 2.0 mg doses of lorazepam they showed a clear preference for placebo. Subjective effects of the drugs were also monitored, and showed changes consistent with the anxiolytic and sedative effects of the drugs. The duration of the effects of lorazepam was unexpectedly long (as long as 6 hours), so the question whether a shorter-acting benzodiazepine would be a more effective reinforcer in this situation remains unanswered.

The dependence potential of benzodiazepines

This discussion deals with several issues of potential importance in making refined comparisons between buspirone and reference drugs as to their relative sedative and antianxiety effects (cost/benefit analyses). Factors considered that may influence the balance of sedative and antianxiety effects include drug dose, initial level of anxiety, environmental contingencies, and criteria for sedation. Additional studies of buspirone are suggested, with special reference to depression and aggression, to explore further some of the properties observed in the clinical trials presented at this symposium on "Buspirone: A Clinical Review of a New, Non-Benzodiazepine Anxiolytic."

"Buspirone: a clinical review of a new, non-benzodiazepine anxiolytic"

Seventy-six male and female Negro chronic schizophrenics were assigned randomly to either diphenylhydantoin or a placebo after discontinuing phenothiazines. During an eight-week treatment course, the dosage of diphenylhydantoin was gradually increased from 325 to 625 mg/day, for most patients. Measures used were the Brief Psychiatric Rating Scale (BPRS), the Nurses Observation Scale for Inpatient Evaluation, and the Crownsville Psychiatric Scale (parts I and II). Statistical analyses were done at four and eight weeks. Patients on both diphenylhydantoin and the placebo deteriorated on most measures. Differences in favor of diphenylhydantoin were found for the BPRS variables, Hostility, and Thought Content. Optimal dosage of diphenylhydantoin appeared to be under 500 mg, daily, since retardation and blunted affect were more predominant with diphenylhydantoin at the highest dose levels. Indications were that men with high initial disorder scores, especially for hostility, responded best to diphenylhydantoin.

Eberhard H. Uhlenhuth

Papers

Comorbidity Rates Do Not Support Distinction between Panic Disorder and Generalized Anxiety Disorder

The dependence potential of benzodiazepines

"Buspirone: a clinical review of a new, non-benzodiazepine anxiolytic"

Diphenylhydantoin effectiveness in the treatment of chronic schizophrenics. A double-blind controlled study with a placebo.

Plasma concentrations of imipramine and clinical response among depressed outpatients.