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The Internal State Scale: replication of its discriminating abilities in a multisite, public sector sample
M S Bauer1, C Vojta, B Kinosian
1Providence VA Medical Center and the Brown University School of Medicine, RI 02908-4799, USA. mark_bauer@brown.edu
Bipolar Disorders
|March 17, 2001
Summary
The Internal State Scale (ISS) effectively identifies mood states in bipolar disorder patients across multiple sites. A revised scoring algorithm improves the formal identification of mixed episodes.
Area of Science:
- Psychiatry
- Psychological Assessment
Background:
- The Internal State Scale (ISS) is a validated self-report tool for mood state discrimination in bipolar disorder.
- Previous validation was primarily in research clinic samples.
Purpose of the Study:
- To extend ISS validation to a multisite public sector sample.
- To test a revised ISS scoring algorithm for formal identification of mixed states in bipolar disorder.
Main Methods:
- Cross-sectional study of 86 bipolar disorder patients across four Veterans Affairs medical centers.
- Mood states (euthymia, mania/hypomania, depression, mixed) assessed via semi-structured interviews and DSM-IV criteria.
- Revised ISS scoring algorithm applied, with ROC curve analysis for optimal cut-offs.
Main Results:
- ISS subscale performance largely replicated original findings, with some differences in the Depression Index.
- ROC analysis determined optimal cut-off scores for the revised algorithm.
- Moderate agreement (kappa score) observed between ISS ratings and expert physician diagnoses, including for mixed states.
Conclusions:
- The ISS demonstrates similar performance in a multisite public sector sample as in initial research samples, confirming its validity.
- A revised scoring algorithm enhances the ISS's capability for formally identifying mixed episodes in bipolar disorder.
- Findings support the ISS as a reliable tool for mood state assessment in clinical settings.
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