PRELIMINARY EVIDENCE OF THE RELIABILITY AND VALIDITY OF THE PROSPECTIVE LIFE-CHART METHODOLOGY (LCM-P)

This article describes the use of the NIMH prospective life-charting m ethodology (NIMH LCM-p) in the context of a formal double-blind, clini cal trial and provides preliminary evidence of its reliability and val idity. Subjects included in this report were 30 outpatients with bipol ar I and II disorder who completed the first 2 years of a long-term ma intenance study: I year on carbamazepine or lithium and a crossover to the other in the second year. The LCM-p follows the same types of gui delines and principles utilized in the previously described retrospect ive life-chart process, allowing for continuity of illness assessment prior and subsequent to study entry. In the LCM-p, daily ratings of se verity of mood symptoms based on the degree of associated functional i ncapacity, provide a more detailed topography of manic and depressive fluctuations. Inter-rater reliability was examined by comparing the se verity of daily LCM-p ratings assigned by two raters. In order to asse ss the validity, we correlated the LCM-p ratings with well-standardize d scares, including Hamilton and Beck Depression Ratings, Young Mania Ratings and the Global Assessment Scale (GAS). The Kappa scores for in ter-rater reliability demonstrated significant and satisfactory streng th of agreement with no fall off over 14 days prior to the rating inte rview. Strong correlations were found: (1) between the LCM-p average s everity for depression rating and the mean Hamilton Depression Rating( r=0.86,p<.001), and the Beck Depression Inventory (r=0.73, p<.001); 2) between the LCM-p average severity for mania rating and the Young Man ia Rating Scale (r=0.61, p<.001); and (3) between the LCM-p average se verity and the GAS (r=-0.81, p<.001). These preliminary data suggest t he reliability and validity of the NIMH-LCM-p in assessing manic and d epressive episode severity. It also provides a useful continuous daily measure of affective illness-related symptom fluctuations that allows for detailed prospective assessment of frequency and pattern of illne ss, treatment response, and continuity with retrospective life chart a ssessments. Published by Elsevier Science Ltd.