<22> AU - Bandura, A AU - Ross, D AU - Ross, SA TI - Transmission of aggressions through imitation of aggressive models SO - Journal of Abnormal and Social Psychology. 1961;63:575-582 <13> AU - Barraclough, B AU - Bunch, J AU - Nelson, B AU - Sainsbury, P TI - A hundred cases of suicide: clinical aspects SO - British Journal of Psychiatry. 1974;125:355-73 <38> AU - Beck, AT AU - Ward, CH AU - Mendelson, M AU - Mock, J AU - Erbaugh, J TI - An inventory for measuring depression SO - Archives of General Psychiatry. 1961;4:561-571 <23> AU - Broca, P TI - Remarques sur le siége de la faculté du langage articulé, suivies d'une observation d'aphémie (perte de la parole) SO - Bulletin de la Société Anatomique. 1861;6:330-357 <57> AU - Brown, GW AU - Birley, JL TI - Crises and life changes and the onset of schizophrenia SO - Journal of Health & Social Behavior. 1968;9(3):203-14 <15> AU - Brown, GW AU - Sklair, F AU - Harris, TO AU - Birley, JL TI - Life-events and psychiatric disorders. 1. Some methodological issues SO - Psychological Medicine. 1973;3(1):74-87 <56> AU - Brown, GW AU - Harris, TO AU - Peto, J TI - Life events and psychiatric disorders. 2. Nature of causal link SO - Psychological Medicine. 1973;3(2):159-76 <10> AU - Burns, T AU - Beadsmoore, A AU - Bhat, AV AU - Oliver, A AU - Mathers, C IN - St George's Hospital Medical School, London. TI - A controlled trial of home-based acute psychiatric services. I: Clinical and social outcome SO - British Journal of Psychiatry. 1993;163:49-54 AB - While research has shown community-based psychiatric care to be as good as, or better than, hospital-based care, generalisation to clinical practice has been difficult. This prospective, randomised controlled study examined a community-based approach feasible within NHS conditions. Ninety-four patients were randomly allocated to experimental and 78 to control treatments and followed for one year. The groups were well matched apart from an excess of psychotic control patients. No differences in clinical or social functioning outcome were found. Both groups improved substantially on clinical measures in the first six weeks, with some slow consolidation thereafter. There were three suicides in the control group and one in the experimental group. Access to care was better in the experimental group (93% attended assessment) than in the control group (75% attended assessment). <2> AU - Cade, JFJ TI - Lithium Salts in the Treatment of Psychotic Excitement SO - Medical Journal of Australia. 1949;2:349-352 <27> AU - Capgras, JMJ AU - Reboul-Lachaux, J TI - L'illusion des "sosies" dans un délire systématisé chronique SO - Bulletin de la Société clinique de médecine mentale. 1923;11:6-16 <53> AU - Coppen, A AU - Noguera, R AU - Bailey, J AU - Burns, BH AU - Swani, MS AU - Hare, EH AU - Gardner, R AU - Maggs, R TI - Prophylactic lithium in affective disorders. Controlled trial SO - Lancet. 1971;2(7719):275-9 <28> AU - Courbon, P AU - Fail, G TI - Syndrome d'illusion de Frégoli et schizophrénie SO - Bulletin de la Société clinique de médecine mentale. 1927;15:121-5 <3> AU - Delay, J AU - Deniker, P AU - Harl, JM TI - Therapeutic use in psychiatry of phenothiazine of central elective action (4560 RP) SO - Annals of Medical Psychology (Paris). 1952;110(2:1):112-7 <36> AU - Department of Health TI - Safety First: Five-Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness SO - Department of Health. 1999: London <51> AU - Edwards, G AU - Gross, MM TI - Alcohol dependence: provisional description of a clinical syndrome SO - British Medical Journal. 1976;1(6017):1058-61 <54> AU - Elkin, I AU - Shea, MT AU - Watkins, JT AU - Imber, SD AU - Sotsky, SM AU - Collins, JF AU - Glass, DR AU - Pilkonis, PA AU - Leber, WR AU - Docherty, JP AU - et al. TI - National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments SO - Archives of General Psychiatry. 1989;46(11):971-82; discussion 983 AB - We investigated the effectiveness of two brief psychotherapies, interpersonal psychotherapy and cognitive behavior therapy, for the treatment of outpatients with major depression disorder diagnosed by Research Diagnostic Criteria. Two hundred fifty patients were randomly assigned to one of four 16-week treatment conditions: interpersonal psychotherapy, cognitive behavior therapy, imipramine hydrochloride plus clinical management (as a standard reference treatment), and placebo plus clinical management. Patients in all treatments showed significant reduction in depressive symptoms and improvement in functioning over the course of treatment. There was a consistent ordering of treatments at termination, with imipramine plus clinical management generally doing best, placebo plus clinical management worst, and the two psychotherapies in between but generally closer to imipramine plus clinical management. In analyses carried out on the total samples without regard to initial severity of illness (the primary analyses), there was no evidence of greater effectiveness of one of the psychotherapies as compared with the other and no evidence that either of the psychotherapies was significantly less effective than the standard reference treatment, imipramine plus clinical management. Comparing each of the psychotherapies with the placebo plus clinical management condition, there was limited evidence of the specific effectiveness of interpersonal psychotherapy and none for cognitive behavior therapy. Superior recovery rates were found for both interpersonal psychotherapy and imipramine plus clinical management, as compared with placebo plus clinical management. On mean scores, however, there were few significant differences in effectiveness among the four treatments in the primary analyses. Secondary analyses, in which patients were dichotomized on initial level of severity of depressive symptoms and impairment of functioning, helped to explain the relative lack of significant findings in the primary analyses. Significant differences among treatments were present only for the subgroup of patients who were more severely depressed and functionally impaired; here, there was some evidence of the effectiveness of interpersonal psychotherapy with these patients and strong evidence of the effectiveness of imipramine plus clinical management. In contrast, there were no significant differences among treatments, including placebo plus clinical management, for the less severely depressed and functionally impaired patients. <48> AU - Endicott, J AU - Spitzer, RL TI - A diagnostic interview: the schedule for affective disorders and schizophrenia SO - Archives of General Psychiatry. 1978;35(7):837-44 AB - The Schedule for Affective Disorders and Schizophrenia (SADS) was developed to reduce information variance in both the descriptive and diagnostic evaluation of a subject. The SADS is unique among rating scales in that it provides for (1) a detailed description of the features of the current episodes of illness when they were at their most severe; (2) a description of the level of severity of manifestations of major dimensions of psychopathology during the week preceding the evaluation, which can then be used as a measure of change; (3) a progression of questions and criteria, which provides information for making diagnoses; and (4) a detailed description of past psychopathology and functioning relevant to an evaluation of diagnosis, prognosis, and overall severity of disturbance. This article reports on initial scale development and reliability studies of the items and the scale scores. <26> AU - Festinger, L AU - Carlsmith, JM TI - Cognitive consequences of forced compliance SO - Journal of Abnormal and Social Psychology. 1959;58:203-210 <39> AU - Folstein, MF AU - Folstein, SE AU - McHugh, PR TI - "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician SO - Journal of Psychiatric Research. 1975;12(3):189-98 <40> AU - Frank, E AU - Prien, RF AU - Jarrett, RB AU - Keller, MB AU - Kupfer, DJ AU - Lavori, PW AU - Rush, AJ AU - Weissman, MM IN - Department of Psychiatry, University of Pittsburgh School of Medicine, PA. TI - Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence SO - Archives of General Psychiatry. 1991;48(9):851-5 AB - In 1988, the MacArthur Foundation Research Network on the Psychobiology of Depression convened a task force to examine the ways in which change points in the course of depressive illness had been described and the extent to which inconsistency in these descriptions might be impeding research on this disorder. We found considerable inconsistency across and even within research reports and concluded that research on depressive illness would be well served by greater consistency in the definition change points in the course of illness. We propose an internally consistent, empirically defined conceptual scheme for the terms remission, recovery, relapse, and recurrence. In addition, we propose tentative operational criteria for each term. Finally, we discuss ways to assess the usefulness of such operational criteria through reanalysis of existing data and the design and conduct of new experiments. <35> AU - Greenberg, PE AU - Stiglin, LE AU - Finkelstein, SN AU - Berndt, ER TI - Depression: a neglected major illness SO - Journal of Clinical Psychiatry. 1993;54(11):419-24 AB - BACKGROUND: To illustrate the burden depression imposes on society, we present estimates of the annual costs of depression--$44 billion--as well as the number of individuals it affects per year--almost 11 million. Although these estimates point to depression as a major illness, this study examines why it is not generally considered as such by the medical and public health communities or by society at large. METHOD: We develop a framework that compares depression with major illnesses such as coronary heart disease, cancer, and AIDS by highlighting salient characteristics of each illness. This comparative illness framework considers the costs, prevalence, distribution of sufferers, mortality, recognition, and treatability of each disease. This comparison underscores many of the similarities and differences among the illnesses examined. RESULTS: Because depression often is not properly recognized and begins to affect many people at a relatively early age, it exacts costs over a longer period of time and in a more subtle manner than other major illnesses. It also imposes a particularly heavy burden on employers in the form of higher workplace costs. CONCLUSION: We conclude that, because of the potential for successful treatment, increased attempts to reach untreated sufferers of depression appear to be warranted. Employers as a group have a particular incentive to invest in the recognition and treatment of this widespread problem, in order to reduce the substantial costs it imposes upon them each year. <49> AU - Greenberg, PE AU - Sisitsky, T AU - Kessler, RC AU - Finkelstein, SN AU - Berndt, ER AU - Davidson, JR AU - Ballenger, JC AU - Fyer, AJ TI - The economic burden of anxiety disorders in the 1990s SO - Journal of Clinical Psychiatry. 1999;60(7):427-35 AB - BACKGROUND: We assess the annual economic burden of anxiety disorders in the United States from a societal perspective. METHOD: Using data from the National Comorbidity Study, we applied multivariate regression techniques to calculate the costs associated with anxiety disorders, after adjusting for demographic characteristics and the presence of comorbid psychiatric conditions. Based on additional data, in part from a large managed care organization, we estimated a human capital model of the societal cost of anxiety disorders. RESULTS: We estimated the annual cost of anxiety disorders to be approximately $42.3 billion in 1990 in the United States, or $1542 per sufferer. This comprises $23.0 billion (or 54% of the total cost) in nonpsychiatric medical treatment costs, S13.3 billion (31%) in psychiatric treatment costs, $4.1 billion (10%) in indirect workplace costs, $1.2 billion (3%) in mortality costs, and $0.8 billion (2%) in prescription pharmaceutical costs. Of the $256 in workplace costs per anxious worker, 88% is attributable to lost productivity while at work as opposed to absenteeism. Posttraumatic stress disorder and panic disorder are the anxiety disorders found to have the highest rates of service use. Other than simple phobia, all anxiety disorders analyzed are associated with impairment in workplace performance. CONCLUSION: Anxiety disorders impose a substantial cost on society, much of which may be avoidable with more widespread awareness, recognition, and appropriate early intervention. <41> AU - Hamilton, M TI - The assessment of anxiety states by rating SO - British Journal of Medical Psychology. 1959;32:50-55 <42> AU - Hamilton, M TI - A rating scale for depression SO - Journal of Neurology, Neurosurgery, and Psychiatry. 1960;23:56-62 <30> AU - Harlow, JM TI - Passage of an iron rod through the head SO - Boston Medical and Surgical Journal. 1848;39:389-393 <18> AU - Harlow, HF TI - The nature of love SO - American Psychologist. 1958;13:573-685 <19> AU - James, W TI - What is an emotion? SO - Mind. 1884;9:188-205 <5> AU - Johnstone, EC AU - Crow, TJ AU - Frith, CD AU - Husband, J AU - Kreel, L TI - Cerebral ventricular size and cognitive impairment in chronic schizophrenia SO - Lancet. 1976;2(7992):924-6 AB - By comparison with age-matched controls in employment, 17 institutionalised schizophrenic patients were shown by computerised axial tomography of the brain to have increased cerebral ventricular size. Within the group of schizophrenic patients increased ventricular size was highly significantly related to indices of cognitive impairment. <12> AU - Kane, J AU - Honigfeld, G AU - Singer, J AU - Meltzer, H IN - Department of Psychiatry, Hillside Hospital, Long Island Jewish Medical Center, Glen Oaks, NY 11004. TI - Clozapine for the treatment-resistant schizophrenic. A double-blind comparison with chlorpromazine SO - Archives of General Psychiatry. 1988;45(9):789-96 AB - The treatment of schizophrenic patients who fail to respond to adequate trials of neuroleptics is a major challenge. Clozapine, an atypical antipsychotic drug, has long been of scientific interest, but its clinical development has been delayed because of an associated risk of agranulocytosis. This report describes a multicenter clinical trial to assess clozapine's efficacy in the treatment of patients who are refractory to neuroleptics. DSM-III schizophrenics who had failed to respond to at least three different neuroleptics underwent a prospective, single-blind trial of haloperidol (mean dosage, 61 +/- 14 mg/d) for six weeks. Patients whose condition remained unimproved were then randomly assigned, in a double-blind manner, to clozapine (up to 900 mg/d) or chlorpromazine (up to 1800 mg/d) for six weeks. Two hundred sixty-eight patients were entered in the double-blind comparison. When a priori criteria were used, 30% of the clozapine-treated patients were categorized as responders compared with 4% of chlorpromazine-treated patients. Clozapine produced significantly greater improvement on the Brief Psychiatric Rating Scale, Clinical Global Impression Scale, and Nurses' Observation Scale for Inpatient Evaluation; this improvement included "negative" as well as positive symptom areas. Although no cases of agranulocytosis occurred during this relatively brief study, in our view, the apparently increased comparative risk requires that the use of clozapine be limited to selected treatment-resistant patients. <47> AU - Kay, SR AU - Fiszbein, A AU - Opler, LA TI - The positive and negative syndrome scale (PANSS) for schizophrenia SO - Schizophrenia Bulletin. 1987;13(2):261-76 AB - The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale (PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment. PMID: 3616518 [PubMed - indexed for MEDLINE] <50> AU - Kline, NS TI - Clinical experiences with iproniazid (marsalid) SO - Journal of Clinical and Experimental Psychopathology. 1958;19:72-78 <25> AU - Koffka, K TI - Perception: An introduction to the Gestalt-theorie SO - Psychological Bulletin. 1922;19:531-585 <4> AU - Kuhn, R TI - The treatment of depressive states with G 22355 (imipramine hydrochloride) SO - American Journal of Psychiatry. 1958;115(5):459-64 <55> AU - Leff, JP AU - Wing, JK TI - Trial of maintenance therapy in schizophrenia SO - British Medical Journal. 1971;3(775):599-604 <20> AU - Maslow, AH TI - A theory of human motivation SO - Psychological Review. 1943;50:370-396 <11> AU - Meadow, R TI - Munchausen syndrome by proxy. The hinterland of child abuse SO - Lancet. 1977;2(8033):343-5 AB - Some patients consistently produce false stories and fabricate evidence, so causing themselves needless hospital investigations and operations. Here are described parents who, by falsification, caused their children innumerable harmful hospital procedures--a sort of Munchausen syndrome by proxy. <43> AU - Montgomery, SA AU - Asberg, M TI - A new depression scale designed to be sensitive to change SO - British Journal of Psychiatry. 1979;134:382-9 AB - The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample. Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change. The inner-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed. <44> AU - National Institute of Mental Health TI - CGI: Clinical Global Impressions SO - Journal. 1970;(Issue):217-222 <45> AU - Overall, JE AU - Gorham, DR TI - The Brief Psychiatric Rating Scale SO - Psychological Reports. 1962;10:799-812 <17> AU - Parkes, CM TI - The first year of bereavement. A longitudinal study of the reaction of London widows to the death of their husbands SO - Psychiatry. 1970;33(4):444-67 <29> AU - Parkinson, J TI - An Essay on the Shaking Palsy SO - Journal. 1817;(Issue) <32> AU - Pavlov, IP TI - Conditioned reflexes: An investigation of the physiological activity of the cerebral cortex (G. V. Anrep, Trans.) SO - Journal. 1927;(Issue) <31> AU - Pippard, J AU - Ellam, L TI - Electroconvulsive treatment in Great Britain SO - British Journal of Psychiatry. 1981;139:563-8 <33> AU - Rogers, CR TI - Significant aspects of client-centered therapy SO - American Psychologist. 1946;1:415-422 <52> AU - Russell, G TI - Bulimia nervosa: an ominous variant of anorexia nervosa SO - Psychological Medicine. 1979;9(3):429-48 AB - Thirty patients were selected for a prospective study according to two criteria: (i) an irresistible urge to overeat (bulimia nervosa), followed by self-induced vomiting or purging; (ii) a morbid fear of becoming fat. The majority of the patients had a previous history of true or cryptic anorexia nervosa. Self-induced vomiting and purging are secondary devices used by the patients to counteract the effects of overeating and prevent a gain in weight. These devices are dangerous for they are habit-forming and lead to potassium loss and other physical complications. In common with true anorexia nervosa, the patients were determined to keep their weight below a self-imposed threshold. Its level was set below the patient's healthy weight, defined as the weight reached before the onset of the eating disorder. In contrast with true anorexia nervosa, the patients tended to be heavier, more active sexually, and more likely to menstruate regularly and remain fertile. Depressive symptoms were often severe and distressing and led to a high risk of suicide. A theoretical model is described to emphasize the interdependence of the various symptoms and the role of self-perpetuating mechanisms in the maintenance of the disorder. The main aims of treatment are (i) to interrupt the vicious circle of overeating and self-induced vomiting (or purging), (ii) to persuade the patients to accept a higher weight. Prognosis appears less favourable than in uncomplicated anorexia nervosa. <8> AU - Stein, LI AU - Test, MA TI - Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation SO - Archives of General Psychiatry. 1980;37(4):392-7 AB - A conceptual model for the development of community-based treatment programs for the chronically disabled psychiatric patient was developed, and the results of a controlled study and follow-up are reported. A community-treatment program that was based on the conceptual model was compared with conventional treatment (ie, progressive short-term hospitalization plus aftercare). The results have shown that use of the community program for 14 months greatly reduced the need to hospitalize patients and enhanced the community tenure and adjustment of the experimental patients. When the special programming was discontinued, many of the gains that were attained deteriorated, and use of the hospital rose sharply. The results suggest that community programming should be comprehensive and ongoing. <24> AU - Stroop, JR TI - Studies of interference in serial verbal reactions SO - Journal of Experimental Psychology. 1935;28:643-662 <16> AU - Szasz, TS AU - Hollender, MH TI - The myth of mental illness SO - American Psychologist. 1960;15:113-118 <37> AU - Taylor, P AU - Gunn, J TI - Homicides by people with mental illness: myth and reality SO - British Journal of Psychiatry. 1999;174(1):9-14 AB - BACKGROUND: Tragic and high profile killings by people with mental illness have been used to suggest that the community care model for mental health services has failed. AIMS: To consider whether such homicides have become more frequent as psychiatric services have changed. METHOD: Data were extracted from Home Office-generated criminal statistics for England and Wales between 1957 and 1995 and subjected to trends analysis. RESULTS: There was little fluctuation in numbers of people with a mental illness committing criminal homicide over the 38 years studied, and a 3% annual decline in their contribution to the official statistics. CONCLUSIONS: There are many reasons for improving the resources and quality of care for people with a mental disorder, but there is no evidence that it is anything but stigmatising to claim that their living in the community is a dangerous experiment that should be reversed. There appears to be some case for specially focused improvement of services for people with a personality disorder and/or substance misuse. <34> AU - Thornicroft, G AU - Sartorius, N IN - World Health Organization, Geneva, Switzerland. TI - The course and outcome of depression in different cultures: 10-year follow-up of the WHO Collaborative Study on the Assessment of Depressive Disorders SO - Psychological Medicine. 1993;23(4):1023-32 AB - The World Health Organization's study on depressive disorders in different cultures began in 1972. Cohorts of depressed patients were identified in Basle, Montreal, Nagasaki, Teheran and Tokyo. The patients were assessed using standardized measures of social and clinical functioning. Ten-year follow-up data on clinical course, service contact, suicidal acts and social function outcomes were available for 439 (79%) patients. Over one-third (36%) were re-admitted at least once in the follow-up period, half of whom (18%) had very poor clinical outcome. Twenty-four per cent suffered severe social impairment for over half the follow-up period, and over one-fifth (21%) showed no full remissions. The best clinical course (one or two reasonably short episodes of depression with complete remission between episodes) was experienced twice as frequently in patients with a diagnosis of endogenous (65%) as in those diagnosed as suffering from psychogenic depression (29%). Among all patients, a fifth (22%) had at least one episode lasting for more than 1 year, and 10% had an episode lasting over 2 years during follow-up. Death by suicide occurred in 11% of patients, with a further 14% making unsuccessful suicide attempts. <14> AU - Vaughn, C AU - Leff, J TI - The measurement of expressed emotion in the families of psychiatric patients SO - British Journal of Social and Clinical Psychology. 1976;15(2):157-65 AB - In a series of studies of the influence of family life on the course of an established schizophrenic illness, it has been shown that the level of emotion expressed by relatives shortly after a schizophrenic patient is admitted to hospital is strongly associated with symptomatic relapse during the nine months following discharge (Brown et al., 1962, 1972). This paper states the case for an abbreviated version of the primary research instrument used in these studies, the Camberwell Family Interview Schedule. In the 1972 study the single most important measure contributing to the overall expressed emotion index proved to be the number of critical remarks made about the patient by the relative when interviewed alone. An analysis of 15 tape-recorded interviews from this study showed that the majority of critical comments were produced within the first hour and there was virtually no relationship between total number of critical comments and length of interview (r = 0.08). This analysis supported the use of a shortened interview in which the areas most likely to produce any criticism were given priority in the sequence of questioning. This abbreviated version has been used successfully in a replication and extension of the 1972 study. A group of 37 schizophrenic patients is being compared with a group of 31 depressed neurotic patients. Patterns of emotional response of these patients' relatives are discussed. <21> AU - Yerkes, RM AU - Dodson, JD TI - The relation of strength of stimulus to rapidity of habit-formation SO - Journal of Comparative Neurology and Psychology. 1908;18:459-482 <46> AU - Young, RC AU - Biggs, JT AU - Ziegler, VE AU - Meyer, DA TI - A rating scale for mania: reliability, validity and sensitivity SO - British Journal of Psychiatry. 1978;133:429-35 AB - An eleven item clinician-administered Mania Rating Scale (MRS) is introduced, and its reliability, validity and sensitivity are examined. There was a high correlation between the scores of two independent clinicians on both the total score (0.93) and the individual item scores (0.66 to 0.92). The MRS score correlated highly with an independent global rating, and with scores of two other mania rating scales administered concurrently. The score also correlated with the number of days of subsequent stay in hospital. It was able to differentiate statistically patients before and after two weeks of treatment and to distinguish levels of severity based on the global rating.