Symptoms

Psychiatric symptoms were assessed with two tools, the Brief Psychiatric Rating Scale expanded version 4.0 (BPRS 4.0) [31] (Zanello et al., Adaptation française de la Brief Psychiatric Rating Scale version 4.0, unpublished) and the Symptom Checklist 90 - Revised (SCL-90-R) [32, 33]. The BPRS 4.0 is a semi-directive interview composed of 24 items rated from 1 (absent) to 7 (severe). In order to have a general representation of symptom severity, and because no calibration of the BPRS 4.0 to equivalent clinical judgments exists, we borrowed and modified the categories defined by Brenner’s group [34]. We considered at intake five categories of general distress defined as follows: no illness (all items scores <3), mild severity (at least one item =3, but no item ≥4), moderate (at least one item =4, but no item ≥5), severe (at least one item =5, but no item ≥6), and extremely severe (at least one item ≥6). This procedure was used because low BPRS 4.0 scores can be obtained even if only one item is rated extremely severe (score = 7) while the others are absent (score = 1). This variable was labeled BPRS-4.0 Categories (BPRS 4.0-C). Changes occurring after CIC intervention were examined comparing the BPRS 4.0 mean score of reality distortion, apathy, activity, mood disturbance, disorganization and somatization dimensions [35], obtained at intake and at discharge.

The SCL-90-R is a self-rating scale composed of 90 items rated from 0 (not at all) to 4 (extremely). At intake, we considered the Global Severity Index (GSI) and transformed it into T-scores (mean = 50, SD = 10) found in published norms [36]. Borrowing the guidelines for interpreting T scores [37], we considered five categories defined as follows: no distress (T ≤ 55), mild (56 ≤ T < 60), moderate (61 ≤ T < 65), severe (65 ≤ T < 70), and extremely severe (T ≥ 70). This variable was labelled SCL-90-R Categories (SCL-90-R-C). Possible changes due to crisis intervention were examined comparing the scores at intake and at discharge on the nine symptoms dimensions of SCL-90-R: Somatisation, Obsessive-compulsivity, Interpersonal sensitivity, Depression, Anxiety, Hostility, Phobic anxiety, Paranoid ideation and Psychoticism.