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Redlich Bossy M, Müller DR, Niedermoser DW, Burrer A, Spiller TR, Vetter S, Seifritz E, Egger ST. Impact of psychopathology on day-to-day living in patients with schizophrenia: A network analysis. Compr Psychiatry 2024; 133:152501. [PMID: 38820645 DOI: 10.1016/j.comppsych.2024.152501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/26/2024] [Accepted: 05/11/2024] [Indexed: 06/02/2024] Open
Abstract
Although the relationship between schizophrenia and disability is well established, the association between the symptoms of the disorder and functional domains remains unclear. The current study explored the nuances of the relationship between symptoms and domains of functioning in a sample of 1127 patients with schizophrenia. We assessed the symptoms of schizophrenia with the Positive and Negative Syndrome Scale (PANSS) and psychosocial functioning with the mini-ICF-APP (mini-International Classification of Functioning Rating for Limitations of Activities and Participation in Psychological Disorders). The mean PANSS score was 94.28 (27.20), and the mean mini-ICF-APP score was 25.25 (8.96), both of which are indicative of severe symptom load and impairment. We were able to show a strong relationship and overlap between symptoms and disability in patients with schizophrenia. We identified several symptoms related to functional impairment. Deficits in judgment and abstract thinking contribute to impairment through poor adherence (to routines and compliance with rules) and difficulties in planning and organizing. We believe that in schizophrenia, symptoms and their interactions constitute a disorder beyond any single manifestation. Furthermore, we suggest that cognitive testing and cognitive treatment should become part of the standard of care for patients with schizophrenia.
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Affiliation(s)
- Mona Redlich Bossy
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Psychology, Faculty of Humanities, University of Fribourg, Fribourg, Switzerland
| | - Daniel R Müller
- Department of Psychology, Faculty of Humanities, University of Fribourg, Fribourg, Switzerland; Department of Psychiatry and Psychotherapy, University Hospital of Psychiatry and Psychotherapy, Faculty of Medice, University of Bern, Bern, Switzerland
| | | | - Achim Burrer
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Tobias R Spiller
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Stephan T Egger
- Department of Adult Psychiatry and Psychotherapy, University Psychiatric Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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Richardson CG. The Underutilization of Mental Health Care Services in the Lives of People with Blindness or Visual Impairment: A Literature Review on Rehabilitation Factors Toward Provision. Clin Ophthalmol 2024; 18:953-980. [PMID: 38566829 PMCID: PMC10986414 DOI: 10.2147/opth.s442430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Roughly 3 million adult Americans have a visual impairment or blindness, and over 4 million adults aged 40 and older. Despite data demonstrating an elevated prevalence of mental health symptoms in people with BVI, this population remains largely untreated. Given that people with BVI often interface with multiple systems of rehabilitative care that are designed to improve quality of life, the relatively low rates of initiation of mental health care services are particularly alarming. In this review, the systematic processes of mental health care services across pertinent rehabilitation groups are identified and critically examined. Patients and Methods A comprehensive literature review was conducted. The literature review utilized a critical systems typology, whereby relevant literature was selected, reviewed, and analyzed intra and extra organizationally. In addition, a thorough discussion of disability-related factors was provided, lending a socio-political lens to the problem. Results Considerable data indicates that short-term mental health care services for people with BVI are ineffective treatment methods, albeit primarily employed in health-rehabilitative processes. Multiple studies offered data indicating the presence of diverse and entangled mental health issues relative to vocational rehabilitation services, mobility tool utility, and emotional reactions to vision loss. Many studies suggested that disability identity work be integrated into health-rehabilitative processes for people with BVI. Conclusion To improve the utility of mental health care services for people with BVI, a reenergization of the mental health care needs of this population must occur. A critical podcast or forum focused on educating listeners about the health-rehabilitation factors that influence the provision of mental health care services can aid to improve future mental health policy and practice for people with BVI. Disability scholars need to advance research on integrating critical theories in work with people with BVI and accelerate qualitative, community-based methods to enhance understanding of this population and their unique mental health needs.
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Muschalla B, Jöbges M. [Patienten mit komorbiden somatischen und psychischen Erkrankungen haben ähnliche Fähigkeitsbeeinträchtigen wie Patienten mit psychischen Erkrankungen]. DIE REHABILITATION 2022; 62:86-93. [PMID: 35772729 PMCID: PMC10089765 DOI: 10.1055/a-1839-5048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES In patients with somatic illness and additional mental disorder, not only motor or sensory functions may be impaired, but also psychological capacities. These become more and more important for work ability in our modern working world. There are presently no data about the type and distribution of psychological capacity impairments in patients with comorbid somatic and mental disorders. These data are however important for estimation of diagnostic and therapy requirements. METHODS 402 orthopedic, cardiological, and neurological patients with additional mental disorders were investigated with a structured clinical assessment for mental disorders (MINI) and psychological capacity impairments (Mini-ICF-APP). RESULTS In all three somatic indications at least half of the comorbid patients had any clinically relevant psychological capacity impairment. Neurological patients (67%) and orthopedic patients (72%) were more often affected than cardiological patients (50.5%). Orthopedic patients are slightly more impaired in self-care; neurological and orthopedic patients are more impaired in mobility; and cardiological patients are less impaired in assertiveness. CONCLUSION In comparison of all three somatic patient groups with mental disorders the number of psychological capacity impairments is similar. In contrast to patients with mental disorders only (i. e. those without somatic comorbidity), the psychological impairment quality in comorbid patients may be influenced by the somatic illness. The data from this study are important in order to estimate diagnostic and therapeutic needs, such as capacity training or compensation of psychological capacity impairments.
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Affiliation(s)
- Beate Muschalla
- Psychotherapy and Diagnostics, Technische Universität Braunschweig, Humboldtstraße Braunschweig Germany
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One-year follow-up of functional impairment in inpatients with mood and anxiety disorders - Potentials of the Mini-ICF-APP. BMC Psychiatry 2022; 22:334. [PMID: 35570275 PMCID: PMC9107757 DOI: 10.1186/s12888-022-03977-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 05/05/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The aim of the study was to investigate functional impairment and its relationship to illness severity in a sample of patients with a diagnosis of mood or anxiety disorder during inpatient treatment and 1 year after discharge. METHODS Two hundred thirty-nine inpatients with primary diagnoses of mood or anxiety disorders were assessed at baseline and at follow-up by a range of validated instruments. Mini-ICF-APP was used for the assessment of functional impairment, BDI-II for the assessment of clinical symptoms and remission. Sample characteristics and measures of impairment at baseline and at follow-up were analysed descriptively. Symptomatically remitted and non-remitted patients were compared with regard to capacity limitations. RESULTS Initially, the sample showed considerable impairment in many capacities, particularly endurance, spontaneous activities, structuring of tasks, competency and flexibility. After 1 year, all capacities significantly improved. The level of impairment was correlated with employment status and severity of clinical symptoms. About 50% of the patients remitted in clinical symptomatology. Retrospectively, the remitted and the unremitted did not differ in functional impairment at baseline but there were considerable differences at follow-up. CONCLUSIONS Mini-ICF-APP is a useful instrument to monitor functional status and change in psychiatric samples, complementing the usual focus on symptom reduction.
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Students or medical professionals: whose knowledge improved after social-medicine training? Results from a quasi-experimental evaluation study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1505-1514. [PMID: 34988614 PMCID: PMC9246797 DOI: 10.1007/s00127-021-02197-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 10/31/2021] [Indexed: 11/23/2022]
Abstract
Purpose Rehabilitation professionals are faced with judging and describing the social-medicine status of their patients. Rehabilitation professionals must know the core concepts of acute unfitness for work, psychological capacities, and long-term work capacity. Acquiring and applying this knowledge, requires training. The research question is if and to what extent medical professionals and students’ knowledge changes after social medicine training. Methods This quasi-experimental study was carried out in the real-life context of social medicine training. Psychology students (n = 42), physicians/psychotherapists (i.e. state-licensed health professionals) (n = 44) and medical assistant professionals (n = 29) were trained. Their social medicine knowledge was measured before and after training by a 10-min expert-approved and content valid knowledge questionnaire. Three free-text questions had to be answered on the essential aspects of present and prognostic work ability and psychological capacities. Answers were rated for correctness by two experts. Paired t tests and variance analysis have been calculated for group comparisons. Results All groups improved their social medicine knowledge from the pre- to the post-test. The students started with the lowest level of knowledge in the pre-test. After training, 69% of the physicians/psychotherapists and 56.8% of the medical assistant professionals, but only 7% of the students, obtained maximum scores for naming psychological capacities. Conclusions Social medicine knowledge increased after a training course consisting of eight lessons. The increase was greater for medical assistant professionals and physicians/psychotherapists than for students. Social medicine training must be adjusted to the trainee groups’ knowledge levels.
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Muschalla B. Prevalence and Correlates of Work-Phobic Anxiety in a National Representative Sample. ZEITSCHRIFT FUR ARBEITS-UND ORGANISATIONSPSYCHOLOGIE 2022. [DOI: 10.1026/0932-4089/a000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Abstract. Work anxiety is a common mental health problem that is often overlooked and often causes long periods of sick leave. This is the first representative survey on the distribution of work-phobic anxiety in Germany. Of the 2,030 working-age participants (18 – 67 years), 7 % had increased work-phobic anxiety of a moderate (5 % with scores >1.5 – 2.5 on a scale from 0 – 4) or high (2 % with scores >2.5 – 4) degree. People with high levels of work-phobic anxiety reported the longest sick leave durations during the past 12 months (8 weeks) and the most periods of unemployment in their professional lives. The three groups were similar in age, sex, and partnership status. People with high work-phobic anxiety perceived themselves least competent in almost all dimensions of psychological capacity. Occupational health must consider work-phobic anxiety as a specific mental health problem closely linked to work-ability problems.
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Exploring the factor structure of the mini-ICF-APP in an inpatient clinical sample, according to the psychiatric diagnosis. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2021; 14:186-195. [PMID: 34861928 DOI: 10.1016/j.rpsmen.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/16/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Psychosocial functioning is a key factor determining prognosis, severity, impairment and quality of life in people who have a mental disorder. The mini-ICF-APP was developed to provide a standardised classification of functioning and disability. However, despite its gaining popularity little is known about its structure and performance. This paper examines the structure of the mini-ICF-APP using factor analysis techniques. MATERIALS AND METHODS In a clinical sample of 3178 patients, with psychiatric diagnoses from several ICD-10 categories, we analysed internal consistency, item inter-correlations and the factorial structure of the data, with reference to ICD-10 diagnostic categories; Neurocognitive Disorders; Alcohol Use Disorders; Substance Use Disorders; Schizophrenia and Psychotic Disorders; Bipolar Disorder; Major Depressive Disorder; Anxiety Disorders; Personality Disorders; and Neurodevelopmental Disorders. RESULTS We found good internal consistency and item inter-correlations (Cronbach alpha=0.92) for the mini-ICF-APP. We were able to identify pivotal domains (flexibility, assertiveness and intimate relationships), which demonstrate sub-threshold influences on other domains. The factor analysis yielded a one-factor model as ideal for the whole sample and for all diagnostic categories. For some diagnostic categories the data suggested a two or three-factor model, however, with poorer fit indices. CONCLUSIONS The factor structure of the mini-ICF-APP appears to modify according to the main diagnosis. However, a one-factor model demonstrates better fit regardless of diagnostic category. Consequently, we consider the mini-ICF-APP to be a trans-diagnostic measurement instrument for the assessment and grading of psychosocial functioning. The use of the mini-ICF-APP sum score seems to best reflect the degree of impairment in an individual, even taking into account that affected domains may lead to sub-threshold effects on other domains.
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Capacity Limitations and Workplace Problems in Patients With Mental Disorders. J Occup Environ Med 2021; 63:609-613. [PMID: 34184654 DOI: 10.1097/jom.0000000000002194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES According to the bio-psycho-social health model of the WHO, chronic illness should not only be described at the level of symptoms, but in respect to capacity limitations. METHODS Patients with common mental disorders (N = 1143, n = 808 employed, n = 581 workplace problems) were investigated concerning their self-rated capacities (Mini-ICF-APP-S). RESULTS Employed patients reported better capacities than unemployed patients. Among the employed patients, those without workplace problems reported better capacities than those with workplace-problems. Different types of workplace-problems were related with specific capacity levels, for example, problems with bullying or conflicts were associated with lower interactional capacities (assertiveness, group integration, dyadic relations), whereas patients with over-taxation problems perceived lower levels of flexibility, competency, structuring of tasks, proactivity and endurance. CONCLUSIONS The capacity self-rating Mini-ICF-APP-S can depict differentiated capacity profiles that may be indicative for specific types of workplace problems.
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Abstract
BACKGROUND This study addresses the question of whether psychosocial functioning measured by the Personal and Social Performance (PSP) Scale is related to various psychopathological measures in a cohort of patients with schizophrenia. METHODS The 'Neuroleptic Strategy Study' (NeSSy) performed at 14 German hospitals between 2010 and 2013 compared two treatment strategies instead of individual drugs. Secondary end-points were the two PSP scales as well as measures of quality of life (SF-36) and the Positive and Negative Syndrome Scale (PANSS). RESULTS 149 patients were randomised. There was no difference between the two treatment strategies (first-generation versus second-generation antipsychotics) with regard to the PSP. There were differences in doctors' assessments regarding psychosocial functioning compared with patients' own assessments. Furthermore, there were relationships between the PSP and quality of life, level of skills (ICF), and severity of disease (PANSS), level of sexual activities and poor well-being under antipsychotic medication but not with cognitive changes. CONCLUSIONS The findings on psychosocial functioning of patients with schizophrenia related to severity and skill level could be confirmed. Further findings were the correlation between psychosocial functioning and quality of life, well-being under treatment, and sexuality what emphasizes the substantial importance of a reduced psychosocial functioning.
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Redlich Bossy M, Mueller D, Seifritz E, Vetter S, Egger ST. Feasibility and Efficacy of a Psychological Therapy for Patients With a Schizophrenic Psychosis in an Inpatient Setting: Study Protocol of a Randomized Switch Controlled Trial. Front Public Health 2020; 8:391. [PMID: 32903368 PMCID: PMC7434967 DOI: 10.3389/fpubh.2020.00391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 07/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Schizophrenic psychoses are severe mental disorders. Despite advances in treatment, outcomes are still unsatisfactory. Pharmacological treatments are still limited, in particular regarding improvements in psychosocial functioning and neuro-cognitive impairment. In recent years new psychological therapies have been developed, demonstrating promising results. However, most of these interventions have been designed for and studied in outpatients; their efficacy and feasibility for patients requiring hospitalization is still unknown. Therefore, we have designed a clinical trial to compare a neuro-cognitive (Integrated Neuro-cognitive Treatment INT); a cognitive-behavioral (Integrated Psychological Therapy IPT); and a control (Cogpack CGP) intervention for patients with a schizophrenic psychosis hospitalized for treatment. Methods: In a three-parallel-arm, single-blind, randomized, controlled study, we compare INT, IPT, and CGP. Participants will take part in two weekly sessions of one intervention for at least 16 sessions. If due to randomization, participants are allocated to a treatment arm not suitable for them, they are allowed to switch intervention after four sessions. Based on a sample size calculation, recruitment will continue until 30 participants have completed the intervention for each treatment arm. Outcome Measurement: Primary outcomes are: change in symptom as measured by the Positive and Negative Syndrome Scale (PANSS), change in psychosocial functioning as assessed by the mini ICF-APP and neuro-cognitive performance, assessed by the Matrics Cognitive Consensus Battery (MCCB). Other outcomes of interest are the Brief Symptom Inventory (BSI) and the Health of the Nation Outcome Scales (HoNOS); together with prescribed medication, treatment retention and completion rates. Outcomes will be measured at baseline, 2 weeks into treatment (prior to a potential switch of intervention arm), post-treatment and at 6 and 12-month post-treatment follow-ups. Expected Outcomes: We expect an overall improvement; however, with differences in specific domains for each treatment arm, with those completing INT showing better outcomes than IPT and CGP, respectively. We anticipate that lower functioning participants will drift to CGP and higher functioning participants to INT. Conclusion: Due to the complexity of treatment for patients with a schizophrenic psychosis, we consider it crucial to compare different treatment options for those more severely affected, therefore, requiring inpatient treatment. Trial registration:www.clinicaltrials.gov (ID: NCT03316664; 17.10.2017).
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Affiliation(s)
- Mona Redlich Bossy
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Mueller
- Department of Psychiatry, Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stephan T Egger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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Egger ST, Weniger G, Bobes J, Seifritz E, Vetter S. Exploring the factor structure of the mini-ICF-APP in an inpatient clinical sample, according to the psychiatric diagnosis. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 14:S1888-9891(20)30066-5. [PMID: 32712046 DOI: 10.1016/j.rpsm.2020.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/14/2020] [Accepted: 05/16/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Psychosocial functioning is a key factor determining prognosis, severity, impairment and quality of life in people who have a mental disorder. The mini-ICF-APP was developed to provide a standardised classification of functioning and disability. However, despite its gaining popularity little is known about its structure and performance. This paper examines the structure of the mini-ICF-APP using factor analysis techniques. MATERIALS AND METHODS In a clinical sample of 3178 patients, with psychiatric diagnoses from several ICD-10 categories, we analysed internal consistency, item inter-correlations and the factorial structure of the data, with reference to ICD-10 diagnostic categories; Neurocognitive Disorders; Alcohol Use Disorders; Substance Use Disorders; Schizophrenia and Psychotic Disorders; Bipolar Disorder; Major Depressive Disorder; Anxiety Disorders; Personality Disorders; and Neurodevelopmental Disorders. RESULTS We found good internal consistency and item inter-correlations (Cronbach alpha=0.92) for the mini-ICF-APP. We were able to identify pivotal domains (flexibility, assertiveness and intimate relationships), which demonstrate sub-threshold influences on other domains. The factor analysis yielded a one-factor model as ideal for the whole sample and for all diagnostic categories. For some diagnostic categories the data suggested a two or three-factor model, however, with poorer fit indices. CONCLUSIONS The factor structure of the mini-ICF-APP appears to modify according to the main diagnosis. However, a one-factor model demonstrates better fit regardless of diagnostic category. Consequently, we consider the mini-ICF-APP to be a trans-diagnostic measurement instrument for the assessment and grading of psychosocial functioning. The use of the mini-ICF-APP sum score seems to best reflect the degree of impairment in an individual, even taking into account that affected domains may lead to sub-threshold effects on other domains.
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Affiliation(s)
- Stephan T Egger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland; Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo. Spain.
| | - Godehard Weniger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Julio Bobes
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo. Spain
| | - Erich Seifritz
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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Zhang M, Yu J, Shen W, Zhang Y, Xiang Y, Zhang X, Lin Z, Yan T. A mobile app implementing the international classification of functioning, disability and health rehabilitation set. BMC Med Inform Decis Mak 2020; 20:12. [PMID: 31992289 PMCID: PMC6988202 DOI: 10.1186/s12911-020-1019-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/03/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Chinese assessment standards of the International Classification of Functioning, Disability and Health Rehabilitation Set is available now. It is coming to be used as a basic functional evaluation tool in China. With data accumulating, a mobile application is needed to eliminate the extra cost of data entry, storage, and graphical presentation of trends. This study aimed to design, develop and test a mobile app based on the International Classification of Functioning, Disability and Health Rehabilitation Set Rehabilitation Set. METHODS The study had three phases. The first involved specifying the functional requirements of the app. Then an app was designed and refined to meet those requirements. In a pilot test, the app was used by rehabilitation professionals in clinical practice and their comments were collected for its further modification in one-on-one interviews. RESULTS The app met the initial requirements, and the pilot study showed it worked as designed. The pilot study also showed that the app is user-friendly and convenient to use in rehabilitation practice. Some feedback was given to improve the app. CONCLUSION An Android mobile app implementing the International Classification of Functioning, Disability and Health Rehabilitation Set was successfully developed.
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Affiliation(s)
- Malan Zhang
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
- Hexian Memorial Affiliated Hospital of Southern Medical University, Guangzhou, 511400, China
| | - Jiani Yu
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Wei Shen
- GuangDong 999Brain Hospital, Guangzhou, China
| | - Yun Zhang
- The Fifth Hospital of Xiamen, Xiamen, China
| | - Yun Xiang
- Shenzhen Nanshan People's Hospital, Shenzhen, China
| | | | - Ziling Lin
- The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Tiebin Yan
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China.
- Engineering Technology Research Center for Rehabilitation and Elderly Care, Sun Yat-sen University, Guangzhou, China.
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Egger ST, Weniger G, Müller M, Bobes J, Seifritz E, Vetter S. Assessing the severity of functional impairment of psychiatric disorders: equipercentile linking the mini-ICF-APP and CGI. Health Qual Life Outcomes 2019; 17:174. [PMID: 31744498 PMCID: PMC6862821 DOI: 10.1186/s12955-019-1235-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background The assessment of functioning and impairment due to psychiatric illness has been acknowledged to be crucial for research and practice. This led to the development of the mini-ICF-APP, which provides a reliable and time-efficient measure of functioning and impairment. Although its use is increasing, it remains unclear how it reflects severity and how change might be interpreted from a clinical perspective. Methods In a clinical sample of 3067 individuals hospitalized for mental health treatment, we used an equipercentile approach to link the mini-ICF-APP with the Clinical Global Impression scale (CGI) at admission and discharge. We linked the mini-ICF-APP sum score to the CGI-S scale and the mini-ICF-APP proportional change between admission and discharge to the CGI-I scale. Results The mini-ICF-APP and CGI scales showed a Spearman correlation of 0.50 (p < .000). CGI-S: “borderline-ill” corresponded to a mini-ICF-APP score 1–2; “mildly-ill” to 3–7; “moderately-ill” to 8–15; “markedly-ill” to 16–24; “severely-ill” to 25–37; and “extremely-ill” to a score ≥ 38. The Spearman correlation between the percentage change of mini-ICF-APP sum score and the CGI-I was 0.32 (p > .000); “no-change” in the CGI-I corresponded to an increase or decrease of 2%; “minimally-improved” to a mini-ICF-APP reduction of 3–30%; “much-improved” to a reduction of 31–63%; “very-much-improved” to a reduction of ≥64% “minimally-worse” to an increase of 3–34% “much-worse” to an increase of 35–67%; and finally “very-much-worse” with an increase of ≥68%. Conclusions Our findings improve understanding of the clinical meaning of the mini-ICF-APP sum score and percentage change in patients hospitalized for treatment.
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Affiliation(s)
- Stephan T Egger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland. .,Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain.
| | - Godehard Weniger
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Mario Müller
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Julio Bobes
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, CIBERSAM, Oviedo, Spain
| | - Erich Seifritz
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
| | - Stefan Vetter
- Centre for Integrative Psychiatry, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital of Zurich, University of Zurich, Lenggstrasse 31, 8032, Zurich, Switzerland
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Psychological capacity limitations according to Mini-ICF-APP are differently related with sick leave in patients from different professional fields. J Psychosom Res 2019; 124:109741. [PMID: 31443813 DOI: 10.1016/j.jpsychores.2019.109741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/12/2019] [Accepted: 06/12/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Up to 29% of the working population suffer from (chronic) mental disorders and work disability. As different professions pose different psychological capacity demands, one core aspect for describing work disability is psychological capacity limitations. The distribution of capacity limitations in patients with chronic mental disorders (CMD) from different professional fields is unknown, as well as their relation with sick leave. OBJECTIVE Are there different work ability limitations in CMD patients working in different professions? METHODS 263 CMD patients from different professions were investigated cross-sectionally in a thorough medical and psychological assessment by a trained psychosomatic study physician. Besides CMD diagnostic (MINI) and subjective work ability limitations (IMET), an observer rating on capacity limitations was conducted with Mini-ICF-APP. RESULTS No relevant differences in perceived work ability limitations were found between the professions. Differences of capacity limitations were better explained by psychopathology than by profession. But capacity limitations were differently related with sick leave in different professions and there are differences in sick leave duration. CONCLUSIONS The variance of capacity limitations was explained by psychopathology. The variance of sick leave duration was explained by profession. Similar capacity limitations are associated differently with sick leave in different professions. Different professional fields may have different tolerances towards the same capacity limitations. Therefore, similar capacity limitations are more or less strongly associated with sick leave in different professions.
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Muschalla B, Poguntke KJ, Linden M. Assessment of Capacity Impairment in Patients with Mental Disorders by Routine Clinical Assessment and by Structured Assessment with the Mini-ICF-APP. Psychopathology 2019; 52:248-255. [PMID: 31578018 DOI: 10.1159/000502123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/10/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Physicians and therapists are also consulted to give judgments on working ability. Ability to work cannot simply be derived from the patient's symptom status but from the illness-related capacity impairments in relation to the work demands. A structured assessment of capacity impairments has been evaluated and applied internationally: the Mini-ICF-APP Social Functioning Scale. It is currently unclear whether a free-text clinical report (i.e., usual clinical practice: clinical exploration according to clinical standards, but without a standardized documentation form, instead a text is written) and a structured capacity assessment correspond to the overall work ability judgment, i.e., the decision whether a patient is "fit for work" or "unfit for work." OBJECTIVES This investigation assessed, for the first time, whether usual clinical judgment and the additional structured capacity rating support the work ability decision. METHODS A total of 100 medical reports from patients in a psychotherapy hospital were excerpted for psychopathological symptoms and capacity disorders using a checklist. Additionally, a structured assessment of capacity disorders was documented on the Mini-ICF-APP rating for all patients. RESULTS In the free-text clinical medical report, endurance, flexibility, and contacts to others were the things mainly reported as impaired. This was similar to the structured Mini-ICF-APP rating. However, other capacity impairments were also reported in the Mini-ICF-APP, i.e., adherence to rules and regulations, planning and structuring, assertiveness, and group integration. When the free-text clinical report and the structured Mini-ICF-APP rating were compared, there was a higher rate of stated impairments covering all capacity dimensions in the Mini-ICF-APP rating. CONCLUSIONS The free-text report in the medical report shows the differences between patients who are fit for work and those who are not, and thus speak for the validity of work ability decisions. However, optimization is possible in terms of depth and differentiation of capacity impairment description by adhering to the standard set by the Mini-ICF-APP.
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Affiliation(s)
- Beate Muschalla
- Psychotherapy and Diagnostics, Technische Universität Braunschweig, Braunschweig, Germany,
| | | | - Michael Linden
- Research Group Psychosomatic Rehabilitation at the Charité University Medicine Berlin, Berlin, Germany
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