1
|
Marconi E, Monti L, Fredda G, Kotzalidis GD, Janiri D, Zani V, Vitaletti D, Simone MV, Piciollo S, Moriconi F, Di Pietro E, Popolo R, Dimaggio G, Veredice C, Sani G, Chieffo DPR. Outpatient care for adolescents' and young adults' mental health: promoting self- and others' understanding through a metacognitive interpersonal therapy-informed psychological intervention. Front Psychiatry 2023; 14:1221158. [PMID: 38025443 PMCID: PMC10651761 DOI: 10.3389/fpsyt.2023.1221158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Psychological distress may result in impairment and difficulty understanding oneself and others. Thus, addressing metacognitive issues in psychotherapy may improve psychopathology in adolescents and young adults (AYAs). We aimed to compare metacognitive interpersonal therapy (MIT)-informed psychotherapy with other treatment-as-usual (TAU) therapies. Methods We administered the Global Assessment of Functioning (GAF) scale, the Clinical Global Impressions-Severity (CGI-S) scale, and the Brief Psychiatric Rating Scale (BPRS) at baseline (BL) and at treatment termination (the endpoint was at 6 months and any last results obtained before that term were carried forward in analyzes). Patients received concomitant psychiatric and psychological treatment. Results Sixty AYAs were involved in the study. There was a significant reduction in symptomatology after the intervention. Twelve patients (17%) dropped out; treatment adherence was 83%. In the MIT group, 2 patients dropped out (11%), and in the TAU group, 9 patients dropped out (19%). All scales showed a significant reduction in symptoms between baseline (BL) and the 6-month endpoint: GAF (χ2 = 6.61, p < 0.001), BPRS (χ2 = 6.77, p < 0.001), and CGI (χ2 = 7.20, p < 0.001). There was a greater efficacy for the MIT group in terms of symptom reduction on the BPRS (t = 2.31; p < 0.05). Conclusion The study confirmed the efficacy of early and integrated care in adolescence and suggested greater symptom reduction for a psychotherapeutic intervention focused on stimulating mentalization skills. The study indicates the usefulness of this type of approach in the treatment of adolescent psychopathology. Due to the small sample size, the results need replication.
Collapse
Affiliation(s)
- Elisa Marconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Laura Monti
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Fredda
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Georgios D. Kotzalidis
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), University of Rome “La Sapienza”, Rome, Italy
| | - Delfina Janiri
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valentina Zani
- Catholic University of the Sacred Heart–Rome, Rome, Italy
| | | | | | | | - Federica Moriconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, Rome, Italy
- Department of Mental Health, Rome, Italy
| | | | - Chiara Veredice
- Pediatric Neuropsychiatry Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart–Rome, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Life Sciences and Public Health Department, Catholic University of Sacred Heart, Rome, Italy
| |
Collapse
|
2
|
Damiani S, Zarbo C, Stolarski M, Zamparini M, Casiraghi L, Rocchetti M, Starace F, Fusar-Poli P, de Girolamo G. Time will tell: Associations between unbalanced time perspectives and symptom severity in individuals with schizophrenia spectrum disorders. Schizophr Res 2023; 261:116-124. [PMID: 37717509 DOI: 10.1016/j.schres.2023.09.016] [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: 10/24/2022] [Revised: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Abstract
Patients with schizophrenia spectrum disorder (SSD) experience disrupted temporality on the immediate timescale. However, insufficient information is available for longer time frames, and the interaction of temporal perspectives with the clinical manifestations of SSD is unknown. We explored the association between unbalanced time perspectives and symptom severity. Thirty-seven Italian mental health services participating in the DiAPAson project recruited 620 patients with DSM-5 SSD (68 % males, mean age = 41.3 ± 9.5 years). Time perspective biases were measured using the Deviation from the Balanced Time Perspective-revisited (DBTP-r) indicator, based on Zimbardo Time Perspective Inventory (ZTPI) scores. Psychiatric symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS) and Brief Negative Symptoms Scale (BNSS). Preliminary analyses examined the associations between ZTPI/DBTP-r and BPRS/BNSS total scores. In secondary analyses, we first tested the associations between the ZTPI/DBTP-r and BPRS/BNSS subscales and then compared ZTPI differences between patients with and without hallucinations, delusions, and conceptual disorganisation. Statistical significance was set at Holm-Bonferroni corrected p < 0.05. Low-to-moderate positive correlations were found between the DBTP-r and BPRS/BNSS total scores (r = 0.29/0.22). The strongest associations were between DBTP-r/ZTPI_Past-Negative and anxiety/depression (r = 0.34/0.36), followed by DBTP-r/ZTPI_Present-Fatalistic with thought disturbances (r = 0.22/0.20). DBTP-r was associated with BNSS anhedonia and avolition (r = 0.21/0.24). DBTP-r was higher in patients with hallucinations (ES = 0.391) and conceptual disorganisation (ES = 0.397) than in those without these symptoms. Unbalanced time perspective was positively associated with the severity of primary and secondary SSD features. These findings provide a rationale for empirical tests focused on balancing time perspectives in patients with SSD.
Collapse
Affiliation(s)
- Stefano Damiani
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
| | - Cristina Zarbo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Manuel Zamparini
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Letizia Casiraghi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Matteo Rocchetti
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Fabrizio Starace
- Department of Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; OASIS service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| |
Collapse
|
3
|
Kim SR, Kim JY, Kim HY, Nho JH, Kim YH, Min SY. Factors related to malnutrition in community-dwelling patients with schizophrenia. Perspect Psychiatr Care 2019; 55:415-423. [PMID: 30430589 DOI: 10.1111/ppc.12327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022] Open
Abstract
PURPOSE This study aims to identify demographic, clinical, and nutritional factors related to malnutrition in community-dwelling patients with schizophrenia. DESIGN AND METHODS We used a descriptive cross-sectional design. Between June and July 2016, 188 community-dwelling patients with schizophrenia were included in this study. FINDINGS Of the 188 participants, 4.3% were classified as malnourished, and 40.4% were at risk of malnutrition. Living status, body weight, and appetite were significant factors related to malnutrition in community-dwelling patients with schizophrenia. PRACTICE IMPLICATION Assessment of nutritional status should be considered along with demographic and nutritional factors in community-dwelling patients with schizophrenia.
Collapse
Affiliation(s)
- Sung Reul Kim
- Department of Nursing, Korea University, Seoul, South Korea
| | - Ji Young Kim
- Department of Nursing, Chonbuk National University, Jeonju, South Korea
| | - Hye Young Kim
- Department of Nursing, Chonbuk National University, Jeonju, South Korea
| | - Ju-Hee Nho
- Department of Nursing, Chonbuk National University, Jeonju, South Korea
| | - Young Hwa Kim
- Department of Nursing, Chonbuk National University, Jeonju, South Korea
| | - So-Young Min
- Department of Nursing, Semyung University, Jecheon, South Korea
| |
Collapse
|
4
|
Remberk B, Bażyńska AK, Brągoszewska J, Niwiński P, Piróg-Balcerzak A, Popek L, Rybakowski F. Inpatient psychiatric treatment is not always effective in adolescent sample. Int J Psychiatry Clin Pract 2018; 22:70-76. [PMID: 28826267 DOI: 10.1080/13651501.2017.1364771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Numerous studies confirm efficacy of psychiatric treatment as well as psychiatric placebo. The aim of the current study was the assessment of improvement rate and factors associated with treatment response in naturalistic group of adolescent inpatients. METHODS Eighty two consecutive adolescent inpatients were recruited. Each patient at the admission and discharge was assessed with brief psychiatric rating scale (BPRS), eating attitude test (EAT-26), clinical global impression scale (CGI-S) and children global assessment scale (CGAS). Individual and family history was assessed by semi-structured interview. Patients, who improved in at least two interviewer-based scales (IMP, n = 67) were compared to the rest (N-IMP, n = 15). For statistical analysis STATISTICA package was used. RESULTS The main difference between groups was ICD-10 diagnosis distribution: in the IMP group more anxiety-related disorders (F4), in the N-IMP group more personality disorders (F6). Other differences include history of paediatric hospitalisations and surgery (more in the N-IMP group). Most of the analysed factors did not differ between groups. CONCLUSIONS The inpatient treatment seems to be most effective in severe mental states and in anxiety-related disorders and least effective in personality disorders. Due to limited inpatient treatment efficacy we believe outpatients services are crucial in adolescent psychiatry.
Collapse
Affiliation(s)
- Barbara Remberk
- a Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology , Warsaw , Poland.,b Child Psychiatry Department , Warsaw Medical University , Warsaw , Poland
| | - Anna Katarzyna Bażyńska
- a Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology , Warsaw , Poland
| | - Joanna Brągoszewska
- a Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology , Warsaw , Poland
| | - Piotr Niwiński
- a Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology , Warsaw , Poland
| | - Agnieszka Piróg-Balcerzak
- a Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology , Warsaw , Poland
| | - Lidia Popek
- a Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology , Warsaw , Poland
| | - Filip Rybakowski
- c Insitute of Psychology , University of Social Sciences and Humanities , Poznan , Poland.,d Adult Psychiatry Department , Poznan University of Medical Sciences , Poznan , Poland
| |
Collapse
|
5
|
Thomas A, Donnell AJ, Young TR. Factor Structure and Differential Validity of the Expanded Brief Psychiatric Rating Scale. Assessment 2016; 11:177-87. [PMID: 15171466 DOI: 10.1177/1073191103262893] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Brief Psychiatric Rating Scale (BPRS) is one of the most widely used measures in psychiatric outcome and clinical psychopharmacology research. To date, however, research on the psychometric properties of the expanded version of the BPRS (BPRS-E) has been limited. An exploratory factor analysis (n = 360) using maximum likelihood extraction with oblimin rotation found a four-factor solution (Thought Disturbance, Animation, Mood Disturbance, Apathy) to underlie the BPRS-E. Furthermore, these factors were logical in nature and estimates of internal consistency were acceptable. A confirmatory factor analysis conducted on a second, independent sample (n = 280) found that for the five models currently available in the literature, the model developed herein provided the best fit to the data. Again, estimates of internal consistency were found acceptable. Finally, the four factors demonstrated appropriate differential validity with regards to both demographic variables and various psychiatric diagnoses.
Collapse
Affiliation(s)
- Adrian Thomas
- Department of Psychology, Auburn University, AL 36849, USA.
| | | | | |
Collapse
|
6
|
Park SC, Jang EY, Kim D, Jun TY, Lee MS, Kim JM, Kim JB, Jo SJ, Park YC. Dimensional approach to symptom factors of major depressive disorder in Koreans, using the Brief Psychiatric Rating Scale: The Clinical Research Center for Depression of South Korea Study. Kaohsiung J Med Sci 2015; 31:47-54. [DOI: 10.1016/j.kjms.2014.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/02/2014] [Accepted: 09/15/2014] [Indexed: 01/25/2023] Open
|
7
|
Clinical outcome and length of stay in an Italian Psychiatric Emergency Service. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1013-20. [PMID: 23689863 DOI: 10.1007/s00127-012-0607-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 10/08/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The aims of the present study were to analyze outcome and to evaluate diagnosis-specific pattern of improvement during a brief hospitalization in a Psychiatric Emergency Service (PES) in a catchment area in Turin, Italy. METHODS A sample of 848 acute patients, consecutively hospitalized between January 2007 and December 2008 in the PES of the San Giovanni Battista Hospital, with diagnoses of non-affective psychosis-affective psychosis, depressive disorder and mania-and personality disorder (DSM-IV-TR) was recruited. All patients were assessed with the Brief Psychiatric Rating Scale (BPRS). One-way analysis of variance was used to measure patients' individual reliable and clinically significant change speed between BPRS assessments, in which change speed was referred to the division of the gap between admission and discharge scores over the number of days of length of stay (LOS). RESULTS The overall sample showed a significant improvement of BPRS total score and each domain during a brief hospitalization (mean LOS 10.5 days), with a different pattern between the diagnostic groups. A significant difference in change speed of BPRS resulted in the whole sample and in each diagnostic groups; patients with mania showed a significantly faster improvement. CONCLUSIONS A brief hospitalization in our service was shown to be highly effective. A different and diagnosis-specific patients' individual reliable and clinically significant change speed was observed, with a significantly faster improvement in patients with mania.
Collapse
|
8
|
Barbato A, Parabiaghi A, Panicali F, Battino N, D'Avanzo B, de Girolamo G, Rucci P, Santone G. Do patients improve after short psychiatric admission?: a cohort study in Italy. Nord J Psychiatry 2011; 65:251-8. [PMID: 21062122 DOI: 10.3109/08039488.2010.533387] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Information on outcomes of acute inpatient care in routine psychiatric practice is scant. In particular, it is uncertain to what extent short hospitalization can produce clinically meaningful changes. AIM Our aim was to estimate the symptomatic outcome in a representative sample of patients admitted for short treatment to general hospital psychiatric units in Italy. METHODS Patients were assessed at admission and discharge using 24-item Brief Psychiatric Rating Scale (BPRS). Reliable change index was calculated to estimate the proportion of change attributable to measurement error and a cut-off score of 38 was adopted to identify the patients who showed clinically significant change. RESULTS Average length of stay was 5.7 days. Mean BPRS score dropped from 53.2 on admission to 41.5 at discharge, showing statistically significant improvement with an effect size of 0.80. However, reliable change was achieved by 24.7% of patients and clinically meaningful change by 13.6%. CONCLUSIONS Reliance on statistical significance and effect size overestimates treatment effects, whereas reliable and clinically significant change index provides a conservative way to assess outcome. Few patients showed relevant improvement after a brief admission.
Collapse
Affiliation(s)
- Angelo Barbato
- Epidemiology and Social Psychiatry Unit, Mario Negri Institute for Pharmacological Research, Milan, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Svindseth MF, Nøttestad JA, Dahl AA. A study of outcome in patients treated at a psychiatric emergency unit. Nord J Psychiatry 2010; 64:363-71. [PMID: 20297944 DOI: 10.3109/08039481003690273] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although being an important part of the psychiatric treatment chain, there are few outcome studies of treatment at psychiatric emergency units (PEU). AIMS The aim was to measure changes in psychopathology and humiliation during admission at a PEU. METHODS The sample consisted of 147 patients examined at admission and discharge. The instruments used were the Brief Psychiatric Rating Scale (BPRS), the Narcissistic Personality Inventory-29 (NPI-29), the Hospital Anxiety and Depression Scale (HADS), a combination of questions measuring negative experiences and Cantril's ladder measuring experienced humiliation. Outcome measures were clinically significant improvement [>10% reduction of the BPRS converted (0-100) score] and changes on the other instruments. RESULTS Median hospitalization time was 13 days (mean 20.4 days). Fifty-six per cent of the patients showed clinical significant improvement (95% CI 48-64%), 42% showed some degree of improvement and 2% were unchanged. The more improved patients had higher scores at admission than those with less improvement on all scales, indicating a floor effect. Small changes were observed for narcissism and experienced humiliation and negative admission events. In multivariate analyses high admission scores on BPRS subscales, thinking disorder and activation and HADS total score were significantly associated with clinically significant improvement. Type and length of admission did not significantly affect the outcome. The BPRS, HADS and NPI-29 scores at discharge were mainly explained by corresponding admission scores. CONCLUSIONS More than half the patients admitted to PEU have clinically significant reduction of psychopathology during their stay. Higher levels of psychopathology at admission were significantly associated with improvement. Negative admission experiences and involuntary admission did not influence outcome.
Collapse
Affiliation(s)
- Marit F Svindseth
- Department of Psychiatry, Sunnmore Hospital, N-6026 Aalesund, Norway.
| | | | | |
Collapse
|
10
|
Rocca P, Mingrone C, Mongini T, Montemagni C, Pulvirenti L, Rocca G, Bogetto F. Outcome and length of stay in psychiatric hospitalization, the experience of the University Clinic of Turin. Soc Psychiatry Psychiatr Epidemiol 2010; 45:603-10. [PMID: 19585061 DOI: 10.1007/s00127-009-0091-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 06/25/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Given the current tendency to shorten psychiatric hospitalization and change its organization, an issue could be raised regarding its outcomes. PURPOSE To analyze features related to length of stay in a short-term inpatient treatment, to study outcomes and to evaluate the diagnosis-specific effects of hospitalization. METHOD A sample of 310 consecutive hospitalized patients, with psychotic disorder, depressive disorder and bipolar disorder (DSM IV-TR), was recruited at the University Psychiatric Clinic, Service for Cognitive Disorders, Department of Neuroscience, University of Turin. Severity of illness was rated using the brief psychiatry rating scale (BPRS). We evaluated relations between length of stay and clinical and socio-demographic features (linear regression) and possible differences confronting BPRS scores at admission and discharge in the different diagnostic subgroups (ANOVA for repeated measures). RESULTS All the sample of patients showed a significant improvement in symptomatology during hospitalization. Worse symptomatology in anxiety-depression domain of BPRS at admission in the whole sample was positively correlated with length of stay. A longer length of stay was also shown in patients with diagnosis of depressive disorder. Finally, a different pattern of improvement of BPRS (total score and domains) was shown between the different diagnostic groups. CONCLUSION Brief hospitalization in our service was shown to be highly effective. Different diagnostic groups had different response to hospitalization, showing faster improvement in characteristic symptomatology, but the anxiety-depression domain showed the highest percentage of change for all the diagnostic groups. We therefore suppose that hospitalization has two effects: a specific (due to tailored therapies) and a non-specific one (due to non-specific therapy and to a placebo-like effect).
Collapse
Affiliation(s)
- Paola Rocca
- Psychiatric Section, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126, Turin, Italy.
| | | | | | | | | | | | | |
Collapse
|
11
|
Theodoridou C, Bowers L, Brennan G, Gilbert D, Winship G. The measurement of psychotic acuity by nursing staff. J Psychiatr Ment Health Nurs 2009; 16:234-41. [PMID: 19291151 DOI: 10.1111/j.1365-2850.2008.01338.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Accurate evaluation of patients' psychotic state is essential to decrease psychotic symptoms and protect the patient and others. The aim of this paper is to conduct a literature review in order to access the utility, reliability and validity of current rating scales that are purported to measure psychotic acuity of inpatient population. A search of a number of electronic databases was undertaken to retrieve potential articles that focus on the measurement of acute psychosis. We identified some conceptual and theoretical problems when using a scale that is monitoring the progress of discharge and assesses the outcome of treatments. The findings revealed a difficulty in finding a commonly agreed definition of acute psychosis and a problem of obtaining frequent measures, and the frequency of measurement and fluctuation in psychosis. The most dominant scales in assessing psychosis were reviewed: the Global Assessment of Functioning Scale, the Brief Psychiatric Rating Scale and the Positive and Negative Symptom Scale. Several issues related to the scales' inter-rater reliability and construct validity remain unexplored. None of these scales addressed the conceptual and theoretical problems that we identified. A new scale that will measure acuity of symptoms in inpatient settings needs to be created.
Collapse
Affiliation(s)
- C Theodoridou
- Research Worker, Institute of Psychiatry, King's College, De Crespigny Park, London, UK.
| | | | | | | | | |
Collapse
|
12
|
Gaudiano BA, Herbert JD. Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: Pilot results. Behav Res Ther 2006; 44:415-37. [PMID: 15893293 DOI: 10.1016/j.brat.2005.02.007] [Citation(s) in RCA: 217] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2004] [Revised: 10/14/2004] [Accepted: 02/28/2005] [Indexed: 11/16/2022]
Abstract
Cognitive behavior therapy (CBT) has been demonstrated in a number of randomized controlled trials to be efficacious as an adjunctive treatment for psychotic disorders. Emerging evidence suggests the usefulness of CBT interventions that incorporate acceptance/mindfulness-based approaches for this population. The current study extended previous research by Bach and Hayes (2002. The use of Acceptance and Commitment Therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70, 1129-1139) using Acceptance and Commitment Therapy (ACT) in the treatment of psychosis. Psychiatric inpatients with psychotic symptoms were randomly assigned to enhanced treatment as usual (ETAU) or ETAU plus individual sessions of ACT. At discharge from the hospital, results suggested short-term advantages in the ACT group in affective symptoms, overall improvement, social impairment, and distress associated with hallucinations. In addition, more participants in the ACT condition reached clinically significant symptom improvement at discharge. Although 4-month rehospitalization rates were lower in the ACT group, these differences did not reach statistical significance. Decreases in the believability of hallucinations during treatment were observed only in the ACT condition, and change in believability was strongly associated with change in distress after controlling for change in the frequency of hallucinations. Results are interpreted as largely consistent with the findings of Bach and Hayes and warrant further investigations with larger samples.
Collapse
Affiliation(s)
- Brandon A Gaudiano
- Department of Psychology, Drexel University, Mail Stop 988, Philadelphia, PA 19102, USA.
| | | |
Collapse
|
13
|
Burlingame GM, Seaman S, Johnson JE, Whipple J, Richardson E, Rees F, Earnshaw D, Spencer R, Payne M, O'Neil B. Sensitivity to change of the Brief Psychiatric Rating Scale-Extended (BPRS-E): An item and subscale analysis. Psychol Serv 2006. [DOI: 10.1037/1541-1559.3.2.77] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
14
|
Quantifying Symptomatic Change During Acute Psychiatric Hospitalization Using New Subscales for the Anchored Brief Psychiatric Rating Scale. Psychol Serv 2004. [DOI: 10.1037/1541-1559.1.1.68] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
15
|
Lachar D, Bailley SE, Rhoades HM, Espadas A, Aponte M, Cowan KA, Gummattira P, Kopecky CR, Wassef A. New subscales for an anchored version of the Brief Psychiatric Rating Scale: construction, reliability, and validity in acute psychiatric admissions. Psychol Assess 2001; 13:384-95. [PMID: 11556275 DOI: 10.1037/1040-3590.13.3.384] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Attending psychiatrists completed an anchored version of the 18-item Brief Psychiatric Rating Scale (BPRS-A) based on admission and evaluation information on a total of 2,921 adult patients treated at 1 public sector acute psychiatric teaching hospital. Exploratory factor analysis was applied to a 6-month sample to construct 4 nonoverlapping subscales: Resistance, Positive Symptoms, Negative Symptoms, and Psychological Discomfort. Confirmatory factor analysis compared these new subscales to 3 other published subscale models using a second 6-month sample. Internal consistency, rater influence, and interrater agreement were estimated in separate studies. Discriminant validity was explored by comparison of diagnosis-based samples. Application of the BPRS-A as a debriefing instrument in the study of symptomatic change and the multiple challenges inherent in psychometric study of such a rating scale in realistic hospital practice are discussed.
Collapse
Affiliation(s)
- D Lachar
- Department of Psychiatry and Behavioral Sciences, University of Texas-Houston Medical School, Harris County Psychiatric Center, University of Texas-Houston Health Science Center, Houston, Texas, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Menon V, Anagnoson RT, Mathalon DH, Glover GH, Pfefferbaum A. Functional neuroanatomy of auditory working memory in schizophrenia: relation to positive and negative symptoms. Neuroimage 2001; 13:433-46. [PMID: 11170809 DOI: 10.1006/nimg.2000.0699] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Functional brain imaging studies of working memory (WM) in schizophrenia have yielded inconsistent results regarding deficits in the dorsolateral prefrontal (DLPFC) and parietal cortices. In spite of its potential importance in schizophrenia, there have been few investigations of WM deficits using auditory stimuli and no functional imaging studies have attempted to relate brain activation during auditory WM to positive and negative symptoms of schizophrenia. We used a two-back auditory WM paradigm in a functional MRI study of men with schizophrenia (N = 11) and controls (N = 13). Region of interest analysis was used to investigate group differences in activation as well as correlations with symptom scores from the Brief Psychiatric Rating Scale. Patients with schizophrenia performed significantly worse and were slower than control subjects in the WM task. Patients also showed decreased lateralization of activation and significant WM related activation deficits in the left and right DLPFC, frontal operculum, inferior parietal, and superior parietal cortex but not in the anterior cingulate or superior temporal gyrus. These results indicate that in addition to the prefrontal cortex, parietal cortex function is also disrupted during WM in schizophrenia. Withdrawal-retardation symptom scores were inversely correlated with frontal operculum activation. Thinking disturbance symptom scores were inversely correlated with right DLPFC activation. Our findings suggest an association between thinking disturbance symptoms, particularly unusual thought content, and disrupted WM processing in schizophrenia.
Collapse
Affiliation(s)
- V Menon
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California 94305-5719, USA
| | | | | | | | | |
Collapse
|