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Migration-related emotional distress among Vietnamese psychiatric patients in Germany: An interdisciplinary, mixed methods study. Transcult Psychiatry 2021; 58:772-788. [PMID: 32389070 DOI: 10.1177/1363461520920329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Culture and socialization influence how individuals perceive and express emotional distress. Research therefore, must consider the context to capture individual experiences. However, the majority of studies on factors associated with emotional distress among migrants use quantitative approaches, limiting an in-depth understanding. This study investigates emic themes of emotional distress among Vietnamese migrants by integrating anthropological and psychiatric approaches. The mixed methods study first quantified differences in reported themes of distress between Vietnamese (n = 104) and German (n = 104) patients, who utilized two psychiatric outpatient clinics in Berlin, Germany. Based on these differences, ethnographic interviews were conducted with 20 Vietnamese patients. In the quantitative part, differences in frequency of reported distress between Vietnamese and German patients indicate cultural and migration-related issues among Vietnamese migrants, such as the upbringing of children in a transcultural context. In the qualitative part, interviews with Vietnamese patients elicited contextualizing information and additional themes of distress. Besides commonly expressed socioeconomic themes, such as work and finances, we identified affectively charged themes concerning roles toward partnership and children. A central emic theme is expressed as "moments of speechlessness," which go beyond a lack of language proficiency and challenge patients in different spheres of life. Migration entails complex affective dynamics, determined by a specific migratory and post-migratory context. Within this context, norms and values determine which themes of distress patients articulate openly. Therefore, an interdisciplinary, mixed-methods approach can yield a contextualized understanding of emotional distress and the complex nature of migration.
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Assessment of dementia in a clinical sample of persons with intellectual disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1618-1629. [PMID: 34196460 DOI: 10.1111/jar.12913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Assessment of age-associated disorders has become increasingly important. METHODS In a clinical setting, people with intellectual disability with and without dementia were assessed retrospectively using the Neuropsychological Test Battery (NTB) and the Dementia Questionnaire for People with Learning Disabilities (DLD) at two different times to analyse neuropsychological changes and diagnostic validity. One group (n = 44) was assessed with both instruments, while the DLD was applied in 71 patients. RESULTS In the NTB (n = 44), only patients with dementia (n = 26) showed a decline in the NTB total score and three subscales. Receiver operating characteristic analysis revealed a diagnostic sensitivity of .67, a specificity of .81, and an area under the curve (AUC) of .767. In the DLD group (n = 71), only those with dementia displayed a decrease in the cognitive and social scale; diagnostic sensitivity and specificity values were low (.61/.63) and the AUC was .704. CONCLUSIONS Neuropsychological assessment was sensitive to detect cognitive changes over time. Sensitivity values of both instruments suggest a reassessment at a later time point.
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Acceptance and commitment-based therapy for patients with psychiatric and physical health conditions in routine general hospital care - Development, implementation and outcomes. J Psychosom Res 2021; 143:110374. [PMID: 33571859 DOI: 10.1016/j.jpsychores.2021.110374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/16/2021] [Accepted: 01/24/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Transdiagnostic approaches are needed to effectively treat patients with a broad range of diagnoses and comorbidities in routine general hospital care. Yet the evidence for the effectiveness of treatments beyond Cognitive Behavioral Therapy (CBT) is largely lacking. We describe the process of implementing an interdisciplinary multi-professional Acceptance and Commitment Therapy (ACT)-based treatment for patients with psychiatric and physical health conditions and present outcomes before and after implementation. METHOD The present investigation was a naturalistic comparative study comparing ACT-based (n = 126) vs. CBT-based (n = 127) treatments in a psychiatric day hospital in Berlin, Germany. Within- and between-group changes (pre- to post-treatment) in everyday functioning and health-related quality of life (primary outcomes; assessed by the Short Form 36 (SF-36)), as well as anxiety and depressive symptoms (secondary outcomes; assessed by the Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory-II (BDI-II)), were analyzed with Generalized Linear Models, and Wilcoxon signed-rank tests and effect size r. RESULTS Data analysis showed statistically significant improvements from pre- to post-treatment (r ranging from 0.27 to 0.61, p < 0.001) for most SF-36 scales as well as for all HADS and BDI-II scores (r ranging from 0.38 to 0.60, p < 0.001) for both the ACT and CBT groups. ACT and CBT showed comparable effects in relation to clinical outcomes. CONCLUSION An interdisciplinary multi-professional ACT-based group treatment is a valuable approach for patients with psychiatric and physical health conditions in real-life hospital settings, with effects equivalent to CBT interventions.
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Process-outcome associations in an interdisciplinary treatment for chronic pain and comorbid mental disorders based on Acceptance and Commitment Therapy. PAIN MEDICINE 2021; 22:2615-2626. [PMID: 33755159 DOI: 10.1093/pm/pnab102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Numerous studies support the effectiveness of Acceptance and Commitment Therapy (ACT) for chronic pain, yet little research has been conducted about its underlying mechanisms of change, especially regarding patients with comorbid mental disorders. The present investigation addressed this issue by examining associations of processes targeted by ACT (pain acceptance, mindfulness, psychological flexibility) and clinical outcomes (pain intensity, somatic symptoms, physical health, mental health, depression, general anxiety). SUBJECTS Participants were 109 patients who attended an ACT-based interdisciplinary treatment program for chronic pain and comorbid mental disorders in a routine care psychiatric day hospital. METHODS Pre- to post-treatment differences in processes and outcomes were examined with Wilcoxon signed-rank tests and effect size r. Associations between changes in processes and changes in outcomes were analyzed with correlation and multiple regression analyses. RESULTS Pre- to post-treatment effect sizes were mostly moderate to large (r between |0.21| and |0.62|). Associations between changes in processes and changes in outcomes were moderate to large for both, bivariate correlations (r between |0.30| and |0.54|) and shared variances accounting for all three processes combined (R2 between 0.21 and 0.29). CONCLUSION The present investigation suggests that changes in pain acceptance, mindfulness and psychological flexibility are meaningfully associated with changes in clinical outcomes. It provides evidence on particular process-outcome associations that had not been investigated in this way before. The focus on comorbid mental disorders informs clinicians about a population of chronic pain patients that often has a severe course of illness and has seldom been studied.
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[Guidance in Simple Language for Psychopathological Assessment of People with Intellectual Disabilities According to the AMDP]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:354-362. [PMID: 33418590 DOI: 10.1055/a-1244-2496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study evaluates the usefulness of a modified version of "AMDP Interview Guidance", the established German instrument in simple language for psychopathological examination. A total of 19 patients with intellectual disabilities underwent psychopathological examination with the help of the original version of the AMDP interview guidance, a modified version and a free, non-standardised and the three versions were assessed. With the original version of the AMDP interview guidance, 50% of the patients with intellectual disabilities were able to answer in a proper way and delivered an appropriate result for the psychopathological assessment. Of the remaining patients 85-90% could handle the questions of the modified version with success. The modified version of the AMDP interview guidance in simple language seems to contribute to a better psychopathological examination compared with the original version. Further studies with a statistically appropriate number of patients need to be carried out in the future.
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Are there effects of consultation–liaison-psychiatry on length of stay in the general hospital? A path analysis. THE EUROPEAN JOURNAL OF PSYCHIATRY 2020. [DOI: 10.1016/j.ejpsy.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A clinical effectiveness trial comparing ACT and CBT for inpatients with depressive and mixed mental disorders. Psychother Res 2020; 31:355-368. [PMID: 32762513 DOI: 10.1080/10503307.2020.1802080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract Objective: Meta-analyses show that Acceptance and Commitment Therapy (ACT) is an efficacious treatment for a wide range of mental health problems. However, few studies have examined the effectiveness of ACT in naturalistic inpatient settings and in direct comparison to Cognitive Behavior Therapy (CBT). The aim of this study was to investigate the effectiveness of ACT and CBT with regard to depression, general symptom strain and life satisfaction. Method: 177 inpatients in a psychiatric ward were included in the study and assigned to either ACT or CBT group intervention. All patients were assessed with the SCID-I interview and disorder-specific questionnaires as well as with a satisfaction with life scale. To control for confounding variables, amongst others, treatment integrity was evaluated. Results: Both the ACT and CBT intervention showed a large, statistically significant and stable symptom reduction over six months across all outcomes. Both approaches led to small improvement in life satisfaction. With regards to depressive symptoms, more than half of the patients reliably recovered due to therapy. Conclusion: ACT and CBT were similarly effective in treating patients with depressive and other mental disorders in a routine clinical setting. ACT is a viable alternative to CBT for treating inpatients.
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The Future is Knocking: How Artificial Intelligence Will Fundamentally Change Psychiatry. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:461-466. [PMID: 32424706 DOI: 10.1007/s40596-020-01243-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/28/2020] [Indexed: 06/11/2023]
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Psychopharmacological Treatment in Older People: Avoiding Drug Interactions and Polypharmacy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:508-518. [PMID: 31452508 DOI: 10.3238/arztebl.2019.0508] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 03/18/2019] [Accepted: 06/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND As the elderly population increases, so, too, does the number of multimorbid patients and the risk of polypharmacy. The consequences include drug interactions, undesired side effects of medication, health impairment, and the need for hospital- ization. 5-10% of hospital admissions among the elderly are attributable to undesired side effects of medication. METHODS This review is based on publications retrieved by a selective search in PubMed and the Cochrane Library that employed the search terms "drug interaction," "undesired side effect," "polypharmacy," "pharmacokinetics," and "pharmacody- namics." RESULTS Elderly patients are particularly at risk of polypharmacy, both because of the prevalence of multimorbidity in old age and because of physicians' uncritical implementation of guidelines. The more drugs a person takes, the greater the risk of drug interactions and undesired side effects. Age-associated changes in pharmacokinetics and pharmacodynamics elevate this risk as well. Physicians prescribing drugs for elderly patients need to know about the drugs' catabolic pathways, protein binding, and inductive and inhibitory effects on cytochrome P450 in order to avoid drug interactions and polypharmacy. CONCLUSION Multiple aids and instruments are available to ensure practical and reasonable drug monitoring, so that the risks of drug interactions and undesired side effects can be detected early and avoided.
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Psychiatrists and neurologists in dementia care: Professionalism, practice, and perspectives. Gen Hosp Psychiatry 2020; 64:105-107. [PMID: 32067822 DOI: 10.1016/j.genhosppsych.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 11/29/2022]
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Abstract
Up to now hardly any quantitative research regarding diagnosis of personality disorders in the environment of Consultation-Liaison Psychiatry and Psychosomatic Medicine is available.The data of 3032 patients aged 17-65 years seen between 1988 and 1997 at the Mount Sinai Hospital in New York, NY, were recorded and analyzed using the Micro-Cares Database System.19,7% (N=598) of patients exhibited a personality disorder. Out of those 7,7% distributed to Cluster A (Odd or Eccentric Behavior), 54,3% to Cluster B and 38,0% to Cluster C.89% of patients with personality disorders showed at least one additional specific psychiatric disorder.Patients with a personality disorder had a lower incidence of somatic disease, but exhibited a higher level in psychosocial impairment and a higher comorbidity in substance abuse. During the previous year they used psychiatric treatment more often and were in need of a more intense social and psychotherapeutical treatment.The age group of 17-40 year old patients with a personality disorder was hospitalized shorter and had less of a lag between hospitalization and time of psychiatric consultation.More reasons for a psychiatric consultation were given when patients with a personality disorder were referred.In the environment of Consultation-Liaison Psychiatry and Psychosomatic Medicine every 5th to 6th patient requires a specific, psychiatric, psychotherapeutic or social treatment because of a personality disorder.The classification of personality disorders into clusters did not yield an additional benefit.
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[Comorbidity of hypoglycaemia anxiety and panic disorder in a patient with type-1 diabetes - Combined treatment with cognitive-behavioral therapy and Continuous Glucose Monitoring (CGM) in a psychosomatic day-treatment center]. Dtsch Med Wochenschr 2020; 145:314-317. [PMID: 32120406 DOI: 10.1055/a-1038-9291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CLINICAL HISTORY AND FINDINGS A patient with T1DM, panic disorder and hypoglycaemia fear diabetes duration 4 years, BMI 25. 6, was treated in the day clinic psychosomatics with a multimodal treatment approach. She reports severe fear of hypoglycaemia and repeated hypoglycaemia. Fearing hypoglycaemia, the patient changed her diabetes self-management and thus experienced limitations in her everyday functionality. DIAGNOSIS Diabetes mellitus type 1, panic disorder and exaggerated fear of hypoglycaemia. THERAPY The combination of continuous glucose monitoring (CGM) and a symptom record diary from classical cognitive-behavioural therapy (CBT) and in addition a multimodal psychotherapeutic group intervention based on Acceptance and Commitmenttherapy (ACT) were applied. The patient learned to differentiate between symptoms of panic attacks and symptoms due to low blood glucose levels. CONCLUSION The combination of psychotherapeutic measures with CGM appears to be a helpful approach to the treatment of disease-specific mental disorders in diabetes mellitus.
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Entwicklung und Validierung von Skalen zur Erfassung der Adhärenz im transdiagnostischen Gruppensetting für ACT und KVT. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2020. [DOI: 10.1026/1616-3443/a000566] [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
Zusammenfassung. Theoretischer Hintergrund: Therapeutische Adhärenz ist eine zentrale Voraussetzung zur Sicherung der Validität von Psychotherapiestudien. Bisher existieren im deutschsprachigen Raum keine Skalen zur Erfassung der Adhärenz im Bereich der Akzeptanz- und Commitmenttherapie (ACT). Fragestellung: Ziel war es, Skalen zur Erfassung der Adhärenz von Therapeut_innen für ACT und der Kognitiven Verhaltenstherapie (KVT) zu entwickeln und deren Gütekriterien zu überprüfen. Methode: Die Validierung der Adhärenzskalen basierte auf n=38 ACT- und n=31 KVT-Gruppentherapiesitzungen zur Behandlung von depressiven und gemischten Störungsbildern. Die Adhärenz wurde durch zwei Rater_innen anhand von Audioaufzeichnungen bewertet. Ergebnisse: Sowohl für die ACT-Adhärenzskala (ICC=.96) als auch für die KVT-Adhärenzskala (ICC=.98) konnten hohe Interraterreliabilitäten erreicht werden. Die konvergente Validität konnte anhand einer negativen Korrelation zwischen den beiden Skalen sichergestellt werden ( r=-.95). Schlussfolgerungen: Beide Adhärenzskalen bieten eine erste Möglichkeit, um manualgetreues Therapeut_innenverhalten in ACT- und KVT-Gruppentherapien für Patient_innen mit gemischten Störungsbildern zu erfassen. Zudem geben die Ergebnisse einen Hinweis darauf, dass sich die beiden Methoden voneinander differenzieren lassen.
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The Medical Care of People With Intellectual Disability. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:809-816. [PMID: 31888794 PMCID: PMC6947689 DOI: 10.3238/arztebl.2019.0809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 05/22/2019] [Accepted: 09/13/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND An estimated 1.5 million persons in Germany are intellectually disabled. Persons with intellectual disability (ID) are especially vulnerable to somatic and mental illnesses. METHODS This review is based on pertinent literature retrieved by selective searches in PubMed and the Cochrane Library. RESULTS Genetic abnormalities are a frequent cause of diseases that affect multiple organs and need interdisciplinary treatment. A number of somatic diseases are more common in persons with ID than in the general population, including epilepsy (30-50% in persons with severe or very severe ID, vs. 0.5% in the general popu- lation) and dementia (five times more common than in the general population). Patients with Down syndrome are 20 times more likely than the general population to develop acute lymphoblastic leukemia. Some mental illnesses, too, are more common in persons with ID, e.g., autism spectrum disorders (7.5-15% vs. 1% in the general population). The history and the findings of the physical and psychiatric examination are assessed in accordance with the biopsychosocial model of disease, and in the light of the patient's mental developmental age. Structured instruments for behavioral evaluation and diagnosis are an important additional component of the diagnostic assessment. A holistic approach is required that takes multiple life areas into account and involves the patient's familial and social environment, while obeying the rules of simple language. Psychotherapeutic and psychosocial measures must be adapted to the patient's cognitive abilities and mental developmental age. CONCLUSION Intellectually disabled persons can be treated in a multimodal, multiprofessional approach. As of early 2019, there were 38 medical centers for adults with intellectual disability or severe multiple disabilities in Germany (Medizinische Behandlungszentren für Erwachsene mit geistiger Behinderung oder schweren Mehrfachbehinderungen, MZEB), where they can be cared for with due attention to their special needs.
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Developing a Diagnostic Algorithm for the Music-Based Scale for Autism Diagnostics (MUSAD) Assessing Adults with Intellectual Disability. J Autism Dev Disord 2019; 49:3732-3752. [PMID: 31161304 DOI: 10.1007/s10803-019-04069-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Initial studies have presented the Music-based Scale for Autism Diagnostics (MUSAD) as a promising DSM-5-based observational tool to identify autism spectrum disorder (ASD) in adults with intellectual disability (ID). The current study is the first to address its clinical utility in a new sample of 124 adults with ID (60.5% diagnosed with ASD). The derived diagnostic algorithm differentiated well between individuals with and without ASD (sensitivity 79%, specificity 74%, area under the curve = 0.81). Inter-rater reliability, assessed by the scorings of four independent experts in 22 consensus cases, was excellent (ICC = 0.92). Substantial correlations with scores from other ASD-specific measures indicated convergent validity. The MUSAD yields accurate and reliable scores, supporting comprehensive ASD diagnostics in adults with ID.
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Take into Account Postoperative Cognitive Dysfunction. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:376. [PMID: 31315806 DOI: 10.3238/arztebl.2019.0376a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Preoperative Screening Required. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:374. [PMID: 31315804 DOI: 10.3238/arztebl.2019.0374a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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[Autism spectrum disorders in adults with intellectual disabilities : Frequencies and characteristics]. DER NERVENARZT 2019; 90:490-496. [PMID: 30377732 DOI: 10.1007/s00115-018-0635-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Collation of frequencies and clinical characteristics of autism spectrum disorders (ASD) in persons with intellectual disability (ID). METHODS Cross-sectional analysis of a clinical psychiatric sample of 710 adults with ID and mental disorders. RESULTS The frequency of ASD in an adult sample with ID was 19%. The occurrence of ASD was associated with a higher severity of ID, male gender (in mild to moderate ID), anticonvulsive therapy and reduced employment rates in workshops. CONCLUSION The ASD are a frequent clinical diagnosis in adults with ID.
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The relationship between causal beliefs and desire for social distance towards people with schizophrenia and depression: Results from a survey of young Ghanaian adults. Psychiatry Res 2019; 271:220-225. [PMID: 30502558 DOI: 10.1016/j.psychres.2018.11.030] [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: 04/23/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 12/01/2022]
Abstract
This study examines attitudes of the young Ghanaian population regarding the relationship between causal beliefs and desire for social distance from people with symptoms of schizophrenia and depression. Respondents (n = 507) were presented with depression and schizophrenia symptoms using unlabeled case vignettes. A factor analysis examined three factors for causal beliefs, and multiple linear regression analysis on the desire for social distance was conducted. The desire for social distance was higher when symptoms in both case-vignettes were attributed to childhood adversities and overall lower when respondents lived in northern regions of Ghana. Only, for vignettes depicting schizophrenia, mental illness attribution was associated with more desire for social distance. Significant gender effects were found for depression vignettes only: female respondents reported significantly more desire for social distance, whereas female gendered vignettes were associated with less desire for social distance by respondents of both genders.
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Abstract
ZusammenfassungSomatische Erkrankungen werden häufig von psychischen Symptomen und Verhaltensauffälligkeiten begleitet. Andererseits weisen viele körperliche Beschwerden auch auf das Vorliegen einer larvierten psychischen Erkrankung hin. Aus diesem Grund hat in den letzten Jahren die Bedeutung der Konsiliarpsychiatrie und Psychotherapie am Allgemeinkrankenhaus deutlich zugenommen. Der vorliegende Artikel gibt einen Überblick über die Aufgaben und die Organisation der Konsiliarpsychiatrie am Allgemeinkrankenhaus. Besonderer Aspekt wird auf die Bedeutung der Konsiliarpsychiatrie für die Arbeit des somatisch tätigen Arztes gelegt. Es sollten Probleme, Arbeitsfelder und Chancen der Konsiliarpsychiatrie am Allgemeinkrankenhaus aufgezeigt werden.
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Demenz bei Down-Syndrom: Ein häufiger psychiatrischer Vorstellungsgrund. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2018; 86:402-409. [DOI: 10.1055/s-0043-124592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Zusammenfassung
Einleitung Diese Studie untersucht die Prävalenz und klinischen Charakteristika von Demenzen bei psychiatrisch vorgestellten Erwachsenen mit Down-Syndrom und leitet Konsequenzen für die klinische Praxis ab.
Methodik Die Patientenmerkmale und Prävalenz von Demenz wurden retrospektiv (2005–2012, N = 75) bei Erwachsenen mit Down-Syndrom im klinisch-psychiatrischen Setting untersucht.
Ergebnisse Bei jedem 3. Patienten mit Down-Syndrom wurde – in der Regel erst nach einer Verlaufsuntersuchung von 6 bis 12 Monaten – eine Demenz diagnostiziert. Patienten mit Demenz waren älter und häufiger weiblich, während sich der Grad der Intelligenzminderung nicht unterschied. Die Schilddrüsen- und Calciumwerte waren bei Menschen mit wie ohne Demenz häufig auffällig.
Diskussion Demenz ist ein häufiger psychiatrischer Vorstellungsgrund bei Menschen mit Down-Syndrom, insbesondere bei Frauen und im höheren Lebensalter. Die Versorgungsstrukturen in Deutschland sollten bedarfsgerecht angepasst werden.
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Personality disorders in patients referred to consultation-liaison psychiatry: Characteristics and medical treatment in a large general hospital. THE EUROPEAN JOURNAL OF PSYCHIATRY 2018. [DOI: 10.1016/j.ejpsy.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
BACKGROUND AND AIMS In recent years, there has been a growing awareness of the need to protect human rights in psychiatry. Within the last years, considerable effort has been made to reduce restrictive measures in mental health settings. Reducing restrictive measures within mental health care has also moved increasingly into the focus of public debate. This study aims, for the first time in a Southeast Asian sample, to explore whether socio-demographic factors affect public attitudes toward restrictions on mentally ill people in Hanoi, Vietnam. METHODS A general population-based survey (self-report questionnaire) was carried out in 2013 in the greater Hanoi area. The survey sample ( N = 813) was recruited according to the latest published census (2009) and micro-census (2013) in Vietnam and Hanoi with regard to the socio-demographic factors gender, age, urbanity, household size and marital status. Multinomial logistic regressions for odds ratios with 95% confidence intervals were calculated to examine the influence of epidemiological variables, like gender and age, on the public attitude toward restrictions imposed on mentally ill people in Vietnam. RESULTS This study found, for the first time in a large Vietnamese sample, that gender and age were associated with public attitudes toward restrictions on mentally ill people. In detail, significantly fewer men endorsed compulsory admission to a hospital and abortion than Vietnamese women. In addition, endorsement of abortion was significantly higher in older people. CONCLUSION The results offer some insight into roles of women in the Vietnamese society and might reflect the traditional gender expectations in Vietnamese families. Moreover, the results emphasize the need for supporting female psychiatric patients and their families within their communities and in the Vietnamese society.
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Public attitudes towards psychiatrists in the metropolitan area of Hanoi, Vietnam. Asian J Psychiatr 2018; 32:44-49. [PMID: 29207317 DOI: 10.1016/j.ajp.2017.11.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Mental health associated stigmatization remains problematic in low and middle-income countries, thus preventing patients from adequate access to psychiatric care. Public attitudes towards psychiatrists have not been examined in many countries, especially not in Vietnam where merely one psychiatrist per 300.000 population is available. The study aims to explore attitudes towards psychiatrists in the Hanoi municipality and to identify socio-demographical factors that influence these attitudes. METHODS Between April and August 2013, a general population-based survey was carried out in the greater Hanoi area, Vietnam. The sample of 817 participants was stratified according to the latest Vietnamese census (2009) and micro-census (2013) with regards to socio-demographic factors. Multivariate analyses were conducted to determine the influence of these factors on attitudes towards psychiatrists. RESULTS Gender and religious beliefs significantly influenced public attitudes towards psychiatrists. Male participants reported significantly more negative perception towards psychiatrists compared to female respondents. Participants following a religion reported significantly more negative attitudes toward psychiatrists than those without self-reported religious attainment. CONCLUSIONS Negative attitudes towards psychiatrists are associated with religious beliefs and gender affiliation in the greater Hanoi area. A strategy that involves religious institutions in raising awareness about mental health issues while considering public's socio-cultural attitudes may pave the way for greater potentialities of adequate psychiatric care, destigmatize the mental health system, and care provider.
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Abstract
BACKGROUND Challenges of migration, particularly concerning the process of acculturation are associated with an increased risk of mental illness. Vietnamese migrants constitute the largest Southeast Asian migrant group in Germany, yet there is no data on the relationship between the mental health status and acculturation among this population. AIMS Therefore, the present study examines the relationship between two well-established dimensions of acculturation, that is, dominant society immersion (DSI) and ethnic society immersion (ESI), the four resulting acculturation strategies (integration, assimilation, separation and marginalization), and severity of depression. METHODS A sample of N = 113 first-generation Vietnamese outpatients from a psychiatric outpatient clinic for Vietnamese migrants in Germany was studied regarding their self-reported depressive symptoms (Beck Depression Inventory-II (BDI-II)) and acculturation (Stephenson Multigroup Acculturation Scale (SMAS)). RESULTS Consistent with the hypotheses, patients reported less severe depressive symptoms, when they reported higher orientation toward the German and the Vietnamese society. Moreover, the results showed that integrated patients reported a lower severity of depression compared to marginalized patients, who reported the highest severity of depression. CONCLUSIONS The findings indicate that among a sample of first-generation Vietnamese patients with depression, an orientation to both, the mainstream society and one's heritage society might serve as a potential resource. The rejection of any orientation to any society is associated with an increased risk for depression.
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[Body weight and mental disorders : Results from a clinical psychiatric cross-sectional study of people with intellectual disabilities]. DER NERVENARZT 2017; 89:552-558. [PMID: 28849297 DOI: 10.1007/s00115-017-0411-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND People with intellectual disabilities (ID) have a shorter life expectancy and higher mortality rate and more often suffer from various physical and mental disorders (WHO: 3-4 times more often than the general population). Obesity is an important risk factor for various disorders. This cross-sectional study examined the body weight and its risk factors in a clinical population of adults with ID. METHODS The prevalence of underweight, normal weight, and overweight was determined using the body mass index (BMI) for 633 patients of an outpatient clinic for people with ID and mental disorders. A multiple logistic regression analysis was used to assess factors for alterations in body weight. RESULTS Approximately one out of two men and two out of three women with ID and mental disorders were overweight. Adults with mild and moderate ID, female gender, increasing age, Down's syndrome, behavioral disorders, and a less supported living situation were associated with a higher rate of obesity. People with dementia and autism spectrum disorders showed a lower rate of obesity. CONCLUSION Young women with ID and mental disorders were particularly at risk for obesity. The respective factors may support the development of specific prevention programs to reduce the risk of overweight and thereby lead to better mental and physical health in people with ID.
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Acculturation strategies and severity of depression among Vietnamese migrants. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AimsMigration with its long-term changes and the resulting task to adjust to the new environment has been associated with an increased risk for mental health problems. This study aims to gain further insight on the relationship between the fours acculturations strategies (integration, assimilation, separation, marginalization) and severity of depression.MethodsA total of n = 79 first generation Vietnamese outpatients from a psychiatric outpatient clinic for Vietnamese migrants in Germany were investigated regarding self-reported depressive symptoms (patient health questionnaire-9) and acculturation (Stephenson multigroup acculturation scale; SMAS).ResultsPatients with an integration acculturation strategy reported lower severity of depression compared to marginalized patients, who reported the highest severity of depression.ConclusionThe results implicate that the integration of both the mainstream society and the ethnic society might serve as a resource, whereas the rejection of both societies might increase the risk of depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Differences in symptom expression between Vietnamese and German patients utilizing a psychiatric outpatient service using the PHQ. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
ObjectiveDespite a large body of work on somatic symptom presentation among people of Asian descent, research has shown heterogeneous results. Examining symptom presentation in clinically and ethnically well-characterized populations constitutes a first step towards better understanding differing patterns symptom of presentation. This is the first larger study aiming to compare Vietnamese and German psychiatric outpatients regarding symptom presentation.Methods110 Vietnamese and 109 German patients seeking psychiatric treatment at two outpatient clinic services in Berlin were asked to complete the patient health questionnaire (PHQ). Comparisons of Vietnamese and German patients were conducted using independent t-tests. The somatic symptom module (PHQ-15), the depression module (PHQ-9) and the original PHQ-modules examining anxiety and psychosocial stress levels were compared for both groups using multivariate analysis. Categorical variables were evaluated using Chi2 analysis. Crohnbach's alpha was calculated separately for both groups and all PHQ modules.ResultsVietnamese patients endorsed significantly higher levels of somatic symptoms overall and on individual somatic items, such as pain-related disturbancies. Yet, German and Vietnamese patients did not differ in terms of depression severity. Vietnamese patients with fewer German language skills showed a significantly higher tendency for somatization. While German patients showed higher total scores on the anxiety- and stress-modules of the PHQ, this difference was not statistically significant. Vietnamese and German patients showed comparable Crohnbach's alpha for all subscales.ConclusionAs data was collected from both groups upon the first visit to an outpatient clinic, the symptoms reported could be reflective of culture related symptom awareness when feeling discomfort in the context of mental illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Preventing postoperative delirium. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 112:289-96. [PMID: 26008890 DOI: 10.3238/arztebl.2015.0289] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 02/09/2015] [Accepted: 02/09/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Delirium is a common complication in elderly hospitalized patients. It prolongs the length of hospital stay, raises costs, increases the workload of the nursing staff, and may necessitate transfer of the patient to a nursing home. The risk of postoperative delirium is particularly high in elderly patients with pre-existing cognitive deficits. METHODS In an open study, we systematically assessed the frequency of postoperative delirium in patients over age 70 on two surgical wards of a general hospital. In a six-month "prevalence phase," from March to August 2011, we counted the number of patients with postoperative delirium, but did not initiate any intervention. Thereafter, in a ten-month "intervention phase" from September 2011 to June 2012, a nurse with special training in the management of delirium carried out an intervention involving component measures of the Hospital Elder Life Program (HELP) on one of the two wards, with the aim of preventing postoperative delirium. The patients on the other ward served as a control group. RESULTS In the prevalence phase, 20.2% of all patients developed postoperative delirium (95% confidence interval [CI], 14.6-26.4). In the intervention phase, postoperative delirium arose in 20.8% (95% CI, 11.3-32.1) of the patients on the ward with no specific interventions, but in only 4.9% (95% CI, 0.0-11.5) of those on the ward where the intervention was carried out. The difference was presumably due to the measures initiated by the specially trained nurse, including validation, improvement of sleep, cognitive activation, early mobilization, improved sensory stimulation, and improved nutritional and fluid intake. Important predictors of postoperative delirium included a low score on the Mini-Mental State Examination, advanced age, and preoperative infection. CONCLUSION The frequency of postoperative delirium in elderly patients with cognitive deficits can be lowered with nursing measures carried out by a specially trained nurse, close postoperative supervision, and cognitive activation.
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[Acute and long-term cognitive consequences of treatment on intensive care units]. DER NERVENARZT 2016; 87:246-52. [PMID: 26910259 DOI: 10.1007/s00115-016-0078-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Following treatment on the intensive care unit (ICU) patients often suffer from acute and long-term cognitive deficits. This is true for patients of all age groups but especially for elderly patients who have undergone surgery and develop postoperative delirium (POD) or postoperative cognitive decline (POCD). Both are associated with severe limitations in the quality of life and long-term outcome. OBJECTIVE Which acute and long-term cognitive effects develop in ICU survivors and how do they influence the outcome? How can POD and POCD be differentiated? METHOD A selective literature search was carried out. RESULTS Following surgery POCD can develop within days to weeks, may persist for weeks or months and can lead to problems in attentiveness even under conditions of inconspicuous consciousness. Remission is possible but may take up to more than 12 months. The POD is a phenomenon characterized by disturbances of consciousness and problems in attention, beginning acutely hours and days postoperatively, can persist for days to weeks and remission can be expected within a few days. While POD often has an organic cause, such as an infection, the pathogenesis of POCD has not been sufficiently elucidated. DISCUSSION Both POD and particularly POCD can lead to a deterioration of cognition following ICU treatment. As efficient treatment still has to be developed preventive methods, such as preoperative screening for risk factors, thorough planning of operative and anesthetic techniques and compensation of risk factors as well as providing assistance to patients, e. g. by a trained nurse should be implemented in the clinical routine more often than is presently the case.
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Influence of urbanity on perception of mental illness stigma: a population based study in urban and rural Hanoi, Vietnam. Int J Soc Psychiatry 2016; 62:685-695. [PMID: 27887028 DOI: 10.1177/0020764016670430] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS To examine, for the first time in Vietnam, whether urbanity of respondents among other socio-demographic factors affects the public perception of stigma attached to persons with mental illness in Hanoi. METHODS A general population-based survey was carried out in 2013 in the greater Hanoi area. The perception of stigma attached to people with mental illness was elicited using Link's perceived discrimination and devaluation scale (PDDS) carried out in Vietnamese language. The survey sample (n = 806) was stratified for gender, urban/rural location, age, household size and marital status, in accordance with the 2013 Vietnamese census. RESULTS Comparing the total score of the PDDS and its single items, we found less perceived stigma and discrimination among the rural population of Hanoi and in respondents who reported religious attainment to either Buddhism or Christianity. Logistic regression analyses found no significant influences of gender, age, household size or marital status regarding the perceived stigma toward persons with mental illness. CONCLUSION Less negative perception of stigma attached to persons with mental illness that was observed among the rural population in the Hanoi area may be interpreted in the light of possibly more demanding living conditions in modern urban Vietnam with less opportunities for mentally ill patients and points toward a dynamic interaction with rapidly changing living conditions in Asian megacities.
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Crossing the bridge - A prospective comparative study of the effect of communication between a hospital based consultation-liaison service and primary care on general practitioners' concordance with consultation-liaison psychiatrists' recommendations. J Psychosom Res 2016; 86:53-9. [PMID: 27302547 DOI: 10.1016/j.jpsychores.2016.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 04/25/2016] [Accepted: 05/07/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Concordance with consultation-liaison (CL) psychiatrists' recommendations by general practitioners (GP) has hardly been studied systematically. We studied if telephone calls or written notes from a hospital based CL-service to GPs, whose patients were treated on medical-surgical wards, can improve GP-concordance, as compared to the usual communication pathway by standard discharge letters written by hospital physicians, and if higher GP-concordance improves outcomes of depressive and anxious symptoms. METHODS 116 inpatients of a general hospital referred to a CL-service with depression and anxiety were allocated to three groups of communication pathways between CL-service and GPs: (1) A telephone call (TC) by CL-psychiatrists with GPs, (2) a copy of the psychiatric consultation report (CR) was handed out to patients, (3) GPs received standard discharge letters of the hospital physicians (communication as usual, CAU). Six weeks after the CL-episode, patients were phoned at home and asked about implementation of recommendations by their GP's. The Hospital Anxiety and Depression Scale (HADS) was used to monitor anxious and depressive symptoms. RESULTS GP-concordance was highest in the TC group, followed by the CR group with significant improvements in medication and psychotherapeutic recommendations compared to CAU. Higher concordance was associated with a significant greater decrease in HADS depression scores but not anxiety scores after 6weeks. CONCLUSION Telephone communication between CL-psychiatrists and GPs improve GPs' concordance with psychiatric recommendations. This easy-to-implement intervention takes about 10min time but prevents loss of information. It may enhance quality of GPs' mental health care and lead to improved outcomes.
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Incorporation of Delirium Prevention in Palliative Medicine. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:433. [PMID: 27397017 PMCID: PMC4941612 DOI: 10.3238/arztebl.2016.0433a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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A study on the usefulness and reliability of the "Scheme of Appraisal of Emotional Development" (SAED) for persons with ID using direct observation in a group-based assessment procedure. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 49-50:108-117. [PMID: 26698407 DOI: 10.1016/j.ridd.2015.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 10/26/2015] [Accepted: 11/19/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Whereas instruments for the assessment of intellectual and social abilities are widely available, instruments for the evaluation of emotional development of persons with intellectual disabilities (ID) are rare. The Scheme of Appraisal of Emotional Development (SAED), an internationally used tool developed by Dosen (2005a. Journal of Intellectual Disability Research, 49, 1, 2005b. Journal of Intellectual Disability Research, 49, 9), is one of the latter and is based on interviews with caregivers. The present study aims to investigate the internal consistency and interrater-reliability by changing the interview procedure into a direct observation and evaluation approach by a whole team instead of by one expert. METHOD The level of emotional development of 175 patients admitted to a psychiatric inpatient unit specialized in the treatment of adults with ID was evaluated with the SAED by the treatment team after an observation period of up to two weeks. The inter- and intra-rater-reliability was assessed by direct observation of the behaviour of an additional 50 patients by two pairs of raters. RESULTS The internal consistency of the SAED dimensions, once rated by team approach, is excellent, and the reliability measures show also good statistical results. CONCLUSION AND IMPLICATIONS The evaluation of the level of emotional development using the SAED by a group-led and/or direct observational procedure show to be a reliable and useful approach. The group-based procedure yields equal results compared with the usual interview guidelines and might lead to an additional training effect within the respective teams. The rater-reliability measures align with those reported in other studies.
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Music-based Autism Diagnostics (MUSAD) - A newly developed diagnostic measure for adults with intellectual developmental disabilities suspected of autism. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 43-44:123-135. [PMID: 26183337 DOI: 10.1016/j.ridd.2015.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 04/20/2015] [Accepted: 05/28/2015] [Indexed: 06/04/2023]
Abstract
UNLABELLED The MUSAD was developed as a diagnostic observational instrument in an interactional music framework. It is based on the ICD-10/DSM-5 criteria for autism spectrum disorder (ASD) and was designed to assess adults on a lower level of functioning, including individuals with severe language impairments. This study aimed to evaluate the psychometric properties of the newly developed instrument. METHODS Calculations were based on a consecutive clinical sample of N=76 adults with intellectual and developmental disabilities (IDD) suspected of ASD. Objectivity, test-retest reliability, and construct validity were calculated and a confirmatory factor analysis was applied to verify a reduced and optimized test version. RESULTS The structural model showed a good fit, while internal consistency of the subscales was excellent (ω>.92). Item difficulties ranged between .04≤pi≤.82 and item-total correlation from .21 to .85. Objectivity was assessed by comparing the scorings of two external raters based on a subsample of n=12; interrater agreement was .71 (ICC 2, 1). Reliability was calculated for four test repetitions: the average ICC (3, 1) was .69. Convergent ASD measures correlated significantly with the MUSAD, while the discriminant Modified Overt Aggression Scale (MOAS) showed no significant overlap. CONCLUSION Confirmation of factorial structure and acceptable psychometric properties suggest that the MUSAD is a promising new instrument for diagnosing ASD in adults with IDD.
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Somatization among ethnic minorities and immigrants: Why does it matter to Consultation Liaison Psychiatry? J Psychosom Res 2015; 79:85-6. [PMID: 25840950 DOI: 10.1016/j.jpsychores.2015.02.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 01/29/2015] [Accepted: 02/16/2015] [Indexed: 11/24/2022]
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Music in diagnostics: using musical interactional settings for diagnosing autism in adults with intellectual developmental disabilities. NORDIC JOURNAL OF MUSIC THERAPY 2015. [DOI: 10.1080/08098131.2015.1039567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Validity of the social communication questionnaire in adults with intellectual disabilities and suspected autism spectrum disorder. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2015; 120:203-214. [PMID: 25928433 DOI: 10.1352/1944-7558-120.3.203] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study examined the validity of the Social Communication Questionnaire (SCQ) to identify autism spectrum disorder (ASD) in 151 adults with intellectual disabilities (ID) in Germany. Sensitivities and specificities for ASD were 98/47% for the SCQ-current version and 92/22% for the SCQ-lifetime version. Sensitivities and specificities were increased to 89/66% and 78/48% by adjusting the recommended cut-points. The SCQ-current score correlated with the Scale for Pervasive Developmental Disorders in Mentally Retarded Persons and the Autism Diagnostic Observation Schedule, whereas the SCQ-lifetime score correlated with the Autism Diagnostic Interview-Revised. Our findings support the use of the SCQ-current version for ASD screening in adults with ID, although the SCQ-lifetime version should be used with caution in this population.
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[Psyche and soma: what can the consultation-liaison psychiatrist contribute?]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2014; 29:54-62. [PMID: 25416207 DOI: 10.1007/s40211-014-0126-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/31/2014] [Indexed: 06/04/2023]
Abstract
In German speaking countries, during the last decades, we can see a growing, though albeit small, integration of psychiatry and psychosomatics into (somatic) medicine. This article outlines the importance of the growing number of elderly patients in medical care as a vantage point for c-l-psychiatrists to play a pro-active role in implementing adequate structures and processes for diagnostics and treatment of this patient group. It is argued that delirium (in dementia) can and should be regarded as a paradigm for a biopsychosocial disorder sui generis. In addition, aspects of the cl-psychiatrists role at two important interfaces of somatic and psychological medicine, i.e. primary care and emergency rooms, are highlighted. Finally, some information about the development of the professionalization of cl-psychiatry in Europe is given.
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Establishing a nurse-based psychiatric CL service in the accident and emergency department of a general hospital in Germany. DER NERVENARZT 2014; 85:1217-24. [PMID: 24969951 DOI: 10.1007/s00115-014-4069-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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[Mental Health Care Utilization of First Generation Vietnamese Migrants in Germany]. PSYCHIATRISCHE PRAXIS 2014; 42:267-73. [PMID: 24858434 DOI: 10.1055/s-0034-1370008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Vietnamese migrants underutilize and are a "hard to reach group" within the existing mental health care system in Germany. METHODS We analyzed migration related and clinical data for all first-time Vietnamese migrants seeking psychiatric help, within the first 30 months of a newly established outpatient clinic, offering culture-sensitive psychiatric treatment in native Vietnamese language. RESULTS Most first time patients were female, first generation Vietnamese migrants with poor German language skills. Only 1 /3 of all patients had a psychiatric history, while this number was higher in patients with schizophrenia. Over time, more first time patients with depression were seeking psychiatric care, accompanied with an increase of non-professional referrals within the Vietnamese communities. CONCLUSION This first study on mental health care utilization in Vietnamese migrants in Germany points towards the fact that "migrants" cannot be considered as a homogeneous group. Mental health care utilization must be evaluated for specific migrant groups, and can be initially improved if offered in native language and when it is referred to by members of migrant communities.
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Comorbid intellectual disability. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:117. [PMID: 24622681 PMCID: PMC3957053 DOI: 10.3238/arztebl.2014.0117a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
Die Akzeptanz- und Commitment Therapie (ACT) ist ein junges Therapieverfahren, welches maßgeblich aus der kognitiven Verhaltenstherapie (KVT) entstanden ist und in der Praxis zunehmend Verbreitung findet. Dabei werden die behavioralen und kognitiven Komponenten der VT vor allem durch Achtsamkeit, Wertorientierung und Akzeptanz ergänzt. Die ACT findet ihre theoretische Begründung in der Bezugsrahmentheorie. Darauf aufbauend wurde für ACT ein konzeptionelles Störungsmodell entwickelt, aus welchem sich klare Behandlungsziele ableiten lassen. Bei ACT werden Behandlungsziele im Gegensatz zu vielen traditionellen Verfahren fundamental anders formuliert: Es geht nicht darum, Symptome und Beschwerden loszuwerden, sondern sein Leben so zu gestalten, dass es Sinn und Wert erhält. Dies kann im Einzelfall heißen, Symptome und Beschwerden anzunehmen und zu akzeptieren, statt wertvolle Lebenszeit im Kampf mit ihnen zu verbringen. Dieser Ansatz macht ACT besonders interessant für die Arbeit mit Patienten, die an chronischen und therapierefraktären Erkrankungen leiden. Desgleichen erscheint ACT durch die explizite Orientierung an Lebenswerten und Akzeptanz für den Einsatz in resilienz-fördernden Präventionsprogrammen prädestiniert. Es existieren bereits einige Metaanalysen, sowie störungsspezifische Studien, die sich mit der Wirksamkeit von der ACT befasst haben. Obwohl die Forschungsergebnisse variieren, weist ein Großteil der Ergebnisse darauf hin, dass die ACT eine wirksame Therapiemethode zu sein scheint. ACT bereichert das Methodenrepertoire in der klinischen Praxis, insbesondere in Bezug auf den aktuellen Forschungsstand werden im vorliegenden Artikel jedoch einige Aspekte kritisch betrachtet.
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Etablierung eines Modells zur Beurteilung der sozioemotionalen Entwicklung bei Menschen mit geistiger Behinderung in ein Team. PSYCHIATRISCHE PRAXIS 2013; 42:35-41. [DOI: 10.1055/s-0033-1349565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Emotional development in adults with autism and intellectual disabilities: a retrospective, clinical analysis. PLoS One 2013; 8:e74036. [PMID: 24066092 PMCID: PMC3774757 DOI: 10.1371/journal.pone.0074036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/26/2013] [Indexed: 12/28/2022] Open
Abstract
Individuals with intellectual disability (ID) are at risk for additional autism spectrum disorders (ASD). A large amount of research reveals deficits in emotion-related processes that are relevant to social cognition in ASD. However, studies on the structure and level of emotional development (ED) assessing emotional maturity according to the normative trajectory in typically developing children are scares. The level of ED can be evaluated by the 'Scheme of Appraisal of Emotional Development' (SAED), a semi-structured interview with a close caregiver. The SAED assesses the level of emotional developmental based on a five stage system in 10 domains, for example, 'interaction with peers' or 'object permanence', which are conducive to the overall emotional developmental level. This study examined the ED as measured by the SAED in 289 adults (mean age: 36 years) with ID with and without additional ASD. A lower level in ED was observed in ASD/ID combined that corresponded to the ED of typically developing children aged 1.5-3 years versus an ED with a corresponding age of 3-7 years in ID individuals without ASD. Moreover, distinct strengths in 'object permanence', and weaknesses in 'interaction', 'verbal communication', 'experience of self', 'affect differentiation', 'anxiety', and 'handling of material objects' led to a characteristic pattern of ED in ASD. SAED domains with highest discriminative power between ID individuals with and without ASD (5/10) were used to predict ASD group membership. The classification using a selection of SAED domains revealed a sensitivity of 77.5% and a specificity of 76.4%. ASD risk increased 2.7-fold with every SAED level. The recognition of delayed and uneven pattern of ED contributes to our understanding of the emotion-related impairments in adults with ID and ASD these individuals. Assessment of intra-individual ED could add value to the standard diagnostic procedures in ID, a population at risk for underdiagnosed ASD.
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The Missing Link: Delayed Emotional Development Predicts Challenging Behavior in Adults with Intellectual Disability. J Autism Dev Disord 2013; 44:786-800. [DOI: 10.1007/s10803-013-1933-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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[Psychometric properties of the Autism-Checklist (ACL) in adults with intellectual disability]. PSYCHIATRISCHE PRAXIS 2013; 41:37-44. [PMID: 23681789 DOI: 10.1055/s-0033-1343193] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the validity of the Autism-Checklist (ACL) in adults with intellectual disability (ID) who are suspected of having autism spectrum disorder. METHODS In 154 adults with ID the results of the ACL were compared to the results of the final diagnostic classification obtained by a multiprofessional case conference for autism. Psychometric properties of the ACL were evaluated. RESULTS The internal consistency as indicated by Cronbach's alpha was 0.81. The ACL sum score highly correlated with established screening measures such as the Social Communication Questionnaire (SCQ: Spearman's rho = 0.620) and the Pervasive Developmental Disorder in Mental Retardation Scale (PDD-MRS: Spearman's rho = 0.490). ROC Analysis revealed an area under the curve of 0.859. The ACL classification complied with the final diagnostic classification in 80.5 % and Cohen's kappa revealed a moderate agreement of 0.596. Sensitivity/specificity of the ACL were 90.7 %/67.6 %, respectively. Interrater-intertime reliability was good (Cohen's kappa = 0.702; Spearman = 0.549; n = 53). In 19 patients (22 %) a diagnosis of ASD had been given prior to referral. CONCLUSION The ACL is a suitable measure for adults with ID and suspicion of autism spectrum disorders.
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Diagnosing autism in a clinical sample of adults with intellectual disabilities: how useful are the ADOS and the ADI-R? RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1642-1655. [PMID: 23475013 DOI: 10.1016/j.ridd.2013.01.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 01/29/2013] [Accepted: 01/29/2013] [Indexed: 06/01/2023]
Abstract
Intellectual disability (ID) and autism spectrum disorder (ASD) are frequently co-occurring conditions. Carefully diagnosing ASD in individuals with ID would allow for more tailored clinical interventions that would improve mental health and quality of life. In this study, we evaluated the psychometric properties of the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R) in a clinical sample of 79 adults with ID who were suspected of also having ASD. In the testable cases (68%), the ADOS was over-inclusive (specificity 45%) but highly sensitive (100%) of ASD. In the ADI-R, the feasibility was 37%, with a sensitivity of 88% and a specificity of 80%. Previously proposed adaptations of the ADOS algorithm were evaluated, and new items and tasks were suggested. The ADOS and the ADI-R were found to be valuable diagnostic tools for adults with ID. Adjustments of the setting and the tasks may further improve their feasibility and specificity.
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