[The use of HoNOS in the treatment of patients]

BACKGROUND

In order to use outcome scores for making decisions about treatment, practitioners need to know the course of scores of several groups of patients.

AIM

To test the applicability of methods for computing cut-off scores and individual changes.

METHOD

Using Health of the Nation Outcome Scales (HoNOS), we analysed repeated assessments of 699 adults and 414 elderly patients in different treatment settings.

RESULTS

Mean HoNOS scores and cut-off scores differentiated between patient groups reasonably well. Scores and threshold values for elderly patients were relatively high. The reliable change index showed few individual changes even for groups where change was expected. The effect size and the standard error of measurement were found to be more sensitive to change.

CONCLUSION

More research is needed before the findings can be generalised.

[ROM in adult psychiatry: an evaluation of measurement instruments]

BACKGROUND

An evaluation of the most commonly used ROM measures in Dutch psychiatry is lacking, both for severe mental illnesses and for common psychiatric disorders.

AIM

To provide an overview of the characteristics and quality of outcome measures.

METHOD

A literature study yielded six outcome measures. The psychometrical, clinical and practical aspects of these scales are described.

RESULTS

The measures are suitable and are of adequate quality.

DISCUSSION

It remains to be seen if any of the outcome measures are suitable for both serious and less serious mental illnesses. The use of a combination of a self-rating scale and an observerrating scale that measure symptoms and domains of functioning may be the most promising choice.

[Validation of two measuring instruments for routine outcome monitoring in psychiatry: the HORVAN study]

BACKGROUND

Transparency in psychiatry can be increased by the use of routine outcome monitoring (rom) instruments. Instruments should be easy to use and take very little time to complete; they also need to have psychometric qualities, be sensitive to change, and provide information about patients' symptoms, and about interpersonal and social functioning.

AIM

To investigate to what extent the combination of Health of the Nation Outcome Scales (HoNOS) and the Outcome Questionnaire (OQ) in the Dutch situation meets the above-mentioned quality criteria and to examine how the combination relates to the Symptom CheckList (SCL-­90).

METHOD

Data for 148 patients collected at three measurement moments were available for analysis. The psychometric qualities of the instruments and their sensitivity to change were checked carefully.

RESULTS

The three scales showed high values for internal consistency (Cronbach's alpha). The HoNOS total score and the subscales of the OQ correlated reasonably well with the SCL­-90 total score (convergence validity). At the first measurements, patients with a comorbid diagnosis had the lowest scores (discrimination validity). The clinically significant change between T1 and T2 and between T2 and T3 was sufficiently high for all three measuring instruments.

CONCLUSION

The combination of the HoNOS rating scale and the self­-report list OQ seems to be suitable for ROM in psychiatry.

The effect of moderate and excessive alcohol use on the course and outcome of patients with bipolar disorders: a prospective cohort study

OBJECTIVE

Comorbid alcohol use disorders (AUDs) are frequently associated with negative effects on course and outcome of bipolar disorder. This prospective cohort study assessed the effect of actual alcohol use (no, moderate, and excessive) on the course and outcome of patients with bipolar disorders.

METHOD

Between June 2003 and November 2005, 137 outpatients (aged 23-68 years) with DSM-IV-diagnosed bipolar I (66%) or II (34%) disorder rated their mood and the number of alcohol units consumed daily for a period up to 52 weeks with the National Institute of Mental Health Self-Rating Prospective Life-Chart Method (LCM). At baseline, the Structured Clinical Interview for DSM-IV was administrated, and demographic, social, and clinical characteristics were obtained. At monthly visits, the Clinical Global Impressions Scale-Bipolar Version (CGI-BP), the Global Assessment of Functioning (GAF) scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey (MOS-SF-36) were rated. Based on the alcohol use in the first 4 weeks of follow-up, patients were assigned to 1 of 3 groups: no/incidental, moderate, or excessive alcohol use.

RESULTS

None of the sociodemographic and clinical characteristics at baseline were significantly different between the 3 drinking groups, with the exception of-and as a consequence of the group assignment-the prevalence of lifetime and current diagnosis of AUD. Also, no differences between the 3 drinking groups were found on any of the clinical outcome variables, ie, number of days ill (depressed, hypomanic/manic, and total); severity of depression, mania, and overall bipolar illness (LCM); GAF score; CGI-BP (depression, mania, and overall); and all the subscales of the MOS-SF-36. Also, the number of episodes according to DSM-IV and the Leapfrog method showed no significant differences between the drinking groups.

CONCLUSIONS

In this sample of patients and with the sensitive measurement of mood and drinking status over a full year, we could not confirm the findings of other studies indicating a negative effect of excessive alcohol use on the course of bipolar illness. This study found that neither moderate nor excessive use of alcohol has a negative effect on the course and outcome of bipolar illness. Possible explanations for these findings are discussed.