Vignette Research on Messy and Confusing Problems in Primary Mental Healthcare.

The average primary care psychologist feels an ever-widening gap between objective, measurable reality as described and the complex and dynamic reality they experience. To obtain a better understanding of this complex dynamic reality, we conducted an exploratory mixed-method study of primary care psychologists. We asked our participants to write vignettes about messy and confusing problems in the complex context of mental healthcare. We then examined the data in portions, exposed the patterns in the data, and subsequently analysed all in conjunction. The 113 vignettes showed experiences of psychologists dealing not only with the patient, but also with the family of the patient and/or employers, working together with other healthcare professionals, struggling with dilemmas and having mixed feelings. However, using the Cynafin Framework, 36% of the vignettes were still rated as simple. Was it because those vignettes contained fewer words (p = .006)? Or because it is difficult to grasp complexity when cause and effect are intertwined with emotions, norms and values? In the discussion, we suggest examining a complex dynamic system in terms of both the consistency of its various elements and the dynamics of the system. We also discuss how to optimize the system's adaptive self-organizing ability and how to challenge ourselves to invent negative feedback loops that can keep the complex system in equilibrium.

The Complexity of Primary Care Psychology: Theoretical Foundations.

How does primary care psychology deal with organized complexity? Has it escaped Newtonian science? Has it, as Weaver (1991) suggests, found a way to 'manage problems with many interrelated factors that cannot be dealt by statistical techniques'? Computer simulations and mathematical models in psychology are ongoing positive developments in the study of complex systems. However, the theoretical development of complex systems in psychology lags behind these advances. In this article we use complexity science to develop a theory on experienced complexity in the daily practice of primary care psychologists. We briefly answer the ontological question of what we see (from the perspective of primary care psychology) as reality, the epistemological question of what we can know, the methodological question of how to act, and the ethical question of what is good care. Following our empirical study, we conclude that complexity science can describe the experienced complexity of the psychologist and offer room for personalized client-centered care. Complexity science is slowly filling the gap between the dominant reductionist theory and complex daily practice.

The effectiveness of staff training focused on increasing emotional intelligence and improving interaction between support staff and clients.

BACKGROUND: Recent research addressed the relationship between staff behaviour and challenging behaviour of individuals with an intellectual disability (ID). Consequently, research on interventions aimed at staff is warranted. The present study focused on the effectiveness of a staff training aimed at emotional intelligence and interactions between staff and clients. The effects of the training on emotional intelligence, coping style and emotions of support staff were investigated. METHOD: Participants were 214 support staff working within residential settings for individuals with ID and challenging behaviour. The experimental group consisted of 76 staff members, 138 staff members participated in two different control groups. A pre-test, post-test, follow-up control group design was used. Effectiveness was assessed using questionnaires addressing emotional intelligence, coping and emotions. RESULTS: Emotional intelligence of the experimental group changed significantly more than that of the two control groups. The experimental group showed an increase in task-oriented coping, whereas one control group did not. The results with regard to emotions were mixed. Follow-up data revealed that effects within the experimental group were still present four months after the training ended. CONCLUSIONS: A staff training aimed at emotional intelligence and staff-client interactions is effective in improving emotional intelligence and coping styles of support staff. However, the need for more research aiming at the relationship between staff characteristics, organisational factors and their mediating role in the effectiveness of staff training is emphasised.

The critical conditions for coalescence in phase field simulations of colliding droplets in shear.

Simulations have been performed using the free-energy binary-liquid lattice Boltzmann method with sufficient resolution that the critical capillary number for coalescence was determined for collisions between droplets in simple shear with a small initial offset in the shear gradient direction. The simulations were used to study the behavior of the interacting interfaces and the film between them during collisions over a wide range of capillary numbers with emphasis on near-critical conditions. From these three-dimensional simulations with deforming interfaces, several features of the evolution of the film between the drops were observed. The critical film thickness was determined to be similar to the interface thickness, a power law described the dependence of the minimum film thickness on the capillary number in collisions without coalescece, and an inflection point was found in the dynamics of the minimum distance between drops that eventually coalesce. The rotation of the film and the flow in it were also studied, and a reversal in the flow was found to occur before coalescence. The mobility of the phase field was therefore important in the continued thinning of the film at the points of minimum thickness after the flow reversal. A comparison of the critical capillary number and critical film thickness in the simulations with the values for experiments in confined simple shear indicated that the effective physical radius of the simulated droplets was on the order of several micrometers. The results are significant for simulations of droplet interactions and emulsion flows in complex geometries and turbulence because they demonstrate the necessary scale of the computations and how parameters, such as the interface thickness and phase field mobility, should be selected for accurate results.

Simulations of droplet coalescence in simple shear flow.

Simulating droplet coalescence is challenging because small-scale (tens of nanometers) phenomena determine the behavior of much larger (micrometer- to millimeter-scale) droplets. In general, liquid droplets colliding in a liquid medium coalesce when the capillary number is less than a critical value. We present simulations of droplet collisions and coalescence in simple shear flow using the free-energy binary-liquid lattice Boltzmann method. In previous simulations of low-speed collisions, droplets coalesced at unrealistically high capillary numbers. Simulations of noncoalescing droplets have not been reported, and therefore, the critical capillary number for simulated collisions was unknown. By simulating droplets with radii up to 100 lattice nodes, we determine the critical capillary number for coalescence and quantify the effects of several numerical and geometric parameters. The simulations were performed with a well-resolved interface, a Reynolds number of one, and capillary numbers from 0.01 to 0.2. The ratio of the droplet radius and interface thickness has the greatest effect on the critical capillary number. As in experiments, the critical capillary number decreases with increasing droplet size. A second numerical parameter, the interface diffusivity (Péclet number) also influences the conditions for coalescence: coalescence occurs at higher capillary numbers with lower Péclet numbers (higher diffusivity). The effects of the vertical offset between the droplets and the confinement of the droplets were also studied. Physically reasonable results were obtained and provide insight into the conditions for coalescence. Simulations that match the conditions of experiments reported in the literature remain computationally impractical. However, the scale of the simulations is now sufficiently large that a comparison with experiments involving smaller droplets (≈10 µm) and lower viscosities (≈10(-6) m(2)/s, the viscosity of water) may be possible. Experiments at these conditions are therefore needed to determine the interface thickness and Péclet number that should be used for predictive simulations of coalescence phenomena.

Training emotional intelligence related to treatment skills of staff working with clients with intellectual disabilities and challenging behaviour.

BACKGROUND: Staff working with clients with intellectual disabilities (ID) who display challenging behaviour may contribute to the continuation of this behaviour, because it causes emotional reactions such as anxiety, anger and annoyance, which may prohibit adequate response behaviour. To enhance staff behaviour and treatment skills a training that aimed at improving emotional intelligence (EQ) was developed. AIM: The goal of this study was to assess whether an EQ training in combination with a video-feedback training programme improves emotional intelligence of staff working with clients with ID and challenging behaviour. METHODS: Participants were 60 staff members working with individuals with ID and challenging behaviour. Thirty-four staff members participated in a 4-month training programme and 26 constituted the control group. A pretest-posttest control group design was used. Effectiveness was assessed by using the Dutch version of the Bar-On EQ-i and the judgments of experts on emotional intelligence. RESULTS: Emotional intelligence of the experimental group changed significantly more than that of the control group. Judgments of experts on emotional intelligence indicated that the change of emotional intelligence of the experimental group improved positively. CONCLUSIONS: The positive effect of the training programme on emotional intelligence is consistent with previous research on emotional intelligence and suggests that emotional intelligence of staff working with clients with ID and challenging behaviour can be influenced by training.

Comparability of scores on the MMPI-2-RF scales generated with the MMPI-2 and MMPI-2-RF booklets.

In most validity studies on the recently released 338-item MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) Restructured Form (MMPI-2-RF; Ben-Porath & Tellegen, 2008; Tellegen & Ben-Porath, 2008), scale scores were derived from the 567-item MMPI-2 booklet. In this study, we evaluated the comparability of the MMPI-2-RF scale scores derived from the original 567-item MMPI-2 booklet with MMPI-2-RF scale scores derived from the 338-item MMPI-2-RF booklet in a Dutch student sample (N = 107). We used a counterbalanced (ABBA) design. We compared results with those previously reported by Tellegen and Ben-Porath (2008). Our findings support the comparability of the scores of the 338-item version and the 567-item version of the 50 MMPI-2-RF scales. We discuss clinical implications and directions for further research.

Psychometric evaluation of the MMPI-2 Restructured Clinical scales in two Dutch samples.

In this article, we evaluate internal validity, internal consistency, and test-retest reliability of the MMPI-2 Restructured Clinical (RC) scales in the Dutch MMPI-2 normative sample (N = 1,244) and a Dutch outpatient psychiatric sample (N = 1,066). We pay special attention to a critique regarding construct drift of RC3 and the redundancy of the RC scales with existing MMPI-2 scales. The results indicate that the RC scales in both samples show comparable or better internal consistencies than the Clinical scales. Also, in both samples, the RC scales demonstrate lower scale-level intercorrelations than the Clinical scales. As to the structural characteristics, principal component analysis of the RC scales provided a clearer pattern than an analysis of the Clinical scales. Furthermore, mean raw scores on the RC scales for men in the Dutch normative sample corresponded highly with those in the U.S. normative sample except for RC2 and RC4. Less correspondence was found for women. Overall, we conclude that the RC scales show satisfactory reliability and promising internal validity in our Dutch samples. We suggest that U.S. validation studies on the RC scales may be generalized to the Dutch-language version of the MMPI-2 RC scales.

[Short-term psychodynamic psychotherapy]. / Kortdurende psychodynamische psychotherapie.

BACKGROUND: The past twenty years have seen many developments in 'psychodynamic' psychotherapy. AIM: To provide an overview of recent developments in short-term psychodynamic psychotherapy. This involves summarizing current approaches and describing in detail the model developed by Malan and Davanloo. A summary is also given of empirical research into the effect of the various treatment modalities. METHOD: Modern manuals were consulted, which describe many of the recent developments and contain contributions by the leading representatives of the various therapeutic orientations. In addition, a literature survey was carried out; by means of Webspirs it was possible to search PsycINFO, Medline and Current Contents for studies relating to empirical research in the effect of psychodynamic psychotherapy. RESULTS There are several variants of the psychodynamic treatment modality. In each of them the treatment duration is reduced, mainly because the focus is on certain particular elements. In addition, a maximum number of sessions is specified. The frequency can be varied and the psychotherapist is much more actively involved than in classical psychoanalytic psychotherapy. Techniques from other therapeutic orientations are integrated, but the focus on defence and affect expressions is preserved. Especially shorter treatment has stimulated empirical research and gradually it is becoming possible to compare short-term treatment with other forms of treatment. CONCLUSION: Short term psychodynamic psychotherapy fits in with modern requirements with regard to efficiency, brevity and (empirical) transparency. This form of treatment deserves its own place in modern psychotherapy because it focuses directly on the patient's actual feelings and emotions. Research into the effectiveness of dynamic therapy has already begun, but more work needs to be done in this area.

A preliminary study of the diagnostic accuracy of the Gerontological Personality disorders Scale (GPS).

BACKGROUND: There is still a lack of diagnostic instruments that are specifically developed to diagnose personality disorders in the elderly. OBJECTIVE: To develop a reliable and valid screening instrument to assess personality disorders in older adults. METHOD: The draft version of the screening instrument (52 items) consists of two sections: one for patients and one for informants. The diagnostic accuracy of the instrument has been assessed in the Netherlands in 159 elderly patients in an ambulatory department of geriatric psychiatry and 96 informants. RESULTS: In the patient section, sixteen items had a reasonable score for both sensitivity and specificity (approximately 70%). The internal consistency was moderate for habitual behavior (HAB; 7 items) and good for biographical information (BIO; 9 items). The test and retest reliability was moderate for HAB and excellent for BIO. The informant section, on the other hand, had a low score for sensitivity (45%) and a good score for specificity (78%). CONCLUSION: A specific instrument has been developed to diagnose personality disorders in older adults. However, further research is necessary to improve the diagnostic accuracy of the Gerontological Personality disorders Scale (GPS).

The relevance of a geriatric sub-classification of personality disorders in the DSM-V.

Little is known about the course of personality disorders across the life span. A major problem is that the current DSM nosology for personality disorders does not account for age-associated changes in behaviour and interpersonal functioning. This editorial will discuss the main diagnostic bottlenecks when applying the current DSM-IV-TR Axis II criteria to older adults. Subsequently, suggestions will be given for future research and the development of a geriatric sub-classification.

[Construction of a scale to signal personality disorders in the elderly]. / Constructie van een schaal voor signalering van persoonlijkheidsstoornissen bij ouderen.

Till now, no specific diagnostic instruments to detect personality disorders in the elderly are available. The aim of our study was to contribute to the construction of a reliable en valid instrument for the detection of personality disorders in older adults. Therefore, a draft version of the instrument was constructed both for the patient and the informant. Both the patient and the informant version of the instrument included 52 items with the same content. These items concerned Habitual behaviour (HAB), Biographical information (BIO) and Observation of actual behaviour (OBS). 159 clients of 60 years and older of a Dutch ambulatory mental health care organisation were assessed with the screening instrument. In 96 of the 159 outpatients one or more informants were included. The results indicate that the internal consistency of seven HAB items, nine BIO items and five OBS items was moderate to good with regard to both the patient and informant instrument. Test-retest reliability of the 21 items of the patient instrument was moderate with regard to HAB, excellent with regard to BIO and moderate with regard to OBS. Interrater reliability of OBS was also moderate. The criterion validity (criterion: DSM-IV TR Axis II classification) of HAB, BIO and OBS based on the 21 items of the patient instrument was fair and with regard to the same 21 items of the informant instrument insufficient. In conclusion, sixteen out of 52 potential items of the patient's draft version of the screening instrument can be used to detect a possible personality disorder. These sixteen items from the HAB and BIO scale are named the Gerontological Personality disorder Scale (GPS). Medical doctors, psychologists and nurses working in ambulatory mental health organisation can use the GPS as a resource during the diagnostic process. Whether the GPS can be used beyond mental health organisations, for example by general practitioners is a subject for future studies.

[Personality diagnosis in elderly psychiatric patients using a Delphi technique]. / Een Delphi-onderzoek naar persoonlijkheidsdiagnostiek in de (A)GGZ bij ouderen.

A Delphi-technique was used as part of the development of a screening instrument to diagnose personality disorders in the elderly. Several statements regarding this subject were tested. Fifty-three Delphi-members, with expertise in the field of mental health services for the elderly and knowledge about the concept 'personality disorder', gave their opinion on the statements. In three successive rounds we aimed to get consensus as well as agreement on the contents of the statements. In the first round the Delphi-panel confirmed the importance of diagnosing personality disorders, with regard to individual therapy in older adults and psycho-educational activities. The DSM-IV Axis II criteria and related assessment-instruments do not take into account the emotional and social context of the elderly people. In the second round the Delphi-panel endorsed the importance of several information sources namely biographical information, informant information, behavioural observations and the reactions of the therapist himself. In the third round, 44 items considering diagnostics on personality were pro-pounded to the panel. There was agreement as well as consensus on 25 out of the 44 items. In conclusion, adjusting the DSM-IV Axis II criteria to the elderly will improve the quality of the diagnostics. Developments of a specific screening instrument for older adults probably will also increase the quality of the diagnostics.

Improved bounce-back methods for no-slip walls in lattice-Boltzmann schemes: theory and simulations.

A detailed analysis is presented for the accuracy of several bounce-back methods for imposing no-slip walls in lattice-Boltzmann schemes. By solving the lattice-BGK (Bhatnagar-Gross-Krook) equations analytically in the case of plane Poiseuille flow, it is found that the volumetric approach by Chen et al. is first-order accurate in space, and the method of Bouzidi et al. second-order accurate in space. The latter method, however, is not mass conservative because of errors associated with interpolation of densities residing on grid nodes. Therefore, similar interpolations are applied to Chen's volumetric scheme, which indeed improves the accuracy in the case of plane Poiseuille flow with boundaries parallel to the underlying grid. For skew boundaries, however, it is found that the accuracy remains first order. An alternative volumetric approach is proposed with a more accurate description of the geometrical surface. This scheme is demonstrated to be second-order accurate, even in the case of skew channels. The scheme is mass conservative in the propagation step because of its volumetric description, but still not in the collision step. However, the deviation in the mass is, in general, found to be small and proportional to the second-order terms in the standard BGK equilibrium distribution. Consequently, the scheme is a priori mass conservative for Stokes flow.

Volumetric method for calculating the flow around moving objects in lattice-Boltzmann schemes.

A method for calculating the fluid flow around moving objects is presented, based on a volumetric representation of the lattice-Boltzmann scheme and surfaces defined by facets. It enables us to move objects of arbitrary shape and orientation independent of the position of the grid nodes. To represent the motion of the object, additional momentum is added to the reflected particles from each facet in the propagation step. These particles are redistributed on nodes in the vicinity of the surface, depending on the position and orientation of the facet. Because the surface is considered to be closed, additional techniques need to be used to guarantee the conservation of mass. The flow field of a moving periodic cubic array of cubes at two Re numbers (Re=0.5 and Re=50) is compared with that of a fixed array. For Re=0.5, no significant deviations are found for the velocity field, pressure field, and the drag force. For Re=50, the drag and pressure field exhibit small fluctuations that relate to the position of the surface relative to the position of the grid. However, the influence of the pressure fluctuations on the velocity field is very small. Results on the velocity for a moving array of cubes show second-order accuracy in the lattice spacing. For physical consistency, the drag force on a periodic cubic array of moving spheres at Re=0.5 is compared with Hasimoto's analytical solution. The dependence on the grid spacing, the resolution of the surface of the object, and the viscosity have been studied. The discrepancies between simulations and the analytical results are smaller than 1.5%. For Re=50, the drag force, the streamline pattern, and the pressure field around a moving sphere in a large periodic domain showed good agreement with data from literature on a single sphere in an infinitely large flow field.

[Personality disorders in the elderly. Three case reports]. / Persoonlijkheidsstoornissen bij ouderen. Drie case-studies.

Little is known about diagnosing personality disorders in elderly persons. The current Axis II nosology is not age related and the majority of psychological tests are unreliable. Three cases dealing with personality disorders are presented. In these cases loss of health, relationships and autonomy are pointed out as the age specific stressors. We studied the relation between psychological symptoms, personality, coping style and age specific stressor. It appeared that elderly persons with personality disorders often have difficulties coping with these stressors. Inadequate coping styles may luxate or exaggerate axis I disorders. Therefore we recommend to pay more attention to the axis II classification during the diagnostical process.

MMPI-2 Personality Psychopathology Five (PSY-5) and prediction of treatment outcome for patients with chronic back pain.

This study investigated the utility of the MMPI-2-based Personality Psychopathology Five (PSY-5) scales (Harkness, McNulty, & Ben-Porath, 1995) in the outcome prediction of behaviorally oriented chronic-pain treatment. The PSY-5 is a dimensional descriptive system for personality and its disorders. The sample consisted of 120 consecutive chronic-back-pain patients who followed a 4-week multimodal treatment program aimed at achieving a normal pattern of functioning, including return to regular work. The psychometric properties of the PSY-5 scales (Aggressiveness, Psychoticism, Constraint, Negative Emotionality/Neuroticism, and Positive Emotionality/Extraversion) were highly similar to the data reported by Harkness et al. (1995) and also corresponded to the characteristics of chronic-pain patients. The results of the hierarchical regression analyses provided support for the utility of the PSY-5 Positive Emotionality/Extraversion scale for the prediction of emotionally oriented outcome. We conclude that the PSY-5 model of personality psychopathology provides a solid basis for the more systematic study of the complex relation between personality characteristics and multidimensional treatment.

Assessment of chronic back pain patient characteristics using factor analysis of the MMPI-2: which dimensions are actually assessed?

Guided by the study of Deardorff et al. (Pain, 54 (1993) 153-158), the MMPI-2 data from 240 chronic back pain patients were factor-analyzed in an attempt to discern the most important dimensions for this patient population. Principal components analysis with an oblique rotation revealed four underlying factors: Psychological disturbances, Extraversion-introversion, Passivity, and Somatic complaints. The factor structure reported by Deardorff et al. was thus successfully replicated. The stability of the factors was also supported using random split subsamples. External measures relevant to pain were used to investigate the external validity of Somatic complaints in a subsample of patients (n=93). Relations were found to number of painful sites, Waddell signs, fear of movement (maximal isometric flexion and extension performance by dynamometry, and cardiovascular fitness (VO2-max). Substantial differences emerged across genders. The derived MMPI-2 dimensions appear to constitute important characteristics associated with chronic pain. It is concluded that MMPI-2 research into chronic pain may become more productive when the instrument and its clinical correlates are examined within a clear conceptual framework of distress and personality relevant for chronic pain and its treatment.