ABSTRACT
BACKGROUND: The weaknesses inherent in rom-data in mental health care are largely ignored in Dutch discussions about the pros and cons of rom. AIM: To promote awareness among users and potential users of rom with regard to the limitations of rom data in mental health care. METHOD: We present a discussion of three types of measurement problems connected with the use of rom data in mental health care: (a) arbitrary calculation rules for identifying changes that are reliable and of clinical significance, (b) arbitrary metrics and constructs and (c) forced objectivation of subjective information. RESULTS: rom measurements are unreliable for use in mental health care because they lack a stable basis. The problems with these measurements are both psychometric and substantive. CONCLUSION: Anyone using or planning to use rom measurements in mental health care should be aware of fundamental measurement problems associated with rom.
Subject(s)
Mental Health Services/standards , Outcome Assessment, Health Care , Psychiatry/standards , Benchmarking , Humans , Mental Disorders/therapy , Netherlands , Quality of Health CareABSTRACT
BACKGROUND: In classical psychoanalysis, countertransference reactions pointed to 'unfinished business' on the part of the therapist. The therapist had to be able to control or eliminate his countertransference reactions in order to protect the patient from the effect of such reactions. According to psychoanalytical thinking today, however, countertransference is considered to be a joint creation of the patient and the therapist. AIM: To demonstrate how countertransference, which was originally a typical psychoanalytical concept, has evolved into a trans-theoretical concept. METHOD: A selection of the voluminous literature is discussed. RESULTS: The countertransference, which was originally a psychoanalytical concept, has been modernised and updated and has been adopted by other psychotherapeutic systems. CONCLUSION: The current notion that countertransference is a concept created jointly by patient and therapist has led to increased interest among practitioners of other types of psychotherapy, making them aware of the diagnostic and therapeutic importance of countertransference.
Subject(s)
Countertransference , Psychoanalysis , Psychoanalytic Therapy/methods , Humans , Transference, PsychologyABSTRACT
BACKGROUND: Most systems for routine monitoring provide therapists with graphical feedback. Many therapists, however, find it extremely difficult to interpret graphs. AIM: To increase therapists' awareness that the interpretation of graphical feedback is inevitably a subjective process. METHOD: A single case was analysed in which the objective graphical scores for successive patient-therapist sessions were shown on two monitor instruments. The scores were then compared with the patient's verbal reactions to the scores and score differences. RESULTS: The clinical example demonstrates that the interpretation of 'objective' graphical feedback depends on the commentary given by the patient. CONCLUSION: Routine monitoring is a subjective process which does not simply reveal the secrets of treatment processes and outcomes; what it does is to raise the lid of 'the black box' very slightly.
Subject(s)
Computer Graphics , Outcome Assessment, Health Care , Psychiatry/instrumentation , Psychiatry/methods , Data Interpretation, Statistical , Feedback , Female , Humans , PsychotherapyABSTRACT
This paper tests the hypothesis that patients' stereotypical dysfunctional interpersonal communication styles would be validly measurable by the command or relationship messages experienced by psychiatric nurses while interacting with the patient in the relatively unstructured every day context of the psychiatric ward. The generalizability of interpersonal pressures exerted by patients was tested by having different psychiatric nurses independently appraise patients' command or relationship messages with the Impact Message Inventory, circumplex version (IMI-C). Generalizability of interpersonal pressures strongly depended on the specific combination of psychiatric nurses. Out of eight classes of command or relationships three turned out to be generalizable across nurses: Dominance, Hostile-Submissive and Friendly Dominance.
Subject(s)
Communication , Mental Disorders/nursing , Nurse-Patient Relations , Personality Inventory/statistics & numerical data , Adolescent , Adult , Aged , Dominance-Subordination , Female , Generalization, Psychological , Hostility , Humans , Interpersonal Relations , Male , Mental Disorders/psychology , Middle Aged , Nursing Assessment/statistics & numerical data , Personality Assessment/statistics & numerical data , Psychiatric Department, Hospital , Psychometrics/statistics & numerical data , Reproducibility of ResultsABSTRACT
OBJECTIVE: An empirical comparison of treatment efficacy estimates as based on psychometric measures of intra-individual change (Reliable Change methods). METHOD: All seven different methods of assessing Reliable Change that have been advocated in the past two decades are compared empirically in a large in-patient sample (n = 107). Estimates of treatment efficacy by each of these seven Reliable Change methods are computed, using pre-/post-score changes on the Brief Psychiatric Rating Scale (BPRS). RESULTS: It is demonstrated that Reliable Change methods may yield very different estimates of treatment efficacy. The Reliable Change method with the fewest statistical assumptions is one of the least sensitive Reliable Change methods. CONCLUSION: Disagreement on the proper definition of Reliable Change is not merely of theoretical importance, but also has major practical implications.
Subject(s)
Individuality , Mental Disorders/therapy , Psychiatric Status Rating Scales/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Patient Admission , Psychometrics , Reproducibility of ResultsABSTRACT
This study aimed to determine the replicability of the interrater reliability coefficients obtained with a standardized and expanded Brief Psychiatric Rating Scale (BPRS-E) in a 1991 psychometric evaluation. Furthermore, intrarater reliability was assessed. At item level, interrater concordance turned out to be satisfactory for most of the BPRS-E items. However, only a few of the items reached acceptable chance-corrected coefficients. In contrast to the previous study, the anxiety-depression subscale met the standard of acceptable interrater reliability in the present study. As in the 1991 study, the 10-item psychotic disintegration scale as well as BPRS-18 global scores met (or closely approximated) this standard. The 6 additional items of BPRS-E did not contribute to the scale's reliability. Joining the samples of the 1991 and replication studies (to cover the range of symptoms' severity and heterogeneity more fully) did not improve interrater reliability. Intrarater reliability coefficients were globally comparable to interrater reliability coefficients. In all, the results of this replication study suggest that only the anxiety-depression subscale, the 10-item psychotic disintegration scale and the BPRS-18 global scale can be used reliably in unselected groups of psychiatric inpatients in acute distress.
Subject(s)
Mental Disorders/diagnosis , Psychiatric Status Rating Scales/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Anxiety Disorders/classification , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Depressive Disorder/classification , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Female , Hospitalization , Humans , Male , Mental Disorders/classification , Mental Disorders/psychology , Middle Aged , Observer Variation , Psychometrics , Reproducibility of ResultsABSTRACT
The interrater reliability, factorial and discriminant validity of a standardized and expanded Brief Psychiatric Rating Scale (BPRS-E) were investigated in a heterogeneous short-stay group of psychiatric inpatients in the Netherlands (n = 162). Repeated separate interviews by single clinicians (psychiatrists, residents or clinical psychologists), best reflecting the way the BPRS is usually employed in clinical practice and psychopharmacological research, were used to determine interrater reliability (n = 79). Although the 5 subscales of the original 18-item BPRS (BPRS-18) were successfully cross-validated in this Dutch sample, 4 of these subscales (except for thought disturbance) were found to lack interrater reliability. The 10-item schizophrenia scale derived from the BPRS-18 by a Scandinavian group met the standard of acceptable interrater reliability; BPRS-18 and BPRS-E global scales approximated this standard. For the thought disturbance subscale, the schizophrenia scale and for BPRS-18 and BPRS-E global scales, findings supported discriminatory power.
Subject(s)
Hospitalization , Mental Disorders/diagnosis , Mental Disorders/psychology , Psychiatric Status Rating Scales/statistics & numerical data , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Observer Variation , Psychiatric Status Rating Scales/standards , Psychometrics , Reproducibility of ResultsABSTRACT
The interrater reliability, temporal stability and factorial, convergent, discriminant and predictive validity of the Nurses Observation Scale for Inpatient Evaluation (NOSIE-30) were investigated in a heterogeneous group of psychiatric inpatients in the Netherlands (n = 179). Data in support of the scale's dimensional structure (recoverability of Anglo-American subscale structure in this Dutch sample and distinctiveness of subscales), discriminatory power and convergent validity are presented. Interrater reliability was satisfactory at global scale level. However, 3 subscales (irritability, psychosis and depression) were found to lack interrater reliability. Although temporal stability coefficients were high, large score changes are presupposed to show that pre- versus posttherapy differences are attributable to real change rather than error. NOSIE-30 had limited predictive value.
