Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records.

BACKGROUND: There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research. AIMS: This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery-Åsberg Depression Rating Scale (MADRS-6). METHOD: A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation. RESULTS: The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set. CONCLUSIONS: The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings.

Evidence of validity and reliability of the Spanish version of the “Observable Social Cognition: A Rating Scale” (OSCARS) in patients with schizophrenia.

Social Cognition (SC) impairment is part of the deficit syndrome of schizophrenia. The Observable Social Cognition: A Rating Scale (OSCARS) evaluates the perceived SC through an external reference informant. The aim of this paper is to analyze the psychometric properties of validity and reliability of its cross-cultural adaptation for the Spanish population.

Evidencias de validez y fiabilidad de laversión española de la “Observable Social Cognition: A Rating Scale” (OSCARS) en pacientes con esquizofrenia / Evidence of validity and reliability of the Spanish version of the “Observable Social Cognition: A Rating Scale” (OSCARS) in patients with schizophrenia

Introducción: El deterioro en la Cognición Social (CS)forma parte del síndrome deficitario de la esquizofrenia. LaObservable Social Cognition: A Rating Scale (OSCARS) evalúala CS percibida a través de un informador externo clave. Elobjetivo del estudio es analizar las propiedades psicométricasde validez y fiabilidad de su adaptación transcultural parapoblación española.Metodología. Estudio observacional y transversal en unamuestra de pacientes ambulatorios con esquizofrenia (n =109) seleccionados mediante muestreo simple aleatorizado.Instrumentos seleccionados: Tarea de Hinting, batería cognitiva de conceso MATRICS, escala de impresión clínica global(CGI-SCH) y cuaderno de datos ad hoc.Resultados. El Análisis Factorial Exploratorio identificóun modelo de dos factores, igual al original, que explican el59,02% del total de la varianza: sesgo cognitivo social y habilidad cognitiva social. Al igual que en la versión original, nose encontraron resultados de correlación con otras medidasde CS: tarea de Hinting (r: – 0,085; p = 0,382) o MSCEIT dela MATRICS (r: 0,015; p = 0,877). No se observaron correlaciones significativas con otros dominios neurocognitivos. Elcoeficiente alpha de Cronbach fue de 0,82 (0,75 y 0,76, paracada factor). El valor de kappa ponderado medio fue 0,43. Lapuntuación del Coeficiente de Correlación Intraclases, 0,84(IC95%: 0,76 – 0,88; p<0,001)Conclusiones. Los hallazgos apoyan la validez y fiabilidad de la adaptación transcultural de la OSCARS como unaherramienta de propiedades psicométricas equivalentes a laoriginal que permite la evaluación de la CS mediante un informante referente en individuos con esquizofrenia. (AU)

Introduction: Social Cognition (SC) impairment is part ofthe deficit syndrome of schizophrenia. The Observable SocialCognition: A Rating Scale (OSCARS) evaluates the perceivedSC through an external reference informant. The aim of thispaper is to analyze the psychometric properties of validityand reliability of its cross-cultural adaptation for the Spanishpopulation.Methods. Observational and cross-sectional study in asample of outpatients with schizophrenia (n = 109), selected by simple randomized sampling. Selected instruments:Hinting task, MATRICS cognitive consensus battery, clinicalglobal impression scale (CGI-SCH) and specific data collection logbook.Results. Exploratory Factor Analysis identified a two-factor model, like the original version, that explains 59.02% ofthe total variance: social cognitive bias and social cognitiveability. As in the original version, no correlation results werefound with other SC measures: Hinting task (r: - 0.085; pvalue = 0.382) or MSCEIT of the MATRICS (r: 0.015; p value 0.877). No specific correlations were observed with otherneurocognitive domains. Cronbach’s alpha coefficient was0.82 (0.75 and 0.76, for each factor). The mean weighted kappa value was 0.43. Intraclass Correlation Coefficient score, 0.84 (95% CI: 0.76 - 0.88; p <0.001). Conclusions. These findings support the validity and thereliability of the cross-cultural adaptation of the OSCARSa tool to assess SC by a referent informant in individualswith schizophrenia with similar psychometric properties tothe original version. (AU)

Factors associated with the use of mechanical restraint in a mental health hospitalization unit: 8-year retrospective analysis.

WHAT IS ALREADY KNOWN ABOUT THE TOPIC?: Our present understanding of mechanical restraint is heterogenous, largely due to the important differences between countries/regions. In Spain, the use of this restrictive practice is not regulated, nor is its use protocolized. Previous studies that have investigated the impact of organizational factors and changes in these protocols are often short and not conducted within a framework designed to establish a long-term plan for reducing the use of mechanical restraint. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: We demonstrate that the implementation of administrative and protocol changes in our psychiatric unit significantly reduced the use of mechanical restraint, thus laying the foundations for a regulatory framework. Our analysis shows that the profile of patients who require mechanical restraint is highly variable, but that certain clinical and institutional aspects within the framework of a long-term plan for the reduction in mechanical restraint can be targeted with long-lasting positive effects. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Organizational changes focussed on training staff, promoting family support and requiring the registration and close monitoring of episodes empower the role of the nursing staff in the prevention, monitoring and regulation of mechanical restraint. ABSTRACT: Introduction Mechanical restraint is a controversial restrictive practice to manage agitation or violent behaviour. Numerous studies have evaluated the factors and organizational changes that influence on mechanical restraint, but only for short time periods. None of those studies have assessed the effects of measures applied within the framework of a long-term plan to reduce the use of mechanical restraint. Given the lack of specific legislation in Spain, more data are required for its proper regulation. Aim/Question To evaluate the risk factors associated and the impact of specific measures designed to minimize the application of mechanical restraint in an acute mental health unit over an 8-year period and previous observation of 5 years. Methods Cross-sectional study based on a retrospective analysis of mechanical restraint records. We compared admissions requiring ≥one episode of restraint versus admissions not requiring this coercive measure. Results Between 2007 and 2014, 412 admissions (12%) required mechanical restraint. The data show that the measures applied in the previous five years had significantly reduced the total hours of restraint per semester. The factors associated with admissions requiring mechanical restraint were involuntary, unscheduled and longer admissions. The best predictor of restraint was involuntary admission (OR = 6.37), followed by the diagnosis of personality disorder (OR = 5.01). Discussion Identification of the factors associated with mechanical restraint would allow for early detection strategies. Our results provide additional evidence on the usefulness of organizational changes to reduce coercive measures, even in a country without specific legislation. Implications for Practice Organizational changes, such as staff training and increased family support during admission of episodes of mechanical restraint, can reduce the use of this measure. These measures also give the nursing staff greater responsibility in terms of their role in registering and monitoring the restrictive practice, thus helping to prevent or minimize the use of mechanical restraint.

Satisfaction with antipsychotics as a medication: the role of therapeutic alliance and patient-perceived participation in decision making in patients with schizophrenia spectrum disorder.

OBJECTIVES: The aim of this study was to identify independent predictors of satisfaction with antipsychotics in patients with schizophrenia spectrum disorders treated in a mental health catchment area. METHODS: Observational analytical study of patients (n = 150) recruited through a convenience sampling method from five mental health units. Satisfaction with the antipsychotic as a medication was evaluated using the Treatment Satisfaction Questionnaire for Medication (TSQM). Therapeutic alliance was assessed by the Working Alliance Inventory Short Form (WAI-S). Patient-perceived participation in decision-making was assessed using COMRADE (Combined Outcome Measure for Risk communication And treatment Decision making Effectiveness). A multiple linear regression analysis was performed to identify variables independently associated with the TSQM 'Global Satisfaction' total score. RESULTS: Two variables - age and higher level of self-perceived participation in treatment decision-making - were directly, significantly, and independently associated (ß coefficient values: 0.209 and 0.432, respectively) with a higher TSQM Global satisfaction score. In addition, the severity of psychotic symptoms was inversely associated with satisfaction (ß coefficient value: -0.205) (R2 = 0.355; R2 adj. = 0.291; F(13) = 5.554; p < 0.01). CONCLUSIONS: These findings suggest that involving the patient in treatment decision-making and optimising the treatment to reduce symptoms, especially in younger patients, could increase satisfaction with antipsychotic treatment.Key PointsPatient involvement in shared decision-making is relevant for treatment satisfaction.Current evidence suggests that improving the doctor-patient relationship optimises antipsychotics outcomes.Self-perceived participation in decision-making predicts satisfaction with antipsychotic medication.Types of antipsychotics do not determine consistent differences in satisfaction.

Esclerosis sistémica y psicosis: a propósito de un caso / Systemic sclerosis and psychosis: Report of a case

Introducción: La esclerosis sistémica (ES) es una enfermedad del tejido conectivo de origen desconocido, multisistémica y cuya afectación principal es la dermis, manifestada fundamentalmente como atrofia cutánea. Tiene baja incidencia de síntomas psicóticos respecto a otros tipos como el lupus sistémico. Caso: Presentamos una paciente que desarrolla un trastorno psicótico de tipo maniforme en el curso de una ES, con la particularidad de presentar ilusiones de tipo complejas zoomórficas y una excelente respuesta a paliperidona intramuscular de liberación prolongada. Discusión: Se analiza el problema del origen de las psicosis sintomáticas, la alteración de la inmunidad como base etiopatogénica de trastornos mentales y el diagnóstico diferencial del caso presentado, así como los tratamientos efectuados (AU)

Introduction: Systemic sclerosis (SSc) is a connective tissue disease of unknown origin, with multisystem involvement and which mainly affects the dermis, manifested as skin atrophy in the majority of cases. It has a low incidence of psychotic symptoms compared to other conditions, such as systemic lupus. Case: In this article we present a patient who developed a maniac type psychotic disorder whilst suffering from SSc, particularly presenting with complex zoomorphic type illusions, with an excellent response to prolonged release intramuscular paliperidone. Discussion: An analysis was made of the origin of the symptomatic diagnosis, impaired immunity, aetiopathogenic basis of mental disorders, and differential diagnosis of the case presented and the treatment given (AU)