[The validity of acute assessments of psychiatric conditions made by psychiatric emergency staff]. / De validiteit van acute inschattingen van toestandsbeelden door ggz-crisisdienstmedewerkers.

BACKGROUND: Earlier research carried out by the outreach psychiatric emergency team in the region of Uden / Veghel in the Netherlands indicated that the preliminary diagnosis of patients in crisis was associated with aggressive behaviour during the later contact between the patient and the staff of the psychiatric emergency team. An accurate diagnosis by the staff of the psychiatric emergency team is important because it should guide the patient towards the right type of treatment by the most appropriate team. The staff of the psychiatric emergency service who make the initial diagnosis are pressed for time and have only limited information.
AIM: To find out what differences there are between the crisis team's initial diagnosis of the psychiatric condition of the patient in crisis and the later diagnosis made after more extensive psychiatric tests are carried out following the regular intake procedure.
METHOD: Our study was based om 129 patients who, in the period of 2009 and 2010, were not known to mental health service and had not had any previous contact with the psychiatric emergency service. The first assessment of a patient's psychiatric condition made by a member of the psychiatric emergency service was compared with the later diagnosis made by a professional psychiatrist after the regular intake procedure. We then investigated the degree of agreement between the two diagnoses using Cohen's kappa so that we could test the validity of the initial screening of the patient's condition.
RESULTS: We found that the staff of the psychiatric emergency team was able to achieve a result that was better than could be expected on the basis of chance. The Cohen's kappas varied between 0.81 for psychotic disorders to 0.31 for borderline personality disorders. Borderline personality disorders, however, tended to be overestimated by the psychiatric emergency staff.
CONCLUSION: Although there was only limited agreement regarding various conditions, it is encouraging that the psychiatric emergency staff were able to assess psychotic disorders accurately on the basis of the initial information they had received. This result is important because in other studies psychotic symptoms were found to be associated with a higher likelihood of aggression during the later outreach consultation.

[Estimating and reporting aggression in relation to personal characteristics of emergency service workers]. / Inschatten en rapporteren van agressie in relatie tot persoonskenmerken van crisismedewerkers.

BACKGROUND: Research on aggression in mental health care has focused mainly on patient characteristics, whereas very little research has been done on the characteristics of the care providers in their reporting of aggression. AIM: To study the characteristics of the care providers of an emergency service in relation to the reporting of aggression. METHOD: All emergency service workers( n = 21) in the Uden-Veghel region were asked to complete a neo-pi-r form. Before 576 outreach contacts had been made with patients in psychiatric crises, the Checklist of Risks in the Crisis-team (crc) was also completed and in cases where the patient exhibited aggressive behaviour, a soas-r form was filled in, following contact with the patient. RESULTS: Significant differences were found between the psychiatric emergency service workers with regard to the mean estimates of the likelihood that they would experience aggression during the consultation and with regard to the proportion of patient contacts for which emergency workers reported aggression. There were indications that the level of conscientiousness of the emergency service workers was positively associated with a higher chance that they would report aggressive behaviour following the consultation. Furthermore, altruism was found to be negatively associated with the likelihood, as predicted by the service workers, that they would be confronted with aggression during contact with the patient. CONCLUSION: Possibly, workers who scored high on conscientiousness and who work thoroughly and in a orderly and systematic manner and who keep to the rules are less flexible in their response to the patient during the interaction. As a result, the patient became irritated more quickly. On the other hand, it could be that conscientious workers completed the form-filling more carefully when aggression had to be reported and as a result they made higher preliminary estimates of the likelihood of aggression and a reported a larger number of incidents of actual aggression.

[Assessing aggressive behaviour at the psychiatric emergency service with a checklist: a replication study]. / Inschatten van agressie tijdens contacten met de ggz-crisisdienst met een checklist: een replicatiestudie.

BACKGROUND: In an earlier study it was found that aggressive behaviour by patients treated by the psychiatric emergency service could be predicted by the use of a newly developed instrument, the Checklist of Risks/ Crisis team (CRC). In this earlier study it was suggested that a replication study, with a larger database, was definitely needed in order to check these findings. AIM: To find out in what circumstances patients (aggressive or non-aggressive) make contact with the crisis team and to ascertain the predictive validity of the CRC. METHODS: During a period of four years (from 1 January 2006 to 31 December 2009) staff members completed the CRC before paying outreach visits to patients experiencing psychiatric crises in the community. In addition, if patients showed any aggressive behaviour during the visit, this was documented by means of the Staff Observation Aggression Scale-Revised (SOAS-r). RESULTS: Our study replicated the earlier finding that the structured clinical risk assessment made on a visual analogue scale (VAS) of the CRC, together with the additional item about whether there were any potentially dangerous persons in the vicinity of the patient, seem to be useful "predictors" of aggression in the future (with correct classification in respectively 91 and 92%). CONCLUSION: The class CRC, detailed monitoring of aggressive incidents by means of the SOAS-r, and the weekly discussions about these incidents all seem to be good instruments for analysing incidents and for increasing the safety of staff members. The methods and techniques introduced at the beginning of the project have gone hand in hand with the reduction in the number of aggressive acts directed at members of the psychiatric emergency service.

[Personality traits of staff members of the psychiatric emergency services]. / Persoonlijkheidskenmerken van crisisdienstmedewerkers in de ggz.

BACKGROUND: In the course of their duties staff members of the psychiatric emergency services may quite often find themselves in unpredictable and, in some cases, threatening situations. For this reason, staff working for the emergency services need to have specific personality traits. AIM: To investigate whether staff members of the emergency services differ from well-educated members of the general public as far as personality traits are concerned. METHOD: The staff of the mental health teams of Oost Brabant in the Netherlands (Uden/ Veghel and Helmond regions) were asked to complete an NEO-PI-R designed to assess their main personality traits. Of the 59 staff members who were invited to participate, 44 completed and returned the questionnaire (76%). The scores of the 44 staff members were compared to those of a norm group of persons with a similar educational level in the general population. RESULTS: The staff of the crisis teams were found to have significantly lower scores on the personality dimension 'Neurotism' and particularly on the facets 'Vulnerability' and 'Self-consciousness' of this dimension. The psychiatric crisis staff had higher scores on the facets 'Competence' and 'Self-discipline' and lower scores on the 'Candour/Frankness/Openness'. Compared to the social workers, the psychiatrists scored higher on the facets 'Assertiveness' and 'Openness to ideas'. CONCLUSION: The lower scores found on the main personality dimension 'Neuroticism' and particularly on the facet 'Vulnerability' suggest that members of the psychiatric crisis team remain calm in stressful situations and are emotionally rather stable persons. Such personality traits can be important in threatening situations where peace and calm have to be preserved. However, in view of the limited sample size and the relatively large number of statistical tests, the findings of this exploratory study should be interpreted with caution.

Treatment goals in addiction healthcare: the perspectives of patients and clinicians.

BACKGROUND: Little is known about the perspectives of either patients or clinicians regarding treatment goals in addiction healthcare. In general, treatment goals involve abstinence or at least reduction of substance use. AIM: To examine and compare the treatment goals indicated by both patients and clinicians at baseline, interim and exit measurement. METHOD: A descriptive study was performed with multiple measurements of treatment goals. Patients (n = 111) and clinicians (n = 20) were recruited from three addiction treatment centres in the Netherlands. A Shared Decision Making Intervention (SDMI) was undertaken to promote and evaluate treatment agreement. RESULTS: Patients identified treatment goals of daytime activities and abstinence or reduced alcohol consumption as most important. Clinicians indicated psychological distress, daytime activities and substance use as most important. Differences between patients and clinicians were found for the treatment goals of physical health (patient > clinician) and psychological distress (clinician > patient). The results further showed that treatment goals of both patients and clinicians become more closely aligned during the course of treatment. CONCLUSION: SDMI provides a method to explore and discuss discrepancy between patients' and clinicians' goals of treatment which leads to convergence. Such convergence is likely to be a necessary prerequisite for positive treatment outcomes.

Shared decision-making reduces drug use and psychiatric severity in substance-dependent patients.

BACKGROUND: In the last decades, shared decision-making (SDM) models have been developed to increase patient involvement in treatment decisions. The purpose of this study was to evaluate a SDM intervention (SDMI) for patients dependent on psychoactive substances in addiction health care programs. The intervention consisted of a structured procedure to reach a treatment agreement and comprised 5 sessions. METHODS: Clinicians in 3 treatment centres in the Netherlands were randomly assigned to the SDMI or a standard procedure to reach a treatment agreement. RESULTS: A total of 220 substance-dependent patients receiving inpatient treatment were randomised either to the intervention (n = 111) or control (n = 109) conditions. Reductions in primary substance use (F((1, 124)) = 248.38, p < 0.01) and addiction severity (F((8)) = 27.76, p < 0.01) were found in the total population. Significant change was found in the total population regarding patients' quality of life measured at baseline, exit and follow-up (F((2, 146)) = 5.66, p < 0.01). On the European Addiction Severity Index, SDMI showed significantly better improvements than standard decision-making regarding drug use (F((1, 164)) = 7.40, p < 0.01) and psychiatric problems (F((1, 164)) = 5.91, p = 0.02) at 3-month follow-up. CONCLUSION: SDMI showed a significant add-on effect on top of a well-established 3-month inpatient intervention. SDMI offers an effective, structured, frequent and well-balanced intervention to carry out and evaluate a treatment agreement.

The dual pathway model of overeating. Replication and extension with actual food consumption.

van Strien et al. [van Strien, T., Engels, R. C. M. E., van Leeuwe, J., Snoek, H. M. (2005). The Stice model of overeating: tests in clinical and non-clinical samples. Appetite, 45, 205-213] extended the negative affect pathway of Stice's dual pathway model of overeating Stice [Stice, E. (1994). Review of the evidence for a sociocultural model of bulimia nervosa and an exploration of the mechanisms of action. Clinical Psychology Review, 14(7), 633-661] successfully with the variables lack of interoceptive awareness and emotional eating. This study aimed to replicate these findings in a sample of female college students with food consumption as the measure for overeating. Structural equation modeling was used to test the original and the extended model and both models fitted. In the extended model, the relation between negative affect and consumption seemed to run only via lack of interoceptive awareness and emotional eating.

Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status.

BACKGROUND: In the last decade, the clinician-patient relationship has become more of a partnership. There is growing interest in shared decision-making (SDM) in which the clinician and patient go through all phases of the decision-making process together, share treatment preferences, and reach an agreement on treatment choice. The purpose of this review is to determine the extent, quality, and consistency of the evidence about the effectiveness of SDM. METHOD: This is a systematic review of randomised controlled trials (RCTs) comparing SDM interventions with non-SDM interventions. Eleven RCTs met the required criteria, and were included in this review. RESULTS: The methodological quality of the studies included in this review was high overall. Five RCTs showed no difference between SDM and control, one RCT showed no short-term effects but showed positive longer-term effects, and five RCTs reported a positive effect of SDM on outcome measures. The two studies included of people with mental healthcare problems reported a positive effect of SDM. CONCLUSIONS: Despite the considerable interest in applying SDM clinically, little research regarding its effectiveness has been done to date. It has been argued that SDM is particularly suitable for long-term decisions, especially in the context of a chronic illness, and when the intervention contains more than one session. Our results show that under such circumstances, SDM can be an effective method of reaching a treatment agreement. Evidence for the effectiveness of SDM in the context of other types of decisions, or in general, is still inconclusive. Future studies of SDM should probably focus on long-term decisions.

Neither restrained eating nor tendency toward overeating predict food consumption after tension induction.

The present study investigates whether the so-called disinhibition effect is better accounted for by tendency toward overeating than by restraint. The rationale was that in mood-induction studies, so far, the disinhibition effect has only been found in studies that applied the Restraint Scale and hardly ever in studies that used other restraint scales. Tension was induced by the public-speaking method in half of 86 female college students before they participated in an alleged taste test. The Restraint Scale (RS), the Three-Factor Eating Questionnaire (TFEQ) and the Dutch Eating Behaviour Questionnaire (DEBQ) were used to measure restraint and tendency toward overeating. No differences were found between the tension and the control condition as to the amounts of food the participants ate. Also no proof of the disinhibition effect was obtained and, remarkably, tendency toward overeating did not predict the amount of food eaten. Possible explanations for these results are offered in the discussion.

[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.

[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.

Assessment of hostility in patients with coronary heart disease.

One of the problems in efforts to more clearly conceptualize hostility is the amount of method variance, which ranges from self-report techniques to interview-based methods and mirrors the multidimensional nature of hostility and related constructs. In addition, rather few studies concerned with the assessment of hostility have specifically used samples of coronary heart disease (CHD) patients. The purpose of this study was, therefore, to examine the multidimensionality of the construct of hostility in a sample of male coronary patients with some frequently used instruments. Factor analysis was used to detect the relevant underlying constructs, which were assessed using a variety of hostility measures in a sample of cardiac patients undergoing baseline assessment in an ongoing health-education intervention study. Measurement included both questionnaires and interviews. Participants (N = 235) were divided into 3 diagnostic groups: patients who had recently undergone (a) a myocardial infarction, (b) coronary artery bypass grafting, or (c) percutaneous transluminal coronary angioplasty. A 4-factor solution appeared to provide the best fit, and the following factors were isolated: Anger-Out, Negative Affect, Coping, and Anger-In. All intercorrelations were less than .50. Medical diagnosis did not differ with regard to the 4 factors found. The total hostility construct as measured by the structured interview (SI) did not fit into the 4-factor model. This study was the first to show that dimensions of anger and hostility constitute valid and relevant aspects of the general construct of hostility for a representative group of CHD patients. The 4 aspects of hostility isolated using some well-known hostility questionnaires and the SI explained most of the observed variance. Although the SI appeared to tap more general state anger, the 4 aspects of hostility may be differentially related to health in those who are coronary prone. Future studies on the role of hostile or negative emotions in CHD patients should, therefore, pay greater attention to the multidimensional nature of hostility and may clearly benefit from the use of the 4-factor model described in this article.

Attachment representations of personality-disordered criminal offenders.

The relation between attachment representations and personality disorders was examined in a sample of 40 Dutch men held in a forensic psychiatric hospital for the commission of serious crimes. Secure attachment representations were virtually absent in the sample; separation from attachment figures in childhood was related to current insecure attachment as well as to personality disorders. Use of attachment theory in research and clinical work with criminals is discussed.

Effects of alcohol and expectancy on self-disclosure and anxiety in male and female social drinkers.

To study the effects of alcohol consumption and expectancy on self-disclosure and self-reported anxiety during a social interaction, 32 male and 32 female social drinkers were assigned to one of four groups comprising a 2 x 2 factorial balanced-placebo design. Alcohol expectancy reduced the intimacy level of self-disclosure but not the amount of self-disclosure. Alcohol consumption had no effect. Thus, in contrast to the common view that alcohol functions as a "social lubricant," it served to inhibit social interaction. There was a three-way interaction among alcohol consumption, expectancy, and gender of subjects, such that the largest increase in anxiety was reported by male subjects who expected but did not receive alcohol. Thus, the previously reported inverse relationship between anxiety and self-disclosure was not confirmed, and alcohol's effect on anxiety seems unrelated to its effect on self-disclosure.

Submission and rebellion: excessive drinking of women in problematic heterosexual partner relationships.

Functionality of alcohol use for coping with partner relationship problems was explored in a group of 45 alcohol-dependent women with semistructured interviews. Six functions were categorized, three of them referring to adjustment and three to opposition to the partner. Respondents who had started excessive drinking mainly in response to problems with the partner reported more partner-related functions than respondents for whom a problematic partner relationship was not an important factor in the development of excessive drinking. Respondents of the first group also reported other characteristics of their relationship, notably they said more often that their partner was dominant. It was concluded that for a subgroup of women with alcohol problems, alcohol use may be a way of coping with a situation of powerlessness toward the partner.

Perception of heart rate and blood pressure: the role of alexithymia and anxiety.

While the ability to estimate heart rate in a laboratory setting appears to be related to anxiety and alexithymia, it is still unclear how the ability to estimate blood pressure is related to these psychological measures. The perception of heart rate and blood pressure in 24 normotensive subjects with varying degrees of alexithymia and anxiety was examined. Results indicate that the estimation of heart rate is related to psychological characteristics, while the estimation of blood pressure is not. More anxious subjects perceived heart rate more accurately than less anxious subjects. Furthermore, high alexithymic subjects perceived heart rate less accurately than low alexithymic subjects. The accuracy of estimation of blood pressure was, however, not related to alexithymia or anxiety. These findings provide further evidence that blood pressure estimates in a laboratory setting are mainly based upon situational cues.

Evaluation of a dutch educational "Driving While Intoxicated (DWI)" prevention program for driving schools.

A DWI prevention program for driving schools consisting of a videotape, slides, a textbook, and a manual was developed and evaluated. Effects of the program on knowledge, attitude, behavior intention, and self-reported DWI behavior were measured by means of a pretest, posttest, one-year follow-up evaluation design. Two-hundred and eight driving school students followed the program and participated in all three measurements. A control group of 228 pupils followed a traditional curriculum without the DWI program and also participated in all three measurements. Principal findings were that knowledge improved, attitudes and behavior intentions were already positive at pretest, DWI was equally reported by both groups, and there was a positive effect on riding with an intoxicated driver.

The effects of alcohol, expectancy, and alcohol beliefs on anxiety and self-disclosure in women: do beliefs moderate alcohol effects?

This study investigates the effects of alcohol, expectancy, and alcohol-related beliefs on self-reported anxiety and self-disclosure behavior in a social interaction situation. Seventy-two female social drinkers were assigned to eight conditions in a 2 x 2 x 2 factorial balanced-placebo design, controlling for drink content, expectancy, and beliefs. Results show that alcohol expectancy resulted in an anxiety reduction in subjects who believed that alcohol has a positive influence on social behavior, whereas expectancy had no effect in subjects with negative alcohol beliefs. Furthermore, subjects who expected alcohol were less anxious when they had positive alcohol beliefs than when they had negative beliefs, whereas beliefs made no difference in subjects who expected tonic. Our results suggest that the effect of alcohol expectancy on social anxiety in women is moderated by differences in the content of their alcohol-related beliefs. We conclude that the inconsistency in previous results about the effect of alcohol expectancy on social behavior might be explained by differences in subjects' alcohol beliefs. Finally, as neither of the three factors had any effect on self-disclosure behavior, we suggest that this behavioral measure is unrelated to self-reported anxiety.

Alcohol and social anxiety in women and men: pharmacological and expectancy effects.

A replication study was conducted to determine pharmacological and expectancy effects of alcohol on self-reported anxiety in a social interaction situation. Thirty-two male and thirty-two female social drinkers were randomly assigned to four conditions in a 2 x 2 factorial balanced placebo design, controlling for drink content and expectations. Results show that in women alcohol expectancy reduced self-reported anxiety, whereas in men there was no significant effect of expectancy. Alcohol consumption reduced anxiety in both men and women. Controlling for beliefs increased some of the effects we found. We conclude that although cognitive factors do mediate the effects of alcohol on self-reported anxiety, this influence seems to be different for men and women and the role of pharmacological factors might be more crucial.

Memories of parental rearing in alcohol and drug addicts: a comparative study.

Memories of parental rearing were investigated in 48 polydrug addicts and 91 alcohol addicts with the EMBU, an instrument for assessing parental rearing styles. Drug addicts remember their fathers and mothers as more rejecting and overprotecting and their mothers as more favoring than do alcoholics. When the age and the sex of addicts are taken into account, the kind of addiction and the sex of the addicts can explain a part of the variance of the overprotection dimension by fathers and mothers. The age of the addicts can explain a part of the variance of the rejection dimension by fathers and mothers. Finally, the variance in the favoring dimension by mothers can be explained by the kind of addiction.