Can we rely on simulated patients' satisfaction with their consultation for assessing medical students' communication skills? A cross-sectional study.

BACKGROUND: In medical education, teaching methods offering intensive practice without high utilization of faculty resources are needed. We investigated whether simulated patients' (SPs') satisfaction with a consultation could predict professional observers' assessment of young doctors' communication skills. METHODS: This was a comparative cross-sectional study of 62 videotaped consultations in a general practice setting with young doctors who were finishing their internship. The SPs played a female patient who had observed blood when using the toilet, which had prompted a fear of cancer. Immediately afterwards, the SP rated her level of satisfaction with the consultation, and the scores were dichotomized into satisfaction or dissatisfaction. Professional observers viewed the videotapes and assessed the doctors' communication skills using the Arizona Communication Interview Rating Scale (ACIR). Their ratings of communication skills were dichotomized into acceptable versus unacceptable levels of competence. RESULTS: The SPs' satisfaction showed a predictive power of 0.74 for the observers' assessment of the young doctors and whether they reached an acceptable level of communication skills. The SPs' dissatisfaction had a predictive power of 0.71 for the observers' assessment of an unacceptable communication level. The two assessment methods differed in 26% of the consultations. When SPs felt relief about their cancer concern after the consultation, they assessed the doctors' skills as satisfactory independent of the observers' assessment. CONCLUSIONS: Accordance between the dichotomized SPs' satisfaction score and communication skills assessed by observers (using the ACIR) was in the acceptable range. These findings suggest that SPs' satisfaction scores may provide a reliable source for assessing communication skills in educational programs for medical trainees (students and young doctors). Awareness of the patient's concerns seems to be of vital importance to patient satisfaction.

Analysis of polyphosphates in fish and shrimps tissues by two different ion chromatography methods: implications on false-negative and -positive findings.

Inorganic polyphosphates (di-, tri- and higher polyphosphates) can be used to treat fish, fish fillets and shrimps in order to improve their water-binding capacity. The practical relevance of this treatment is a significant gain of weight caused by the retention/uptake of water and natural juice into the fish tissues. This practice is legal; however, the use of phosphates has to be declared. The routine control testing of fish for the presence of polyphosphates, produced some results that were difficult to explain. One of the two analytical methods used determined low diphosphate concentrations in a number of untreated samples, while the other ion chromatography (IC) method did not detect them. This initiated a number of investigations: results showed that polyphosphates in fish and shrimps tissue undergo a rapid enzymatic degradation, producing the ubiquitous orthophosphate. This led to the conclusion that sensitive analytical methods are required in order to detect previous polyphosphate treatment of a sample. The polyphosphate concentrations detected by one of the analytical methods could not be explained by the degradation of endogenous high-energy nucleotides like ATP into diphosphate, but by a coeluting compound. Further investigations by LC-MS-MS proved that the substance responsible for the observed peak was inosine monophsosphate (IMP) and not as thought the inorganic diphosphate. The method producing the false-positive result was modified and both methods were ultimately able to detect polyphosphates well separated from natural nucleotides. Polyphosphates could no longer be detected (<0.5 mg kg-1) after modification of the analytical methodology. The relevance of these findings lies in the fact that similar analytical methods are employed in various control laboratories, which might lead to false interpretation of measurements.

An investigation of the prototype validity of the borderline DSM-IV construct.

OBJECTIVE: To investigate the prototype validity of the borderline personality disorder (BPD) DSM-IV construct. METHOD: Patients (n = 930) from the Norwegian Network of Psychotherapeutic Day Hospitals. Exploratory/confirmatory factor analyses, correlation and reliability statistics, chi-square, and frequency distributions. RESULTS: Number of BPD criteria showed no distinct threshold between No-BPD and BPD patients among whom 136 different combinations of criteria occurred. Both factor analyses supported that one component/latent variable accounted for the variance of the BPD criteria, showing a high convergent and discriminant validity. The criterion of unstable relationships displayed the highest diagnostic efficiency, and that of chronic feelings of emptiness the lowest. CONCLUSION: The prototype theoretical model for BPD fitted the data well and appeared to be satisfactory described by the current criteria. The emptiness criterion needs a more appropriate definition and the hierarchy of the criteria in DSM-IV should be revised.

One-year follow-up of patients with cluster C personality disorders: a prospective study comparing patients with "pure" and comorbid conditions within cluster C, and "pure" C with "pure" cluster A or B conditions.

This one-year, post-treatment prospective study of consecutively admitted patients to a national psychiatric in-patient clinic, compares patients belonging to four subgroups of DSM-III-R personality disorder (PDs): "pure cluster A (N = 21), "pure" B (N = 67), "pure" C (N = 251), and Axis II "comorbid" C (N = 138). Outcome was measured by SCl-90 and occupational status. Axis I disorders were controlled for in all analyses. Contrary to our hypothesis, patients in pure cluster C had no better outcome than either Axis II comorbid cluster C patients or patients with pure cluster A or B. Although pure C patients relapsed in symptom distress after discharge, comorbid C patients did not. C patients with an additional Histrionic PD were less at risk to be a case at follow up (GSI level > 1.00). Cluster C disorders as a whole had negative impact upon outcome in the total sample. These findings suggest the need for better treatment of patients with cluster C conditions.

Schemas, affect consciousness, and cluster C personality pathology: a prospective one-year follow-up study of patients in a schema-focused short-term treatment program.

In this prospective study the aim was to investigate the relationship between affect consciousness and Cluster C personality pathology (DSM-IV, Axis-II). Forty-four patients with panic disorder and/or agoraphobia and Cluster C personality traits were treated in a schema-focused program comprising a first panic/agoraphobia-focused phase and a second personality-focused phase, being finally assessed at a one-year follow-up. According to the treatment strategy, affect consciousness was expected to change during the second phase, independent of change in agoraphobic avoidance being focused in the first phase. Pretreatment level of affect consciousness during treatment was related to a reduction in avoidant personality pathology (not dependent or obsessive-compulsive) from pretreatment to follow-up, while increase in affect consciousness did not contribute in the same way. These results indicate that affect consciousness is important as a selection criterion, as a parameter in treatment with focus on schemas and schema-avoidance, and as a predictor for outcome in agoraphobic patients with avoidant personality pathology.

Inventory of interpersonal problems: a three-dimensional balanced and scalable 48-item version.

Interpersonal relating has been a focus of attention in psychiatry for decades. To address this domain, a self-rating scale, the Inventory of Interpersonal Problems (IIP; Horowitz, Rosenberg, Baer, Ureño, & Villaseñor, 1988), was developed. Analysis of the psychometric properties of IIP presented in this article was performed by principal component analysis (PCA) for the purpose of obtaining subscales with a balanced, bipolar dimensionality. The model was validated by the resulting dimensions' ability to discriminate among different categories of personality disorders (PDs). The problem of a General Complaint factor affecting PCAs of questionnaires such as the IIP is discussed thoroughly, and ways of avoiding the problem are outlined. We present a three-dimensional structure of the IIP with both theoretically appealing and statistically robust dimensions of Assertiveness, Sociability, and Interpersonal Sensitivity based on 48 (out of 127) items. Balanced, additive indexes using the subset of 48 items appeared psychometrically sound by showing much lower correlations internally and less confounding from the General Complaint factor than extant indexes derived from the IIP. External validity seemed to be bolstered by all subscales' discriminating significantly between different PDs versus no PDs, on both cluster and single diagnosis levels. Our analysis seemed to substantiate the reliability (scalability) of three dimensions of the IIP tapping different areas of the interpersonal relational field.

More than one way to change: a study of course heterogeneity during and after short-term psychiatric in-patient treatment.

UNLABELLED: This study describes differences in course and outcome, defined by GSI (SCL-90) at admission, discharge, and one-year follow-up, in 458 patients receiving in-patient treatment for long-standing symptom and/or personality disorders. A K-mean cluster analysis identified seven subgroups of patients, representing four clinical distinct, meaningful patterns of change: early improvement, late improvement, relapsing after discharge, and a severe chronic course. MAIN FINDINGS: the subgroups had unique correlates among socio-demographic, diagnostic, and treatment-related characteristics. One of the relapsing groups had a high rate of Cluster C personality disorders, whereas the other had low participation in the anxiety programme. The group with severe chronic course showed occupational maladjustment and high number of both Axis I and II disorders. IMPLICATIONS: anxiety patients should participate in anxiety-treatment programmes, Cluster C patients should be followed and monitored for relapse, and severe chronic patients should be offered specialised treatment for their co-existing substance abuse and/or eating disorders.

Determination of chloramphenicol in muscle, liver, kidney and urine of pigs by means of immunoaffinity chromatography and gas chromatography with electron-capture detection.

A rapid and specific clean-up procedure based on immunoaffinity chromatography (IAC) with polyclonal antibodies for the gas chromatographic determination with electron-capture detection of chloramphenicol in pig muscle tissue, organs and urine is described. A commercially available IAC material was used for the analysis. A decrease in the capacity of the column after being used more than 100 times was observed. Mean recoveries were 69, 54, 62 and 95% for spiked pig muscle tissue, liver, kidney and urine, respectively. The limit of detection was 0.2 micrograms/kg for muscle tissue, 2.0 micrograms/kg for liver and kidney and 0.4 micrograms/kg for urine.

Clomipramine in the treatment of agoraphobic inpatients resistant to behavioral therapy.

BACKGROUND: Both behavior-modification methods and antidepressants have proved to be effective in the treatment of agoraphobia. The authors examined the effects of clomipramine on agoraphobia in patients who failed to respond to exposure-based behavioral treatment. METHOD: Eighteen patients with panic disorder with agoraphobia who had not responded to previous inpatient behavioral treatment were recruited to a 12-week, placebo-controlled, double-blind crossover study of clomipramine, at top doses of 150 mg/day for 3 weeks. The patients were assessed on measures of phobic avoidance, agoraphobic cognitions, panic, state and trait anxiety, subjective anxiety, and depression. RESULTS: One patient dropped out of the study after 6 weeks. On most outcome measures, the 17 study completers had significantly (p < .05) lower symptom scores at posttest in the active drug period than at posttest in the placebo period; however, the clinical gains were modest. CONCLUSION: The short-term efficacy of clomipramine for agoraphobic patients who failed to respond lastingly to behavioral treatment was demonstrated. It remains to be shown that clomipramine can lead to clinically significant and lasting benefits in these patients.

[Can the use of hypnotics be reduced? Systematic influence on attitudes and prescription practice in a psychiatric department]. / Kan vi redusere hypnotikaforbruket? Systematisk påvirkning av holdninger og forskrivningspraksis i en psykiatrisk sengeavdeling.

Because of frequent use of hypnotics to treat insomnia in the population in general and in institutions especially, an alternative programme of treatment has been developed at the psychiatric hospital, Modum Bads Nervesanatorium. The programme includes different components and levels of treatment, wherein use of hypnotics is the last choice. The main focus is on sleep hygiene, which consists mainly of working on the patients' own attitude towards and experience of sleep problems. The pre-requisite for running such a programme is a systematic approach to these attitudes among the staff, and the prescribing patterns by physicians.

[Institutionalized treatment of agoraphobia with panic anxiety]. / Institusjonsbehandling av agorafobi med panikkangst.

We describe an integrated behavioral-psychodynamic treatment programme for inpatients suffering from agoraphobia and panic anxiety. This programme emphasizes intensive drug-free exposure training followed by work with anxiety-laden dynamic conflicts. We present promising results of evaluation studies, and discuss the important role of cognitive reconstruction of anxiety and of passive and active avoidant attitudes in exposure training. Lastly, we make certain recommendations concerning the approach to anxiety problems in general practice.

[Depression. A disease or personal style]. / Depresjon. Sykdom eller personlighetsmønster.

This article presents an overview of the epidemiology, classification, symptomformation and treatment of depressive disorders, especially the unipolar, nonpsychotic type. It points out the complexity of these disorders and the fact that the medical profession covers only a part of the total spectrum. The recognition of these limitations should not drive the doctor to despair or resignation. It should contribute to the efforts to gain a deeper understanding of the depressive patient and better insight into the use of different treatment modalities. Three case presentations are used to illustrate the diagnostic reflections and choice of treatment.