[The assessment of cognitive abilities in psychiatric patients: are widely used psychological tests still up-to-date?]. / Wie zeitgemäß sind die in der deutschsprachigen Erwachsenenpsychiatrie verwendeten psychologischen Leistungstests?

OBJECTIVE: Evaluation of widely used tests for the assessment of cognitive abilities of adult psychiatric patients in German speaking countries by current psychometric standards. METHODS: The German Wechsler Adult Intelligence Scales (HAWIE, HAWIE-R, WIE), the Multiple Choice Vocabulary Test (MWT-B), the German adaption and revision of the Benton Visual Retention Test (BT; 10-Item version, 20-Item version), and the d2 Test of attention (Test d2, d2-C, d2-R) were evaluated. A systematic search for relevant psychometric test publications in German language journals and textbooks was carried out. Three evaluation criteri a were considered: 1) theoretical foundation, 2) availability of actual test norms, 3) usual psychometric test validity and reliability criteria. RESULTS: The theoretical foundation of all of the psychological tests under review was found to be very weak. The norm values of some of the tests are outdated. Most of the psychological tests do not fulfill high quality standards of psychometric testing. CONCLUSIONS: The examined psychological tests for the assessment of cognitive abilities of psychiatric patients only partly conform to current standards of psychological testing. It is likely that the test results are of limited value. Misleading or even incorrect clinical evaluations might be a frequent outcome.

[Patterns of alcohol consumption: a cluster analytic study of the Trierer Alcoholism Inventory (TAI) in an Austrian clinical sample]. / Differentielle Alkoholkonsummuster: Eine typologische Untersuchung mit dem Trierer Alkoholismusinventar (TAI) in einer österreichischen klinischen Untersuchungsgruppe.

OBJECTIVE: The Trierer Alcoholism Inventory (TAI) assesses differential patterns of alcohol consumption in patients with alcohol use disorders. Previous cluster analytic studies with the TAI identified four distinct patterns of alcohol consumption. The aim of the present study was to replicate the cluster profiles of the TAI in an Austrian clinical sample. The discriminative validity of the TAI cluster profiles was evaluated with several external independent socio-demographic and clinical variables. A practical method to determine the similarity between an individual and a group profile of the TAI was also explored. METHODS: The TAI was administered to N = 238 patients who were admitted to an inpatient unit for alcohol withdrawal. Data were submitted to k-means cluster analysis with different starting partitions. Different cluster solutions were compared with regard to their stability, similarity (Rand-Index) and the consistency of the within-cluster profiles. RESULTS: A five-cluster solution was found to be stable. The five cluster represent different and distinctive alcohol consumption patterns: 1) Socially integrated alcohol consumption; 2) Excessive consumption, loss of self-control and severe psychosomatic consequences of long-term alcohol abuse; 3) Isolated and hidden alcohol consumption, 4) Inconspicuous alcohol consumption; 5) Residual cluster of non-classifiable cases. The discriminative validity of the cluster solution was supported with regard to age, gender, unemployment, living-situation, problems with partner, symptoms of psychological distress, and number of withdrawal treatments within the last five years. CONCLUSIONS: The study found further evidence for distinct patterns of alcohol consumption as measured by the Trierer Alcoholism Inventory. The development of clinical treatment concepts for patients with alcohol use disorders can be expected to benefit from the information obtained by the administration of the TAI-typology of alcohol consumption patterns.

A double-blind, randomized, parallel group study to compare the efficacy, safety and tolerability of slow-release oral morphine versus methadone in opioid-dependent in-patients willing to undergo detoxification.

AIMS: Evaluation of the efficacy and safety of slow-release oral morphine (SROM) compared with methadone for detoxification from methadone and SROM maintenance treatment. DESIGN: Randomized, double-blind, double-dummy, comparative multi-centre study with parallel groups. SETTING: Three psychiatric hospitals in Austria specializing in in-patient detoxification. PARTICIPANTS: Male and female opioid dependents (age > 18 years) willing to undergo detoxification from maintenance therapy in order to reach abstinence. INTERVENTIONS: Abstinence was reached from maintenance treatment by tapered dose reduction of either SROM or methadone over a period of 16 days. MEASUREMENTS: Efficacy analyses were based on the number of patients per treatment group completing the study, as well as on the control of signs and symptoms of withdrawal [measured using Short Opioid Withdrawal Scale (SOWS)] and suppression of opiate craving. In addition, self-reported somatic and psychic symptoms (measured using Symptom Checklist SCL-90-R) were monitored. FINDINGS: Of the 208 patients enrolled into the study, 202 were eligible for analysis (SROM: n = 102, methadone: n = 100). Completion rates were 51% in the SROM group and 49% in the methadone group [difference between groups: 2%; 95% confidence interval (CI): -12% to 16%]. The rate of discontinuation in the study was high mainly because of patients voluntarily withdrawing from treatment. No statistically significant differences between treatment groups were found in terms of signs and symptoms of opiate withdrawal, craving for opiates or self-reported symptoms. SROM and methadone were both well tolerated. CONCLUSIONS: Detoxification from maintenance treatment with tapered dose reduction of SROM is non-inferior to methadone.

Cause-specific excess mortality in suicidal patients: gender differences in mortality patterns.

OBJECTIVE: Few studies have investigated gender-specific excess mortality in suicidal patients. The objective of this study was to examine the risk of dying from all causes of death in male and female suicidal patients. METHOD: This study included 4140 patients who received psychiatric treatment in two Austrian hospitals after non-fatal suicidal behavior between 1989 and 2001. Mortality was prospectively assessed for a maximum follow-up period of 17 years (1989-2005). Gender-specific standardized mortality ratios were calculated for all causes of death. Rate ratios were used to assess gender differences. RESULTS: Males but not females had an elevated risk to die from "natural" causes of death. Mortality from "unnatural" causes of death, particularly suicide, was elevated in both genders. The female suicide risk markedly exceeded the risk for males. In both genders, mortality caused by substance use disorders was considerably elevated. CONCLUSION: Significant gender differences in the excess mortality of suicidal patients underline the need for gender-specific research in psychiatry.

Multilevel modeling was a convenient alternative to common regression designs in longitudinal suicide research.

BACKGROUND AND OBJECTIVE: The prospective investigation of repetitive nonfatal suicidal behavior is associated with two methodological problems. Due to the commonly used definitions of nonfatal suicidal behavior, clinical samples usually consist of patients with a considerable between-person variability. Second, repeated nonfatal suicidal episodes of the same subjects are likely to be correlated. We examined three regression techniques to comparatively evaluate their efficiency in addressing the given methodological problems. STUDY DESIGN AND SETTING: Repeated episodes of nonfatal suicidal behavior were assessed in two independent patient samples during a 2-year follow-up period. The first regression design modeled repetitive nonfatal suicidal behavior as a summary measure. The second regression model treated repeated episodes of the same subject as independent events. The third regression model represented a hierarchical linear model. RESULTS: The estimated mean effects of the first model were likely to be nonrepresentative for a considerable part of the study subjects. The second regression design overemphasized the impact of the predictor variables. The hierarchical linear model most appropriately accounted for the heterogeneity of the samples and the correlated data structure. CONCLUSION: The nonhierarchical regression designs did not provide appropriate statistical models for the prospective investigation of repetitive nonfatal suicidal behavior. Multilevel modeling provides a convenient alternative.

[Evaluation of the short-form social support questionnaire (SOZU-K-22) in clinical and non-clinical samples]. / Evaluation der Kurzform des Fragebogens zur Sozialen Unterstützung (SOZU-K-22) in klinischen und nichtklinischen Stichproben.

Three versions (22-item, 10-item, and 7-item) of the social support questionnaire (F-SOZU) were psychometrically evaluated in two clinical and three non-clinical Austrian samples. The distribution of sum scores in all three versions was negatively skewed; means on the item-level were in the upper region of the five-point scale (M > 4.0) in all non-clinical samples. Internal consistency estimates were found to be satisfying for the total test scores (alpha > 0.85). The 10-item and the 7-item forms correlated highly with the 22-item form total score (r > 0.90). Principal components analysis supported a one dimensional solution in all forms. The discussion focuses on the problem of the highly skewed test scores. It is also argued that the use of the 7-item version might be preferable and more efficient if the researcher is only interested in obtaining a global score for perceived social support.

Replication of a two-factor model of the Beck Depression Inventory in alcohol dependents and suicide attempters.

The factor structure of the Beck Depression Inventory (BDI) is still controversial. The present study attempted to replicate a general two-factor model (cognitive-affective and somatic factors) of the BDI with a confirmatory Procrustes rotation procedure in two clinical samples of patients being treated for alcohol dependence (N(1) = 243, N(2) = 148) and one clinical sample of patients admitted to an acute psychiatric ward because of an act of deliberate self-harm (N(3) = 144). In addition, due to the neglect of gender-specific analysis in factor-analytic studies of the BDI, the two-factor model was tested for males and females separately. The results did not support the validity of the two-factor model in the total samples. Gender-specific findings indicated a better fit of the model in male samples. Possible implications of a gender-specific factor structure of the BDI are discussed.