Assessing quality of life in people with multiple sclerosis.

PURPOSE: The quality of life of multiple sclerosis (MS) patients was assessed using two MS specific quality of life measures (FAMS and SF-54) and a short generic measure (EuroQol) in order to make recommendations for routine assessment. Factors contributing to quality of life within this population were also considered. METHOD: Questionnaires were either sent by post or completed at interview. Ninety-six MS patients known to a consultant in rehabilitation medicine completed the questionnaires. RESULTS: Patients scored very low on subscales related to physical health. Correlations were high between the FAMS and SF-54 but low with the EuroQoL. Stepwise multiple linear regressions showed mood measures to account for the most variance on all quality of life composite scores. The MS patients within the study had much lower SF-36 quality of life scores than the general population and other illness groups. CONCLUSIONS: The EuroQol did not measure the same aspects of quality of life as the FAMS and SF-54 and was not found to be a sensitive measure within this sample. The SF-54 suffered from floor effects on physical health subscales and therefore the FAMS was recommended.

Assessment of emotional problems in people with multiple sclerosis.

OBJECTIVE: To investigate the occurrence of emotional problems in multiple sclerosis (MS) patients. The utility of rating scales used to measure such problems was studied to make recommendations for clinical practice. DESIGN: Questionnaires were both sent by post and completed with an assistant psychologist at a home visit. SUBJECTS: Ninety-six MS patients in contact with a rehabilitation consultant. MEASURES: Patients were assessed using the Guy's Neurological Disability Scale (GNDS), Extended Activities of Daily Living Scale (EADL), Hospital Anxiety and Depression Scale (HAD), Beck Anxiety and Depression Scales (BAI, BDI), Clinical Outcomes in Routine Evaluation Measure (CORE) and the Brief Symptom Inventory (BSI). RESULTS: Rates of anxiety and depression ranged from 16% to 48% according to the measures used. All mood scales were highly significantly correlated with each other. Disability as measured by the GNDS, but not the EADL, was significantly correlated with all mood measures. Kappa values showed poor correspondence in the classification of cases. Receiver operating characteristic curves indicated an optimum cut-off point of 7/8 on the HAD and 2/3 on the General Health Questionnaire (GHQ-12). CONCLUSIONS: Rates of emotional problems were low given the highly disabled population studied. The HAD was relatively insensitive in comparison with the BAI and BDI. The GHQ-12 was sensitive and therefore recommended as a short screening measure. An alternative short screen, 'Emotional GNDS', was proposed.

The closure of a long-stay psychiatric hospital: a longitudinal study of patients' behavior.

This paper summarises longitudinal data based on repeat assessments of the behavioural functioning of 90 long-stay psychiatric patients. Data were gathered over a period of 4-5 years that spanned a hospital closure and the resettlement of patients in various alternative settings. Time-series analyses of individual data sets showed that resettlement led to no significant behavioural change in the majority of patients. However, some significant behavioural improvements were evidenced for approximately 20% of the group, while behavioural deterioration occurred in approximately 12%. Supplementary findings showed that following resettlement the quality of care provided significantly improved in many respects. However, access to social, recreational or vocational activities was reduced. In addition, the level of physical health symptomatology was shown to increase for this group of patients.

The run-down and closure of a psychiatric hospital. Effects on patients' behaviour.

The run-down and closure of psychiatric hospitals can be stressful for both staff and patients. Interviews with approximately 50% of over 100 long-stay psychiatric patients during an 18 month period preceeding a hospital closure show them to be generally ill-informed as to reasons for closure and future plans for their care. However, repeat measures of behavioural functioning (CAPE and REHAB) during this running-down period show no significant changes in patients' behaviour.

British community norms for the Brief Symptom Inventory.

British community norms (N = 376) for the Brief Symptom Inventory (Derogatis & Spencer, 1982) are presented. Means are significantly higher than previously published US norms for all symptom dimensions, and show variability according to age, sex and work status. The proportion of 'cases' in the sample is similar to other British estimates. It is recommended that culturally relevant norms should be established and used in future work with this instrument.

Development of a taxonomy of therapist difficulties: initial report.

While psychotherapists discuss amongst themselves and in supervision the struggles they experience face-to-face with their patients, empirical study of therapists' experience of psychotherapy has been scant and there has been little investigation of therapists' difficulties. We require tools for such investigation and in this initial report we describe the development of a taxonomy of situations that psychotherapists experience as difficult and indicate lines of research to which the taxonomy might be applied. We also suggest that our procedure might serve as a model of collective self-study for other groups of practitioner-researchers. Using accounts of our own difficulties as therapists, we constructed a consensual set of experimental categories that could be applied to describe them. These were designated as Therapist (T)-Incompetent, T-Damaging, T-Puzzled, T-Threatened, T-Out of Rapport, T's Personal Issues, Painful Reality/T's Ethical Dilemma (a combined category), T-Stuck, and T-Thwarted. We then employed a fresh set of 30 accounts, which were also drawn from our own experience but had not contributed to the development of the taxonomy, to study the taxonomy's reliability. Each of us rated the presence and predominance of the categories for each of the 30 accounts. Both presence and predominance of all nine categories in the taxonomy could be reliably identified, with about three raters required to ensure good reliability for all categories; alphas (for our group of seven raters) were in the range 0.88-0.95 for presence-absence and 0.83-0.94 for predominance. We conclude that the taxonomy is a serviceable tool for further investigation. We also show that we are discriminable from one another as therapists in terms of the kinds of difficulty we reported, differences amongst us conforming to what we know of one another's therapeutic practice. We note implications for the diagnostic use of the taxonomy in training and supervision.