[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.

Aggression and seclusion on acute psychiatric wards: effect of short-term risk assessment.

BACKGROUND: Short-term structured risk assessment is presumed to reduce incidents of aggression and seclusion on acute psychiatric wards. Controlled studies of this approach are scarce. AIMS: To evaluate the effect of risk assessment on the number of aggression incidents and time in seclusion for patients admitted to acute psychiatric wards. METHOD: A cluster randomised controlled trial was conducted in four wards over a 40-week period (n = 597 patients). Structured risk assessment scales were used on two experimental wards, and the numbers of incidents of aggression and seclusion were compared with two control wards where assessment was based purely on clinical judgement. RESULTS: The numbers of aggressive incidents (relative risk reduction -68%, P<0.001) and of patients engaging in aggression (relative risk reduction RRR = -50%, P<0.05) and the time spent in seclusion (RRR = -45%, P<0.05) were significantly lower in the experimental wards than in the control wards. Neither the number of seclusions nor the number of patients exposed to seclusion decreased. CONCLUSIONS: Routine application of structured risk assessment measures might help reduce incidents of aggression and use of restraint and seclusion in psychiatric wards.

[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.

A serological investigation into contagious caprine pleuropneumonia (CCPP) in Ethiopia.

For a comparison of serological tests for CCPP, sera from 767 goats were examined. They were subjected to three tests: complement fixation test (CFT) with Mycoplasma capricolum subspecies capripneumoniae antigen; blocking ELISA (B-ELISA) with Mycoplasma capricolum subspecies capripneumoniae antigen; and CFT with Mycoplasma mycoides subspecies mycoides small colony type antigen. Antibodies were detected by these three tests in 23%, 2% and 12%, respectively, of sera from districts in which CCPP had not been reported, and in 60%, 83% and 87%, respectively, in sera from areas in which CCPP had been reported. The specificity of the tests is discussed. The use of the B-ELISA test for the diagnosis and for epidemiological studies of CCPP is strongly recommended.

[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.

[Assessment of the Salmonella burden in slaughter pigs through the results of meat-juice-ELISA]. / Zur Erfassung der Salmonellenbelastung von Schlachtschweinen durch die Ergebnisse des Fleischsaft-ELISA.

During a study on the salmonella infection rate in slaughter pigs, bacteriological results were collected from faecal samples and intestinal lymphnodes, and serological results were acquired from meat-juice-ELISA. Serological findings and resulting serological parameters were analysed for their capacity to provide an indication of the salmonella burden in a given lot of slaughter pigs or in the farm of origin. The arithmetic mean antibody concentration of a lot of slaughter pigs or a piggery, or the number of animals reacting above 30% according to the Danish standard, or the number of animals reacting above 40% according to the Danish standard are all three equally suited to differentiate between a low and a high level of infection. The mean antibody concentration was found to be the best parameter for epidemiological studies that compare the serological status between herds or investigate the development of antibodies within a given piggery.

[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.

[Contribution to the differentiation of cross-reacting antibodies in brucellosis serology--1. Reactions with various Yersinia serotypes and antibody avidity]. / Beiträge zur Differenzierung von kreuzreagierenden Antikörpern in der Brucellose-Serologie--1. Untersuchungen mit verschiedenen Yersinia Serotypen und zur Antikörper-Avidität.

Brucella and Yersinia enterocolitca O:9 (Y.e.O:9) have antigenic determinants in common causing cross-reactions which interfere strongly in Brucella serology. Hoffmann (1988) observed cross-reactivity between Y.e.O:9, Y.e.O:5, and Y.e.O:6 and used an ELISA for the differentiation between Brucella- and Yersinia antibodies since Y.e.O:5 and Y.e.O:6 produced only low-level cross-reactions with Brucella antigen. The observations of Hoffmann were confirmed and led to the construction of an ELISA with 4 antigens. Sera from natural outbreaks of brucellosis and from artificial infections with Brucella and Y.e.O:9 were properly identifiable by this system. Furthermore, the test material has been used to measure the antibody avidity by a specially designed ELISA. This test produced a further divergence between specific and non-specific reactions.

[Possibilities for standardization of ELISA for detection of Salmonella antibodies in sera and meat juices of pigs]. / Uberlegungen zur Standardisierung des ELISA zur Bestimmung der Salmonellaantikörper in Seren und Fleischsäften des Schweins.

Programmes for controlling salmonella infections in German piggeries are based on the meat-juice-ELISA conducted in various investigation centres by using different test-kits. A usual procedure for harmonization (standardisation) of results is the calculation of the percentage of antibody-concentration from field samples in relation to the extinctions of a set of control-sera with known antibody concentrations. Whether this system is still acceptable in case of using different test-kits seems to be questionable. In principle, difficulties arise by calculating field results from the regression curve of control-sera because the calculated percentages of antibodies do not represent the antibody concentration but, instead, the percentages of the extinctions measured, and secondly, because control-sera presently in use are directed against different salmonella serovars. In regard to the number of laboratories involved and because of a variety of test-kits used it seems to be more adequate to include only one anti-Salmonella Typhimurium standard-serum at a given antibody concentration which is to be tested repeatedly on every test-plate. Simultaneously, further controls should include another anti-Salmonella Typhimurium and one anti-Salmonella Choleraesuis serum which should provide results similar to the Danish system which is regarded as a standard. As well, a negative serum must be included in the test and a minimum difference in extinctions between this negative serum and the standard positive control-serum should be reached to prove the validity of results from the test plate.

No effect of negative mood on the alcohol cue reactivity of in-patient alcoholics.

Forty in-patient alcoholics were exposed to an alcohol cue (holding and smelling an alcoholic drink) while in a negative mood, and while in a neutral mood. For the negative mood condition either a distressing or depressing Mood Induction Procedure (MIP) was used. In the control condition, a neutral MIP was used. In the negative mood condition, the subjects were found to be more distressed, more irritated, less calm, and less satisfied than in the neutral mood condition. In all conditions, following exposure to the alcohol cue, the desire to drink, systolic blood pressure, and heart rate variability increased, while self-efficacy beliefs to resist the urge to drink, and heart rate decreased. In sum, alcohol cue reactivity was observed, but not in response to a negative as opposed to a neutral mood or a distressed versus a depressed mood.

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.

[Necessity of double testing of meat juice samples from pigs using ELISA for the determination of Salmonella status in pig farms]. / Uber den Nutzen von Doppelbestimmungen bei Fleischsaftuntersuchungen mittels ELISA für die Beurteilung des Salmonellenstatus von Schweinebeständen.

According to the test protocol of the "meat juice ELISA" for detection of salmonella antibodies in pigs, all meat juice samples and serum controls are to be tested in duplicate. Results from routine investigations of repeatedly double tested meat juice and serum samples have been used to analyze the effect of double testing versus single testing with regard to the reliability of the final result. In case of an individual animal, testing of samples in duplicate increases the reliability of the results significantly, especially, if samples are retested at different occasions. In contrast, such a difference between mono and double testing of samples is not of importance when a group of animals is tested in order to determine the mean antibody rate in a herd. Here, results from double testing practically do not contribute to a higher reliability of the final result. This observation provides the possibility to reduce the costs for investigation programmes drastically.

Detection of Brucella species in organs of naturally infected cattle by polymerase chain reaction.

A polymerase chain reaction (PCR) assay was used to detect Brucella species in the uterus, udder, spleen, lymph nodes, kidney and liver of three cows which had been naturally infected in an outbreak of brucellosis, and the results were compared with the results of bacteriological investigations. All 18 samples reacted positively in the PCR, but five samples had weak bands after the electrophoretic separation of PCR mixtures. No Brucella strains could be detected in these five samples by bacterial cultivation, but all the other samples gave positive results. A pre-enrichment procedure was necessary for the PCR. A PCR with DNA from eight Yersinia strains gave no amplification product.