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"INTERMED": A method to assess health service needs - II. Results on its validity and clinical use

GENERAL HOSPITAL PSYCHIATRY 1999年第1期21卷 49-56页

作者： Stiefel, FC de Jonge, P Huyse, FJ Guex, P Slaets, JPJ Lyons, JS Spagnoli, J Vannotti, M CHU Vaudois Div Autonome Med Psychosociale Vaudois Switzerland Vrije Univ Amsterdam Ziekenhuis Psychiat Consultatieve Dienst NL-1007 MB Amsterdam Netherlands Ziekenhuis Leyenburg Dept Geriatr Med NL-2545 CH Den Haag Netherlands NW Mem Hosp Dept Psychiat Chicago IL 60611 USA

The validity and clinical use of a recently developed instrument to assess health care needs of patients with it physical illness, called INTERMED, is investigated. The INTERMED combines data reflecting patients' biological, psychological, and social characteristics with information on health care utilization characteristics. An example of a patient population in which such an integral assessment can contribute to the appropriateness of care, are patients with low back pain of degenerative or unknown origin. It supports the validity and the clinical usefulness of the INTERMED when clinically relevant subgroups in this heterogeneous population can be identified and described based on their INTERMED scores. The INTERMED was utilized in a group of patients (N = 108) having low back pain who vary on the chronicity of complaints, functional status, and associated disability. All patients underwent a medical examination and responded to a battery of validated questionnaires assessing biological, psychological, and social aspects of their life. In addition, the patients mere assessed by the INTERMED. It tons studied whether it proved to be possible to form clinically meaningful groups of patients based on their INTERMED scores;for this, a hierarchical cluster analysis tons performed. In order to clinically describe them, the groups of patients weve compared with the data from the questionnaires. The cluster analysis on the INTERMED scores revealed three distinguishable groups of patients. Comparison with the questionnaires assessing biological, psychological, and social aspects of disease showed that one group can be characterized as complex patients with chronic complaints and reduced capacity to work who apply for a disability compensation. The other groups differed explicitly with regard to chronicity, but also on other variables. By means of the INTERMED, clinically relevant groups of patients can be identified, which supports ifs use in clinical practice and its use a

关键词：方差分析卡方分布聚类分析横断面研究腰痛/诊断腰痛/心理学腰痛/治疗病史记录/标准需求估价/标准病人医疗护理计划心理测定学/标准可重复性结果瑞士女(雌)性人类男(雄)性

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Use of the Beck Depression Inventory for Primary Care to screen for major depression disorders

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GENERAL HOSPITAL PSYCHIATRY 1999年第2期21卷 106-111页

作者： Steer, RA Cavalieri, TA Leonard, DM Beck, AT Univ Med & Dent New Jersey Sch Osteopath Med Dept Psychiat Stratford NJ 08084 USA Univ Med & Dent New Jersey Sch Osteopath Med Dept Med Stratford NJ 08084 USA Univ Penn Sch Med Dept Psychiat Philadelphia PA 19104 USA

To ascertain how effective the Beck Depression Inventory for Primary Care (BDI-PC) was in screening for DSM-IV major depression disorders (MDD) in outpatients who were scheduled for routine office visits with physicians specializing in internal medicine, the BDI-PC was administered to 60 male and 60 female outpatients. The internal consistency of the BDI-PC was high (alpha 0.85), and the Mood Module from the Primary Care Evaluation of Mental Disorders was used to diagnose MDD. The BDI-PC scores were not significantly correlated with sex, age, ethnicity, or total number of medical diagnoses. A BDI-PC cuttoff score of 4 and above yielded 98% maximum clinical efficiency with 97% (95% CI 82%-99%) sensitivity and 99% (95% CI 94%-99%) specificity rates, respectively,for identifying patients with and without MDD. The BDI-PC is discussed as an effective case-finding instrument for screening primary care patients for MDD. (C) 1999 Elsevier Science Inc.

关键词：贝叶斯定理置信区间抑郁症/诊断抑郁症/流行病学诊断试验常规/标准健康调查内科学/统计学和数值数据新泽西/流行病学初级卫生保健/方法初级卫生保健/统计学和数值数据精神病状态评定量表/标准心理测定学/标准 ROC曲线参考值样本大小抽样研究女(雌)性人类男(雄)性中年人

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"INTERMED": A method to assess health service needs - I. Development and reliability

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GENERAL HOSPITAL PSYCHIATRY 1999年第1期21卷 39-48页

作者： Huyse, FJ Lyons, JS Stiefel, FC Slaets, JPJ de Jonge, P Fink, P Gans, ROB Guex, P Herzog, T Lobo, A Smith, GC van Schijndel, RS Vrije Univ Amsterdam Ziekenhuis Psychait Consultatieve Dienst NL-1007 MB Amsterdam Netherlands Northwestern Univ Mem Hosp Dept Psychiat Chicago IL 60611 USA CHU Vaudois Dept Psychosocial Med CH-1011 Lausanne Switzerland Ziekenhuis Leyenburg Dept Geriatr Med NL-2545 CH Den Haag Netherlands Aarhus Univ Hosp Hosp Psychiat DK-8240 Risskov Denmark Vrije Univ Amsterdam Ziekenhuis Dept Internal Med NL-1007 MB Amsterdam Netherlands Univ Freiburg Klinikum Abt Psychotherapie & Psychosomat Med D-7800 Freiburg Germany Univ Hosp Psychosomat Serv E-50009 Zaragoza Spain Monash Med Ctr Dept Psychol Med Clayton Vic 3168 Australia

The purpose of this paper is to describe the development and to test the reliability of a new method called INTERMED, for health service needs assessment. The INTERMED integrates the biopsychosocial aspects of disease and the relationship between patient and health care system in a comprehensive scheme and reflects an operationalized conceptual approach to case mix or case complexity. The method is developed to enhance interdisciplinary communication between (para-) medical specialists and to provide a method to describe case complexity for clinical, scientific, and educational pur poses. First, a feasibility study (N = 21 patients) tons conducted which included double scoring and discussion of the results. This led to a version of the instrument on which two interrater reliability studies were performed. In study 1, the INTERMED was double scored for 14 patients admitted to an internal ward by a psychiatrist and an internist on the basis of a joint interview conducted by both. In study 2, on the basis of medical charts, two clinicians separately double scored the INTERMED in 16 patients referred to the outpatient psychiatric consultation service. Aver aged over both studies, in 94.2% of all ratings there was no important difference between the raters (more than 1 point difference). As a research interview, it takes about 20 minutes;as part of the whole process of history taking it takes about 15 minutes. In both studies, improvements were suggested by the results. Analyses of study I revealed that on most items there was considerable agreement;some items were improved. Also, the reference point for the prognoses was changed so that it reflected both short- and long-term prognoses. Analyses of study 2 showed that in this setting, less agreement between the raters was obtained due to the fact that the raters were less experienced and the scoring procedure was move susceptible to differences. Some improvements-mainly of the anchor points-were specified which may furth

关键词：病史记录/方法病史记录/标准模型心理学需求估价/标准荷兰观察者偏差预后心理测定学/方法心理测定学/标准社会适应人类

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Use of the pediatric symptom checklist in the pediatric neurology population

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PEDIATRIC NEUROLOGY 1999年第2期20卷 116-120页

作者： Anderson, DL Spratt, EG Macias, MM Jellinek, MS Murphy, JM Pagano, M Griesemer, DA Holden, KR Barbosa, E Med Univ S Carolina Dept Pediat Charleston SC 29425 USA Massachusetts Gen Hosp Dept Pediat Boston MA 02114 USA

The purpose of this study was to evaluate the effectiveness of the Pediatric Symptom Checklist (PSC) as a mental health screening instrument in a busy pediatric neurology population in comparison with more lengthy, time-consuming assessment methods. One hundred two children were screened using the PSC. PSC results were compared with scores on the Child Behavior Checklist (CBCL), results from structured interviews, and ratings of adaptive functioning using the Children's Global Assessment Scale (CGAS). Thirty-nine of the patients (38%) scored 63 or above on the CBCL, indicating psychosocial impairment. Using a cutoff score of 22, the PSC correctly identified 35 of these 39 positive cases (sensitivity 89.7) and 48 of the 63 children with CBCL scores below 63 (specificity 76.2). CGAS scores were significantly negatively correlated with PSC scores (r = -0.60. P < 0.05). The PSC correctly identified 85.9% of children who scored 70 or below on the CGAS. Among the 53 children with psychiatric diagnoses on the basis of the interview, 41 scored above the cutoff of 22 on the PSC. Results suggest that the PSC is an efficient and accurate screen for identification of mental health problems in the pediatric neurology population. (C) 1999 by Elsevier Science Inc. All rights reserved.

关键词：行为症状/并发症行为症状/诊断诊断试验常规/标准精神障碍/并发症精神障碍/诊断神经系统疾病/并发症前瞻性研究精神病状态评定量表/标准心理测定学/方法心理测定学/标准参考值敏感性与特异性社会经济因素儿童儿童学龄前女(雌)性人类男(雄)性

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Depressive symptoms and mentally ill chemical abusers' perception of the treatment environment in residential settings

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ADDICTIVE BEHAVIORS 1999年第1期24卷 139-144页

作者： Nuttbrock, LA Rahav, MR Rivera, JJ Ng-Mak, DS Argus Community Inc New York NY USA

In assessing the socioenvironmental characteristics of psychiatric treatment programs, researchers typically assume that their measurements are unaffected by client characteristics. However, our analysis among mentally ill chemical abusers in a therapeutic community and community residences found significant associations between subscales of the Community Oriented Program Evaluation Scale (COPES) and depressive symptoms, as measured by the CES-D, after 2, 6, and 12 months of treatment. Investigators of treatment environments should consider depressive symptoms as a possible threat to the validity of their findings. (C) 1998 Elsevier Science Ltd.

关键词：抑郁/心理学诊断双重(精神病学) 纵向研究精神障碍/心理学精神障碍/治疗病人满意度心理测定学/标准可重复性结果寄托治疗/方法寄托治疗/标准社会知觉物质相关性障碍/心理学物质相关性障碍/治疗精神病集体治疗时间因素成年人人类男(雄)性

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Behavioral validation of the Childhood Anxiety Sensitivity Index in children

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JOURNAL OF CLINICAL CHILD PSYCHOLOGY 1999年第1期28卷 105-112页

作者： Rabian, B Embry, L MacIntyre, D Univ So Mississippi Dept Psychol Hattiesburg MS 39406 USA

Examined the construct validity of the Childhood Anxiety Sensitivity Index (CASI) in young children through the use of a behavioral challenge task. Elementary-school children completed the CASI as well as self-report measures of state and trait anxiety and subjective fear prior to and immediately following a stair-stepping task designed to increase physiological arousal. Results indicate that the CASI was a significant predictor of the degree of state anxiety and subjective fear reported in response to the challenge task, even after controlling for pretask levels of state anxiety and fear, respectively. Additionally, the CASI predicted changes in fear experienced in response to the challenge task. The findings lend support to the validity of the CASI in preadolescent children and suggest that the CASI possesses unique clinical utility relative to measures of trait anxiety. However, results of this study must be interpreted cautiously, because a large portion of the variance in response to arousal was left unaccounted for by the CASI and the overall model.

关键词：非洲裔美国人/心理学焦虑/诊断焦虑/病因学焦虑/病理生理学焦虑/心理学横断面研究疾病易感性欧洲大陆世系人群/心理学恐惧/生理学恐惧/心理学心率心理测定学/标准回归分析可重复性结果疾病严重程度指数应激心理学/并发症应激心理学/心理学气质/分类儿童女(雌)性人类男(雄)性

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The Doors and People Memory Test: Validation of norms and some new correction formulae

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BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 1999年第Pt 3期38卷 305-314页

作者： Davis, C Bradshaw, CM Szabadi, E Univ Nottingham Sch Med Psychopharmacol Sect Div PsychiatQueens Med Ctr Nottingham NG7 2UH England

Objectives. To validate the normative data on the Doors and People Memory Test (D&P) using a new sample of normal participants, and to investigate the relationship between D&P performance and general intellectual level. Design. 281 normal participants (16-75 years), subdivided into 10-year age bands, were tested on the D&P and the National Adult Reading Test (NART). Method. Each participant's raw scores on the D&P were converted into scaled scores, and scaled memory 'indices' were derived using the test manual. Stepwise multi-linear regression was used to predict the indices using age and NART error score as predictor variables. For each participant the discrepancy between the predicted and obtained values of each index was converted into a z score using the SD of the discrepancies from the whole sample. Results. The distributions of raw and scaled scores on the D&P were similar to those of the original standardization sample. The Visual-Verbal and Recall-Recognition Discrepancy indices had smaller dispersions in the present sample than in the original sample. None of the indices was significantly related to age. The Total Memory, Combined Visual Memory, Combined Verbal Memory, and Overall Forgetting indices were significantly correlated with NART error score. Conclusions. The present data constitute a cross-validation of the normative data presented in the D&P test manual. Two points of dissimilarity are noted: (i) cutting scores derived for the Visual-Verbal and Recall-Recognition indices based on the test manual norms may be unduly conservative;and (ii) the relationship between some of the DBP indices and NART error score may lead to systematic errors in interpreting the scaled scores derived from the manual. 'Correction formulae' based on the regression equations derived from the present sample are provided.

关键词：年龄分布方差分析面部智力线性模型记忆/分类记忆/生理学记忆障碍/诊断神经心理学测验/标准神经心理学测验/统计学和数值数据心理测定学/标准心理测定学/统计学和数值数据参考值可重复性结果空间知觉/生理学青少年成年人老年人女(雌)性人类男(雄)性中年人

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The Rorschach test in clinical diagnosis: A critical review, with a backward look at Garfield (1947)

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JOURNAL OF CLINICAL PSYCHOLOGY 2000年第3期56卷 395-430页

作者： Wood, JM Lilienfeld, SO Garb, HN Nezworski, MT Univ Texas Dallas Dept Psychol El Paso TX 79968 USA Emory Univ Atlanta GA 30322 USA Pittsburgh VA Hlth Care Syst Pittsburgh PA USA Univ Pittsburgh Pittsburgh PA 15260 USA Univ Texas Dallas Dallas TX 75230 USA

The present article comments on a classic study by Garfield (1947) then reviews research on the Rorschach and psychiatric diagnoses. Despite a few positive findings, the Rorschach has demonstrated little validity as a diagnostic tool. Deviant verbalizations and bad form on the Rorschach. and indices based on these variables, are related to Schizophrenia and perhaps to Bipolar Disorder and Schizotypal Personality Disorder. Patients with Borderline Personality Disorder also seem to give an above-average number of deviant verbalizations. Otherwise the Rorschach has not shown a well-demonstrated relationship to these disorders or to Major Depressive Disorder. Posttraumatic Stress Disorder (PTSD), anxiety disorders other than PTSD, Dissociative identity Disorder, Dependent, Narcissistic, or Antisocial Personality Disorders, Conduct Disorder, or psychopathy. (C) 2000 John Wiley ei Sons, Inc.

关键词：精神障碍/诊断心理学临床/标准心理测定学/标准罗尔沙赫氏试验/历史罗尔沙赫氏试验/标准历史 20世纪人类

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Inflated perceptions of responsibility and obsessive-compulsive symptoms

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BEHAVIOUR RESEARCH AND THERAPY 1999年第4期37卷 325-335页

作者： Wilson, KA Chambless, DL Univ N Carolina Dept Psychol Chapel Hill NC 27599 USA

In Salkovskis' [Salkovskis, P. (1985). Obsessional-compulsive problems: a cognitive-behavioural analysis. Behaviour Research and Therapy, 28, 571-588;Salkovskis P. (1989) Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems. Behaviour Research and Therapy, 27, 677-682] cognitive model for obsessive-compulsive disorder (OCD), inflated perception of responsibility is highlighted as the critical feature that maintains the disorder. In the current study, the relationship between responsibility and obsessive-compulsive (OC) symptoms was examined. Specifically, three measures of responsibility were evaluated for their psychometric properties. These measures were then used to test Salkovskis's model by examining the relationships among pervasive responsibility, automatic thoughts related to causing harm, and OC symptom severity. Findings provide partial support for the validity and reliability of the measures and for the model as a whole. Based on regression analyses, data support that pervasive responsibility significantly contributes to the prediction of OC symptoms. Furthermore, this relationship appears to be mediated by automatic thoughts related to causing harm in OCD contexts. (C) 1999 Elsevier Science Ltd. All rights reserved.

关键词：横断面研究强迫性障碍/分类强迫性障碍/诊断强迫性障碍/心理学知觉失真精神病状态评定量表/标准心理测定学/标准回归分析结果可重复性社会责任统计学非参数成年人女(雌)性人类男(雄)性

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Development of a screening questionnaire for tobacco/nicotine dependence according to ICD-10, DSM-III-R, and DSM-IV

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ADDICTIVE BEHAVIORS 1999年第2期24卷 155-166页

作者： Kawakami, N Takatsuka, N Inaba, S Shimizu, H Gifu Univ Sch Med Dept Publ Hlth Gifu 500 Japan

A 10-item questionnaire (the Tobacco Dependence Screener;TDS) for screening of tobacco/nicotine dependence according to ICD-IO, DSM-III-R, and DSM-IV was newly developed. The reliability and validity were assessed in three samples of smokers in Japan. A total of 58 male smokers completed the TDS and the Fagerstrom Tolerance Questionnaire (FTQ), and they were interviewed using the World Health Organization's Composite International Diagnostic Interview (Sample 1). A total of 118 male and 36 female smoking outpatients completed the TDS and the FTQ and provided a breath sample for carbon monoxide measurement (Sample 2). A total of 194 male smokers joined a health education program using a health risk appraisal (HRA) and reported their smoking status and completed the TDS 6 months after receiving the HRA results (Sample 3). The Cronbach's alpha coefficients for the TDS ranged from .74 to .81 among the samples, whereas those for the FTQ ranged from .41 to .64. Receiver operator characteristic analyses indicated that the TDS had a better screening performance for ICD-10, DSM-III-R, and DSM-IV diagnoses than did the FTQ. The TDS score significantly and positively correlated with the severity of the diagnoses, the carbon monoxide levels, number of cigarettes smoked per day, and years of smoking. The TDS score was significantly lower in those who quit smoking than in those who did not quit smoking after the HRA. It is suggested that the TDS is a reliable and useful screening questionnaire for tobacco/nicotine dependence according to ICD-10, DSM-III-R, and DSM-IV. (C) 1999 Elsevier Science Ltd.

关键词：行为成瘾/诊断置信区间预测/方法 Logistic模型普查/方法比值比精神病状态评定量表/标准心理测定学/标准问卷调查/标准参考值可重复性结果敏感性与特异性戒烟/统计学和数值数据烟草对健康的危害/诊断成年人女(雌)性人类男(雄)性中年人

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