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Delirium subtype identification and the validation of the Delirium Rating Scale - Revised-98 (Dutch version) in hospitalized elderly patients
- Authors:
- DE ROOIJ Sophia E., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(9), September 2006, pp.876-882.
- Publisher:
- Wiley
Delirium is the most common acute neuropsychiatric disorder in hospitalized elderly. The Dutch version of the Delirium Rating Scale - Revised-98 (DRS-R-98) appears to be a reliable method to classify delirium. The aim of this study was to determine the validity and reliability of the DRS-R-98 and to study clinical subtypes of delirium using the DRS-R-98. Patients received the Dutch version of the DRS-R-98, the Mini-Mental State Examination, the Confusion Assessment Method, and a clinical diagnosis of delirium according to DSM-IV criteria, and their relatives the Informant Questionnaire Cognitive Decline in the Elderly. The DRS-R-98 validation cohort (n = 65) consisted of 23 patients with delirium, 22 patients with dementia, and 20 non-psychiatric comparison patients. For the delirium subtype study, a second cohort comprising 54 delirious patients was investigated. Median DRS-R-98 scores significantly distinguished delirium from dementia and no psychiatric disorder. Inter-rater reliability (intra-class correlation 0.97) and internal consistency (Crohnbach's alpha 0.94) were high. Positive scores of DRS-R-98 item 4 (affect liability) and item 7 (motor agitation) predicted the presence of non-hypoactive delirium, with a specificity of 89% and a sensitivity of 57%. The results show that the Dutch version of the DRS-R-98 is a valid and reliable measure of delirium severity and distinguishes patients with delirium from patients with dementia and comparison patients.
Invariance of SCL-90-R dimensions of symptom distress in patients with peri partum pelvic pain (PPPP) syndrome
- Authors:
- ARRINDELL W. A., et al
- Journal article citation:
- British Journal of Clinical Psychology, 45(3), September 2006, pp.377-391.
- Publisher:
- Wiley
There are no studies available that have examined the factorial invariance of dimensions underlying the Symptom Checklist-90-Revised (SCL-90-R) across at least three distinct samples. In the following study, we wished to determine whether a dimensional model comprising eight primary factors previously identified in psychiatric out-patients, phobics and the general population (Arrindell & Ettema, 2003) could be extended to a homogeneous sample of pain patients comprising females suffering from peri partum pelvic pain (PPPP) syndrome (N=413). The internal consistency and discriminant validity of the dimensions were also examined. The SCL-90-R and measures of disability, pain-related fear, pain intensity and fatigue were administered to the participants. The multiple group method was used to determine factorial invariance. Pearson correlations were determined between the SCL-90-R and aforementioned measures. The factorial invariance of an 8-dimensional model of primary factors underlying the SCL-90-R, namely, agoraphobia, anxiety, depression, somatization, cognitive-performance deficits, interpersonal sensitivity-mistrust, acting-out hostility and sleep difficulties, was extended with success to the present sample of PPPP patients. In spite of substantial correlations between the internally consistent SCL-90-R symptom dimensions, some evidence of discriminant validity was reported in that specific subscales showed different patterns of correlations with measures of disability, pain-related fear, pain intensity and fatigue. The 8-dimensional system based on the work of Arrindell and Ettema (2003) was invariant across psychiatric patients, phobics, the general population and pain patients. The invariance of the SCL-90-R hostility dimensions may have implications for a re-formulation of Watson and Clark's tripartite model of general distress, specific anxiety and specific depression.
Premature termination of short-term inpatient psychotherapy: client's perspectives on causes and effects
- Authors:
- THUNNISSEEN Moniek, REMANS Yole, TRIJSBERG Wim
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 27(2), Summer 2006, pp.265-273.
- Publisher:
- Emerald
This study investigates what motivated patients to end their treatment prematurely, and to give recommendations for changes in the policy. Between May 1999 and December 2001, 24 patients were dropouts from a three-month in-patient psychotherapy programme in the Netherlands. The authors held interviews with 16 of them. The aim was to find out what they experienced during the treatment, which factors (from the patient's point of view) led to their leaving and how they functioned after they left the institution. Nearly half of the dropouts reported that they ended treatment in the first two weeks because of very high levels of anxiety. The remaining dropout patients reported more diffuse motives. Most patients recommended more supportive elements in the treatment to prevent dropout. As a result of the study, staff changed its attitude and endorsed a more supportive approach, especially in the first weeks of the treatment. In the next period from January 2002 till May 2003 the dropout rate was reduced from 16% to 8%.
Effect of the Meeting Centres Support Program on informal carers of people with dementia: Results from a multi-centre study
- Authors:
- DROES R-M, et al
- Journal article citation:
- Aging and Mental Health, 10(2), March 2006, pp.112-124.
- Publisher:
- Taylor and Francis
Because of the complex nature of the problems that carers of persons with dementia encounter, several comprehensive support programs for carers were developed in the past decade. One such program is the Meeting Centres Support Program (MCSP) that integrates different types of support for persons with dementia and their carers, which have proved to be effective in practice and/or research. Within the framework of a study into the national implementation of the MCSP, it was investigated whether the positive effects found in carers that participated in the first Amsterdam Meeting Centres, were also achieved in other regions of The Netherlands. A pre-test–post-test control group design with matched groups was applied. In total, 94 carers in the MCSP in eight meeting centres and 34 carers of dementia patients who frequented regular psychogeriatric day care (PDC) in three nursing homes were included in the study. During the study period 23 carers of the MCSP group and 21 carers of the PDC group dropped out. At baseline and after seven months indicators of burden (psychological and psychosomatic symptoms, feelings of burden and time between start of support and institutionalization of the persons with dementia) were measured, as well as potential determinants of burden (sense of competence, coping strategies, experienced support, loneliness and the emotional impact of behaviour problems). Though on a group level no effect was found, either in psychological and psychosomatic symptoms or in the determinants of burden, a subgroup of carers who felt lonely (n?=?22) at baseline benefited significantly more from the MCSP than from PDC in terms of psychological and psychosomatic symptoms. A majority of MCSP carers (82.1%) experienced less burden and more professional support. After seven months significantly fewer persons with dementia in the MCSP (4%) were institutionalized as compared to the patients in PDC (29%). Patients in the MCSP participated for a longer period of time before institutionalization. Although the effect on sense of competence of carers that was found in the Amsterdam study was not found in this multi-centre study, the effect on burden and delayed institutionalization of the person with dementia were confirmed. The integrated MCSP also proved more effective than PDC in decreasing psychological and psychosomatic symptoms in lonely carers. Further dissemination of the MCSP is therefore recommended.
Cannabis use and mental health in secondary school children: findings from a Dutch survey
- Authors:
- MONSHOUWER Karin, et al
- Journal article citation:
- British Journal of Psychiatry, 188(2), February 2006, pp.148-153.
- Publisher:
- Cambridge University Press
This study aims to investigate the association between cannabis use and mental health in adolescence. Data from 5551 adolescents aged 12–16 years were drawn from the Dutch Health Behaviour in School-Aged Children school survey, carried out as part of the international 2001 World Health Organization project. After adjusting for confounding factors, cannabis use was linked to externalising problems (delinquent and aggressive behaviour) but not to internalising problems (withdrawn behaviour, somatic complaints and depression). An increasing frequency of use resulted in stronger links. No significant gender or age by cannabis interaction effects were found. The results are also discussed in relation to the liberal drug policy in The Netherlands.
Patients with minor mental disorders leading to sickness absence: a feasibility study for social workers’ participation in a treatment programme
- Authors:
- BROUWERS Evelien P. M., et al
- Journal article citation:
- British Journal of Social Work, 36(1), January 2006, pp.127-138.
- Publisher:
- Oxford University Press
Minor mental disorders are common among patients who visit their general practitioner. In the Netherlands, they are associated with high costs due to absenteeism, disability benefits and medical consumption (consumption of drugs as well as expenditure of medical staff’s time). In the Netherlands, a protocol was developed for the treatment of minor mental disorders, based on the principles of brief cognitive behaviour therapy. The cost-effectiveness of this protocol was tested in a group of patients whose minor mental disorders had lead to sickness absence. The protocol was completed by Dutch social workers, one of whose core tasks normally is to provide psychosocial care. The main aims of the protocol are for the patient to regain functionality and to prevent long-term disability. The protocol emphasizes patients’ own responsibility and active role in the recovery process, includes homework assignments and stresses the importance of early work resumption. This article focuses on a discussion of the feasibility of this treatment for minor mental disorders. The evidence for or against the protocol’s cost-effectiveness will be discussed in future papers. The results show that patients, social workers and general practitioners were motivated to participate and that the protocol was well received by all three groups. If the treatment also proves to be cost-effective, it would appear to be a promising intervention for a frequently encountered problem in primary care.