Patient-centeredness in psychiatric work disability evaluations and the reproducibility of work capacity estimates.

OBJECTIVES: To evaluate the extent of patient-centeredness in psychiatric work disability evaluations and its association with the reproducibility of work capacity (WC) estimates. METHODS: In our mixed methods study, 29 video-taped interviews conducted in psychiatric work disability evaluations were coded with the Roter Interaction Analysis System (RIAS) and different measures of patient-centeredness were derived from these codings, including a summary patient-centred communication ratio. Four experts each estimated a claimant's WC on a scale from 0% to 100%. RESULTS: Patient-centred communication ratios were always >1, suggesting a preponderance of psychosocial information exchange. In contrast, utterances reflecting empathy were rare e.g., the expert did not address the claimant's emotions in 25 of 29 interviews. None of the derived patient-centeredness measures showed a significant association with WC reproducibility. CONCLUSIONS: Many of the experts' questions addressed the claimant's lifestyle and psychosocial situation. However, this likely reflected factual requirements for the expert opinion, rather than patient-centeredness. Indeed, the experts rarely showed empathy, which is a hallmark characteristic of patient-centeredness. The reproducibility of work capacity estimates was not modulated by patient-centeredness, irrespective of its quantification. PRACTICE IMPLICATIONS: Patient-centeredness in work disability evaluations should find its entry in continuing education of experts.

Effects of nature-adapted lighting solutions ("Virtual Sky") on subjective and objective correlates of sleepiness, well-being, visual and cognitive performance at the workplace.

Exposure to natural daylight benefits human well-being, alertness, circadian rhythms and sleep. Many workplaces have limited or no access to daylight. Thus, we implemented a light-panel ("Virtual Sky"), which reproduced nature-adapted light scenarios. In a laboratory office environment, three lighting scenarios were presented during the day: two lighting conditions with nature-adapted spectral light distributions, one with static and one with dynamic clouds, and a standard office lighting condition. We compared the impact of the three lighting scenarios on subjective and objective measures of alertness, cognitive performance, wellbeing, visual comfort, contrast sensitivity, and cortisol levels in 18 healthy young male volunteers in a within-participant cross-over study design. We found no evidence that an 8-h lighting scenario with static or dynamic clouds during the waking day (9am-5pm) was associated with any significant effect on objective and/or subjective alertness, cognitive performance and morning cortisol concentrations compared to standard workplace lighting. However, the dynamic light scenario was accompanied with lower levels of perceived tensionafter completing cognitive tasks and less effort to concentrate compared to the static lighting scenarios. Our findings suggest that apart from smaller effects on tension and concentration effort, nature-adapted lighting conditions did not improve daytime alertness and cognitive performance in healthy well-rested young participants, as compared to standard office lighting.

[Integration of the Insured Person's Perspective in the Quality Assessment of Medical Evaluations]. / Integration der Versichertenperspektive in die Qualitätsbewertung der Begutachtung.

Integration of the Insured Person's Perspective in the Quality Assessment of Medical Evaluations Abstract. In the current practice of medical work disability evaluations and other pension assessments, insured persons in Switzerland lack the possibility to routinely provide feedback on the extent to which they felt treated with dignity and respect by medical experts, which, according to occasional complaints, does not always seem to be the case. In order to be able to systematically capture such aspects of interactive fairness, we developed a questionnaire, the Basel Fairness Questionnaire (BFQ). The BFQ contains 30 statements such as «The reviewer listened to me.¼, which the insured person can agree to on four levels (from «I do not agree at all.¼ to «I fully agree.¼). For validating the questionnaire, 305 claimants for disability pensions completed the BFQ after their medical work disability evaluation. A factor analysis conducted on the answered questions confirmed our assumption that the BFQ questions covered the areas of 1) respect and trust, 2) participation, 3) case familiarity of the expert, and 4) transparency of the evaluation process. Furthermore, our study demonstrated divergent and convergent validity of the BFQ with other questionnaire instruments. The BFF opens up the possibility to capture the abstract concept of fairness by means of assessments of concrete expert behavior. We expect that the questionnaire can thus contribute to quality assurance in this sensitive area.

Digitally Assisted Standard Diagnostics in Insurance Medicine (DASDIM): psychometric data in psychiatric work disability evaluations.

PURPOSE: Insurers often commission psychiatric experts to evaluate the eligibility of workers with mental disorders for disability benefits, by estimating their residual work capacity (RWC). We investigated the validity of a standardized, computer-based battery of established diagnostic instruments, for evaluating the personality, cognition, performance, symptom burden, and symptom validity of claimants. METHODS: One hundred and fifty-three claimants for benefits were assessed by the assembled test battery, which was applied in addition to a conventional clinical work disability evaluation. RESULTS: A principal component analysis of the test and questionnaire battery data revealed six factors (Negative Affectivity, Self-Perceived Work Ability, Behavioral Dysfunction, Working Memory, Cognitive Processing Speed, and Excessive Work Commitment). Claimants with low, medium, and high RWC exclusively varied in the factor Negative Affectivity. Importantly, this factor also showed a strong association to psychiatric ratings of capacity limitations in psychosocial functioning. CONCLUSIONS: The findings demonstrate that the used test battery allows a substantiation of RWC estimates and of psychiatric ratings by objective and standardized data. If routinely incorporated in work disability evaluations, the test battery could increase their transparency for all stakeholders (insurers, claimants, medical experts, expert case-coordinators, and legal practitioners) and would open new avenues for research in the field of insurance medicine.Implications for rehabilitationThe residual work capacity (RWC) estimation by medical experts is internationally good practice, but plagued by a relatively low interrater agreement.The current study shows that psychiatric RWC estimates and capacity limitation ratings can be substantiated by data from objective, standardized psychometric instruments.Systematically using such instruments might help to improve the poor interrater agreement for RWC estimates in work disability evaluations.Such data could also be used for adopting vocational trainings and return-to-work programs to the individual needs of workers with mental health problems.

No evidence for auditory N1 dishabituation in healthy adults after presentation of rare novel distractors.

Previous studies were not able to show that presentation of change stimuli leads to dishabituation of the auditory evoked potential (AEP) component N1 for repeated stimuli. However, these change stimuli were usually themselves repeatedly presented. Here, we tested whether the presentation of non-repeating distractor stimuli ('novels') would lead to N1 dishabituation. The study sample consisted of 18 healthy participants who had to identify auditory target stimuli (´targets´) among repeated standard stimuli and rare novels. AEPs to standards were separately averaged, depending on the preceding stimulus (standards after standards, standards after targets, and standards after novels) and were compared by F statistics and Bayesian t-test. Moreover, N1 repetition effects within recording blocks were analyzed in single trial analyses. The analyses showed that targets elicited significantly larger N1 amplitudes than standards and standards elicited larger N1 amplitudes than novels. In contrast, the N1 amplitude to standards did not vary with the preceding stimulus. The single trial analyses revealed significant, but similar N1 amplitude decreases within the recording blocks for all standards. The current study revealed no evidence for N1 dishabituation, as the N1 amplitude for standards after novels was not increased as compared to the N1 for standards after standards. Thus, stimulus variation had no impact on the N1 of repeated standards, as also suggested by the single trial analyses. The lack of N1 dishabituation is at odds with the assumption that the N1 amplitude decrease after repeated stimulation results from habituation.

The assessment of capacity limitations in psychiatric work disability evaluations by the social functioning scale Mini-ICF-APP.

OBJECTIVE: Insurers frequently commission medical experts to estimate the degree of the remaining work capacity (RWC) in claimants for disability benefits. The social functioning scale Mini-ICF-APP allows for a rating of activity and participation limitations in thirteen capacity domains, considered as particularly relevant for work ability. The current study sought to evaluate the role of the Mini-ICF-APP ratings in psychiatric work disability evaluations, by examining how the capacity limitation ratings varied with the claimants' primary psychiatric diagnoses and how the ratings were related to RWC estimates. METHODS: Medical experts estimated the RWC of 946 claimants with mental disorders and rated their activity and participation limitations using the Mini-ICF-APP, with higher ratings reflecting more severe limitations. The ratings were compared between claimants with different psychiatric diagnoses by analyses of variance. The mean Mini-ICF-APP rating across all capacity domains as well as all capacity-specific ratings were entered in simple or multiple regression models to predict the RWC in an alternative job. RESULTS: The Mini-ICF-APP capacity limitation ratings in all domains but mobility were higher for claimants with personality and behavior disorders as compared to those with mood disorders or with neurotic, stress-related and somatoform disorders. The largest differences were observed in social capacities (e.g. group integration: F 2, 847 = 78.300, P < 0.001). In claimants with depression, all ratings increased with the severity of the diagnosis (all Fs 2, 203 > 16.393, all Ps < 0.001). In the overall sample, the mean Mini-ICF-APP rating showed a strong negative correlation with the estimated RWC (r = -.720, P < 0.001). Adding the capacity-specific ratings to the prediction model improved this prediction only marginally. DISCUSSION: The Mini-ICF-APP allows for documenting claimants' activity and participation limitations, which is likely to increase the transparency of medical experts' RWC estimates and enables them to check the plausibility of such estimates. However, our study showed that despite the strong association between RWC and Mini-ICF-APP ratings, half of the RWC variance was unrelated to the capacity limitations documented in the Mini-ICF-APP.

The reduced auditory evoked potential component N1 after repeated stimulation: Refractoriness hypothesis vs. habituation account.

Similar to other event-related potential (ERP) components, the amplitude of the auditory evoked N1 depends on the interstimulus interval (ISI). At ISIs > 0.4 s, the amplitude of the N1 increases with longer ISIs, until it saturates at ISIs around 10 s. This amplitude increase with increasing ISI has been conceptualized as a function of N1 recovery or N1 refractoriness. Habituation (as a simple form of learning) represents an elaborated, opposing account for such stimulus repetition effects. For passive oddball experiments (stimulation protocols with frequent standards and rare deviants), the two accounts make different predictions. According to the habituation account, the presentation of small deviants should lead to an increased N1 for subsequent standards (= dishabituation); according to the N1 refractoriness account, there should be no or just minor effects on the N1. In the current study, we tested these predictions and compared the ERPs to standards after small deviants and to standards preceded by other standards. We observed that the ERPs to standards after small deviants were characterized by a small mismatch negativity with an onset latency > 150 ms, but the N1 to standards after deviants did not differ from the N1 to standards preceded by other standards. This negative finding is in line with other previous studies that were also not able to reveal evidence for N1 dishabituation. Aside from this repeated lack of evidence for dishabituation, the N1 habituation account is challenged by the finding that the N1 decrease is stronger for more intense stimuli. Overall, the current and previous findings are more compatible with the N1 refractoriness account, although the mechanisms underlying N1 refractoriness remain to be elucidated. Knowledge about these mechanisms would also help to understand why N1 deficits in schizophrenia are more pronounced at longer ISIs.

Indirect and Neuropsychological Indicators of Pedophilia.

The present study aimed to differentiate pedophilic child sex offenders (CSOs) from nonoffending controls (CTLs), as well as contact from noncontact CSOs. For this purpose, we investigated 21 contact CSOs, 20 noncontact CSOs (child pornography offenders), as well as 21 CTLs on neuropsychological test measures and indirect test measures of sexual interest. Multiple logistic regression models showed that three parameters of indirect tests and two neuropsychological test parameters allowed the differentiation of CSOs from CTLs with a maximum accuracy of 87%. The profile of contact and noncontact CSOs was remarkably similar and the optimal model for this group differentiation had a maximum accuracy of 66%, with slightly increased levels of risk-taking behavior and greater susceptibility for perceptual interference in contact CSOs than in noncontact CSOs. The findings suggest that standardized, objective methods can support the assessment of sexual offenders against children in forensic psychiatry and legal psychology.

Perceived fairness of claimants undergoing a work disability evaluation: Development and validation of the Basel Fairness Questionnaire.

BACKGROUND: There are currently no tools for assessing claimants' perceived fairness in work disability evaluations. In our study, we describe the development and validation of a questionnaire for this purpose. METHOD: In cooperation with subject-matter experts of Swiss insurance medicine, we developed the 30-item Basel Fairness Questionnaire (BFQ). Claimants anonymously answered the questionnaire immediately after their disability evaluation, still unaware about its outcome. For each item, there were four response options, ranging from "strongly disagree" to "strongly agree". The construct validity of the BFQ was assessed by running a principal component analysis (PCA). RESULTS: In 4% of the questionnaires, the claimants' perception on the disability evaluation was negative (below the median of the scale). The PCA of the items responses followed by an orthogonal rotation revealed four factors, namely (1) Interviewing Skills, (2) Rapport, (3) Transparency, and (4) Case Familiarity, explaining 63.5% of the total variance. DISCUSSION: The ratings presumably have some positive bias by sample selection and response bias. The PCA factors corresponded to dimensions that subject-matter experts had beforehand identified as relevant. However, all item ratings were highly intercorrelated, which suggests that the presumed underlying dimensions are not independent. CONCLUSION: The BFQ represents the first self-administered instrument for measuring claimants' perceived fairness of work disability evaluations, allowing the assessment of informational, procedural, and interactive justice from the perspective of claimants. In cooperation with Swiss assessment centres, we plan to implement a refined version of the BFQ as feedback instrument in work disability evaluations.

The effect of shared distinctiveness on source memory: An event-related potential study.

An illusory correlation (IC) is the erroneous perception that two actually uncorrelated categories are correlated. The Shared Distinctiveness Approach (SDA) explains ICs with heightened accessibility of distinctive category combinations in episodic memory. However, empirical evidence for this approach is heterogeneous. In the present event-related potential (ERP) study, we exploited the fact that more distinctive items elicit larger P300 responses than less distinctive items, which potentially predict subsequent memory performance differences for such items. Distinctiveness at encoding was created by presenting words that differed from frequently presented, positive words in valence, font color, or both. We hypothesized that shared distinctiveness (deviation in both color and valence) would lead to an enhanced P300 subsequent memory effect (SME), better source memory performance, and an overestimation of the frequency of shared distinctive items. Behavioral results indicated the presence of shared distinctiveness effects on source memory and frequency estimation. Unexpectedly, memory also was enhanced for positive items in the frequent color. This pattern also was reflected in the P300 for highly positive and negative items. However, shared distinctiveness did not modulate the P300 SME, indicating that the processing of distinctive features might only indirectly contribute to better encoding. This study shows that shared distinctiveness indeed is associated with better source memory and ICs. Because effects were observed for the most frequent and the least frequent category combination, our results imply that the processing of distinctiveness might involve attention allocation to diametrical category combinations, thereby accentuating the differences between the categories.

Enhanced processing of facial emotion for target stimuli.

It is as yet unresolved to what extent the pre-attentive detection of auditory deviance is modulated by emotion. The current event-related potential study was designed to investigate simultaneously the auditory and the visual mismatch negativity (MMN), as well as the impact of emotion on the auditory MMN. Thirty healthy participants saw sequences of neutral and fearful face stimuli and were instructed to identify easily detectable target faces by button press, whereas simultaneously presented auditory stimuli did not require any behavioral response. Increased N170 and N250 amplitudes to fearful faces indicated a differential processing of the fearful and neutral faces as standards. A visual MMN was clearly elicited by fearful face deviants, but hardly by neutral face deviants. Neither the auditory MMN nor the processing of visual targets was modulated by the facial emotion. However, the N250 modulation by emotion was surprisingly larger in target than in non-target trials. Findings suggest that the pre-attentive detection of auditory deviance as reflected in the auditory MMN is not substantially modulated by emotion induced by visual stimulation. The wide lack of a significant visual MMN to neutral deviants indicates that this deviance detection is not driven by physical stimulus properties (because otherwise the visual MMN to fearful and neutral deviants should have the same magnitude) but strongly by the emotional significance. The behavioral significance of targets apparently led to an enhanced processing of emotional features even though these features were irrelevant for target detection task.

Psychopathy, Neuroticism, and Abusive Behavior in Low Risk Child Sex Offenders.

Personality traits are considered as an important aspect in the assessment of child sex offenders (CSOs). The current study sought to elucidate the association between neuroticism, psychopathy, and abusive behavior in low risk CSOs. 43 pedophilic CSOs and 21 controls (CTLs) completed the NEO-Personality Inventory-Revised (NEO-PI-R), Psychopathy Checklist: Screening Version (PCL:SV), and Multiphasic Sex Inventory (MSI). Our results revealed small differences in PCL scores between CSOs and CTLs, with comparatively low levels of psychopathy in both groups. Higher levels of neuroticism were associated with higher PCL scores, in both CSOs and CTLs. However, higher PCL scores in CSOs did not correlate with higher MSI total scores on the subscale child molest. These findings suggest an ambiguous role of psychopathy in CSOs: higher levels of psychopathy co-occur with higher levels of neuroticism, but psychopathy does apparently not modulate abusive behavior, at least not in low risk offenders, as currently investigated.

Direct Electrophysiological Evidence for Prefrontal Control of Hippocampal Processing during Voluntary Forgetting.

Forgetting does not necessarily reflect failure to encode information but can, to some extent, also be voluntarily controlled. Previous studies have suggested that voluntary forgetting relies on active inhibition of encoding processes in the hippocampus by the dorsolateral prefrontal cortex (DLPFC) [1-4]. During attentional and sensorimotor processing, enhanced DLPFC theta power alongside increased alpha/beta oscillations are a neural signature of an inhibitory top-down mechanism, with theta oscillations reflecting prefrontal control and alpha/beta oscillations occurring in areas targeted by inhibition [5-12]. Here, we used intracranial EEG recordings in presurgical epilepsy patients implanted in DLPFC (n = 13) and hippocampus (n = 15) during an item-method directed forgetting paradigm. We found that voluntary forgetting is associated with increased neural oscillations in the low theta band (3-5 Hz) in DLPFC and in a broad theta/alpha/beta (6-18 Hz) frequency range in hippocampus. Combining time-lagged correlation analysis, phase synchronization, and Granger causality in 6 patients with electrodes in both DLPFC and hippocampus, we obtained converging evidence for a top-down control of hippocampal activity by the DLPFC. Together, our results provide strong support for a model in which voluntary forgetting relies on enhanced inhibition of the hippocampus by the DLPFC.

Auditory N100 gating in patients with schizophrenia: A systematic meta-analysis.

OBJECTIVE: The study sought to assess the presence of auditory N100 gating deficits in patients with schizophrenia by meta-analysis. METHODS: Literature was screened for studies on patients with schizophrenia that used the paired-click paradigm and reported N100 data. Both electroencephalographic and magnetoencephalographic studies were considered. N100 gating measures as well as the N100 amplitudes to the initial and repeated stimulus were extracted and subjected to a meta-analysis. RESULTS: The literature research revealed 29 studies, reporting either N100 gating or N100 amplitude measures in paired-click experiments. Patients with schizophrenia exhibited less N100 gating than healthy controls across studies (mean g = -0.405, SE = 0.051). However, what appeared as a gating deficit in patients was due to reduced N100 amplitudes to the initial stimulus in this group (mean g = 0.610, SE = 0.075). Patients and controls did not differ in their N100 amplitudes to the repeated stimulus (mean g = 0.042, SE = 0.066). CONCLUSION: There is no evidence for an auditory N100 gating deficit in schizophrenia, but for an impaired N100 response recovery. SIGNIFICANCE: Previous findings on impaired N100 gating in schizophrenia patients reflect deficient processing of auditory salience rather than defective inhibition of repeating redundant auditory stimulation.

Inhibition and attentional control in pedophilic child sexual offenders - An event-related potential study.

OBJECTIVE: Impaired response inhibition might play a role in child sexual offences. Recording of event-related potentials (ERPs) can help to clarify whether child sexual offenders (CSOs) show an altered processing of stop signals and commission errors. METHODS: In the current ERP study, we investigated these processes in a Go/Nogo task on two groups of CSOs, pedophilic contact CSOs and non-contact CSOs (child pornography offenders), as well as on non-offenders as controls. RESULTS: Behaviorally, CSOs showed a slight, but non-significant increase of the false alarm rate to Nogo cues, as compared to controls. The amplitudes of the ERP components N2 and P3 to Nogo cues followed by correctly withhold responses did not vary between CSOs and controls. The analysis of the ERPs to committed errors showed that the Ne amplitudes (reflecting error detection) did not differ between the groups either, whereas the Pe amplitudes (reflecting error evaluation and error awareness) were strongly diminished in CSOs. This diminishment was primarily found in contact CSOs. CONCLUSIONS: The findings suggest that response inhibition, processing of stop signals, and error detection are not necessarily impaired in CSOs. However, CSOs appear to dedicate less cognitive resources to the evaluation of committed errors. SIGNIFICANCE: This selective alteration could reflect a reduced sense of responsibility for misconduct in this offender group, which might contribute to their delinquent behavior.

Illusory correlations despite equated category frequencies: A test of the information loss account.

Illusory correlations (IC) are the perception of covariation, where none exists. For example, people associate majorities with frequent behavior and minorities with infrequent behavior even in the absence of such an association. According to the information loss account, ICs result from greater fading of infrequent group-behavior combinations in memory. We conducted computer simulations based on this account which showed that ICs are expected under standard conditions with skewed category frequencies (i.e. 2:1 ratio for positive and negative descriptions), but not under conditions with equated category frequencies (i.e. 1:1 ratio for positive and negative descriptions). Contrary to these simulations, our behavioral experiments revealed an IC under both conditions, which did not decrease over time. Thus, information loss alone is not sufficient as an explanation for the formation of ICs. These results imply that negative items contribute to ICs not only due to their infrequency, but also due to their emotional salience.

The event-related potential component P3a is diminished by identical deviance repetition, but not by non-identical repetitions.

Mismatch negativity (MMN) represents an event-related potential (ERP) component which is elicited by deviant sound events in an otherwise regular, repetitive stimulation. The MMN amplitude typically decreases when two identical deviants are presented in direct succession, but it remains stable when the two deviants vary from the standard in different features. Less is known about such repetition effects on another ERP component, the P3a, which usually follows the MMN. In the current study, we investigated how the P3a was affected by identical and non-identical repetitions of sound deviants. The ERP analysis revealed that the P3a amplitudes were strongly diminished when the repeated deviants were identical, but the P3a remained stable when the repeated deviants varied. The findings suggest that not only the deviance detection system, as reflected in the MMN, but also subsequent attention switch systems, as reflected in the P3a, operate independently across different sound features.