[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.

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.

Polystyrene as an affinity chromatography matrix for the purification of antibodies.

Affinity chromatography is used for the purification of diagnostic polyclonal antibodies in order to ensure specificity. Most commonly, activated bead-formed agarose or its derivatives are used as gel matrices. Alternative matrix materials have been described, but as yet they do not appear to offer important advantages. In this study, pulverized polystyrene (PS 158K, BASF, Mannheim, Germany) was used as a solid phase for the immobilisation of bovine immunoglobulins (Ig). Affinity chromatography was performed using these coated polystyrene beads as the column matrix material in the purification of anti-bovine Ig. The polystyrene binding capacity for the different bovine Ig classes was compared using the Mancini single radial immunodiffusion technique, and ELISA procedures were used to monitor the antibody reactivity of purified and unpurified antibodies. The degree of purification was comparable to the most commonly used procedure using gel matrices from activated bead-formed agarose (e.g. CNBr-activated Sepharose 4B, Pharmacia/LKB Biotechnology, Uppsala, Sweden), but the antibody yield per ml column volume was distinctly lower. In order to raise the yield, such polystyrene bead columns with immobilized antigen can be re-used without loss of activity or larger column volumes can be used to raise the binding capacity. The polystyrene material is quite durable, chemically and immunologically inert and has a long shelf life. We conclude that polystyrene based affinity chromatography is efficient, simple and cheap.

The importance of cattle as a food source for Glossina morsitans morsitans Katete district, Eastern Province, Zambia.

The feeding habits of Glossina morsitans morsitans in the Eastern Province of Zambia were studied. A total of 687 meals were identified. Results show that 75.1% of the meals were taken on cattle. These results are discussed in relation to the published data on feeding patterns of Glossina morsitans morsitans and the control of tsetse or tsetse-transmitted trypanosomosis in the study area.

The feeding habits of the tsetse, Glossina pallidipes Austen on the south Kenya coast, in the context of its host range and trypanosome infection rates in other parts of east Africa.

The results of blood-meal identifications for 651 Glossina pallidipes from 5 subpopulations near the Kenya coast south of Mombasa, and one, 70 km inland, are presented. Bushpigs and/or warthogs were important hosts for G. pallidipes at all sites. Other major hosts included elephant, buffalo and bushbuck where they were present, and on a dairy ranch nearly 30% of feeds were taken from cattle. There was a general relationship between the numbers and diversity of wild herbivores and the abundance of G. pallidipes. These results are discussed in relation to published data on feeding patterns and trypanosome infection rates for G. pallidipes from other parts of East Africa. Overall, there are significant correlations between the proportions of bovid feeds and T. vivax infections. Bovid-feeding G. pallidipes populations with high T. vivax infection rates in south-east Uganda and western Kenya contrast with the coastal, suid-feeding populations with low T. vivax rates. These characteristics are presented as clines extending across East Africa.

Verbal analysis of doctor-patient communication.

A microscopic analysis of doctor-patient communication in the general practitioner's surgery is presented. Verbatim transcripts of 85 medical interviews, audiotaped in a natural situation were analysed. The effects of type of complaint, patient gender and physician gender on the process of verbal communication were assessed. This study focused upon the relational aspects of communication, using Stiles' Verbal Response Mode coding system (VRM), and, to a limited extent, upon the content of patient's complaints--whether they were primarily somatic or of a psychosocial nature. The hypothesis of an asymmetrical relation between physician and patient was confirmed. Results partially confirmed the hypothesis that interviews of psychosocial patients take more time than those of somatic patients. There was also some evidence that psychosocial patients try to exert more control over the conversation as compared to somatic patients. Male and female patients differed in the way they elaborated their complaints. When telling their complaints, women referred more to persons (family, friends, colleagues) than did men. In case of male GP's, the interviews of female patients took more time than those of male patients. The largest differences were between male and female physicians. In agreement with the hypothesis males were more imposing and presumptuous (giving more advisements and interpretations). Female GP's were more attentive and non-directive (giving more subjective and objective information and acknowledgements). The medical interviews of female GP's took more time than the interviews of their male colleagues. The results are discussed in the light of theoretical concepts of harmony and discrepancy with respect to doctor-patient communication and theories about gender differences.

Serological crossreactivity between Brucella abortus and Yersinia enterocolitica 0:9. III. Specificity of the in vitro antigen-specific gamma interferon test for bovine brucellosis diagnosis in experimentally Yersinia enterocolitica 0:9-infected cattle.

The course of immunological reaction in 10 Yersinia enterocolitica 0:9 experimentally-infected heifers was followed using the conventional brucellosis tests complement fixation test (CFT), serum agglutination test (SAT) and brucella card test (BCT), and a recently developed Brucella antigen-specific gamma interferon (IFN-gamma) test. Initially, the animals were exposed orally to 10(10) colony-forming units (CFU) of Y. enterocolitica 0:9. Four weeks later, they were inoculated intravenously with 10(8) CFU of Y. enterocolitica 0:9 cells. After oral inoculation, the response in the conventional brucellosis tests was minimal. Only after intravenous inoculation were CFT and SAT titres and BCT reactions comparable to natural, false positive brucellosis reactors. After oral exposure the Brucellergen-stimulated release of IFN-gamma peaked at values above the cut-off stimulation index of 2.5 in 80% of the heifers. After intravenous inoculation, stimulation indices above 2.5 were present in only 10% of the animals. Two B. abortus infected control cattle showed stimulation indices of 3.1 and 3.4, and a negative control animal exhibited a stimulation index of 1.0. These findings show, in contrast to a previous study, that the Brucellergen-specific IFN-gamma assay cannot be used as a specific and discriminatory test for B. abortus infections.

Fractionation of trypanosome antigens for species-specific sero-diagnosis.

Crude somatic antigens from isolated and ultrasonically treated trypanosomes were fractionated by column chromatography. A protein-free antigenic fraction was isolated which reacted monospecifically when tested against hyperimmune sera from rabbits. The method has a potential application in the improvement of serodiagnosis of trypanosomiasis.

The discriminant validity of the Eating Disorder Inventory--2.

The scores of 78 bulimia nervosa (BN) patients and 67 general psychiatric outpatients on the Revised Eating Disorder Inventory (EDI-2) were compared in a multivariate discriminant analysis. The bulimia scale was found to correctly classify 97 per cent of all cases. Of the EDI-2 scales thought to be not directly related to food and weight, only interoceptive awareness (IA) and asceticism (AS) showed discriminative validity. Three eating-related items were found to account for the discriminative value of the IA scale, and the new AS scale was found to be a discriminative extension of the EDI.

Effects of alcohol and expectancy on self-disclosure and anxiety in male and female social drinkers.

To study the effects of alcohol consumption and expectancy on self-disclosure and self-reported anxiety during a social interaction, 32 male and 32 female social drinkers were assigned to one of four groups comprising a 2 x 2 factorial balanced-placebo design. Alcohol expectancy reduced the intimacy level of self-disclosure but not the amount of self-disclosure. Alcohol consumption had no effect. Thus, in contrast to the common view that alcohol functions as a "social lubricant," it served to inhibit social interaction. There was a three-way interaction among alcohol consumption, expectancy, and gender of subjects, such that the largest increase in anxiety was reported by male subjects who expected but did not receive alcohol. Thus, the previously reported inverse relationship between anxiety and self-disclosure was not confirmed, and alcohol's effect on anxiety seems unrelated to its effect on self-disclosure.

The effects of alcohol, expectancy, and alcohol beliefs on anxiety and self-disclosure in women: do beliefs moderate alcohol effects?

This study investigates the effects of alcohol, expectancy, and alcohol-related beliefs on self-reported anxiety and self-disclosure behavior in a social interaction situation. Seventy-two female social drinkers were assigned to eight conditions in a 2 x 2 x 2 factorial balanced-placebo design, controlling for drink content, expectancy, and beliefs. Results show that alcohol expectancy resulted in an anxiety reduction in subjects who believed that alcohol has a positive influence on social behavior, whereas expectancy had no effect in subjects with negative alcohol beliefs. Furthermore, subjects who expected alcohol were less anxious when they had positive alcohol beliefs than when they had negative beliefs, whereas beliefs made no difference in subjects who expected tonic. Our results suggest that the effect of alcohol expectancy on social anxiety in women is moderated by differences in the content of their alcohol-related beliefs. We conclude that the inconsistency in previous results about the effect of alcohol expectancy on social behavior might be explained by differences in subjects' alcohol beliefs. Finally, as neither of the three factors had any effect on self-disclosure behavior, we suggest that this behavioral measure is unrelated to self-reported anxiety.

Alcohol and social anxiety in women and men: pharmacological and expectancy effects.

A replication study was conducted to determine pharmacological and expectancy effects of alcohol on self-reported anxiety in a social interaction situation. Thirty-two male and thirty-two female social drinkers were randomly assigned to four conditions in a 2 x 2 factorial balanced placebo design, controlling for drink content and expectations. Results show that in women alcohol expectancy reduced self-reported anxiety, whereas in men there was no significant effect of expectancy. Alcohol consumption reduced anxiety in both men and women. Controlling for beliefs increased some of the effects we found. We conclude that although cognitive factors do mediate the effects of alcohol on self-reported anxiety, this influence seems to be different for men and women and the role of pharmacological factors might be more crucial.

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.