Why are some cases not on track? An item analysis of the Assessment for Signal Cases during inpatient psychotherapy.

Within the Routine Outcome Monitoring system "OQ-Analyst," the questionnaire "Assessment for Signal Cases" (ASC) supports therapists in detecting potential reasons for not-on-track trajectories. Factor analysis and a machine learning algorithm (LASSO with 10-fold cross-validation) were applied, and potential predictors of not-on-track classifications were tested using logistic multilevel modeling methods. The factor analysis revealed a shortened (30 items) version of the ASC with good internal consistency (α = 0.72-0.89) and excellent predictive value (area under the curve = 0.98; positive predictive value = 0.95; negative predictive value = 0.94). Item-level analyses showed that interpersonal problems captured by specific ASC items (not feeling able to speak about problems with family members; feeling rejected or betrayed) are the most important predictors of not-on-track trajectories. It should be considered that our results are based on analyses of ASC items only. Our findings need to be replicated in future studies including other potential predictors of not-on-track trajectories (e.g., changes in medication, specific therapeutic techniques, or treatment adherence), which were not measured this study.

[The ICD-10 Symptom Rating (ISR): validation of the depression scale in a clinical sample]. / Das ICD-10 Symptomrating (ISR): Validierung der Depressionsskala an einer klinischen Stichprobe.

The ICD-10 Symptom Rating (ISR) 1 measures the severity of psychiatric disorders with 29 items on 5 subscales as comprehensively as possible. The following syndromes are measured: Depressive syndrome, anxiety syndrome, obsessive-compulsive syndrome, Somatoform syndrome, eating disorder syndrome as well as additional items that cover various mental syndromes, and an overall score. The study reports findings on the validity and sensitivity to change of the depression subscale (ISR-D). In a clinical sample of N=949 inpatients with depression spectrum disorders the convergent validity was determined by correlation with the Beck Depression Inventory (BDI) 3 and the subscale "depression" of the Symptom-Checklist-90-R (SCL-90-R) 4. The high correlation between the different instruments confirms the validity of the ISR-Depression Scale. The sensitivity to change of the ISR seems higher than that of the BDI and the SCL-90. Because of its economy and the good psychometric properties the ISR is recommended for use in clinical samples.

[Review Model for the Assessment of Psychometric Instruments--Recommendations of the German College of Psychosomatic Medicine (DKPM)]. / Kriterienkatalog zur Beurteilung psychodiagnostischer Selbstbeurteilungsinstrumente--Empfehlung des Deutschen Kollegiums für Psychosomatische Medizin (DKPM).

OBJECTIVES: Psychometric instruments are commonly applied in psychotherapeutic research and care for the baseline assessment of symptoms, the planning of therapeutic interventions, the assessment of the longitudinal course of symptoms and outcomes of therapeutic interventions as well as quality management of care. Psychometric properties as well as economic aspects should be considered in the selection of specific instruments. It is assumed that users of psychometric instruments face a great variety of instruments and related information. For that reason, it seems challenging to absorb the current knowledge and to integrate it into clinical practice and research. Thus, it is likely that well-known, established and easily accessible instruments are commonly used, while new developed instruments might not be disseminated in research and healthcare. METHODS: Based on available international review models, the working group "Psychometrics and Psychodiagnostics" of the German College of Psychosomatic Medicine (DKPM) has developed and tested a review model specifically tailored for psychotherapeutic research and care. RESULTS: The different steps of development, as well as the final review model based on the consensus of the working group are presented. The review model contains 6 generic terms (reliability, validity, objectivity, reference groups and aspects of application) with 21 different criteria to be assessed with 0-3 asterisks (*). The criteria are clearly operationalized and the practical use of the review model is explained and discussed. CONCLUSIONS: With the review model for the assessment of psychometric instruments a well-defined evaluation system is made available for research and clinical practice which has been developed by an expert group. The review model facilitates systematic, transparent and comparative evaluation of psychometric instruments along clearly defined criteria. It also supports the selection of psychometric instruments in research and care. Next, the working group aims at disseminating and implementing the review model as well as the application and publication of reviews for different psychometric instruments based on the review model.

How does the ICD-10 symptom rating (ISR) with four items assess depression compared to the BDI-II? A validation study.

OBJECTIVE: The "ICD-10 Symptom-Rating" (ISR) is a novel 29-item self-rating questionnaire with scales for the assessment of depression, anxiety, OCD, somatisation and eating disorders and additional items. This study aims at the validation of the depression subscale. METHODS: Based on a sample of 1844 depressed inpatients, the ISR was correlated with the Beck-Depression-Inventory-II (BDI-II). To estimate the sensitivity to change, the effect sizes were also calculated. RESULTS: The correlation between ISR and BDI-II was r=0.79. The sensitivity to change for the BDI-II was d=1.44, for the ISR-depression scale d=1.64. LIMITATIONS: The studied sample shows a higher psychiatric and somatic comorbidity, a lower mean age and a higher level of education than comparable samples from other psychiatric or psychosomatic studies. Although we cannot find any effects of these differences on our results, they cannot be fully dismissed without further study. CONCLUSION: The ISR-depression scale correlates highly with the BDI-II. Being more sensitive to change than the BDI-II, the ISR is a useful tool to diagnose and measure the severity and course of depression.

Extreme deviations from expected recovery curves and their associations with therapeutic alliance, social support, motivation, and life events in psychosomatic in-patient therapy.

OBJECTIVES: Within the clinical support tools (CST) of the OQ-Analyst, the "Assessment for Signal Cases" (ASC) evaluates the therapeutic alliance, social support, motivation, and life events. We investigated whether the ASC covers domains of importance in treatment weeks with extreme deviations from expected recovery curves (ERCs). METHODS: Psychosomatic in-patients were monitored weekly with the ASC and the "Outcome Questionnaire" (OQ-45). The ERCs of the OQ-45 empirical algorithm were used to define treatment weeks with extreme positive deviations (EPD), extreme negative deviations (END), or without extreme deviations (NO). Associations between the ASC scales and EPD as well as END were analyzed by multilevel models. RESULTS: While each ASC scale was positively associated with EPD, only the social support and life events scales were negatively related to END. CONCLUSIONS: CSTs prioritizing social support and life events might be more effective in preventing treatment failure.

Providing patient progress feedback and clinical support tools to therapists: is the therapeutic process of patients on-track to recovery enhanced in psychosomatic in-patient therapy under the conditions of routine practice?

OBJECTIVES: In previous studies of patients on-track to recovery (OT) involving therapists receiving only patient progress feedback without clinical support tools (CST) inconsistent results were found. Possible effects of combining patient progress feedback with CST on OT patients remain unclear. METHODS: At intake (t1), 252 patients of two in-patient psychosomatic clinics were randomized either into the experimental group (EG) or the treatment-as-usual control group (CG). Both groups were monitored weekly using the self-report instruments "Outcome Questionnaire" (OQ-45) and "Assessment of Signal Cases" (ASC). Therapists received weekly patient progress feedback (OQ-45) and CST feedback (ASC) only for EG patients starting at the week following intake (t2). Patients who did not deviate negatively from expected recovery curves by at least one standard deviation were considered OT patients (N=209; NEG=111; NCG=98). Since therapists received feedback at t2 for the first time, different patterns of change (OQ-45 scales) between the groups from t1 to t2, t2 to t3 (intake+two weeks), t2 to t4 (intake+three weeks), and t2 to t5 (last available OQ-45 score) were evaluated by multilevel models. RESULTS: Merely from t2 to t3, the EG improved significantly more on the OQ-45 symptom distress scale than the CG (p<0.05; g=0.12). CONCLUSION: Providing patient progress feedback and CST to therapists did not substantially surpass treatment-as-usual for OT patients in this explorative study except for a very small time-limited enhancement of symptom change.

[Efficacy of psychosomatic inpatient treatment for somatoform disorders: results of a multicenter study]. / Wie wirksam ist psychosomatische Therapie bei somatoformen Storungen? Ergebnisse einer Multicenterstudie.

OBJECTIVES: The present study describes self- and therapist-reported treatment effects of inpatient psychotherapy for various somatoform disorders. METHODS: A total of 2,062 patients with the primary diagnosis F45.XX (ICD-10, Somatoform Disorders) were treated at 17 psychosomatic clinics in Bavaria, Germany. Subgroup analyses were performed for F45.0X, F45.3X, and F45.4X as well as a combined group of F45.1X, F45.2X, and F45.5X. RESULTS: Symptom severity decreased for all subgroups of somatoform disorders. The pre-post effect size was d = -.58 for the Symptom Check-List 90-R (GSI), and -1.26 for the impairment score rated by the therapist. Symptom levels differed among the various subgroups; patients with somatoform pain had the highest scores. CONCLUSIONS: Patients with various somatoform disorders appear to profit well from psychosomatic inpatient psychotherapy. Patients with somatoform pain disorders reported the lowest effect on GSI, but received the highest effect in the therapist ratings.

Primary Prevention Programme for Burnout-Endangered Teachers: Follow-Up Effectiveness of a Combined Group and Individual Intervention of AFA Breathing Therapy.

Background. Early retirement of teachers due to burnout is frequent in Germany. In this study short- and medium-term effects of AFA breathing therapy were evaluated. Methods. This study was designed as a longitudinal controlled intervention design with four points of measurements: before assessment (T1), after intervention (T2), three months (follow up 1) (T3) after intervention, and six months (follow up 2) after intervention (T4). The intervention lasted a total of 11 weeks (weekly group therapy for eight weeks and three weeks of individual breathing session). The effects of intervention were measured with the questionnaire "work-related behaviour and experience Patterns" (AVEM) at four times. Results. In the intervention group 64 teachers and in the self-selected control group 27 teachers were included. The AVEM scales "subjective significance of work" and "professional ambition" changed over time and within both groups (interaction effect). Significant improvements over the four measurements were observed in the intervention group in two AVEM scales: "emotional distancing" (F = 6.3; P < 0.01) and "balance and mental stability" (F = 4.4; P < 0.02). Conclusions. AFA breathing therapy showed short- and medium-term effects in the intervention group over four points of measurements. It may be assumed that breath therapy supports teachers in resisting occupational demand.

Feedback on patient progress and clinical support tools for therapists: improved outcome for patients at risk of treatment failure in psychosomatic in-patient therapy under the conditions of routine practice.

OBJECTIVES: Although psychosomatic in-patient treatment is effective, 5-10% of the patients deteriorate. Providing patient progress feedback and clinical support tools to therapists improves the outcome for patients at risk of deterioration in counseling, outpatient psychotherapy, and substance abuse treatment. This study investigated the effects of feedback on psychosomatically treated in-patients at risk of treatment failure. METHODS: At intake, all patients of two psychosomatic clinics were randomized either into the experimental group or the treatment-as-usual control group. Both groups were tracked weekly with the "Outcome Questionnaire" (OQ-45) measuring patient progress and with the clinical support tool "Assessment of Signal Cases" (ASC). Therapists received feedback from both instruments for all their experimental group patients. "Patients at risk" were defined as patients who deviated from expected recovery curves by at least one standard deviation. Of 252 patients, 43 patients were at risk: 23 belonged to the experimental group, 20 to the control group. The feedback effect was analyzed using a level-2-model for discontinuous change, effect size (d), reliable change index (RCI), and odds ratio for reliable deterioration. RESULTS: For patients at risk, the experimental group showed an improved outcome on the OQ-45 total scale compared to the control group (p<0.05, d=0.54). By providing feedback, the rate of reliably deteriorated patients at risk was reduced from 25.0% (control group) to 8.7% (experimental group) - odds ratio=0.29. All reliably improved patients at risk belonged to the experimental group. CONCLUSION: Feedback improves the outcome of patients at risk undergoing psychosomatic in-patient treatment.

The impact of personality traits on the success of a multimodal obesity treatment.

This prospective study investigated personality traits as predictors of the outcome in a 52-week weight-loss program for obesity. Personality traits were rated with the Inventory of Interpersonal Problems (IIP) in 54 consecutive obese outpatients when entering a multimodal weight-reduction program. The value of these variables to predict success was assessed after 12, 26, and 52 weeks of treatment. A stepwise linear regression analysis for all follow-ups was calculated to examine the impact of each IIP item subscale on weight reduction. The IIP item subscale "intrusive or needy" significantly correlated with weight reduction observed at every follow-up examination and accounts for 13.6% to 29.8% of the variance (p values < .05). Obese patients describing themselves as excessively friendly, outgoing, and sociable improved more from a weight-loss program than those with lower instances of these traits. Accordingly, personality traits deserve more attention at initial assessment and while planning treatment of obese patients.

How to compare scores from different depression scales: equating the Patient Health Questionnaire (PHQ) and the ICD-10-Symptom Rating (ISR) using Item Response Theory.

A wide range of questionnaires for measuring depression are available. Item Response Theory models can help to evaluate the questionnaires exceeding the boundaries of Classical Test Theory and provide an opportunity to equate the questionnaires. In this study after checking for unidimensionality, a General Partial Credit Model was applied to data from two different depression scales [Patient Health Questionnaire (PHQ-9) and ICD-10-Symptom Rating (ISR)] obtained in clinical settings from a consecutive sample, including 4517 observations from a total of 2999 inpatients and outpatients of a psychosomatic clinic. The precision of each questionnaire was compared and the model was used to transform scores based on the assumed underlying latent trait. Both instruments were constructed to measure the same construct and their estimates of depression severity are highly correlated. Our analysis showed that the predicted scores provided by the conversion tables are similar to the observed scores in a validation sample. The PHQ-9 and ISR depression scales measure depression severity across a broad range with similar precision. While the PHQ-9 shows advantages in measuring low or high depression severity, the ISR is more parsimonious and also suitable for clinical purposes. Furthermore, the equation tables derived in this study enhance the comparability of studies using either one of the instruments, but due to substantial statistical spread the comparison of individual scores is imprecise.

[Prevalence and comorbidity of somatoform disorder in psychosomatic inpatients: a multicentre study]. / Pravalenz und Komorbiditat der somatoformen Storung: Eine Multicenter-Studie.

OBJECTIVES: This epidemiological multicenter study investigates the prevalence and comorbidity of somatoform disorder in psychosomatic inpatients. METHODS: Twenty psychosomatic hospitals collected the diagnoses of all treated patients in the years 1998 to 2007. The data were analysed at the "Institute for Quality Assurance in Psychotherapy and Psychosomatic Medicine" (IQP),Munich. RESULTS: Of the 100,607 patients surveyed, 18,492 (18.4 %) fulfilled the ICD-10 criteria for a somatoform disorder. 91.9 % of patients with somatoform disorder have at least one, on average 2.8 additional psychiatric disorders. The mean duration of the symptoms before current treatment was 62.6 months. CONCLUSIONS: The prevalence of somatoform disorder in psychosomatic inpatients is comparable to that found in data from internal or general medicine patients. However, there are major differences in the distribution of the diagnostic subgroups of somatoform disorder.

[Retest-reliability and sensitivity to change of the ICD-10-Symptom-Rating (ISR) in different samples]. / Retest-Reliabilität und Änderungssensitivität des ICD-10-Symptom-Rating (ISR) in verschiedenen Stichproben.

Assessment of the retest-reliability and sensitivity to change of the ICD-10-Symptom-Rating (ISR) is provided. The ISR was filled out repeatedly by a non-clinical as well as different samples of psychosomatic patients. Between the two measurements either no or an integrated psychosomatic treatment took place. During the treatment free phase a high degree of stability of the test scores was expected, whereas a significant improvement of test scores was expected for the respective scales over the treatment phase. The retest-reliability for the individual scales ranges from 0.70 to 0.94. Between admission to a psychosomatic treatment and discharge significant differences were found for all scales. The retest-reliability showed satisfactory results comparable to similar, symptom-oriented instruments. Furthermore, the instruments reproduces symptomatic changes consistently and is - from our point of view - suitable for the assessment of change.

Effects of functional relaxation and guided imagery on IgE in dust-mite allergic adult asthmatics: a randomized, controlled clinical trial.

Although relaxation and imagination techniques have repeatedly proven their effectiveness in asthma, nothing is known about the immunological effects of these complementary interventions. Therefore, the aim of this study is to investigate the effects of the brief relaxation technique of functional relaxation (FR) with guided imagery (GI) on serum IgE in adult patients with dust mite allergic asthma in a randomized, controlled trial. Sixty-four patients were treated over a 4-week period and assessed at baseline, after treatment and after 4 months for follow-up. Due to its significant role in the pathophysiology of allergic asthma, the serum IgE was employed as outcome measure in this investigation. Participation in FR, GI, and FR/GI led to decreases in serum IgE (IU/mL) of -54.7 +/- 67.1, -49.5 +/- 93.4, and -28.4 +/- 93.9 compared with an increase of 27.7 +/- 43.2 in CI. Our study confirmed a positive and clinically relevant effect of FR and GI on total serum IgE levels.

[Factor structure and psychometric properties of the ICD-10-Symptom-Rating (ISR) in samples of psychosomatic patients]. / Faktorstruktur und psychometrische Eigenschaften des ICD-10-Symptom-Rating (ISR) an Stichproben psychosomatischer Patienten.

The ICD-10-Symptom-Rating (ISR) is a self-rating questionnaire for patients. According to its conceptualization, the instrument was developed to closely represent the syndrome structure of the ICD-10 while assessing the extent of psychological distress an individual suffers from. The results of different factor analyses testing the postulated syndrome structure as well as item and scale characteristics are reported here. Data was collected from a consecutive sample of 1 057 psychosomatic patients of the University Hospital Charité Berlin. Evaluation of the dimensional structure of the questionnaire included exploratory and confirmatory factor analyses each computed with a randomized half of the sample. Multi-Sample-Analyses with different subgroups of the sample were performed to test the stability of the factor structure. The individual factors were constituted by the postulated syndrome units of the ICD-10 involving a high and uniform distribution of accounted variance. They also proved themselves satisfactorily stable over the different subsamples. The scales showed a high degree of internal consistency with relatively small gender and age effects, while psychological disorders had a large effect on the means of the scales. Taking a perspective of test theory, the ICD-10-Symptom-Rating is in accordance with the syndrome structure of the ICD-10 and suitable for the assessment of psychological symptoms. Other aspects pertaining to the reliability and validity of the ISR remain to be proven in future research.

[AFA breathing therapy to prevent burnout for teachers]. / Die AFA-Atemtherapie als Burnout-Prophylaxe bei Lehrerinnen und Lehrern.

BACKGROUND: AFA breathing therapy has been shown to have positive effects on burnout-associated work-related patterns of behavior and experience. OBJECTIVE: To assess the effects of AFA breathing therapy on teachers. METHODS: Volunteers without relevant psychopathology (excluded by VDS90 screening) were included in the study. Evaluation was based on the 'Fragebogen zur Erfassung des arbeitsbezogenen Verhaltens- und Erlebensmusters (AVEM)' - 'Questionnaire for the assessment of work-related patterns of behavior and experience'. The AVEM comprises 11 scales like subjective relevance of work, readiness to exert oneself, perfectionism, ability to detach from work, calmness and mental equilibrium, and perceived social support. RESULTS: In most scales, mean scores improved significantly over the course of the treatment. Furthermore, in 9 out of 11 AVEM-scales, mean intra-individual differences improved significantly more in the course of the treatment phase than in the course of the control phase. CONCLUSION: AFA breathing therapy could prove effective for burnout prevention.

[The effectiveness of psychosomatic inpatient treatment - results of a multicenter follow-up study]. / Effektivität stationärer psychosomatischer Krankenhausbehandlung - Ergebnisse einer multizentrischen Katamnesestudie.

OBJECTIVES: This multicenter follow-up study examines the effectiveness of psychosomatic inpatient treatment under the conditions of routine practice. METHODS: We chose a naturalistic design with one pre- and two postmeasurements: admission, discharge, and 1-year follow-up with a follow-up sample of 935 patients from five psychosomatic hospitals.We assessed the effectiveness of inpatient psychosomatic treatments with the Global Severity Index (GSI) of the SCL-90-R at admission (M = 1.20, SD = 0.68), discharge (M = 0.67, SD = 0.58), and 1-year follow-up (M = 0.83, SD = 0.68) as well as with the Veränderungsfragebogen des Erlebens und Verhaltens (VEV-K) at discharge (M = 125.42, SD = 27.27) and follow-up (M = 115.50, SD = 31.16). RESULTS: Significant improvements were shown in the GSI from admission to discharge (F = 802.70, df = 1, p

[Development of the "ICD-10-Symptom-Rating"(ISR) questionnaire]. / Entwicklung des Fragebogens "ICD-10-Symptom-Rating" (ISR).

OBJECTIVES: Construction of the newly developed "ICD-10 Symptom Rating" (ISR) is presented together with some statistical data. This questionnaire is founded on the well-known ICD-10, according to which symptoms are relevant for assessing psychological disorders. The ISR aims at a comprehensive evaluation of the severity of psychological disorders. The ISR 2.0 has 29 items and six syndrome scales: Depression, Anxiety, Obsessive/Compulsive, Somatoform, Eating Disorders, and the Supplementary Scale, which covers a variety of syndromes, as well as a total score. METHODS AND RESULTS: In a first cross-validation with 108 patients, some rather high correlations were found between the SCL-90-R and the ISR. They ranged from r = 0.78 to 0.37 for the individual syndrome scales, and amounted to r = 0.78 for the GSI versus the total score.

Conduct disorder in girls: neighborhoods, family characteristics, and parenting behaviors.

BACKGROUND: Little is known about the social context of girls with conduct disorder (CD), a question of increasing importance to clinicians and researchers. The purpose of this study was to examine the associations between three social context domains (neighborhood, family characteristics, and parenting behaviors) and CD in adolescent girls, additionally testing for race moderation effects. We predicted that disadvantaged neighborhoods, family characteristics such as parental marital status, and parenting behaviors such as negative discipline would characterize girls with CD. We also hypothesized that parenting behaviors would mediate the associations between neighborhood and family characteristics and CD. METHODS: We recruited 93 15-17 year-old girls from the community and used a structured psychiatric interview to assign participants to a CD group (n = 52) or a demographically matched group with no psychiatric disorder (n = 41). Each girl and parent also filled out questionnaires about neighborhood, family characteristics, and parenting behaviors. RESULTS: Neighborhood quality was not associated with CD in girls. Some family characteristics (parental antisociality) and parenting behaviors (levels of family activities and negative discipline) were characteristic of girls with CD, but notll. There was no moderation by race. Our hypothesis that the association between family characteristics and CD would be mediated by parenting behaviors was not supported. CONCLUSION: This study expanded upon previous research by investigating multiple social context domains in girls with CD and by selecting a comparison group who were not different in age, social class, or race. When these factors are thus controlled, CD in adolescent girls is not significantly associated with neighborhood, but is associated with some family characteristics and some types of parental behaviors. However, the mechanisms underlying these relationships need to be further investigated. We discuss possible explanations for our findings and suggest directions for future research.