The associations of quality of life and general functioning with trauma, borderline intellectual functioning and mild intellectual disability in outpatients with serious mental illness.

BACKGROUND: Trauma and intellectual disability are highly prevalent in the serious mental ill (SMI). Little is known of their impact on general functioning and quality of life. AIM: This study investigated the association of trauma and intellectual disability (ID) with general functioning and quality of life in SMI. METHODS: Patient characteristics and diagnoses were extracted from electronic patient records. We used the Trauma Screening Questionnaire (TSQ), the Screener for Intelligence and Learning Disabilities (SCIL), the Health of the Nation Outcome Scale (HoNOS) and the Manchester Short Assessment of Quality of Life (MANSA) to asses trauma, intellectual impairment, general functioning and quality of life. Proportions on cut-off scores were analysed with cross-tabulations, questionnaire scores with t-tests. Multivariable associations were determined by logistic regression analysis. RESULTS: 611 patients from an outpatient service were assessed. Trauma and ID were associated with each other (r = -0.207). Trauma was associated with worse general functioning and a lower quality of life. Mild intellectual disability (MID) or borderline intellectual functioning (BIF) were associated with worse general functioning. CONCLUSIONS: For patients with SMI, trauma and ID should be identified early in care to treat the lower general functioning and quality of life it caused.

[The predictive value of mild intellectual disability/ borderline intellectual functioning and ptsd for treatment results in severely mentally Ill patients]. / Voorspellende waarde van lichte verstandelijke beperking en PTSS voor behandelresultaten van patiënten met ernstige psychiatrische aandoeningen.

BACKGROUND: Little is known about the influence of mild intellectual disability/borderline intellectual functioning (mid/biF) or posttraumatic stress disorder (ptsd) on treatment results in severely mentally ill (smi).
AIM: To investigate whether screeners determining mid/biF or ptsd are associated with less favorable treatment outcome in smi.
METHOD: The screener for intelligence and learning disabilities (scil) was used to screen for mid/biF. The trauma screening questionnaire (tsq) was used to detect ptsd. Outcomes of these screeners were associated with repeated measures on the health of the nation outcome scales (HoNOS) in 628 smi at the Mental Care Centre of Oost Brabant.
RESULTS: In 628 patients one or more HoNOS was acquired. In 352 (56%) patients a scil was acquired, in 334 (53%) patients a tsq. The largest improvement was observed in patients not meeting the criteria for mid/biF and/or ptsd. Less improvement was observed in patients with ptsd and a suspected iq between 70-85, estimated with the scil. No significant change on the HoNOS was observed in patients with an estimated iq below 70.
CONCLUSION: Routine screening for mid/biF and ptsd symptoms is important for early recognition of the disorder, resulting in providing better treatment interventions for patients with mid/biF and ptsd.

[Burn-out, commitment, personality and experiences during work and training; survey among psychiatry residents]. / Bevlogenheid en burn-out in relatie tot persoonlijkheid en context bij aiossen psychiatrie: een verkennend onderzoek.

BACKGROUND: In the last few years international studies have reported on increase in burn-out and depressive symptoms among psychiatry residents. In the field of research, however, commitment and dedication are now being mentioned more frequently as positive factors that counterbalance burn-out. AIM: To find out how a group of Dutch psychiatry residents feel about their work, to discover their degree of burn-out and commitment and to clarify the various factors involved. METHOD: 59 psychiatry residents from four teaching hospitals were asked to complete questionnaires concerning burn-out (U-BOS-C), commitment (UWES-15) and personality (BFI-NL). Respondents were also asked to describe how they felt about their experiences during their work and to give their views on the instruction and training they were receiving. RESULTS: In the U-BOS-C section only four trainees (almost 7%) met the criteria for burn-out. In the BFI-NL section the psychiatry residents obtained significantly lower scores on neuroticism and higher scores on empathy than did a comparable norm group of a similar age. The scores of the psychiatry residents indicated that the term 'being proud of your work' was significantly related to a feeling of commitment and particularly to all subscales that reflected commitment. CONCLUSION: In our study the percentage of psychiatry residents with burn-out is significantly lower than the percentage reported elsewhere in the literature. In fact, our results demonstrate that the psychiatry residents who were the subject of our study regarded themselves as being emotionally stable, friendly and committed to their work.

[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.

[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.

[Assessing aggression in patients of the mental health crisis service]. / Het inschatten van agressie bij patiënten van de ggz-crisisdienst.

BACKGROUND: Care workers of the outreach psychiatric crisis team are frequently confronted with aggressive patients. To prevent dangerous situations from developing it could be advantageous to have in place a method of risk assessment that is based on information about patients before they are actually contacted by the crisis team. AIM: To test the predictive validity of an instrument specifically designed to assess the risks of aggression from severely disturbed psychiatric patients before they are seen by the crisis team. METHODS: Over a period of two years and prior to any outreach contact with patients in crisis situations a Checklist of Risks to the Crisis team (CRC) was completed. Then, following outreach contact with the patient any perceived aggression was recorded by means of the Staff Observation Aggression Scale-Revised (SOAS-R). RESULTS: Aggressive behaviour by patients was observed during 51 of 499 crisis contacts with members of the outreach crisis team. On the basis of three factors in the CRC, namely the clinical assessment on a visual-analogue scale, an estimate of the number of aggressive persons in the vicinity of the crisis patient concerned and the reporting of crises by the patient himself, it was possible to predict outwardly directed aggression with a sensitivity of 74% and a specificity of 84%. CONCLUSIONS: Although the findings still need to be reproduced, an instrument such as the crc could be very useful to members of the crisis service.

[Aggressive incidents while on crisis duty]. / Agressie tijdens crisisdiensten van de ggz.

Being on duty in a crisis team of the Mental Health Service can be a highly emotional and stressful experience. Pressed for time and providing a 24-hour service, team-members often have to make major decisions without consulting and agreement of all the parties concerned. The East Brabant Mental Health Service (GGZ OostBrabant) felt they needed to find out more about the threatening behaviour encountered by the crisis team and to identify the risk factors. For this purpose a weekly record was kept of all the incidents that occurred and these were discussed and analysed with the help of the Staff Observation Aggression Scale-Revised. In 2002 14% of the crisis contacts involved aggression. A striking feature of these incidents was that they occurred relatively often at certain times: at the end of the morning or very late at night/in the early hours of morning. The weekly meeting at which the incidents can be fully discussed is an opportunity to pass on to all staff members the knowledge and skills needed to deal with aggression.