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2.
Behav Ther ; 51(2): 294-309, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32138939

RESUMO

Irritability is a substrate of more than one dozen clinical syndromes. Thus, identifying when it is atypical and interfering with functioning is crucial to the prevention of mental disorder in the earliest phase of the clinical sequence. Advances in developmentally based measurement of irritability have enabled differentiation of normative irritable mood and tantrums from indicators of concern, beginning in infancy. However, developmentally sensitive assessments of irritability-related impairment are lacking. We introduce the Early Childhood Irritability-Related Impairment Interview (E-CRI), which assesses impairment associated with irritable mood and tantrums across contexts. Reliability and validity are established across two independent samples varied by developmental period: the Emotional Growth preschool sample (EmoGrow; N = 151, M = 4.82 years) and the When to Worry infant/toddler sample (W2W; N = 330, M = 14 months). We generated a well-fitting two-factor E-CRI model, with tantrum- and irritable mood-related impairment factors. The E-CRI exhibited good interrater, test-retest, and longitudinal reliability. Construct and clinical validity were also demonstrated. In both samples, E-CRI factors showed association to internalizing and externalizing problems, and to caregiver-reported concern in W2W. Tantrum-related impairment demonstrated stronger and more consistent explanatory value across outcomes, while mood-related impairment added explanatory utility for internalizing problems. The E-CRI also showed incremental utility beyond variance explained by the Family Life Impairment Scale (FLIS) survey indicator of developmental impairment. The E-CRI holds promise as an indicator of impairment to inform identification of typical versus atypical patterns reflecting early emerging irritability-related syndromes in the initial phase of the clinical sequence.


Assuntos
Transtornos do Comportamento Infantil/diagnóstico , Entrevista Psicológica/métodos , Humor Irritável , Agressão/psicologia , Pré-Escolar , Mecanismos de Defesa , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Projetos de Pesquisa
3.
PLoS One ; 15(3): e0229538, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32187183

RESUMO

Participation, defined as 'involvement in life situations' according to the World Health Organisation, is a well-recognized concept and critical indicator of quality of life. In addition it has become an important outcome measure in child rehabilitation. However, little is known about the level of participation of young children with Developmental Disabilities. The aim of this study was to capture their subjective experiences of participation. An adapted informed consent based on a comic strip was used to get the children's assent. A Photo Elicitation study was used, in which photographs were taken by the children when they were involved in meaningful activities. The photographs were then used to facilitate communication with the children and to initiate in depth-interviews. Forty-seven interviews with 16 children between five and nine years were conducted based on their photographs. This method generated rich data, confirming that young children with Developmental Disabilities were able to inform us accurately on their experiences of participation. Data was analysed by means of an inductive thematic analysis. Results showed that children perceived their participation as satisfying when they can play, learn and join in family gatherings resulting in feelings of inclusion, recognition and belonging. When there are-on occasions-moments that their participation was obstructed, the children used two strategies to resolve it. Or they walked away from it and choose not to participate, or when autonomously motivated for the activity, they relied primarily on their context (i.e. mothers) as enabling their participation. Related to the data, children discussed themes related to their person, activities, connections and mediators between those themes. These themes fit well within earlier and current research on the subject of participation.


Assuntos
Deficiências do Desenvolvimento/psicologia , Entrevista Psicológica/métodos , Participação Social/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtorno do Espectro Autista/fisiopatologia , Criança , Pré-Escolar , Comunicação , Deficiências do Desenvolvimento/fisiopatologia , Emoções/fisiologia , Família , Feminino , Humanos , Masculino , Motivação/fisiologia , Pais , Fotografação/métodos , Pesquisa Qualitativa , Qualidade de Vida , Percepção Visual/fisiologia
4.
PLoS One ; 15(1): e0227364, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895938

RESUMO

OBJECTIVES: Depression is a common illness with substantial economic consequences for society and a great burden for affected individuals. About 30% of patients with depression do not respond to repeated treatments. Psychiatric comorbidity is known to affect duration, recurrence and treatment outcome of depression. However, there is a lack of knowledge on the extent to which psychiatric comorbidity is identified in the clinical setting for depressed patients in secondary psychiatric care. Therefore, the aim of this study was to compare the agreement between traditional diagnostic assessment (TDA) and a structured and comprehensive diagnostic procedure (SCDP) for identification of personality and anxiety disorder comorbidity in depressed patients in secondary psychiatric care. METHODS: 274 patients aged 18-77 were referred from four secondary psychiatric care clinics in Sweden during 2012-2017. ICD-10 diagnoses according to TDA (mostly unstructured by psychiatric specialist and residents in psychiatry), were retrieved from medical records and compared to diagnoses resulting from the SCDP in the study. This included the Mini International Neuropsychiatric Interview, the Structured Interview for DSM Axis II Personality Disorders and semi-structured questions on psychosocial circumstances, life-events, psychiatric symptoms, psychiatric treatments, substance use, and suicidal and self-harm behaviour. The assessment was carried out by psychiatric specialists or by residents in psychiatry with at least three years of psychiatric training. RESULTS: SCDP identified personality disorder comorbidity in 43% of the patients compared to 11% in TDA (p<0,0001). Anxiety disorder comorbidity was identified in 58% with SCDP compared to 12% with TDA (p<0,0001). CONCLUSIONS: Important psychiatric comorbidity seems to be unrecognized in depressive patients when using TDA, which is routine in secondary psychiatric care. Comorbidities are better identified using the proposed model involving structured and semi-structured interviews together with clinical evaluations by clinical experts.


Assuntos
Transtornos de Ansiedade , Transtorno Depressivo , Entrevista Psicológica/métodos , Transtornos da Personalidade , Atenção Secundária à Saúde/métodos , Adolescente , Adulto , Idoso , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Comorbidade , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/epidemiologia , Escalas de Graduação Psiquiátrica , Psiquiatria , Psicoterapia , Suécia , Adulto Jovem
5.
Psychiatry Res ; 282: 112612, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31630041

RESUMO

Psychiatric evaluations of asylum seekers in the U.S. play an important role in asylum cases; however, there are significant barriers to assessing asylum seekers' psychological trauma. Telephonic psychiatric evaluations provide an opportunity to access important resources to bolster their case. In this retrospective study, we considered the efficacy of telephonic psychiatric evaluations and assessed their potential as a solution to meet the needs of asylum seekers. Ten affidavits produced from telephonic evaluations were compared to twenty produced from in-person evaluations using a standardized scoring rubric. Providers who conducted telephonic evaluations also completed a structured interview and a qualitative assessment of themes was conducted. Overall, there was a small, but non-significant difference in overall score. The presence of descriptions of cognitive complaints, appearance, motor activity and use of checklists were, however, all significantly lower in telephonic compared to in-person affidavits. Providers agreed that despite limitations, the ability to diagnose and advocate for asylum seekers is equivalent regardless of format. This study identifies that telephonic psychiatric evaluations produce comparable results to in-person evaluations with the benefit of reaching a hard to reach population. Evaluators, lawyers, and judges should consider these results in weighing the risk-benefits of a telephonic evaluation of an asylum seeker.


Assuntos
Entrevista Psicológica/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Trauma Psicológico/diagnóstico , Refugiados/psicologia , Telemedicina/métodos , Adulto , Feminino , Humanos , Masculino , Estudos Retrospectivos , Estados Unidos
6.
Int J Med Educ ; 10: 195-202, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31658442

RESUMO

Objectives: To evaluate the effectiveness of including interactive video-based patient cases in preparatory lectures on medical students' patient-centredness and attitudes towards psychiatry. Methods: This study was designed as a quasi-experimental intervention study. A preparatory lecture on diagnostic interviewing was given to 204 fourth-year medical students before a 4-week psychiatry clerkship. The students were divided into two groups. One group (n=102) received a preparatory lecture including an interactive video case portraying a doctor performing a diagnostic interview with a simulated patient (intervention group). The other group (n=102) received a conventional preparatory lecture using text-based instructional material (control group). We conducted a paired sample t-test to compare the students' confidence in exhibiting patient-centred communication and their attitudes towards psychiatry before receiving the preparatory lecture and after having completed a minimum of three weeks of clerkship training. Results: A total of 102 students, 51 in each group, completed a questionnaire at both measurement points. In the intervention group, we found a statistically significantly difference for the students' patient-centredness before (M=69.4, SD=10.0) and after (M=73.8, SD=8.6) the intervention t(97)=2.38, p= 0.02, but no changes in attitudes t(98) =1.07, p=0.28. In the control group, we found no changes in patient-centredness or attitudes. Conclusions: Video cases in preparatory lectures appear to be better than text-based material at improving students' patient-centredness in psychiatry. However, neither video cases nor text-based material seem to influence the students' attitudes.


Assuntos
Educação Médica/métodos , Assistência Centrada no Paciente/normas , Psiquiatria/educação , Estudantes de Medicina/psicologia , Estágio Clínico/métodos , Dinamarca , Avaliação Educacional , Humanos , Entrevista Psicológica/métodos , Inquéritos e Questionários , Gravação em Vídeo
7.
PLoS One ; 14(10): e0224394, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31661529

RESUMO

BACKGROUND: The communication of prognosis represents an ethical and clinical challenge in medical practice due to the inherent uncertain character of prognostic projections. The literature has stressed that the mode of communicating prognoses has an impact on patients' hope, which is considered to play a major role in adapting to illness and disability. In light of this, this study aims to explore health professionals' (HPs) perceptions of the role of hope in rehabilitation and to examine if and how they use strategies to maintain hope when discussing prognostic information with patients. METHODS: Eleven qualitative semi-structured interviews with a purposive sample of HPs were conducted at two rehabilitation clinics in the Canton of Ticino, Switzerland. The interviews were analyzed using thematic analysis. RESULTS: The HPs perceive hope in rehabilitation as a double-edged sword. Three main strategies were identified to maintain hope while avoiding false hope: 1) giving space for self-evaluation; 2) tailoring the communication of prognostic information; and 3) supporting the patient in dealing with the prognosis. These strategies are particularly suitable when HPs consider that patients might not be ready to accept the prognosis, due to their expectations for recovery. CONCLUSIONS: The strategies identified here support a person-centered approach to the communication of prognosis and are in line with existing protocols for the communication of unfavorable medical information. The findings emphasize the need for strengthening communication and inter-professional collaboration skills of rehabilitation HPs.


Assuntos
Pessoal de Saúde/psicologia , Esperança/ética , Reabilitação/psicologia , Adulto , Atitude do Pessoal de Saúde , Comunicação , Feminino , Humanos , Entrevista Psicológica/métodos , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente/ética , Prognóstico , Pesquisa Qualitativa , Autoavaliação , Suíça
8.
Int J Med Educ ; 10: 163-171, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31473692

RESUMO

Objectives: The aim was to explore the experiences of fourth-year medical students of diagnostic consultations in a simulated primary care setting, in order to gain an insight into the suitability of such simulated consultations for assessing the diagnostic reasoning skills of medical students. Methods: This single-centre study employed a qualitative, cross-sectional design. Twelve fourth-year medical students volunteered to be filmed across 21 simulated, primary care consultations. The setting closely resembled OSCE stations, with a clinician present at each station monitoring the students' performance using a station-checklist. Upon completion of each station, participants reflected on their experiences using video-stimulated recall. Interviews were transcribed and analysed using Interpretative Phenomenological Analysis. Results: The simulated scenarios were often perceived to have limited fidelity with predictable outcomes. At times, preoccupation with the assessment checklist meant that students were more likely to focus on asking questions than interpreting the information they were gaining. Some students felt scrutinized during the consultations, while others struggled to adapt to the time pressure. Overall, the artificial setting seemed to promote a reductionist diagnostic approach and an attitude of 'ticking boxes' rather than engaging in active diagnostic reasoning. Conclusions: The present findings call into question the assumption that observation-based assessment of the performance of medical students during simulated consultations can be reliably used to assess their diagnostic skills. Future studies need to explore how current assessment modalities could be better adapted to facilitate active engagement in diagnostic reasoning.


Assuntos
Competência Clínica , Educação de Graduação em Medicina/métodos , Atenção Primária à Saúde/métodos , Estudantes de Medicina , Estudos Transversais , Diagnóstico , Avaliação Educacional , Feminino , Humanos , Entrevista Psicológica/métodos , Masculino , Simulação de Paciente
10.
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 41(4): 297-302, July-Aug. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1011514

RESUMO

Objective: The Montgomery-Åsberg Depression Rating Scale (MADRS) is widely used to assess depression severity. The Structured Interview Guide for the MADRS (SIGMA) was created to standardize MADRS assessment. The objective of this study was to translate and validate the original SIGMA into a Brazilian Portuguese version (SIGMA-VB). Methods: We translated and cross-culturally validated the original SIGMA into the SIGMA-VB, and assessed its psychometric properties using data from 93 adult outpatients enrolled in the Integral Assessment in Unipolar Depression (AIUNI) trial. Participants were assessed by two raters on five visits over 8 weeks. We calculated multiple interrater reliability indexes for the SIGMA-VB and used the Hamilton Depression Hating Scale (HAM-D) for validation purposes. Results: According to the SIGMA-VB, participants had moderate depression at baseline followed by mild depression at 8 weeks. We found over 90% of correlation between scores attributed by different raters using the SIGMA-VB. Correlations between the SIGMA-VB and the HAM-D were above 66%. Conclusion: Our findings confirm that the SIGMA-VB is a valid and reliable instrument to assess depression severity in clinical research and practice. Its interrater reliability was similar to that of a previously published Japanese version of the SIGMA.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Idoso , Adulto Jovem , Escalas de Graduação Psiquiátrica/normas , Tradução , Inquéritos e Questionários , Depressão/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Brasil , Comparação Transcultural , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Entrevista Psicológica/métodos , Pessoa de Meia-Idade
11.
BMC Psychol ; 7(1): 49, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337443

RESUMO

BACKGROUND: Nowadays there is a growing interest in exploring causes of fatigue symptoms and the possible linked aspects in patients with Chronic Kidney Disease (CKD) receiving hemodialysis (HD) treatment. Inflammatory processes were demonstrated to influence motivational systems functioning in chronic conditions. However, there is a lack of connection between quantitative motivational systems measure and patients self-report motivational and fatigue issue. Thus, the aim of this study was to identify an association between HD patients reward mechanisms, fatigue severity and psychosocial variables emerging from semi-structured interviews. METHODS: Interviews were held for a sample of ninety-four patients (54 males, 40 females; Mage = 62.98 ± 17.94; dialytic mean age in months = 76.55 ± 84.89) receiving chronic HD treatment and consequently analyzed by means of quantitative and qualitative analysis. Behavioral motivation systems reflecting inhibition/approach tendency to rewards were measured by Behavioral Inhibition/Activation System (BIS/BAS) scale and the fatigue severity experienced by HD patients was measured with the Fatigue Severity Scale. Scale results were correlated to psychosocial variables and topics derived from the semi-structured interviews. RESULTS: Findings highlight the presence of two effects: one related to the Behavioral Activation System (BAS) as a protective factor against the HD treatment pervasive consequences; the other one deals with the self-reported levels of fatigue that seemed to significantly interfere with patients' daily life, as a function of gender. CONCLUSIONS: Such results encourage the use of a mixed method approach to understand the complexity of the subjective experience of patients' facing chronic disease and treatments.


Assuntos
Atitude Frente a Saúde , Fadiga/psicologia , Entrevista Psicológica/métodos , Qualidade de Vida/psicologia , Diálise Renal/psicologia , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Recompensa , Fatores de Risco , Autorrelato
12.
Suicide Life Threat Behav ; 49(6): 1746-1761, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31237377

RESUMO

OBJECTIVE: The aim of this study was to evaluate the efficacy of a problem-solving intervention for the prevention of suicidal risk in Brazilian adolescents with elevated suicidal potential and depressive symptoms. METHODS: A randomized controlled trial was conducted involving 100 participants (mean age 17.2 years, 60% women, 46% mixed race), allocated to the problem-solving intervention (n = 50) or the usual care control group (n = 50). Blinded interviewers conducted assessments at pretreatment, posttreatment, 1, 3, and 6 months of follow-up. The main outcome was suicidal orientation; secondary outcomes were suicidal risk, suicidal plans and attempts, depressive symptoms, and problem-solving skills. RESULTS: At posttreatment and up to 6-month follow-up, there was lower suicidal orientation and suicidal risk in the problem-solving group compared to the control group. There were lower suicidal plans and attempts (0.0% participants vs 2.2% with a suicide plan and 2.2% with both suicide plan and attempt); risk difference was 0.04 (95% CI: 0.01-0.09) and the number needed to treat was 25 (95% CI: 11-70). Significant effects of the intervention on depressive symptoms were found at posttreatment and maintained for 6 months. The change in global and functional problem-solving skills mediated the reduction in suicide orientation. CONCLUSIONS: Thus, suicidal risk can be successfully prevented in adolescents.


Assuntos
Adaptação Psicológica , Depressão , Resolução de Problemas , Ideação Suicida , Suicídio , Adolescente , Comportamento do Adolescente/psicologia , Depressão/diagnóstico , Depressão/terapia , Feminino , Humanos , Entrevista Psicológica/métodos , Masculino , Psiquiatria Preventiva/métodos , Técnicas Psicológicas , Medição de Risco/métodos , Suicídio/prevenção & controle , Suicídio/psicologia , Resultado do Tratamento
13.
J Rehabil Med ; 51(7): 532-538, 2019 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-31161225

RESUMO

OBJECTIVE: Physical activity is an essential part of managing heart failure. However, adherence to activity recommendations is low, especially in female patients. The aim of this study was to investigate the perceptions of healthcare providers regarding sex differences in physical activity, motivation, barriers, and whether adaptations in care based on sex might be meaningful. METHODS: This is a qualitative study; data were collected in semi-structured interviews with healthcare providers. The data were analysed using qualitative content analysis. RESULTS: The major overarching theme was that healthcare providers feel that "Men and women are equal, but different". This theme was explained in terms of 7 sub-themes with associated categories, as follows: "Men and women prefer and perform different physical activity regardless of health status", "Male and female heart failure patients have different motivations for, and barriers to, being active", "Factors related to differences in physical activity and physical capacity between male and female heart failure patients", "Heart failure has more impact on physical activity and physical capacity than patient's sex", and "Tailoring activity advice for heart failure patients based on sex." DISCUSSION: Healthcare providers had clear opinions regarding the existence of sex differences that might affect patients' care. Several differences were identified in male and female heart failure patients in terms of physical activity. There seems to be a conflict between fear of discriminating and the value of personalizing care.


Assuntos
Exercício Físico/fisiologia , Insuficiência Cardíaca/reabilitação , Entrevista Psicológica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Caracteres Sexuais
14.
Australas Psychiatry ; 27(4): 362-365, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31165642

RESUMO

OBJECTIVE: This study determined the cultural appropriateness of the Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID-I) as an acceptable tool for diagnosing mental illness among Indigenous people. METHODS: De-identified qualitative feedback from participants and psychologists regarding the cultural appropriateness of the SCID-I for Indigenous people using open-ended anonymous questionnaires was gathered. Aboriginal Medial Service staff and Indigenous Support Workers participated in a focus group. RESULTS: A total of 95.6% of participants felt comfortable during the 498 questionnaires completed. Psychologists also provided qualitative feedback for 502 (92.3%) interviews, of whom 40.4% established a good rapport with participants. Of the participants, 77.7% understood the SCID-I questions well, while 72.5% did not require any cultural allowances to reach a clinical diagnosis. CONCLUSION: When administered by a culturally safe trained psychologist, SCID-I is well tolerated in this group.


Assuntos
Competência Cultural , Entrevista Psicológica/métodos , Entrevista Psicológica/normas , Transtornos Mentais/diagnóstico , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Austrália/etnologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Retroalimentação , Serviços de Saúde do Indígena/organização & administração , Humanos , Transtornos Mentais/etnologia , Reprodutibilidade dos Testes , Inquéritos e Questionários
15.
PLoS One ; 14(5): e0216682, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31067286

RESUMO

Many stroke survivors require care from informal carers such as family members and friends who may experience adverse impacts. This study aimed to qualitatively explore the unmet needs of carers of stroke survivors, and their preferences for interventions and support services. We conducted 24 semi-structured, qualitative interviews with carers of stroke survivors from the Hunter region, Australia. Inductive thematic analysis was used in the context of a needs-led framework to identify key themes of their unmet needs. Key unmet needs identified by carers of stroke survivors in this study centred on four main themes: (1) social relationships and support; (2) adequacy of information; (3) taking care of oneself; and (4) accessing appropriate services. Carers of stroke survivors desired the development of services which provide connectivity to information, training, education and community support; and inclusion in a community with social relationships and other carers of stroke survivors. Ongoing unmet needs often result in adverse health and quality of life outcomes for carers of stroke survivors. Co-designed programs and resources for carers, particularly relating to unmet needs in social, information, self-care and service access domains are needed.


Assuntos
Cuidadores/psicologia , Qualidade de Vida/psicologia , Reabilitação do Acidente Vascular Cerebral/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Família , Feminino , Amigos , Humanos , Entrevista Psicológica/métodos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Autocuidado , Apoio Social , Acidente Vascular Cerebral/fisiopatologia , Sobreviventes/psicologia
16.
Dig Dis Sci ; 64(10): 2784-2797, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31037593

RESUMO

BACKGROUND: Nonadherence to direct-acting agents (DAAs) for hepatitis C (HCV) decreases viral response. To measure nonadherence to DAAs, a reliable, valid, and easily implemented method is needed. AIMS: The goals of this study were to refine a previously validated (in patients with hypertension) self-report measure of extent of nonadherence and reasons for nonadherence in the context of DAAs and to obtain initial evidence of content validity and reliability. METHODS: Phase I involved two focus groups with patients with HCV (n = 12) and one focus group with prescribers of HCV medications (n = 6) to establish content validity of reasons for nonadherence. Subsequent cognitive interviews with patients (n = 11) were conducted to refine items. Phase II was a prospective cohort study involving weekly administration of the refined measure by telephone to patients (n = 75) who are prescribed DAAs to evaluate reliability and consistency with viral response. RESULTS: In the cohort study, internal consistency ranged from acceptable (α = .69) to very high (α = 1.00) across time points and was quite high on average (α = .91). Across the 75 participants, there were 895 measurement occasions; of those, nonadherence was reported on only 27 occasions (3%), all of which occurred in the first 12 weeks. These 27 occasions represented 19 (26%) different individuals. At 12 weeks, 1 (1%) of patients had a detectable HCV viral load; at 12-24 weeks posttreatment, 4 (5%) had a sustained viral response. Nonadherent patients reported an average of 1.41 reasons for nonadherence. CONCLUSIONS: This multi-method study established content validity of reasons for nonadherence and reliability of extent of nonadherence. High rates of adherence and viral response were consistent with previous studies using other nonadherence measurement methods.


Assuntos
Hepatite C , Adesão à Medicação , Adulto , Estudos de Coortes , Feminino , Grupos Focais , Hepatite C/tratamento farmacológico , Hepatite C/psicologia , Humanos , Entrevista Psicológica/métodos , Masculino , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Psicometria/métodos , Reprodutibilidade dos Testes , Autorrelato/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
17.
Cir. Esp. (Ed. impr.) ; 97(5): 275-281, mayo 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187274

RESUMO

Introducción: El objetivo del presente estudio es examinar la precisión diagnóstica de los test de cribado utilizados para detectar la necesidad de atención psicológica en pacientes remitidos para cirugía torácica. Métodos: Se evaluó la presencia de malestar emocional en un total de 105 pacientes remitidos para cirugía torácica por medio de la entrevista clínica psicológica (variable criterio). Los métodos de cribado utilizados fueron: el juicio del médico (sí/no), la Escala Hospitalaria de Ansiedad y Depresión (HADS), la pregunta única para evaluar depresión "¿se siente usted deprimido?" (ADEP) (1-5) y la pregunta única para medir ansiedad "¿se siente ansioso?" (AANA) (1-5). Resultados: De acuerdo con la entrevista entrevista clínica psicológica, el 34% de los pacientes fueron casos clínicos que requerían intervención psicológica. La puntuación total de la escala HADS (punto de corte 10) mostró una sensibilidad del 0,89, especificidad del 0,75 y un ABC de 0,883; la ADEP (punto de corte 1) mostró una sensibilidad del 0,79, especificidad del 0,74 y ABC del 0,795; la AANS (>1) obtuvo una sensibilidad del 0,78, especificidad del 0,41 y ABC de 0,69 y el juicio del médico mostró una sensibilidad del 0,47 y especificidad del 0,86. Conclusiones: Un alto porcentaje de pacientes remitidos para cirugía torácica requirieron intervención psicológica. El mejor instrumento para identificar a aquellos pacientes con necesidades psicológicas, tomando la entrevista psicológica como variable criterio, fue la puntuación total del HADS. Este instrumento es simple y breve, bien aceptado por los pacientes, de fácil aplicación en un servicio de cirugía torácica y tiene buena capacidad diagnóstica


Introduction: The aim of the present study was to examine the diagnostic accuracy of screening tests in detecting cases requiring psychological intervention among patients referred for thoracic surgery. Methods: Emotional distress was evaluated in 105 patients referred for thoracic surgery by means of a diagnostic psychological interview (criterion variable). The screening ability of the following methods was analyzed: the physician's opinion (Yes/No), Hospital Anxiety and Depression Scale (HADS), single-item interview: «Are you depressed?» (Depression Question, ADEP) (1-5) and the single-item interview: «Are you anxious?» (Anxiety Question, ANXQ) (1-5). Results: According to the clinical interview, 34% of the patients were clinical cases requiring psychological intervention. The total HADS (cut-off point of 10) showed a sensitivity = 0.89, specificity = 0.75 and AUC = 0.883; the ADEP scale (>1) showed a sensitivity = 0.79, specificity = 0.74 and AUC = 0.795; the ANXQ scale (>1) showed a sensitivity = 0.78, specificity = 0.41 and AUC = 0.690; and the physician's opinion showed a sensitivity = 0.47 and specificity = 0.86. Conclusions: A high percentage of patients referred for thoracic surgery required psychological intervention. The best instrument to identify those patients requiring psychological care, taking a psychological interview as the criterion variable, was the total HADS score. This test is brief, simple and well accepted by patients; it is easy to implement within a thoracic surgery service and has a good diagnostic accuracy


Assuntos
Humanos , Masculino , Feminino , Estresse Psicológico/diagnóstico , Cirurgia Torácica/organização & administração , Procedimentos Cirúrgicos Torácicos/psicologia , Ansiedade/diagnóstico , Depressão/diagnóstico , Entrevista Psicológica/métodos , Neoplasias Pulmonares/cirurgia , Cuidados Pré-Operatórios/métodos , Escalas de Graduação Psiquiátrica , Sensibilidade e Especificidade
18.
Cir Esp ; 97(5): 275-281, 2019 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31010579

RESUMO

INTRODUCTION: The aim of the present study was to examine the diagnostic accuracy of screening tests in detecting cases requiring psychological intervention among patients referred for thoracic surgery. METHODS: Emotional distress was evaluated in 105 patients referred for thoracic surgery by means of a diagnostic psychological interview (criterion variable). The screening ability of the following methods was analyzed: the physician's opinion (Yes/No), Hospital Anxiety and Depression Scale (HADS), single-item interview: «Are you depressed?¼ (Depression Question, ADEP) (1-5) and the single-item interview: «Are you anxious?¼ (Anxiety Question, ANXQ) (1-5). RESULTS: According to the clinical interview, 34% of the patients were clinical cases requiring psychological intervention. The total HADS (cut-off point of 10) showed a sensitivity=0.89, specificity=0.75 and AUC=0.883; the ADEP scale (>1) showed a sensitivity=0.79, specificity=0.74 and AUC=0.795; the ANXQ scale (>1) showed a sensitivity=0.78, specificity=0.41 and AUC=0.690; and the physician's opinion showed a sensitivity=0.47 and specificity=0.86. CONCLUSIONS: A high percentage of patients referred for thoracic surgery required psychological intervention. The best instrument to identify those patients requiring psychological care, taking a psychological interview as the criterion variable, was the total HADS score. This test is brief, simple and well accepted by patients; it is easy to implement within a thoracic surgery service and has a good diagnostic accuracy.


Assuntos
Estresse Psicológico/diagnóstico , Cirurgia Torácica/organização & administração , Procedimentos Cirúrgicos Torácicos/psicologia , Ansiedade/diagnóstico , Depressão/diagnóstico , Feminino , Humanos , Entrevista Psicológica/métodos , Neoplasias Pulmonares/cirurgia , Masculino , Cuidados Pré-Operatórios/métodos , Escalas de Graduação Psiquiátrica , Sensibilidade e Especificidade , Espanha
19.
BMJ ; 365: l1476, 2019 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-30967483

RESUMO

OBJECTIVE: To determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression. DESIGN: Individual participant data meta-analysis. DATA SOURCES: Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-February 2015). INCLUSION CRITERIA: Eligible studies compared PHQ-9 scores with major depression diagnoses from validated diagnostic interviews. Primary study data and study level data extracted from primary reports were synthesized. For PHQ-9 cut-off scores 5-15, bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, among studies that used semistructured diagnostic interviews, which are designed for administration by clinicians; fully structured interviews, which are designed for lay administration; and the Mini International Neuropsychiatric (MINI) diagnostic interviews, a brief fully structured interview. Sensitivity and specificity were examined among participant subgroups and, separately, using meta-regression, considering all subgroup variables in a single model. RESULTS: Data were obtained for 58 of 72 eligible studies (total n=17 357; major depression cases n=2312). Combined sensitivity and specificity was maximized at a cut-off score of 10 or above among studies using a semistructured interview (29 studies, 6725 participants; sensitivity 0.88, 95% confidence interval 0.83 to 0.92; specificity 0.85, 0.82 to 0.88). Across cut-off scores 5-15, sensitivity with semistructured interviews was 5-22% higher than for fully structured interviews (MINI excluded; 14 studies, 7680 participants) and 2-15% higher than for the MINI (15 studies, 2952 participants). Specificity was similar across diagnostic interviews. The PHQ-9 seems to be similarly sensitive but may be less specific for younger patients than for older patients; a cut-off score of 10 or above can be used regardless of age.. CONCLUSIONS: PHQ-9 sensitivity compared with semistructured diagnostic interviews was greater than in previous conventional meta-analyses that combined reference standards. A cut-off score of 10 or above maximized combined sensitivity and specificity overall and for subgroups. REGISTRATION: PROSPERO CRD42014010673.


Assuntos
Confiabilidade dos Dados , Transtorno Depressivo Maior/diagnóstico , Programas de Rastreamento/métodos , Questionário de Saúde do Paciente/estatística & dados numéricos , Idoso , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Entrevista Psicológica/métodos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica/normas , Sensibilidade e Especificidade
20.
Int J Eat Disord ; 52(4): 388-397, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30843618

RESUMO

OBJECTIVE: Although avoidant/restrictive food intake disorder (ARFID) has been included as a new diagnostic entity of childhood feeding and eating disorders, there is a lack of measures to reliably and validly assess ARFID. In addition, virtually nothing is known about clinical characteristics of ARFID in nonclinical samples. METHOD: The present study presents the development and validation of an ARFID module for the child and parent version of the Eating Disorder Examination (EDE) in a nonclinical sample of N = 39 children between 8 and 13 years with underweight and/or restrictive eating behaviors. For evaluating the ARFID module's reliability, the convergence of diagnoses between two independent raters and between the child and parent module was determined. The module's validity was evaluated based on the full-length child version of the EDE, a 24 h food record, parent-reported psychosocial functioning and self-reported quality of life, and objective anthropometric measures. RESULTS: In total, n = 7 children received an ARFID diagnosis. The ARFID module showed high interrater reliability, especially for the parent version, and high convergence between child and parent report. Evidence for the module's convergent, divergent, and discriminant validity was provided. Specifically, children with versus without ARFID reported significantly less macro- and micronutrient intake and were more likely to be underweight. DISCUSSION: This pilot study indicates the child and parent version of the EDE ARFID module to be promising for diagnosing ARFID in a structured way but still necessitates a validation in a larger clinical and community-based sample.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Entrevista Psicológica/métodos , Qualidade de Vida/psicologia , Adolescente , Criança , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Humanos , Masculino , Projetos Piloto , Reprodutibilidade dos Testes , Estudos Retrospectivos
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