Helle Østermark Sørensen

Improving the physical health of long-term psychiatric inpatients.

Background: Patients with psychiatric illness have increased somatic morbidity and increased mortality. Knowledge of how to integrate the prevention and care of somatic illness into the treatment of psychiatric patients is required. The aims of this study were to investigate whether an intervention programme to improve physical health is effective. Methods: An extension of the European Network for Promoting the Health of Residents in Psychiatric and Social Care Institutions (HELPS) project further developed as a 12-month controlled cluster-randomized intervention study in the Danish centre. Waist circumference was a proxy of unhealthy body fat in view of the increased risk of cardiovascular diseases and type 2 diabetes. Results: Waist circumference was 108 cm for men and 108 cm for women. Controlled for cluster randomization, sex, age, and body fat, the intervention group showed a small, but not significant, reduction in waist circumference, while participants in the control group showed a significant increase in waist circumference. Conclusions: The intervention had a positive effect on the physical health of the patients measured by a reduction in the increase of waist circumference.

Development and psychometric properties of a five-language multiperspective instrument to assess clinical decision making style in the treatment of people with severe mental illness (CDMS)

BackgroundThe aim of this study was to develop and evaluate psychometric properties of the Clinical Decision Making Style (CDMS) scale which measures general preferences for decision making as well as preferences regarding the provision of information to the patient from the perspectives of people with severe mental illness and staff.MethodsA participatory approach was chosen for instrument development which followed 10 sequential steps proposed in a current guideline of good practice for the translation and cultural adaptation of measures. Following item analysis, reliability, validity, and long-term stability of the CDMS were examined using Spearman correlations in a sample of 588 people with severe mental illness and 213 mental health professionals in 6 European countries (Germany, UK, Italy, Denmark, Hungary, and Switzerland).ResultsIn both patient and staff versions, the two CDMS subscales “Participation in Decision Making” and “Information” reliably measure distinct characteristics of decision making. Validity could be demonstrated to some extent, but needs further investigation.ConclusionsTogether with two other five-language patient- and staff-rated measures developed in the CEDAR study (ISRCTN75841675) – “Clinical Decision Making in Routine Care” and “Clinical Decision Making Involvement and Satisfaction” – the CDMS allows empirical investigation of the complex relation between clinical decision making and outcome in the treatment of people with severe mental illness across Europe.

The development and evaluation of a five-language multi-perspective standardised measure: clinical decision-making involvement and satisfaction (CDIS)

BackgroundThe aim of this study was to develop and evaluate a brief quantitative five-language measure of involvement and satisfaction in clinical decision-making (CDIS) – with versions for patients (CDIS-P) and staff (CDIS-S) – for use in mental health services.MethodsAn English CDIS was developed by reviewing existing measures, focus groups, semistructured interviews and piloting. Translations into Danish, German, Hungarian and Italian followed the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force principles of good practice for translation and cultural adaptation. Psychometricevaluation involved testing the measure in secondary mental health services in Aalborg, Debrecen, London, Naples, Ulm and Zurich.ResultsAfter appraising 14 measures, the Control Preference Scale and Satisfaction With Decision-making English-language scales were modified and evaluated in interviews (n = 9), focus groups (n = 22) and piloting (n = 16). Translations were validated through focus groups (n = 38) and piloting (n = 61). A total of 443 service users and 403 paired staff completed CDIS. The Satisfaction sub-scale had internal consistency of 0.89 (0.86-0.89 after item-level deletion) for staff and 0.90 (0.87-0.90) for service users, both continuous and categorical (utility) versions were associated with symptomatology and both staff-rated and service userrated therapeutic alliance (showing convergent validity), and not with social disability (showing divergent validity), and satisfaction predicted staff-rated (OR 2.43, 95%CI 1.54- 3.83 continuous, OR 5.77, 95%CI 1.90-17.53 utility) and service user-rated (OR 2.21, 95%CI 1.51-3.23 continuous, OR 3.13, 95%CI 1.10-8.94 utility) decision implementation two months later. The Involvement sub-scale had appropriate distribution and no floor or ceiling effects, was associated with stage of recovery, functioning and quality of life (staff only) (showing convergent validity), and not with symptomatology or social disability (showing divergent validity), and staff-rated passive involvement by the service user predicted implementation (OR 3.55, 95%CI 1.53-8.24). Relationships remained after adjusting for clustering by staff.ConclusionsCDIS demonstrates adequate internal consistency, no evidence of item redundancy, appropriate distribution, and face, content, convergent, divergent and predictive validity. It can be recommended for research and clinical use. CDIS-P and CDIS-S in all 3 five languages can be downloaded at http://www.cedar-net.eu/instruments.Trial registrationISRCTN75841675.

Reducing psychotropic pharmacotherapy in patients with severe mental illness: a cluster-randomized controlled intervention study

Background: Many patients with mental illness receive psychotropic medicine in high dosages and from more than one drug. One of the consequences of this practice is obesity, which is a contributing factor to increased physical morbidity and premature death. Methods: Our study was a cluster-randomized intervention study involving 6 facilities and 174 patients diagnosed with severe mental illnesses (73% schizophrenia). The intervention period was 12 months and consisted of teaching sessions with the staff and evaluating the patients’ intake of psychotropic medication. At index, 44% met criteria for obesity and 76% met criteria for overweight. Waist circumferences were 108 cm for men and 108 cm for women. Olanzapine, clozapine and quetiapine were the most common prescribed antipsychotics. Mean values of daily doses of antipsychotic were 2.5. Results: The intervention showed no significant differences between the intervention and control group regarding psychotropic treatment. At follow up, independent of intervention, patients receiving antipsychotic polypharmacy had a larger waist circumference compared with patients receiving antipsychotic monotherapy of 9.8 cm (1.5–18.1) (p = 0.028). Discussion and conclusion: We found both a high prevalence of obesity and that the patients received treatment with antipsychotic polypharmaceutics in high dosages. Active awareness did not change practice and we must think of other ways to restrict treatment with psychotropics in this group of patients.

Content and implementation of clinical decisions in the routine care of people with severe mental illness

Abstract Background: Clinical decision making (CDM) in the treatment of people with severe mental illness relates to a wide range of life domains. Aims: To examine content of CDM in mental health care from the perspectives of service users and staff and to investigate variation in implementation of decisions for differing content. Method: As part of the European multicenter study clinical decision making and outcome in routine care for people with severe mental illness (ISRCTN75841675), 588 service users and their clinicians were asked to identify the decisions made during their last meeting. Decisions were then coded into content categories. Two months later, both parties reported if these decisions had been implemented. Results: Agreement between patients and staff regarding decision making was moderate (κ = 0.21–0.49; p < 0.001). Decisions relating to medication and social issues were most frequently identified. Overall reported level of implementation was 73.5% for patients and 74.7% for staff, and implementation varied by decision content. Conclusions: A variety of relevant decision topics were shown for mental health care. Implementation rates varied in relation to topic and may need different consideration within the therapeutic dyad.

Erratum to: Courses of helping alliance in the treatment of people with severe mental illness in Europe: a latent class analytic approach

Purpose The helping alliance (HA) between patient and therapist has been studied in detail in psychotherapy research, but less is known about the HA in long-term community mental health care. The aim of this study was to identify typical courses of the HA and their predictors in a sample of people with severe mental illness across Europe over a measurement period of one year.

Helping Alliance and Unmet Needs in Routine Care of People With Severe Mental Illness Across Europe: A Prospective Longitudinal Multicenter Study

Abstract The helping alliance (HA) refers to the collaborative bond between patient and therapist, including shared goals and tasks. People with severe mental illness have a complex mixture of clinical and social needs. Using mixed-effects regression, this study examined in 588 people with severe mental illness whether an increase in the HA is associated with fewer unmet needs over time, and whether change in the HA precedes change in unmet needs. It was found that a reduction in unmet needs was slower in patients with higher HA (B = 0.04, p < 0.0001) only for patient-rated measures. Improvement in both patient-rated and staff-rated HA over time was associated with fewer subsequent patient-rated (B = −0.10, p < 0.0001) and staff-rated (B = −0.08, p = 0.0175) unmet needs. With positive changes in the HA preceding fewer unmet needs, findings provide further evidence for a causal relationship between alliance and outcome in the treatment of people with severe mental illness.

P-1018 - Assessment of mental illness in danish workplaces the use of SCL-90-R as screening instrument to identify possible psychiatric cases

Introduction Many cases of mental illness are not detected and therefore not treated adequately. One reason for the low detection rate is that people do not spontaneously report psychological problems. Probing for psychopathology using screening-tools is a potential solution to this problem. The Symptom Checklist 90 revised (SCL-90-R) is a reliable and valid instrument in the assessment of psychological problems. Studies have shown that individuals with SCL-90-R total scores > 0.63 or values of > 0.63 in two or more subscales have a high risk of mental illness. Screening for mental disorders can take place in many settings. One potential setting, which has received relatively little attention, is that of the workplace. Objectives To investigate whether the workplace is a useful setting for screening for mental disorders. Aims To identify the SCL-90-R cut-off point which ensure maximum sensitivity and specificity in the detection of people with mental illness in the setting of a workplace. Methods The SCL-90-R was distributed to workers at 4 different workplaces. Individuals with total scores > 0.63 or values of > 0.63 in two or more subscales were invited to undergo diagnostic assessment by a doctor according to the Present State Examination. Results A total of 438 workers completed the questionnaire. From this sample 98 met SCL-90-R criteria to undergo PSE and of these 53 were evaluated to be in need of further treatment. The results on optimal SCL-90-R cut-off regarding sensitivity, specificity etc. are not yet available, but will be presented at the EPA conference.

Erratum to Courses of helping alliance in the treatment of people with severe mental illness in Europe: a latent class analytic approach[Soc Psychiatry Psychiatr Epidemiol, 10.1007/s00127-014-0963-4]

Purpose The helping alliance (HA) between patient and therapist has been studied in detail in psychotherapy research, but less is known about the HA in long-term community mental health care. The aim of this study was to identify typical courses of the HA and their predictors in a sample of people with severe mental illness across Europe over a measurement period of one year.

Erratum to: Courses of helping alliance in the treatment of people with severe mental illness in Europe

Purpose The helping alliance (HA) between patient and therapist has been studied in detail in psychotherapy research, but less is known about the HA in long-term community mental health care. The aim of this study was to identify typical courses of the HA and their predictors in a sample of people with severe mental illness across Europe over a measurement period of one year.