Katharina Joest

Psychometric evaluation of the Psychotic Symptom Rating Scales.

BACKGROUND The aims of this study were to examine the psychometric properties of a German version of the Psychotic Symptom Rating Scales (PSYRATS) in a sample of patients with schizophrenic spectrum disorders and affective disorders with delusions and to validate subscales of the PSYRATS with other ratings of psychotic symptoms. SAMPLING AND METHODS Two hundred patients with schizophrenic spectrum disorder and affective disorders with delusions were examined. Psychometric properties of the PSYRATS items and scales were determined, and the scores of the PSYRATS scales and subscales were compared to the Positive and Negative Syndrome Scale (PANSS) and other ratings of psychotic symptoms. RESULTS The PSYRATS items and scales were found to have excellent interrater reliability. Two factors for the delusions scale (DS) and 4 factors of the auditory hallucinations scale were found. Subscales of the DS and auditory hallucinations scale were replicated by factor analysis, and the validity of the subscales was supported. CONCLUSIONS The German version of the PSYRATS is a reliable and valid assessment tool for delusions and hallucinations. The findings support the validity of the PSYRATS subscales. The DS is also applicable for patients with affective disorders.

Expressed emotion, perceived criticism and 10-year outcome of depression.

Outcome studies of patients suffering from depression indicate a high relapse rate and a tendency towards chronicity. A family atmosphere characterised by expressed emotion (EE) and perceived criticism (PC) was reported to be a robust predictor of outcome in affective disorders. The aim of the study was to analyze the association between EE, PC and long-term outcome of depression. Fifty inpatients with major depression were followed up 1, 2 and 10 years after discharge from the hospital. After 10 years, 26 patients (56.5%) had at least one recurrence. Spousal EE, assessed with the Five-Minute Speech Sample (FMSS), and the Perceived Criticism Index (PCI) were not significant prognostic factors for depression outcome. The significance of EE and PC for the long-term course of depression has to be questioned. The findings indicate a need to examine factors that may partly mediate the effect of EE and PC on the outcome of depression.

Dimensions of Delusional Experience Scale: A Psychometric Evaluation of a German Version

Background: Delusional experience is a fundamental symptom of psychotic illness. Over recent years, a multidimensional perspective has become increasingly important regarding this phenomenon. Several instruments to measure different dimensions of delusions have been constructed. The aims of this study were to examine the reliability and validity of a German version of the Dimensions of Delusional Experience Scale (DDE). Methods: Two hundred inpatients with a schizophrenic spectrum disorder or an affective disorder with delusions were examined with the DDE, the Positive and Negative Syndrome Scale (PANSS) and other rating scales for delusional experiences. Results: The scale was found to have good reliability and excellent inter-rater reliability. The 2 factors, delusional involvement and delusional construct, found by Kendler et al. [Am J Psychiatry 1983;140:466–469] could be replicated. The convergent and differential validity of the scale was supported. Besides the content-related aspect ‘bizarreness’, the DDE mainly assesses cognitive aspects, emotional and behavioral aspects are not incorporated. Conclusions: The results support the value of a multidimensional perspective of delusional experiences. The German version of the DDE is a reliable and valid assessment tool for different dimensions of delusions, and an economical instrument for research and clinical practice. Further research is needed to reveal the dimensional structure underlying delusional experience.

Leichtere depressive Störungen in der Hausarztpraxis - Verbesserung der Versorgung durch Veränderung der Praxiskommunikation?

Leichtere, subsyndromale depressive Störungen treten in der hausärztlichen Versorgung ebenso häufig auf wie schwerere Depressionen (Major Depression). Obwohl zwischenzeitlich in mehreren Studien gezeigt werden konnte, dass mit entsprechenden Symptomen betroffene Patienten in vielerlei Hinsicht deutlich beeinträchtigt sind, ist die Frage der adäquaten Behandlung dieser Störungsbilder noch weitestgehend ungeklärt. Mit der vom Bundesministerium für Bildung und Forschung (BMBF) geförderten Studie PRAXKOM soll untersucht werden, inwieweit durch eine einfache und praktikable Veränderung der Praxiskommunikation die effektive Behandlung und die Zufriedenheit der Patienten mit der allgemeinärztlichen Versorgung verbessert werden kann. Hierfür werden in einem zweiphasigen Vorgehen zunächst durch leitfadengestützte, qualitative Interviews Patienten, Ärzte und Arzthelferinnen bezüglich möglicher Ansatzpunkte und Hürden für Veränderungen befragt. In einem zweiten Studienabschnitt sollen dann die auf der Basis der Befragung entwickelten Interventionen in einer randomisierten Studie evaluiert werden.