Does method matter? Assessing the validity and clinical utility of structured diagnostic interviews among a clinical sample of first-admitted patients with psychosis: A replication study

IntroductionIncreasingly, diagnostic assessments in clinical practice are made using structured diagnostic interviews or self-rating scales imported into clinical practice from research studies and big-scale surveys. Although structured diagnostic interviews have been shown to be highly reliable in research, the use of such method in clinical contexts are more questionable. In fact the validity and clinical utility of such methods in naturalistic contexts have rarely been evaluated. In this study we report on a replication study of Nordgaard et al (22) Assessing the diagnostic validity of a structured psychiatric interview in a first-admission hospital sample. World Psychiatry, 11 (3): 181–185.MethodsThe study sample comprises 55 first-admitted inpatients to a treatment facility specializing in the assessment and treatment of patients with psychotic disorders.ResultsWe found poor agreement between diagnoses generated by Structured Clinical Interview for DSM-IV and Best-estimate consensus diagnoses (κ value 0.21).DiscussionWe identified over-reliance on self-report, vulnerability to response set in dissimulating patients, and a strong diagnosis and comorbidity focus, as possible reasons for misdiagnosis with the SCID. We conclude that structured diagnostic interviews performed by mental health professionals without solid psychopathological knowledge and experience are not recommendable for clinical practice

Editorial Board

Source at http://dx.doi.org/10.1186/s12888-017-1345-8 Background: The duration of untreated psychosis is determined by both patient and service related factors. Few studies have considered the geographical accessibility of services in relation to treatment delay in early psychosis. To address this, we investigated whether treatment delay is co-determined by straight-line distance to hospital based specialist services in a mainly rural mental health context. Methods: A naturalistic cross-sectional study was conducted among a sample of recent onset psychosis patients in northern Norway (n = 62). Data on patient and service related determinants were analysed. Results: Half of the cohort had a treatment delay longer than 4.5 months. In a binary logistic regression model, straight-line distance was found to make an independent contribution to delay in which we controlled for other known risk factors. Conclusions: The determinants of treatment delay are complex. This study adds to previous studies on treatment delay by showing that the spatial location of services also makes an independent contribution. In addition, it may be that insidious onset is a more important factor in treatment delay in remote areas, as the logistical implications of specialist referral are much greater than for urban dwellers. The threshold for making a diagnosis in a remote location may therefore be higher. Strategies to reduce the duration of untreated psychosis in rural areas would benefit from improving appropriate referral by crisis services, and the detection of insidious onset of psychosis in community based specialist services

Does method matter? Assessing the validity and clinical utility of structured diagnostic interviews among a clinical sample of first-admitted patients with psychosis: A replication study

Introduction: Increasingly, diagnostic assessments in clinical practice are made using structured diagnostic interviews or self-rating scales imported into clinical practice from research studies and big-scale surveys. Although structured diagnostic interviews have been shown to be highly reliable in research, the use of such method in clinical contexts are more questionable. In fact the validity and clinical utility of such methods in naturalistic contexts have rarely been evaluated. In this study we report on a replication study of Nordgaard et al (22) Assessing the diagnostic validity of a structured psychiatric interview in a first-admission hospital sample. World Psychiatry, 11 (3): 181–185. Methods: The study sample comprises 55 first-admitted inpatients to a treatment facility specializing in the assessment and treatment of patients with psychotic disorders. Results: We found poor agreement between diagnoses generated by Structured Clinical Interview for DSM-IV and Best-estimate consensus diagnoses (κ value 0.21). Discussion: We identified over-reliance on self-report, vulnerability to response set in dissimulating patients, and a strong diagnosis and comorbidity focus, as possible reasons for misdiagnosis with the SCID. We conclude that structured diagnostic interviews performed by mental health professionals without solid psychopathological knowledge and experience are not recommendable for clinical practice

Studies in pathways to care - duration of untreated psychosis and its determining factors in early psychosis

Mange pasienter med en førstegangspsykose får behandling sent i forløpet og har en lang varighet av ubehandlet psykose (VUP). Forsinket behandling kan skyldes både indre (lidelse og pasient relaterte) og ytre (tjeneste og systemrelaterte) faktorer. Til tross for at nyere forskning har dokumentert at en stor del av forsinkelsen skjer mens pasienten mottar behandling i spesialisthelsetjenesten, så er denne komponenten av VUP lite utforsket. Formålet med studien var å gi en epidemiologisk beskrivelse av behandlingsveier for pasienter med førstegangspsykose i et norsk helsetjenestetilbud, undersøke VUP på gruppenivå, undersøke årsakene til forsinket behandling, og å teste hypotesen om at forsinket behandling er medbestemt av tjeneste- og systemrelaterte faktorer. For å undersøke disse tema samlet vi inn data fra tre ulike populasjoner: 1) pasienter i behandling, 2) behandlere ved distriktspsykiatriske sentere, og 3) fastleger. VUP hadde en medianverdi på 19.5 uker i dette utvalget. Vi fant at forsinkelse i helsetjenesten utgjorde mer enn halvparten av den totale forsinkelsen. Faktorene knyttet til indre faktorer var svært idiosynkratiske, og det er stor variasjon i hvor og hvordan pasienter kommer i kontakt med helsetjenesten. Viktige determinanter for forsinkelse i helsetjenesten var forsinket henvisning og forsinket diagnose. Beslutninger om å henvise var medbestemt av fysisk kontekst og terskelen for innleggelse var forhøyet i mer perifere områder. Forsinket diagnose og feildiagnose, muligens knyttet til at man undervurderer heterogeniteten i den kliniske presentasjon ved tidlig psykose, bidro også til forsinket behandling. På bakgrunn av disse funn fremholder vi at VUP er et flerdimensjonalt begrep som innbefatter både indre og ytre faktorer. Forsinket behandling forårsakes av et samspill mellom flere faktorer, på ulike nivåer, og er også bestemt av den fysiske konteksten. En bedre forståelse av hvor og hvorfor forsinkelser i behandling skjer vil gjøre det mulig å uforme tjenester for raskere oppdagelse og behandling av psykose. Funnene i denne undersøkelsen understreker at et viktig mål for tidlig intervensjon er å bedre henvisningspraksis og å unngå forsinket diagnose for pasienter som allerede mottar behandling i spesialisthelsetjenesten

Negotiating the boundaries of psychosis: A qualitative studyof the service provider perspective on treatment delay incommunity mental health

Aim: Evidence shows that many patients are detected and treated late in their course of illness, and that substantial delay occurs even after entry to mental health services. Although several studies have examined the service user and carer perspectives on treatment delay, few have explored the issue from the service provider perspective. The aim of this study was to broaden our understanding of treatment delay by exploring the service provider perspective on reasons for treatment delay in community mental health services. Methods: A qualitative study using data from focus group interviews with 33 healthcare professionals in community mental health care. Interview data were digitally recorded and transcribed verbatim, and analysed using a grounded theory approach. Results: Service providers perceived divergent or conflicting perspectives as the main challenge in early psychosis. Clinical negotiation was chosen as the main term describing the interactions between patients and healthcare professionals: This was observed in 3 overlapping areas: (1) Negotiating the patients status as help‐seeker; (2) Negotiating the place and conditions of treatment and (3) Negotiating the meaning of distressing experiences and the timing of treatment options. Conclusions: This study suggests that delay in initiation of treatment for psychosis in community mental health is related to clinical challenges of early disengagement from services and diagnostic uncertainty. Service providers found negotiating the therapeutic relationship and patient‐centred flexibility more useful in ensuring engagement than an assertive outreach approach. Diagnostic uncertainty was resolved through watchful waiting using a distress‐overload conceptualization in assessing changes in mental state and service needs

Negotiating the boundaries of psychosis: A qualitative study of the service provider perspective on treatment delay in community mental health

Aim: Evidence shows that many patients are detected and treated late in their course of illness, and that substantial delay occurs even after entry to mental health services. Although several studies have examined the service user and carer perspectives on treatment delay, few have explored the issue from the service provider perspective. The aim of this study was to broaden our understanding of treatment delay by exploring the service provider perspective on reasons for treatment delay in community mental health services. Methods: A qualitative study using data from focus group interviews with 33 healthcare professionals in community mental health care. Interview data were digitally recorded and transcribed verbatim, and analysed using a grounded theory approach. Results: Service providers perceived divergent or conflicting perspectives as the main challenge in early psychosis. Clinical negotiation was chosen as the main term describing the interactions between patients and healthcare professionals: This was observed in 3 overlapping areas: (1) Negotiating the patients status as help-seeker; (2) Negotiating the place and conditions of treatment and (3) Negotiating the meaning of distressing experiences and the timing of treatment options. Conclusions: This study suggests that delay in initiation of treatment for psychosis in community mental health is related to clinical challenges of early disengagement from services and diagnostic uncertainty. Service providers found negotiating the therapeutic relationship and patient-centred flexibility more useful in ensuring engagement than an assertive outreach approach. Diagnostic uncertainty was resolved through watchful waiting using a distressoverload conceptualization in assessing changes in mental state and service needs