Individuals with knee impairments identify items in need of clarification in the Patient Reported Outcomes Measurement Information System (PROMIS®) pain interference and physical function item banks - a qualitative study

Background: The content and wording of the Patient Reported Outcome Measurement Information System (PROMIS) Physical Function and Pain Interference item banks have not been qualitatively assessed by individuals with knee joint impairments. The purpose of this investigation was to identify items in the PROMIS Physical Function and Pain Interference Item Banks that are irrelevant, unclear, or otherwise difficult to respond to for individuals with impairment of the knee and to suggest modifications based on cognitive interviews. Methods: Twenty-nine individuals with knee joint impairments qualitatively assessed items in the Pain Interference and Physical Function Item Banks in a mixed-methods cognitive interview. Field notes were analyzed to identify themes and frequency counts were calculated to identify items not relevant to individuals with knee joint impairments. Results: Issues with clarity were identified in 23 items in the Physical Function Item Bank, resulting in the creation of 43 new or modified items, typically changing words within the item to be clearer. Interpretation issues included whether or not the knee joint played a significant role in overall health and age/gender differences in items. One quarter of the original items (31 of 124) in the Physical Function Item Bank were identified as irrelevant to the knee joint. All 41 items in the Pain Interference Item Bank were identified as clear, although individuals without significant pain substituted other symptoms which interfered with their life. Conclusions: The Physical Function Item Bank would benefit from additional items that are relevant to individuals with knee joint impairments and, by extension, to other lower extremity impairments. Several issues in clarity were identified that are likely to be present in other patient cohorts as well

The operationalized psychodynamic diagnostics system. Clinical relevance, reliability and validity

In this paper, we present a multiaxial system for psychodynamic diagnosis, which has attained wide usage in Germany in the last 10 years. First we will discuss the 4 operationalized psychodynamic diagnostics (OPD) axes: illness experience and treatment assumptions, relationships, mental conflicts, and structure, then clinical applications will be outlined. Focus psychodynamic formulations can be employed both with inpatients and with outpatients. Studies show good reliability in a research context and acceptable reliability for clinical purposes. Validity will be separately summarized as content, criterion, and construct validity. Validity studies indicate good validity for the individual axes. Numerous studies on the OPD indicate areas of possible improvement, for example for clinical purposes the OPD should be more practically formulated

Assessing Psychological Well-Being: Self-Report Instruments for the NIH Toolbox

Objective— Psychological well-being (PWB) has a significant relationship with physical and mental health. As part of the NIH Toolbox for the Assessment of Neurological and Behavioral Function, we developed self-report item banks and short forms to assess PWB. Study Design and Setting— Expert feedback and literature review informed the selection of PWB concepts and the development of item pools for Positive Affect, Life Satisfaction, and Meaning and Purpose. Items were tested with a community-dwelling U.S. internet panel sample of adults aged 18 and above (N=552). Classical and item response theory (IRT) approaches were used to evaluate unidimensionality, fit of items to the overall measure, and calibrations of those items, including differential item function (DIF). Results— IRT-calibrated item banks were produced for Positive Affect (34 items), Life Satisfaction (16 items), and Meaning and Purpose (18 items). Their psychometric properties were supported based on results of factor analysis, fit statistics, and DIF evaluation. All banks measured the concepts precisely (reliability ≥0.90) for more than 98% of participants. Conclusion— These adult scales and item banks for PWB provide the flexibility, efficiency, and precision necessary to promote future epidemiological, observational, and intervention research on the relationship of PWB with physical and mental health

Interactions between Obsessional Symptoms and Interpersonal Ambivalences in Psychodynamic Therapy: An Empirical Case Study

The classical symptom specificity hypothesis (Blatt, 1974) particularly associates obsessional symptoms to interpersonal behavior directed at autonomy and separation from others. Cross-sectional group research, however, has yielded inconsistent findings on this predicted association, and a previous empirical case study (Cornelis et al., in press; see Chapter 2) documented obsessional pathology to be rooted in profound ambivalences between autonomous and dependent interpersonal dynamics. Therefore, in the present empirical case study, concrete operationalizations of the classical symptom specificity hypothesis are contrasted to alternative hypotheses based on the observed complexities in Chapter 2. Dynamic associations between obsessional symptoms and interpersonal functioning is further explored, aiming at further contribution to theory building (i.e., through suggestions for potential hypothesis-refinement; Stiles, 2009). Similar to the first empirical case study (Chapter 1), Consensual Qualitative Research for Case studies is used to quantitatively and qualitatively describe the longitudinal, clinical interplay between obsessional symptoms and interpersonal dynamics throughout the process of supportive-expressive psychodynamic therapy. In line with findings from Chapter 1, findings reveal close associations between obsessions and interpersonal dynamics, and therapist interventions focusing on interpersonal conflicts are documented as related to interpersonal and symptomatic alterations. Observations predominantly accord to the ambivalence-hypothesis rather than to the classical symptom specificity hypothesis. Yet, meaningful differences are observed in concrete manifestations of interpersonal ambivalences within significant relationships. Findings are again discussed in light of conceptual and methodological considerations; and limitations and future research indications are addressed

Alternative Aspects - Personality Studies

This submission contains data and codebooks from several personality studies conducted 1990-2017, organized by assessment instrument. For demographic information about the study participants, please refer to Background Information Questionnaire (BIQ) - Personality Studies (http://d-scholarship.pitt.edu/id/eprint/35424). Studies: 1. Validity in the Diagnosis of Personality Disorders ("Validity") 2. Screening for Personality Disorders ("Screening") 3. Interpersonal Functioning in Borderline Personality ("Interpersonal Functioning") 4. Interpersonal Functioning and Emotion in Borderline Personality ("Emotion and Interpersonal Functioning") 5. Interpersonal Functioning and Emotion in Borderline Personality ("Couples") Measure Description: The 10-item Alternative Aspects (AA) instrument was created to compare qualitatively different aspects of personality disorder. The clinical literature suggests at least three implicit meanings for the phrase “personality disorder”: a “lack” of character (e.g., poor tolerance for frustration, a lack of perseverance, excessive difficulty in the face of minor stresses), “bad” character (e.g., sociopathy, cruelty, exploitation), or a rigid, maladaptive interpersonal “style” (the DSM meaning of the term and the broadest of the three) resulting in subjective distress, functional impairment, or both. Therefore, the first three items rate each of these three domains on a 5-point scale ranging from “little to none” to “severe”. Items 4 through 10 rate impairment due to personality pathology within 6 specific areas: subjective distress, marital/intimate relationships, parenting (if applicable), occupational functioning, other social relations, distress imposed upon significant others, as well as overall distress. Data Analysis Notes: Validity & Screening studies used scale range 1-5 for all questions. IFB, E-IFB & Couples used a scale of 1-5 for first three questions and used the nine point scale from the RAPFA to rate severity and pervasiveness of dysfunction for the last seven questions. Ratings for the variable “Parent” were made only if the participant had children. Persons with no children (and those lacking any history of responsibilities for child care, including step or foster children) received a ‘98’ or ‘not applicable’ rating. References: N/

The PROMIS satisfaction with social participation measures demonstrated responsiveness in diverse clinical populations

To conduct a longitudinal evaluation of PROMIS® Social Function measures (Satisfaction with Participation in Social Roles, and Satisfaction with Participation in Discretionary Social Activities) in English-speaking people with chronic health conditions

Rejection Distress Suppresses Medial Prefrontal Cortex in Borderline Personality Disorder

BACKGROUND: Borderline personality disorder (BPD) is characterized by an elevated distress response to social exclusion (i.e., rejection distress), the neural mechanisms of which remain unclear. Functional magnetic resonance imaging studies of social exclusion have relied on the classic version of the Cyberball task, which is not optimized for functional magnetic resonance imaging. Our goal was to clarify the neural substrates of rejection distress in BPD using a modified version of Cyberball, which allowed us to dissociate the neural response to exclusion events from its modulation by exclusionary context. METHODS: Twenty-three women with BPD and 22 healthy control participants completed a novel functional magnetic resonance imaging modification of Cyberball with 5 runs of varying exclusion probability and rated their rejection distress after each run. We tested group differences in the whole-brain response to exclusion events and in the parametric modulation of that response by rejection distress using mass univariate analysis. RESULTS: Although rejection distress was higher in participants with BPD (F1,40 = 5.25, p = .027, η2 = 0.12), both groups showed similar neural responses to exclusion events. However, as rejection distress increased, the rostromedial prefrontal cortex response to exclusion events decreased in the BPD group but not in control participants. Stronger modulation of the rostromedial prefrontal cortex response by rejection distress was associated with higher trait rejection expectation, r = −0.30, p = .050. CONCLUSIONS: Heightened rejection distress in BPD might stem from a failure to maintain or upregulate the activity of the rostromedial prefrontal cortex, a key node of the mentalization network. Inverse coupling between rejection distress and mentalization-related brain activity might contribute to heightened rejection expectation in BPD

Indicators of Affect Dynamics: Structure, Reliability, and Personality Correlates

Gefördert im Rahmen des Projekts DEA

PROMIS measures of pain, fatigue, negative affect, physical function, and social function demonstrated clinical validity across a range of chronic conditions

To present an overview of a series of studies in which the clinical validity of the National Institutes of Health’s Patient Reported Outcome Measurement Information System (NIH; PROMIS) measures was evaluated, by domain, across six clinical populations