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Diagnoses at admission over a three-year, three-cohort prospective study
Source publication
Background. Psychiatric diagnoses are important for treatment planning. There are a number of current challenges in the area of psychiatric diagnosis with important treatment implications. In this study, we examined the differential usefulness of two semi-structured interviews of differing length compared to clinical diagnoses for generation of dia...
Contexts in source publication
Context 1
... same three experienced, master-level, admission staff members participated over all three Table 1. As can be seen in the table, the ages of the cases declined slightly each year and there was a slight shift in the diagnostic distribution. ...Context 2
... can be seen in Table 1, the overall pattern of admission diagnoses changed slightly over the study period. Diagnoses of major depressive disorder became more common and diagnoses of psychosis became less so. ...Context 3
... same three experienced, master-level, admission staff members participated over all three Table 1. As can be seen in the table, the ages of the cases declined slightly each year and there was a slight shift in the diagnostic distribution. ...Similar publications
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Objective:
In the ACHIEVE randomized controlled trial, an 18-month behavioral intervention accomplished weight loss in persons with serious mental illness who attended community psychiatric rehabilitation programs. This analysis estimates costs for delivering the intervention during the study. It also estimates expected costs to implement the inte...
OBJECTIVE Competitive employment may improve life quality for adults with severe mental illness, but it is not known for whom or under what circumstances. On the basis of previous research demonstrating benefits of family contact for African-American adults with severe mental illness, it was hypothesized that frequent family contact would moderate...
Citations
... Finally, the unexplained heterogeneity may jeopardize the interpretation of metaanalysis results. However, the overall estimated kappa aligns with two prior metaanalyses [9,17] as well as what is usually measured in single reports of very wellconducted studies, like Kottwicki [73] longitudinal study of reliability between SDI and NSDI. Moreover, our study used best practices for conducting systematic reviews, including PRISMA guidelines. ...
Unlabelled:
We aimed to find agreement between diagnoses obtained through standardized (SDI) and non-standardized diagnostic interviews (NSDI) for schizophrenia and Bipolar Affective Disorder (BD).
Methods:
A systematic review with meta-analysis was conducted. Publications from 2007 to 2020 comparing SDI and NSDI diagnoses in adults without neurological disorders were screened in MEDLINE, ISI Web of Science, and SCOPUS, following PROSPERO registration CRD42020187157, PRISMA guidelines, and quality assessment using QUADAS-2.
Results:
From 54231 entries, 22 studies were analyzed, and 13 were included in the final meta-analysis of kappa agreement using a mixed-effects meta-regression model. A mean kappa of 0.41 (Fair agreement, 95% CI: 0.34 to 0.47) but high heterogeneity (Î2 = 92%) were calculated. Gender, mean age, NSDI setting (Inpatient vs. Outpatient; University vs. Non-university), and SDI informant (Self vs. Professional) were tested as predictors in meta-regression. Only SDI informant was relevant for the explanatory model, leaving 79% unexplained heterogeneity. Egger's test did not indicate significant bias, and QUADAS-2 resulted in "average" data quality.
Conclusions:
Most studies using SDIs do not report the original sample size, only the SDI-diagnosed patients. Kappa comparison resulted in high heterogeneity, which may reflect the influence of non-systematic bias in diagnostic processes. Although results were highly heterogeneous, we measured a fair agreement kappa between SDI and NSDI, implying clinicians might operate in scenarios not equivalent to psychiatry trials, where samples are filtered, and there may be more emphasis on maintaining reliability. The present study received no funding.
... Auch erwies sich, dass die Diagnosen, die auf einem unstrukturierten diagnostischen Prozess basieren, über mehrere Jahre teilweise sehr stark schwanken bzw. sich verändern (74,0%), während dies bei semi-strukturieren diagnostischen Interviews nicht der Fall ist (4,0-11,0%) (Kotwicki & Harvey, 2013). Außerdem wurden Hinweise darauf gefunden, dass Patientinnen und Patienten häufig für psychische Probleme psychotherapeutische Hilfe in Anspruch nehmen möchten, die in semi-strukturierten diagnostischen Interviews eher als komorbide Störungen identifiziert werden (Zimmerman & Mattia, 2000). ...
This thesis focuses on misdiagnoses and diagnostic processes and methods in clinical psychology research and practice.
... These data were collected from May 2016 to December 2017, during which time all admissions to treatment services were administered a battery of assessments as part of the standard admissions process. All patients received a diagnosis with a structured procedure that has been previously published (Kotwicki and Harvey, 2013). This procedure included a structured interview with the MINI International Neuropsychiatric Inventory (MINI; Sheehan et al., 1998). ...
Computerized cognitive training (CCT) interventions are increasing in their use in outpatient mental health settings. These interventions have demonstrated efficacy for improving functional outcomes when combined with rehabilitation interventions. It has recently been suggested that patients with more cognitive impairment have a greater therapeutic response and that reduced engagement in training can identify cases who manifest low levels of benefit from treatment. Participants were psychiatric rehabilitation clients, with diagnoses of major depression, bipolar disorder and schizophrenia. Newly admitted cases received CCT, delivered via Brain HQ, with cognitive functioning divided into groups on the basis of a BACS t-score of 40 or less vs. more. Training engagement was indexed by the number of training levels achieved per day trained. Forty-nine cases trained on average for 17 days and completed a mean of 150 levels. Overall, patients improved by an average of 4.4 points (0.44 SD) in BACS t-scores (p < .001). Improvements were positively correlated with training engagement (r = 0.30, p < .05), but not with days trained (r = 0.09) or levels earned (r = 0.03) alone. Patients with higher levels of baseline cognitive performance had reduced cognitive gains (p < .003), but did not have less training engagement (p = .97). Diagnoses did not predict cognitive gains (p = .93) or target engagement (p = .74). Poorer performance at baseline and higher levels of training engagement accounted for >10% in independent variance in cognitive gains. The mean level of cognitive improvement far exceeded practice effects. The index of engagement, levels achieved per training day, is easily extracted from the training records of patients, which would allow for early and continuous monitoring of treatment engagement in CCT activities and therapist intervention as needed to improve engagement.
... Any differences between the primary and generalizability samples seem to be sample-specific, rather than reflecting a difference due to race, as we obtained the same pattern of relations in both Black and White participants in the latter. Although two different clinical interviews were used in the primary versus the generalizability sample, the SCID-IV and MINI interviews have been shown to have comparable diagnostic stability (Kotwicki & Harvey, 2013). Nonetheless, replication using the SCID-5 (First, Williams, Karg, & Spitzer, 2015) would confirm the present findings. ...
Depressive and anxiety disorders are severe and disabling conditions that result in substantial cost and global societal burden. Accurate and efficient identification is thus vital to proper diagnosis and treatment of these disorders. The Inventory of Depression and Anxiety Symptoms (IDAS) is a reliable and well-validated measure that provides dimensional assessment of both mood and anxiety disorder symptoms. The current study examined the clinical utility of the IDAS by establishing diagnostic cutoff scores and severity ranges using a large mixed sample (N = 5,750). Results indicated that the IDAS scales are good to excellent predictors of their associated Structured Clinical Interview for DSM-IV diagnoses. These findings were replicated using Diagnostic and Statistical Manual of Mental Disorders–Fifth edition(DSM-5) criteria assessed via the Mini-International Neuropsychiatric Interview. We provide three cutoff scores for each scale that can be used differentially depending on the goal of their use: screening, efficiency, or diagnosis confirmation. The identified severity ranges allow users to characterize individuals as mild, moderate, or severe, providing clinical information beyond diagnostic status. Finally, the 10-item IDAS Dysphoria scale and 20-item General Depression scale demonstrate strong ability to predict internalizing diagnoses and may represent an efficient way to screen for the presence of internalizing psychopathology.
... We did not interview patients, in contrast to Ogloff et al. (2015) who conducted SCID interviews, making the present study not directly comparable to theirs. Several previous studies have reported moderate to poor agreement between unstructured clinical diagnosis and SCID-based diagnoses (e.g., Kotwicki & Harvey, 2013;Miller, Dasher, Collins, Griffiths, & Brown, 2001;Ramirez Basco et al., 2000;Samuel, 2015;Samuel et al., 2013;Shear et al., 2000), and the present study adds a similar observation regarding agreement between clinical diagnosis and the evidence available on the medical record (as in Hansen et al., 2000) among forensic inpatients. Because we did not conduct interviews, we were unable to compare structured assessment with the unstructured clinical assessment conducted by clinicians, and therefore cannot draw conclusions about differences between unstructured and structured clinical assessment. ...
Research suggests that co-occurring substance use disorder (SUD) is prevalent among adults with psychiatric illness. Studies with forensic patients in Australia indicate that co-occurring disorders (CD) are underdiagnosed. To help determine how widespread CD underdiagnosis is in forensic populations internationally, we compared current diagnoses recorded in the clinical record with clinical evidence gathered during forensic assessment meeting DSM-IV criteria for SUD, in a Canadian sample of 638 male forensic inpatients. Among 491 with a major mental illness diagnosis, most (61%) met criteria for CD but only 19% were diagnosed as such. CD was associated with longer hospitalization, and with greater evidence of criminal history, antisociality, and risk of violent recidivism, regardless of how CD was defined. Identifying CD based on documented evidence, though, allowed for slightly greater detection of group differences. Underdiagnosing SUD has a potential impact on understanding substance use as a criminogenic treatment need in forensic mental health.
... We then developed multilevel models using clients' moving average SMORS scores and time since admission as predictor variables, categorizing them by the type of discharge, selecting the model having the best goodness of fit. We also compared initial engagement scores across diagnoses that were generated for all cases with a highly systematic assessment procedure (Kotwicki and Harvey 2013) and compared patients who were receiving financial aid based on income consideration to those who cost of care was covered by their family. Figure 1 presents the course of eligibility for the financial incentive as a function of three different possible moving average cut-off scores. ...
Significant numbers of individuals with severe mental illnesses are difficult to engage in treatment services, presenting challenges for care. To be able to assess the relationship between engagement and discharge outcomes, we modified the ?Milestones of Recovery Scale?. This scale was modified for content to match the current clinical setting, evaluated for inter-rater reliability after modification in a sample of 233 cases receiving psychiatric rehabilitation, and then was administered to 423 additional psychiatric rehabilitation clients over a 24-month study period. In an effort to determine whether provision of financial incentives lead to sustained increases in client engagement, a cut off for client eligibility for financial incentives was evaluated on the basis of the reliability study and the course of engagement was related to receipt of this incentive and successful completion of treatment in a new sample of 423 patients. Of this sample, 78?% received an initial financial incentive during treatment (were initially engaged), and 93.3?% of that subgroup sustained this level of engagement it over their entire course of treatment. Of the 22?% of cases not receiving an initial incentive, only 5.4?% improved in their engagement to levels required for the incentive. Longitudinal analysis demonstrated that individuals who maintained or increased their level of engagement over time were more likely to complete treatment in accordance with planned treatment goals. The initial engagement and the course of engagement in treatment predicted successful completion, but incentives did not lead to increased engagement in initially poorly engaged patients. These data are interpreted in terms of the likely success of extrinsic rewards to increase engagement in mental health services.
... The low rate (3.1%) of in-person exclusion of a diagnosis of either schizophrenia or bipolar illness, in a sample that was screened for the presence of these conditions in an electronic health record, provides excellent information about the validity of these chart diagnoses. This issue has been addressed previously for schizophrenia [Harvey et al., 2012a,b], but confirmation studies for chart diagnoses of bipolar illness are less common [Kotwicki and Harvey, 2013]. ...
Given the prominence of cognitive impairments and disability associated with schizophrenia and bipolar disorder, substantial interest has arisen in identifying determinants of the diseases and their features. Genetic variation has been linked to skills that underlie disability (“functional capacity” or FC), highlighting need for understanding of these relationships. We describe the design and methods of a large, multisite, observational study focusing on the genetics of functional disability in schizophrenia and bipolar disorder, presenting initial data on recruitment, and characterization of the sample. Known as Veterans Affairs (VA) Cooperative Studies Program (CSP)#572, this study is recruiting, diagnosing, and assessing U.S. Veterans with either schizophrenia or bipolar I disorder. Assessments include neuropsychological (NP) testing, FC, suicidality, and co-morbid conditions such as posttraumatic stress disorder (PTSD). A sample of “psychiatrically healthy” Veterans from another project serves as a comparison group. An interim total of 8,140 participants (42.1% schizophrenia) have been recruited and assessed as of September 30, 2013, with 9 months of enrollment remaining and with a target sample size of 9,500. Veterans with schizophrenia were more likely to never have married, whereas lifetime PTSD and suicidality were more common in the bipolar veterans. Performance on the FC measures and NP tests was consistent with previous results, with mean t-scores of 35 (−1.5 SD) for schizophrenia and 41 (−0.9 SD) for the bipolar Veterans. This large population is representative of previous studies in terms of patient performance and co-morbidities. Subsequent genomic analyses will examine the genomic correlates of performance-based measures. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.
... If the participant responded yes to any of these first questions, follow-up questions, according to the specific criteria, were asked in order to assess whether they met criteria for the relevant condition. Kotwicki and Harvey (2013) report that the MINI substantially improves upon the stability of diagnoses compared to unstructured procedures relying on clinician diagnoses. Further, the authors report that the differences in rates of changes in diagnoses between the Structured Clinical Interview for DSM disorders are nonsignificant (chi 2 (1)=2.01, ...
The serotonin (5-HT) system has been implicated in both depression and reward and punishment processing. This thesis presents data from four studies designed to better understand the role of serotonin in decision-making and mood. Following the general introduction and description of the main experimental methods, the first experimental chapter presents a study that examined the relationship between naturally-varying 5-HT1A receptor availability, measured using positron emission tomography, and decision-making in healthy volunteers. This study identified correlations between 5-HT1A receptor availability in the hippocampal complex and both impulsivity and sensitivity to the probability of an outcome during decision-making. The second experimental chapter examined decision-making in healthy volunteers 3 days following MDMA (3,4-methylenedioxymethamphetamine) administration, when serotonin transmission is thought to be reduced. A specific type of decision-making process, “pruning” (the reflexive avoidance of aversive outcomes when searching through a tree of potential decisions), was significantly attenuated 3 days following MDMA administration. However, the expected positive relationship between the attenuation in this decision-making process and low mood was not observed. The third experimental chapter attempted to extend this finding using the acute tryptophan depletion method, which removes tryptophan (the precursor to serotonin) from the diet and is thought to reduce serotonin synthesis. Performance on three decision making tasks (pruning, gambling and impulsivity) was examined in healthy volunteers following tryptophan depletion. Results revealed that treatment decreased participants’ choosing of high probability gambles. The final chapter examined pruning in unmedicated depressed patients, and found that they behaved very similarly to healthy volunteers when evaluating aversive outcomes in the context of a tree of potential decisions, despite the hypothesised disruption to the serotonin system in this disorder. These experiments provide a more complete understanding of the relationship between serotonin, decision-making and mood, and are discussed in relation to theories of depression that pose a central role for disrupted decision-making.
Background:
Early life adversity such as childhood emotional, physical, and sexual trauma is associated with later-life psychiatric and chronic medical conditions, including elevated inflammatory markers. Although previous research suggests a role for chronic inflammatory dysfunctions in several disease etiologies, specific associations between childhood trauma types and later life inflammation and health status are poorly understood.
Methods:
We studied patients (n=280) admitted to a psychiatric rehabilitation center. Self-reported histories of childhood emotional, physical, and sexual trauma were collected with a standard instrument. At the time of admission, we also assessed individuals' body mass index (BMI) and collected blood samples used to examine inflammatory marker C-reactive protein (CRP) levels.
Results:
The prevalence of all three types of abuse was relatively high, at 21% or more. 50% of the sample had elevations in CRP, with clinically significant elevations in 26%. We found that compared to a history of emotional or physical abuse, a history of childhood sexual trauma was more specifically associated with elevated CRP. This result held up when using linear regressions to examine the contribution of BMI.
Limitation:
Our sample is relatively young, with an average age of 27.2 years and minimal representation of ethnic and racial minority participants.
Conclusion:
Relative to childhood emotional and physical trauma, childhood sexual trauma may lead to elevated inflammatory responses, confirmed in our finding of an association between CRP and sexual abuse. Future studies need to assess the causal link between childhood sexual trauma and poorer health outcomes later in life.
This study analyzes the performance of the Center for Epidemiologic Studies Depression Scale (CES-D) to screen for major depressive disorder (MDD) in adults. We divided adults into three groups such as community-indwelling adults, patients with chronic diseases, and psychiatric patients. Electronic searches were performed on the MEDLINE, EMBASE, CINAHL, and PsycINFO database using the following keywords: depression, depressive disorder, major, and CES-D scale. The Quality Assessment of Diagnostic Accuracy Studies-2 was applied to assess the risk of bias in diagnostic studies. We reviewed 33 studies, including 18,271 adults that met the selection criteria. In meta-analysis, the pooled sensitivity was 0.86 on community-indwelling adults, 0.85 on patients with chronic diseases and 0.85 on psychiatric patients. The pooled specificity was 0.74, 0.84, and 0.88, respectively, and the summary receiver-operating characteristic curves were 0.88, 0.91, and 0.93, respectively. The RE correlation was a negative value (-0.394) only in patients with chronic diseases, showing no heterogeneity between studies. The CES-D, which has shown high diagnostic accuracy in adults, can be recommended for use as a first-stage screener for MDD. As a result, the early application of the CES-D can lead to disease prevention in adults at risk for depression.
