Reliability and validity of the OPD-conflict-questionnaire in an inpatient treatment sample

Psychotherapy is subjected to the legal conditions of quality assurance(QA). Does operationalized psychodynamic diagnostics (OPD) contribute substantially to this? We investigated the application of OPD in outpatient psychodynamic psychotherapy, inpatient treatment, rehabilitation, and legal assessment. Psychodynamic diagnostics, treatment plan, and evaluation by means of the OPD and Heidelberg Structural Change Scale (HSCS) may be comprehensibly described for quality assurance (QA) of outpatient and inpatient psychotherapy. Virtually all psychodynamic conceptualized departments for psychosomatic medicine and psychotherapy as well as some rehabilitation centres applied OPD. Furthermore, data-collection periods were defined during and after inpatient short- and long-term psychotherapy. OPD serves QA in legal assessment and is of a pivotal significance in judicial proceedings. It must be deliberated whether more extensive use of QA, in cooperation with outpatient psychotherapists and in comparison to institutions, could be of benefit to patients.

In a randomized controlled clinical trial (RCT) we evaluated an inpatient psychodynamic treatment for adolescents suffering from mixed disorders of conduct and emotions. The sample consisted of severely impaired adolescents with remarkable deficits regarding psychic structure. The current study wanted to examine if the manualized treatment did not only reduce symptoms but also enhance the structural level of the patients. The axis structure of the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA) was used to assess the structural level of N = 46 adolescent inpatients. To examine differences between the patients‘ structural level at the beginning and at the end of inpatient treatment we conducted a repeated measures ANOVA. The overall score as well as the three subscores of the axis structure improved significantly during inpatient treatment. The corresponding effect sizes were large (η(2) = .29 to .47). The inpatient psychodynamic treatment led to significant improvements regarding symptomatology as well as psychic structure. However, further studies with larger sample size and control group data should be conducted to confirm these results.

Myelofibrosis (MF), polycythaemia vera (PV) and essential thrombocythaemia (ET) are associated with a considerable disease burden and a reduced quality of life (QoL) (Emanuel et al, 2012; Mesa et al, 2016). Patients with myeloproliferative neoplasms (MPN) experience many symptoms, with fatigue being one of the most severe (Scherber et al, 2011; Johansson et al, 2012; Abelsson et al, 2013). Few studies have explored how symptom burden affects the work productivity and daily activities of these patients (Mesa et al, 2016). We previously conducted a survey, the 'US MPN Landmark Survey', reporting a substantial reduction in QoL and work productivity, suggesting a reduction of symptom burden may improve QoL and productivity of MPN patients (Harrison et al, 2017). As previous studies have suggested that QoL and overall symptom burden can differ between countries, we conducted the Landmark Survey in 6 countries outside the US. Here we present the first UK-specific analysis of the survey data exploring the impact of the overall symptom burden experienced by MPN patients. The methodology used was a cross-sectional survey of MPN patients and treating physicians conducted in 2016 in Australia, Canada, Germany, Italy, Japan and the UK. Physician and patient surveys were not linked and explored: physician-patient relationship, disease management/treatment attitudes, treatment and treatment goals and the economic, emotional and physical burden of the disease. Work productivity, absenteeism, presenteeism and activity impairment were measured using the Work Productivity and Activity Impairment Index (Reilly et al, 1993). Each domain was measured on a 0–100% scale with a higher percentage indicating a greater amount of impairment. Data were stratified by overall symptom severity, calculated by combining the number of symptoms and their associated severity for each patient. This was used to allocate patients into quartiles (Q1 = lowest symptoms burden; Q4 = highest symptom burden) at a global level (Table 1). Eligibility included ≥18 years of age, a diagnosis of MF, PV or ET, and not participating in a clinical trial. Patients were recruited in the UK via their managing physician following routine consultations or via a patient organization, MPN Voice (http://www.mpnvoice.org.uk/). All respondent data were anonymised with analysis presented at an aggregated level. All analyses presented are descriptive in nature with relevant descriptive statistics reported. Confidence intervals are presented for numeric outcomes (i.e. means) and for patient-reported impact ratings. No formal hypothesis testing was performed. Overall, 286 patients (45 MF, 78 PV, 163 ET) and 31 physicians completed the survey in the UK. Respondent demographics are presented in Table 1. UK physicians reported a numerically higher number of patients under their care than the rest of the world (ROW) (UK vs. ROW; 26·58 vs. 13·66 MF, 49·84 vs. 19·81 PV, 52·45 vs. 20·02 ET respectively) and mostly agreed with the statement 'There is not enough time during the appointment to discuss all of the symptoms a patient is experiencing' (74% agreed in UK vs. 54% agreed in ROW) (Table 1). Over 98% of patients had experienced symptoms in the previous 12 months. Almost half of Q3 and Q4 patients agreed with the statement 'MPN symptoms reduce my life quality' (49% "agree strongly"). However, 40% of Q1 and Q2 patients stated they "Somewhat agree" with the statement (Table 1). Q3 and Q4 patients reported a higher emotional burden in that more patients reported they experienced each emotional burden more 'frequently' than those in Q1 and Q2. This burden was particularly marked when interfering in the patients' family/social life (Q3 and Q4 57% vs. Q1 and Q2 24%) and interfering in patients' sex life (Q3 and Q4 58% vs .Q1 and Q2 22%) (Fig 1). A third of patients in Q3 and Q4 reported reducing their hours at work compared with Q1 and Q2 patients (34% vs. 16%), voluntarily terminating a job (17% vs. 7%) or going on disability allowance (12% vs. 1%) (Fig 1). A higher overall work impairment, absenteeism (missing work due to condition), presenteeism (working whilst sick) and activity impairment was reported by Q3 and Q4 patients compared to Q1 and Q2 patients (48·6% vs. 21·7%, 13% vs. 1·9%, 41·3% vs. 20·4% and 49·9% vs. 21·8%, respectively) (Fig 1). Our data demonstrates that UK MPN patients experience a high disease burden. This burden was higher than in ROW cohorts (Harrison et al, 2017). The stratification of patients into symptom severity quartiles was conducted at a global level, with UK patients disproportionately represented in the higher symptom burden group. Patients reported that 'MPN symptoms reduce my life quality' regardless of their overall symptom burden, suggesting a significant impact QoL in the lower burden groups. High emotional burden was noted with patients 'frequently' experiencing anxiety, worry and frustration, and impact on family and social life, suggesting that the burden could be felt further afield than the patient directly. Impact on patients' work productivity and activity impairment was high and demonstrated a greater societal burden of MPNs, with Q3 and Q4 patients associated with a higher burden across all facets. It is possible that financial burdens associated with work-related stress increases emotional and symptom burden associated with MPNs. Whilst further research would need to be conducted to confirm this relationship, the assumption is supported by data demonstrating that patients with high symptom burden also experience a higher emotional and work/financial burden. The development of improved treatments and management strategies aimed at improving the symptom burden patients experience will assist in alleviating this burden. UK physicians felt there was not enough time in appointments to address all symptoms, more so than ROW. To help mitigate this, patient support structures are needed, such as adopting telemedicine to collect symptom feedback prior to appointments. The high impact of symptom burden proves to be a challenge for both the clinical and patient community. Both groups require further support from the wider stakeholder community. Such strategies would also be complimentary to the patient support structures mentioned above (i.e. telephone clinics, remote symptom monitoring via mobile apps), and have previously demonstrated to be of benefit in previous trials across various disease areas, including haematological cancers (Breen et al, 2015). Ali: Novartis: consultancy, honoraria, expenses for travel and accommodations. Harrison: Novartis: consultancy, honoraria, expenses for travel and accommodations, research funding, speakers bureau; Shire: honoraria, speakers bureau; Gilead: honoraria, speakers bureau; Baxalta: consultancy, honoraria, speakers bureau; Incyte: honoraria, speakers bureau. Mead: Novartis: consultancy, honoraria, expenses for travel and accommodations, research funding, speakers bureau; Taylor -Stokes: Adelphi Real World: employment. Waller: Adelphi Real World: employment. All authors designed the research survey. John Waller analysed the data and wrote the paper.

Patients with acute leukaemia undergoing chemotherapy experience multiple symptoms that interfere with activities of daily living. Exercise-based interventions have been used to remedy disease and treatment-related symptoms in patients with cancer. We explored the impact of exercise and health counselling on symptom prevalence, severity and longitudinal patterns. Explorative analysis of M.D. Anderson Symptom Inventory and Brief Fatigue Inventory completed weekly in a randomized controlled trial of patients with acute leukaemia undergoing consolidation chemotherapy. Seventy patients were consecutively recruited and randomly allocated to usual care (n=36) or 12-week supervised exercise and health counselling (n=34) at Copenhagen University Hospital, 2011-2014. There was no difference in symptom prevalence between groups, but we found a significant increase in symptom and fatigue severity in the intervention group during the study period. However, the symptom burden reduced significantly in both groups at 12 weeks. Longitudinally, the symptom cluster; 'drowsiness, fatigue, disturbed sleep, difficulty remembering' was significantly more severe in the intervention group. Intervention and control group participants had substantial symptom and fatigue burden during 12-week moderate exercise and health counselling in patients with acute leukaemia undergoing chemotherapy. A greater symptom burden was found in the intervention group during the 12weeks, though reducing in both groups at 12weeks. Studies are needed to examine the link between exercise and symptom severity.

Introduction: During the last two decades, the concept of social capital has been used increasingly frequently in health sciences due to the direct and indirect relationships between social capital and populations' physical and mental health. Therefore, it is necessary to build an instrument to quantify this concept confidently and reliably. Objective: The study aimed to internal consistency and dimensionality of a seven-item scale to measure social capital in Colombia's general population of adults. Methods: An online validation study included a sample of 700 adults aged between 18 and 76 years; 68% were females. Participants completed a seven-item scale called the Cognitive Social Capital Scale (CSCS). Cronbach's alpha and McDonald's omega were computed to test internal consistency. The authors explore the internal consistency and dimensionality of the CSCS. Results: The CSCS presented a low internal consistency (Cronbach's alpha of 0.56 and McDonald's omega of 0.59) and poor dimensionality. Then, the researchers tested a five-item version (CSCS-5). The CSCS-5 showed high internal consistency (Cronbach's alpha of 0.79 and McDonald's omega of 0.80) and a one-dimension structure with acceptable goodness-of-fit indicators. Discussion: The CSCS-5 presents high internal consistency and a one-dimensional structure to measure cognitive capital social in the Colombian sample. Authors can recommend measuring social capital in the general Colombian population. Further research should corroborate this pencil and paper application findings and explore other reliability and validity indicators.

The aim was to investigate the psychometric properties, i.e. reliability (internal consistency) and validity (factor structure and relationships with other scales) of the Dissociative Experiences Scale (DES) in a random sample from the Swedish population. Six hundred subjects between 18 and 59 years of age were randomly sampled from the population of a catchment area in a suburb of Stockholm and 181 patients with a range of post-traumatic disorders were included. A second-order analysis revealed two components, which reflected normal and pathological dissociation, and could readily be summed into one scale. The internal consistency was high (Cronbach's alpha=0.87). High scorers in the DES had more fearful attachment, more interpersonal problems, more severe symptoms and lower sense of coherence. A subgroup of patients with significant dissociation was identified. The psychometric properties are sufficient for use of the DES as a screening instrument for dissociative symptoms.

Nonsuicidal self-injury in connection with the axes Structure and Relationship of the OPD-KJ-2 (Operationalized Psychodynamic Diagnostics in Childhood and Adolescence) Abstract. This study investigates nonsuicidal self-injury (NSSV) in relation to psychological structure as well as inter- and intrapersonal relationships. The Structure and Relationship axes of the OPD-CA-2 (Operationalized Psychodynamic Diagnosis in Childhood and Adolescence) were used to record relationship dynamics and structural aspects; the MOUSI was applied for nonsuicidal self-injury. The sample included 40 adolescent psychiatric patients, most of whom were in inpatient care. A total of 20 adolescents with and 20 without NSSV were compared with regard to the Structure and Relationship axes. The two samples showed no differences on the Structure axis, whereas differences were found on the Relationship axis. Adolescents with NSSV, for example, were more likely to gently influence others and to react in interactive settings more openly toward their counterpart than adolescents without NSSV. In their relationship to themselves, the adolescents with NSSV were more often assessed as tormented and reproachful. Results indicate that the Relationship axis of the OPD-CA-2 can provide helpful information, so that this should be considered in psychotherapeutic measures for NSSV patients.

To assess the relationship between the axis IV (structure) of the Operationalized Psychodynamic Diagnostics (OPD) and sociodemographic, clinical and psychopathological features, we rated the structural level of 156 psychiatric inpatients, which was related to sociodemographic variables, to clinical diagnoses (particularly to personality and substance use disorders), to suicidal ideation and self-injurious behavior (SIB) as well as to the psychopathological impairment at admission (measured by the SCL-90). We found significant associations among the structural level on the one hand and the marital status, the professional group, a comorbid personality disorder, suicidal ideation and SIB on the other hand. There were no associations with the sex, the age, the school education, the occupational situation or the SCL-90 findings. Our results replicate and extend previous findings. For every-day routine, it is possible to derive a preliminary judgement of the structural level by means of the marital status, the professional group, a comorbid personality disorder, suicidal ideation and SIB.

The general objective of this article is to study the unclear and overlapping relationship between social anxiety disorder (SAD) and avoidant personality disorder (AvPD) from an interpersonal perspective. The first specific objective is to compare the disorders with regard to interpersonal problems and general symptom distress. The second specific objective is to examine interpersonal subgroups and pathoplasticity. In a cross-sectional design, patients from an outpatient psychotherapy clinic diagnosed with social anxiety disorder (SAD, n=299), avoidant personality disorder (AvPD, n=180), or the comorbid condition of both disorders (AvPD+SAD, n=29) were assessed before treatment. Patients filled out the Inventory of Interpersonal Problems (IIP-64) and the Symptom Checklist-Revised (SCL-R-90) before treatment. From an interpersonal perspective, the relationship between the diagnostic groups is well described by the severity continuum hypothesis, with similar interpersonal problems related to Nonassertiveness and lower levels of general interpersonal stress in the SAD group compared to the two AvPD groups. However, other differences in severity do not fit the severity continuum hypothesis, as there are no differences in severity on the global severity index, and, moreover, the SAD group has the most severe problems on the SCL-90 phobic anxiety scale. Interpersonal pathoplasticity is not found in the diagnostic groups or in the full sample. However, three interpersonal subgroups are identified in the full sample, designated as Nonassertive, Friendly-submissive, and Cold-submissive. Implications for treatment are discussed. SAD is characterized by a lower level of interpersonal distress compared to AvPD, but the two disorders are similar in having Nonassertiveness as their general interpersonal problem. Contrary to expectation, SAD and AvPD did not differ in general level of symptom severity, and patients with SAD reported more problems with phobic anxiety than AvPD patients did. When understanding SAD and AvPD as different conceptualizations of the same disorder and analysing all patients together, three distinct interpersonal subgroups emerge, which can be identified as Nonassertive, Friendly-submissive, and Cold-submissive.

Objective: Internal consistency of scales is crucial for the quality of clinical practices, and scales that measure various aspects of clinical disorders must possess acceptable internal consistency. In the assessment of the internal consistency of the scales, the present study considered the Cronbach’s alpha’s coefficient. This study aims (1) to provide a practical sample size guide based on Cronbach’s alpha for medical researchers; (2) to investigate the factors related to the determination of the sample size needed for a correct estimation of Cronbach’s alpha. Method: The calculation steps of the two sample size approaches (desired precision and desired power) proposed by Bonett are detailed and the sample size tables of these approaches are tabulated. Results: Findings indicate that as the number of items in the scale increases, the sample size decreases to a certain level but reaches a plateau when the number of items is about 30. Furthermore, it is claimed that the sample size should be at least 45 (and more) in order to calculate a meaningful internal consistency coefficient. Conclusions: In the present study, we extracted detailed information about the key components of sample size calculation for Cronbach’s alpha and provided an easy and practical tables, which will enable clinicians to determine the appropriate sample size for their internal consistency studies.

The importance of patient-reported outcome measurement in chronic kidney disease (CKD) populations has been established. However, there remains a lack of research that has synthesised data around CKD-specific symptom and health-related quality of life (HRQOL) burden globally, to inform focused measurement of the most relevant patient-important information in a way that minimises patient burden. The aim of this review was to synthesise symptom prevalence/severity and HRQOL data across the following CKD clinical groups globally: (1) stage 1-5 and not on renal replacement therapy (RRT), (2) receiving dialysis, or (3) in receipt of a kidney transplant. MEDLINE, PsycINFO, and CINAHL were searched for English-language cross-sectional/longitudinal studies reporting prevalence and/or severity of symptoms and/or HRQOL in CKD, published between January 2000 and September 2021, including adult patients with CKD, and measuring symptom prevalence/severity and/or HRQOL using a patient-reported outcome measure (PROM). Random effects meta-analyses were used to pool data, stratified by CKD group: not on RRT, receiving dialysis, or in receipt of a kidney transplant. Methodological quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data, and an exploration of publication bias performed. The search identified 1,529 studies, of which 449, with 199,147 participants from 62 countries, were included in the analysis. Studies used 67 different symptom and HRQOL outcome measures, which provided data on 68 reported symptoms. Random effects meta-analyses highlighted the considerable symptom and HRQOL burden associated with CKD, with fatigue particularly prevalent, both in patients not on RRT (14 studies, 4,139 participants: 70%, 95% CI 60%-79%) and those receiving dialysis (21 studies, 2,943 participants: 70%, 95% CI 64%-76%). A number of symptoms were significantly (p < 0.05 after adjustment for multiple testing) less prevalent and/or less severe within the post-transplantation population, which may suggest attribution to CKD (fatigue, depression, itching, poor mobility, poor sleep, and dry mouth). Quality of life was commonly lower in patients on dialysis (36-Item Short Form Health Survey [SF-36] Mental Component Summary [MCS] 45.7 [95% CI 45.5-45.8]; SF-36 Physical Component Summary [PCS] 35.5 [95% CI 35.3-35.6]; 91 studies, 32,105 participants for MCS and PCS) than in other CKD populations (patients not on RRT: SF-36 MCS 66.6 [95% CI 66.5-66.6], p = 0.002; PCS 66.3 [95% CI 66.2-66.4], p = 0.002; 39 studies, 24,600 participants; transplant: MCS 50.0 [95% CI 49.9-50.1], p = 0.002; PCS 48.0 [95% CI 47.9-48.1], p = 0.002; 39 studies, 9,664 participants). Limitations of the analysis are the relatively few studies contributing to symptom severity estimates and inconsistent use of PROMs (different measures and time points) across the included literature, which hindered interpretation. The main findings highlight the considerable symptom and HRQOL burden associated with CKD. The synthesis provides a detailed overview of the symptom/HRQOL profile across clinical groups, which may support healthcare professionals when discussing, measuring, and managing the potential treatment burden associated with CKD. PROSPERO CRD42020164737.

To examine the association between symptoms severity and treatment burden in people living with HIV. Correlational, secondary analysis of data from participants diagnosed with HIV enrolled in a descriptive, cross-sectional study examining physical activity patterns. We analysed data from 103 men and women using self-report data collected between March 2016 - February 2017. Our primary statistical analyses consisted of explanatory multivariate modelling with individual PROMIS-29 scores representing symptom severity and treatment burden measured using the Treatment Burden Questionnaire-13. Greater symptom severity was associated with higher levels of cumulative treatment burden as well as higher levels of task-specific medication and physical activity burden. Multivariate regression analyses revealed that fatigue was a risk factor of cumulative treatment burden as well as task-specific medication and physical activity treatment burden. Effect sizes of multivariate models ranged from small (0.11) to medium (0.16). Additionally, post hoc analyses showed strong correlations between fatigue and other measured symptoms. Findings support extant treatment burden literature, including the importance of addressing symptom severity in conjunction with treatment burden screening in the clinical setting. Results also suggest clinical interventions focused on the reduction of fatigue could reduce treatment burden in people living with HIV. Strong correlations between fatigue and other symptoms indicate the potential for reducing fatigue by addressing other highly clustered symptoms, such as depression. People living with HIV exhibiting higher levels of fatigue are at high risk for treatment burden and poorer self-management adherence. Clinicians should consider incorporating symptom and treatment burden assessments when developing, tailoring and modifying interventions to improve self-management of HIV and other co-morbid conditions.

Validation of the Spanish version of the Liver Disease Quality of Life questionnaire in transplant patients

Background/Aims:Psychotherapy research has continually placed emphasis on the role of the therapeutic relationship. The current provision of mental health care, however, is often carried out in a variety of contexts and involves a range of health professionals. Measures for assessing the therapeutic relationship provided in community settings by multidisciplinary mental health teams is therefore required. The aim of this study was to describe the development of the Norwegian version of the Scale To Assess the therapeutic Relationship (N-STAR) and to examine its reliability.Methods:A pilot study was conducted with clients with mental health issues (n=29) and mental health practitioners (n=29). Participants were recruited from a Norwegian community mental health setting and asked to complete the N-STAR. Data were analysed using T-tests, Cronbach's alpha, the Pearson correlation coefficient (r) and the intraclass correlation coefficient (ICC).Results:The internal consistency of the N-STAR total scale was good, whereas the subscales showed acceptable to questionable internal consistencies. There was a significant association between the total scores of clients and therapists (r = 0.42, p = 0.02), and the consistency in agreement between the clients' and the therapists' scores was good (ICC= 0.57, p = 0.02).Conclusion:The N-STAR total scale showed promising results in terms of its internal consistency and level of client-therapist agreement. Further research is needed to evaluate N-STAR measurement properties in larger samples in order to establish this method as a way of assessing and monitoring the therapeutic relationship in community mental health settings in Norway.

Interpersonal- and self-relatedness problems are strongly correlated on a global level. However, few studies have examined associations between distinct forms of interpersonal problems and specific types of problems in self-relatedness. We hypothesized that patients with domineering interpersonal problems would exhibit a more positive self-image than patients with submissive interpersonal features. We also wanted to examine if the self-hostile and self-accepting aspects of patients’ self-relatedness were differentially associated with their interpersonal problems. A large clinical outpatient sample (N = 958) was divided into eight subgroups (Octant Groups) of patients with different predominant interpersonal problems, as measured with the 64 item version of the Inventory of Interpersonal Problems—IIP-64. Self-relatedness was measured with the Introject surface of the Structural Analysis of Social Behavior—SASB Introject. ANCOVA analyses showed that patients with more positive and self-accepting self-images displayed domineering, but also warmer forms of interpersonal problems than peers with more negative self-images. Dividing the self-relatedness variable into Self-Hostile and Self-Accepting components yielded a new finding: patients within different interpersonal Octant Groups differed significantly with regard to Self- Acceptance, but not with respect to Self-Hostility. The former component may be reflective of a more stable personality feature than Self-Hostility, thereby rendering it less susceptible to change.