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Biomedical subjects

Stefan Priebe

Publications and source records attributed to Stefan Priebe.

At least 19 recordsLinked to original sources
PubMed2006

A new scale to assess the therapeutic relationship in community mental health care: STAR.

BACKGROUND: No instrument has been developed specifically for assessing the clinician-patient therapeutic relationship (TR) in community psychiatry. This study aimed to develop a measure of the TR with clinician and patient versions using psychometric principles for test construction. METHOD: A four-stage prospective study was undertaken, comprising qualitative semi-structured interviews about TRs with clinicians and patients and their assessment of nine established scales for their applicability to community care, administering an amalgamated scale of more than 100 items, followed by Principal Components Analysis (PCA) of these ratings for preliminary scale construction, test-retest reliability of the scale and administering the scale in a new sample to confirm its factorial structure. The sample consisted of patients with severe mental illness and a designated key worker in the care of 17 community mental health teams in England and Sweden. RESULTS: New items not covered by established scales were identified, including clinician helpfulness in accessing services, patient aggression and family interference. The new patient (STAR-P) and clinician scales (STAR-C) each have 12 items comprising three subscales: positive collaboration and positive clinician input in both versions, non-supportive clinician input in the patient version, and emotional difficulties in the clinician version. Test-retest reliability was r=0.76 for STAR-P and r=0.68 for STAR-C. The factorial structure of the new scale was confirmed with a good fit. CONCLUSIONS: STAR is a specifically developed, brief scale to assess TRs in community psychiatry with good psychometric properties and is suitable for use in research and routine care.

Adult↗
PubMed2006

Trust, choice and power in mental health: a literature review.

Trust, choice and empowerment of patients are emerging as important issues in mental health care. This may be due to an increasingly consumerist attitude amongst patients and as a consequence of postmodern cultural changes in society. This study aimed to find evidence for the influence of trust, patient choice and patient empowerment in mental health care. A literature review was undertaken. Six searches of PubMed were made using the key terms trust, patient choice and power combined separately with psychiatry and mental health. The literature search found substantial research evidence in the areas of trust, choice and power including validated scales measuring these concepts and evidence that they are important to patients. Trust in general health clinicians was found to be high and continuity of care increases patients' trust in their clinician. However, only qualitative research has been found on trust in mental health settings and further quantitative studies are needed. Patient choice is important to patients and improves engagement with services, although studies on outcome show varying results. Empowerment has impacted more at an organisational level than on individual care. Innovative research methodologies are needed to expand on the present significant body of research, utilising qualitative and quantitative techniques.

Choice Behavior↗
PubMed2006

Dimensions underlying outcome criteria in bipolar I disorder.

OBJECTIVE: Various subjective and objective criteria are used to assess outcome in bipolar disorder. In this study, we explored to what extent they reflect distinct categories and whether underlying dimensions can be identified. PATIENTS AND METHODS: One-hundred and twenty-one subjects with at least three episodes of bipolar I disorder (DSM-IV) were assessed on average 4.8 years after hospitalization. We assessed 14 variables reflecting different outcome criteria including subjective quality of life (SQOL), self-rated and observer-rated psychopathology, and functioning and disability. A principal component analysis was computed across all outcome variables. Identified dimensions were correlated with sociodemographic characteristics, illness history, premorbid adjustment and personality traits. RESULTS: Three outcome dimensions were identified, i.e. a 'general subjective', a 'functioning/disability' and a 'manic/psychotic symptoms' dimension. Together they explain 69% of the total variance. The 'general subjective' dimension consists of SQOL scales and self-rated depressive symptoms. It is associated with comorbid anxiety disorders and personality disorders, high neuroticism and not having been in hospital in the last year. The 'functioning/disability' dimension comprises of criteria reflecting negative symptoms, disability and low functioning. It is associated with more prior illness episodes and low premorbid adjustment. The 'manic/psychotic symptoms' dimension consists of observer-rated manic and positive psychotic symptoms. It is correlated with not currently taking a specific medication. LIMITATIONS: Cross-sectional design with a limited sample size. CONCLUSION: The findings indicate that outcome criteria in bipolar I disorder can be grouped into three distinct dimensions reflecting (1) subjective appraisals, (2) functioning/disability and (3) manic/psychotic symptoms. While measurement of psychotic/manic symptoms has become a matter of course, until now few studies have assessed disability or subjective appraisal in bipolar illness. Therefore important aspects of bipolar illness might be overseen. For a better understanding, we suggest that longitudinal studies of bipolar I disorders should consider all three dimensions of outcome and measure them separately.

Adaptation, Psychological↗
PubMed2006

Effect of body-oriented psychological therapy on negative symptoms in schizophrenia: a randomized controlled trial.

BACKGROUND: In order to improve the treatment of medication-resistant negative symptoms in schizophrenia, new interventions are needed. Neuropsychological considerations and older reports in the literature point towards a potential benefit of body-oriented psychological therapy (BPT). This is the first randomized controlled trial specifically designed to test the effectiveness of manualized BPT on negative symptoms in chronic schizophrenia. METHOD: Out-patients with DSM-IV continuous schizophrenia were randomly allocated to either BPT (n=24) or supportive counseling (SC, n=21). Both therapies were administered in small groups in addition to treatment as usual (20 sessions over 10 weeks). Changes in negative symptom scores on the Positive and Negative Symptom Scale (PANSS) between baseline, post-treatment and 4-month follow-up were taken as primary outcome criteria in an intention-to-treat analysis. RESULTS: Patients receiving BPT attended more sessions and had significantly lower negative symptom scores after treatment (PANSS negative, blunted affect, motor retardation). The differences held true at 4-month follow-up. Other aspects of psychopathology and subjective quality of life did not change significantly in either group. Treatment satisfaction and ratings of the therapeutic relationship were similar in both groups. CONCLUSIONS: BPT may be an effective treatment for negative symptoms in patients with chronic schizophrenia. The findings should merit further trials with larger sample sizes and detailed studies to explore the therapeutic mechanisms involved.

Adult↗
PubMed2006

[How do community-based mental health staff in Austria perceive their job? -- a qualitative study].

OBJECTIVE: The aim of this study was to explore, using a simple qualitative design, how community mental health staff in Austria perceive their job. METHOD: 195 community-based mental health professionals answered seven open questions on how they perceive their job. The main areas covered were the most important tasks of the job, skills necessary to perform these tasks, as well as positive and negative aspects of the job. Answers were subjected to thematic content analysis. RESULTS: For most professionals, contact with clients and team colleagues were the major rewards of the job. Aspects experienced as stressful were the clients' illness, role ambiguity, team conflicts and lack of time. Necessary skills many respondents did not feel competent in were specialised knowledge and psychosocial skills. CONCLUSIONS: It might be useful to revise existing forms of collaboration within multiprofessional teams. The responsibility for difficult patients may be shared by several members of the team, who should contribute their specific knowledge. Training should be tailored towards the needs of the different professional groups and focus on those skills that are required in community mental health care.

Attitude of Health Personnel↗
PubMed2006

Complementary medicines in psychiatry: review of effectiveness and safety.

BACKGROUND: The use of complementary medicines in those with mental health problems is well documented. However, their effectiveness is often not established and they may be less harmless than commonly assumed. AIMS: To review the complementary medicines routinely encountered in psychiatric practice, their effectiveness, potential adverse effects and interactions. METHOD: Electronic and manual literature search on the effectiveness and safety of psychotropic complementary medicines. RESULTS: Potentially useful substances include ginkgo and hydergine as cognitive enhancers, passion flower and valerian as sedatives, St John's wort and s-adenosylmethionine as antidepressants, and selenium and folate to complement antidepressants. The evidence is less conclusive for the use of omega-3 fatty acids as augmentation treatment in schizophrenia, melatonin for tardive dyskinesia and 18-methoxycoronaridine, an ibogaine derivative, for the treatment of cocaine and heroin addiction. CONCLUSIONS: Systematic clinical trials are needed to test promising substances. Meanwhile, those wishing to take psychotropic complementary medicines require appropriate advice.

Antidepressive Agents↗
PubMed2006

Effectiveness and costs of acute day hospital treatment compared with conventional in-patient care: randomised controlled trial.

BACKGROUND: Data on effectiveness of acute day hospital treatment for psychiatric illness are inconsistent. AIMS: To establish the effectiveness and costs of care in a day hospital providing acute treatment exclusively. METHOD: In a randomised controlled trial, 206 voluntarily admitted patients were allocated to either day hospital treatment or conventional wards. Psychopathology, treatment satisfaction and subjective quality of life at discharge, 3 months and 12 months after discharge, readmissions to acute psychiatric treatment within 3 and 12 months, and costs in the index treatment period were taken as outcome criteria. RESULTS: Day hospital patients showed significantly more favourable changes in psychopathology at discharge but not at follow-up. They also reported higher treatment satisfaction at discharge and after 3 months, but not after 12 months. There were no significant differences in subjective quality of life or in readmissions during follow-up. Mean total support costs were higher for the day hospital group. CONCLUSIONS: Day hospital treatment for voluntary psychiatric patients in an inner-city area appears more effective in terms of reducing psychopathology in the shortterm and generates greater patient satisfaction than conventional in-patient care, but may be more costly.

Adult↗
PubMed2006

Use of standardised outcome measures in adult mental health services: randomised controlled trial.

BACKGROUND: Routine use of standardised outcome measures is not universal. AIMS: To evaluate the effectiveness of standardised outcome assessment. METHOD: A randomised controlled trial, involving 160 representative adult mental health patients and paired staff (ISRCTN16971059). The intervention group (n=101) (a) completed monthly postal questionnaires assessing needs, quality of life, mental health problem severity and therapeutic alliance, and (b) received 3-monthly feedback. The control group (n=59) received treatment as usual. RESULTS: The intervention did not improve primary outcomes of patient-rated unmet need and of quality of life. Other subjective secondary outcome measures were also not improved. The intervention reduced psychiatric inpatient days (3.5 v.16.4 mean days, bootstrapped 95% CI1.6-25.7), and hence service use costs were 2586 UK pounds (95% CI 102-5391) less for intervention-group patients. Net benefit analysis indicated that the intervention was cost-effective. CONCLUSIONS: Routine use of outcome measures as implemented in this study did not improve subjective outcomes, but was associated with reduced psychiatric inpatient admissions.

Adult↗
PubMed2006

Assessing explanatory models for common mental disorders.

OBJECTIVES: This article addresses the clinical implications of 3 questions: (1) Can a simple checklist, suitable for use by practitioners, assess all components of explanatory models (EMs) for mental distress? (2) Are perceived causes of mental distress actually related to treatment preferences? (3) Are EMs influenced uniquely by ethnic group, or are they more closely associated with the presence of common mental disorders? METHOD: From February 2003 to January 2004, we investigated EMs for mental distress among 79 Bangladeshi, 85 black Caribbean, and 97 white British people who reported difficulties in the preceding month. EMs were assessed by a self-report checklist that inquired about the identity, causes, timeline, consequences, controllability, and preferred treatments for mental distress. Common mental disorders were assessed using the Clinical Interview Schedule (revised). RESULTS: Independent of ethnic group, people with common mental disorders were more likely to give spiritual causal explanations (odds ratio [OR] = 3.1, 95% CI = 1.9 to 4.9), to report behavioral (OR = 2.2, 95% CI = 1.3 to 3.8) and financial consequences (OR = 3.3, 95% CI = 1.8 to 6), and to prefer complementary treatments (OR = 4.6, 95% CI = 2.3 to 9.1). Compared with black Caribbean and white British subjects, Bangladeshi subjects more often gave spiritual or physical causal explanations. Compared with white British subjects, Bangladeshi and black Caribbean subjects preferred medical and spiritual treatments, whereas white British subjects, as compared with the other 2 ethnic groups, preferred self-management and social treatments. Causal explanations did not always relate to the corresponding treatment preferences. CONCLUSIONS: EMs can be assessed by a simple checklist, show variations by ethnic group, and are associated with common mental disorders. Identifying EMs may strengthen the assessment of common mental disorders.

Adult↗
PubMed2006

[Comparison of socio-demographic characteristics of patients with PTSD in the four countries of former Yugoslavia following the war].

OBJECTIVE: To determine the socio-demographic characteristics of survivors who presented for treatment in therapeutic centers in the four Balkan countries involved in the study by summarizing the results of STOP study ("Treatment Seeking and Treatment Outcomes in People Suffering from PTSD Following the War and Migration in the Balkans"). STOP study was performed in the following countries: Bosnia and Herzegovina (specialized center Sarajevo), Croatia (centers in Zagreb and Rijeka), Serbia and Montenegro (center in Belgrade), Germany (center in Dresden) and United Kingdom (center in London). METHODS: The authors applied a socio-demographic questionnaire in patients with PTSD who presented for treatment in the centers. RESULTS: The authors present the differences among the socio-demographic characteristics of survivors who presented for treatment in therapeutic centers in the four Balkan countries involved in the study according to: gender, status (refugee, war veterans, refugee and war veteran, civilian), ethnic background, employment status, marital status and household monthly net income. CONCLUSIONS: Comparative statistical analysis of data obtained through interviews in four countries shows significant differences across the centers concerning socio-economic characteristics of the patients.

Bosnia and Herzegovina↗
PubMed2005

Research on mental disorders and their care in immigrant populations: a review of publications from Germany, Italy and the UK.

OBJECTIVE: The review aims to identify the extent and nature of research on mental disorders and their care in immigrant populations in three major European countries with high levels of immigration, i.e. Germany, Italy, United Kingdom (UK). METHOD: Peer-reviewed publications on the subject from the three countries between 1996 and 2004 were analyzed. The research questions addressed, the methods used, and the results obtained were assessed. RESULTS: Thirteen papers reporting empirical studies were found from Germany, four from Italy and 95 from the UK. Studies addressed a range of research questions and most frequently assessed rates of service utilization in different immigrant groups. The most consistent finding is a higher rate of hospital admissions for Afro-Caribbean patients in the UK. Many studies had serious methodological shortcomings with low sample sizes and unspecified inclusion criteria. DISCUSSION: Despite large scale immigration in each of the three studied countries, the numbers of relevant research publications vary greatly with a relatively high level of empirical research in the UK. Possible reasons for this are a generally stronger culture of mental health service research and a higher number of researchers who are themselves from immigrant backgrounds in the UK. CONCLUSION: Overall the evidence base to guide the development of mental health services for immigrant populations appears limited. Future research requires appropriate funding, should be of sufficient methodological quality and may benefit from collaboration across Europe.

Biomedical Research↗
PubMed2005

Who seeks treatment after a traumatic event and who does not? A review of findings on mental health service utilization.

This review aimed to identify factors associated with seeking treatment from mental health services after a traumatic event. Databases of literature were searched in a systematic manner and 24 relevant articles were found. Although many of the findings are inconsistent, the most important factors associated with treatment seeking appear to be a higher level of psychopathology, the type and level of the traumatic event, and sociodemographic characteristics, in particular female gender. Even though the evidence is insufficient to guide service development, suggestions for future research are made. The methodological quality of research should be improved to establish whether the inconsistency of findings reflects methodological artefacts or true differences between different samples and contexts.

Humans↗
PubMed2005

Morale and job perception of community mental health professionals in Berlin and London.

INTRODUCTION: Morale and job perception of staff in community mental health care may influence feasibility and quality of care, and some research has suggested particularly high burnout of staff in the community. The aims of this study were to: a) assess morale, i. e. team identity, job satisfaction and burnout, in psychiatrists, community psychiatric nurses and social workers in community mental health care in Berlin and London; b) compare findings between the groups and test whether personal characteristics, place of working and professional group predict morale; and c) explore what tasks, obstacles, skills, enjoyable and stressful aspects interviewees perceived as important in their jobs. METHODS: In all, 189 mental health professionals (a minimum of 30 in each of the six groups) responded to a postal survey and reported activities per week using pre-formed categories. Perception of professional role was assessed on the Team Identity Scale, job satisfaction on the Minnesota Job Satisfaction Scale, and burnout on the Maslach Burnout Inventory. Seven simple open questions were used to elicit the main tasks, skills that staff did and did not feel competent in, aspects that they did and did not enjoy in their job, and obstacles and factors that caused pressure. Answers were subjected to content analysis using a posteriori formed categories. RESULTS: Weekly activities and morale varied between sites and professional groups. Some mean scores for groups in London exceeded the threshold for a burnout syndrome, and are particularly less favourable for social workers. Working in London predicted higher burnout, lower job satisfaction and lower team identity. Being a psychiatrist predicted higher team identity, whilst being a social worker was associated with higher burnout and lower job satisfaction. Male gender predicted lower burnout and higher team identity. However, professional group and site interacted in predicting burnout and job satisfaction. Psychiatrists in London had much more favourable scores than the other two groups, whilst this did not hold true in Berlin. Answers to open questions revealed universal aspects, such as enjoying direct patient contact and disliking bureaucracy, but also various views that were specific to a site or professional group or both. CONCLUSIONS: Burnout remains a problem for some, but not all, professional groups in community mental health care, and social workers in London appear to be a group with particularly low morale. Differences between professional groups depend on the location, and it remains unclear to what extent job-related and general factors impact on the morale of mental health professionals. Answers to open questions reveal general as well as specific aspects of the job perception of the professional groups, some of which may be relevant for service development, training and supervision. More conceptual and methodological work and more extensive studies are required to develop a better understanding of how community mental health professionals perceive their job and how morale may be improved.

Adult↗
PubMed2005

Do personality traits predict post-traumatic stress?: a prospective study in civilians experiencing air attacks.

BACKGROUND: Previous studies have suggested an association between personality traits and post-traumatic stress. These studies either focused exclusively on military veterans or assessed personality traits after the traumatic event. This study investigates to what extent personality traits as assessed before the traumatic experience predict post-traumatic stress in civilians experiencing air attacks at the end of the exposure to stressful events and 1 year later. METHOD: The revised version of the NEO Personality Inventory was administered to 70 students in Belgrade, Yugoslavia. In 1999, 1 or 2 years after the assessment, all students were exposed to air attacks for 11 weeks. At the end of the attacks and 1 year later post-traumatic stress was measured on the Impact of Event Scale. RESULTS: Pre-trauma personality predicted 13% of the variance of intrusion scores 1 year after the attacks. There was no significant correlation between personality traits and subsequent avoidance scores at any point of time. CONCLUSIONS: Personality traits that are assessed before a traumatic event can, to a limited extent, predict intrusive symptoms in a non-clinical sample of civilians. Pre-trauma assessments of personality might be less strongly associated with post-traumatic stress than personality traits obtained after the traumatic event.

Adult↗
PubMed2005

[Job satisfaction and burnout in professionals in austrian mental health services].

OBJECTIVE: The aim of this study was to explore job satisfaction, professional role and burnout among community mental health staff in Austria. METHODS: The Minnesota Job Satisfaction Questionnaire, the GHQ-12, the Maslach Burnout Inventory and a questionnaire exploring staff's professional role and team identity were administered to 195 community-based mental health professionals in two Austrian regions. Staff's job perception was assessed in open questions. Predictors of burnout scores were identified in multivariate analyses. RESULTS: While the mental health professionals had elevated scores on the GHQ-12, their levels on the three burnout subscales were low. Social workers and psychologists showed the lowest job satisfaction, social workers also had low role identity scores. Being in the current job for a short time and disposing of psychosocial skills were predictors of high job satisfaction. High burnout scores were predicted by the lack of basic psychosocial competence and a lack of general knowledge in mental health care. The effect of caseload on psychological well-being was positive as well as negative. CONCLUSIONS: Even if the mental health professionals in our study show high levels of general stress, they seem to have less emotional problems resulting from extensively dealing with troubled individuals. Improving basic psychosocial competence and general expertise in mental health care might have a protective effect against developing a burnout syndrome.

Adult↗
PubMed2005

[Psychological trauma in psychiatric textbooks published in german - the dominating view of psychiatrists between 1945 and 2002].

AIM: The study investigates the concepts of psychological trauma and their changes over time in psychiatric textbooks published in German between 1945 and 2002, assuming that textbooks reflect the established and dominating views of their time. METHOD: [corrected] In psychiatric textbooks, the terminology, concepts of illness, and recommendations for assessment and treatment concerning psychological trauma were analysed. RESULTS: The concept of psychological trauma that had existed since 1916 continued to dominate textbooks up until the 1960s. Findings on holocaust survivors entered textbooks not before the mid 1970s. Since the mid 1990s, the concept of Post-Traumatic Stress Disorder has been widely established in textbooks. CONCLUSION: Changes of dominating views on this issue in textbooks appear to have been extremely slow and occurred with significant delays in the past. The change of the dominating view in the 1970s was linked to the establishment of a new generation of leading psychiatrists. Since the introduction of PTSD, psychiatric textbooks have given up a previously negative attitude towards patients suffering from psychological trauma.

Attitude of Health Personnel↗