Search

Clinical interviewing is the basic method to understand how a person feels and what are the presenting complaints, obtain medical history, evaluate personal attitudes and behavior related to health and disease, give the patient information about diagnosis, prognosis, and treatment, and establish a bond between patient and physician that is crucial for shared decision making and self-management. However, the value of this basic skill is threatened by time pressures and emphasis on technology. Current health care trends privilege expensive tests and procedures and tag the time devoted to interaction with the patient as lacking cost-effectiveness. Instead, the time spent to inquire about problems and life setting may actually help to avoid further testing, procedures, and referrals. Moreover, the dialogue between patient and physician is an essential instrument to increase patient's motivation to engage in healthy behavior. The aim of this paper was to provide an overview of clinical interviewing and its optimal use in relation to style, flow and hypothesis testing, clinical domains, modifications according to settings and goals, and teaching. This review points to the primacy of interviewing in the clinical process. The quality of interviewing determines the quality of data that are collected and, eventually, of assessment and treatment. Thus, interviewing deserves more attention in educational training and more space in clinical encounters than it is currently receiving. [ABSTRACT FROM AUTHOR]

Many studies have been conducted on psychological distress but the question of how to conceptualize and assess this phenomenon still remains a controversial issue. Clinimetrics, the science of clinical measurements, may pave the ground for a substantial revision of the clinical conceptualization and assessment of this construct. A Rasch analysis was performed to evaluate whether the Symptom Checklist-90-Revised (SCL-90-R) and its subscales were valid indices of underlying dimensions of psychological distress. Based on the clinimetric validation of the SCL-90-R, as well as on a critical review of the available literature, a concept analysis of psychological distress was performed. The SCL-90-R total score misfitted the Rasch model but it was found to have a Person Separation Reliability Index of 0.94. Model fit was achieved after the exclusion of six misfitting items. Paired t tests indicated that all the subscales of the SCL-90-R were unidimensional. Psychological distress was defined as a subjective, unifying, dimensional, and transdiagnostic construct consisting in a unique experience of discomfort, which may involve a sense of demoralization, the experience of feeling broken or mental pain, a sense of anguish, symptoms of somatization and attention deficit hyperactivity disorder (ADHD), feelings of anger, self-perceived lack of control, and self-criticism. Our findings also showed that the SCL-90-R could reliably differentiate healthy stress from psychological distress, and identify individuals at risk of psychiatric disorders. The total score of the 84-item version of the SCL-90-R may be used as an overall indicator of psychological distress. The subscales are recommended to assess the severity of specific symptomatic manifestations of psychological distress. [ABSTRACT FROM AUTHOR]

Background: The Depression, Anxiety and Stress Scale-21 (DASS-21) is a widely used patient-reported outcome measure. While psychometric properties of the DASS-21 have been studied, insufficient attention has been devoted to the assessment of its clinimetric properties. This study verified the clinimetric properties of the Italian version of the DASS-21 according to Clinimetric Patient-Reported Outcome Measures (CLIPROM) criteria. Methods: This is a cross-sectional study involving 951 university students from April to September 2020. Participants were asked to fill in the DASS-21 via an online survey. Participation was voluntary. Item Response Theory (IRT) models were used to test dimensionality, scalability, and sensitivity of DASS-21. Results: IRT analyses showed that the DASS-21 total score was a multidimensional measure of psychological distress. Fit to the Rasch model was achieved after excluding five misfitting items and adjusting the sample size, resulting in a 16-item version of the DASS-21. The 16-item version entailed the clinimetric property of sensitivity but included inter-correlated items. Brief versions of the DASS21 subscales of depression, anxiety, and stress, which did not include locally dependent items, fitted the Rasch model expectations, and had an acceptable unidimensionality and scalability, were identified. Conclusion: The 16-item version of the DASS-21 may be used as an overall indicator of dysthymia and should be supplemented with the brief versions of the depression, anxiety, and stress subscales, which were found to be valid clinimetric indices. [ABSTRACT FROM AUTHOR]

Behavioural lifestyle interventions focused on diet and physical activity are a cornerstone for the treatment of obesity. However, their effects vary substantially across individuals in terms of magnitude and durability. Personalized approaches that target psychological well‐being may be promising to facilitate healthy behaviours and sustained weight loss. This preliminary study aimed to explore whether the sequential combination of behavioural lifestyle intervention (BLI) and well‐being therapy (WBT) may result in more favourable outcomes than BLI alone in promoting weight loss (primary outcome) and improving psychological well‐being, distress, dietary behaviours and physical activity (secondary outcomes). A total of 83 patients with obesity were randomly assigned to BLI/WBT (N = 38) or BLI group (N = 45). The BLI group received a 12‐week behavioural weight loss programme, whereas the BLI/WBT group received the same programme followed by an additional 4‐week WBT, adapted for group interventions. Data were collected at pretreatment (baseline, T1), at the end of BLI/WBT (T2), at 6‐month (T3) and 12‐month (T4) follow‐ups. There was a significant weight loss in both treatment groups at T2, T3 and T4. The BLI/WBT group showed greater improvements in depressive symptoms at T3 and T4, in autonomy at T2, in personal growth at T4 and in global well‐being at T4 compared with BLI group. WBT yielded no additional effect on weight loss. However, the secondary outcomes indicate that WBT may have enduring effects that reduce vulnerability to psychological distress in patients with obesity. In order to confirm these preliminary findings and explore whether a more intensive and individualized WBT can foster sustained weight loss, future studies are needed. [ABSTRACT FROM AUTHOR]

It is common for a general practitioner to meet patients who suffer from mental disorders such as depression or anxiety in the context of Primary Care (Alexander et al., 2008; Anthony et al., 2010; Consensus ISS, 2022; Regier et al. 1978, 1993; Goldberg & Goodyer, 2005; Ustün & Sartorius, 1995; WHO, 2016). This study reports data about clinical activity during the period 2016-2018 regarding the psychological assistance provided by the project "Lo psicologo nella Casa della Salute" in the Italian city of Bologna (Aru et al., 2019). The "Casa della Salute" (CdS) is a territorial health care outpatient facility that aims to offer services of Primary Care to the general population of a specific district. Moreover, CdS is a starting point for the collaboration between the Mental Health Department (MHD) and the Primary Care Department (PCD). Previous experiences about psychologist in Primary Care (Liuzzi, 2010; Solano, 2009) highlighted: (1) positive increase of therapeutic outcomes through improvement of appropriate access to psychological care and (2) active role of psychologist in promoting communication between different professionals involved in mental health care. In the 2016-2018 period, different interventions have been organized: (1) orientation towards the network of Health Services, (2) psychological interventions to support the activity of the health personnel of the CdS, (3) low intensity psychological intervention (6-8 session), (4) psychotherapy intervention (15-20 session). Statistical analyses have been conducted on a sample of 613 patients who were referred to the psychologist of the CdS. The results indicates that the "Lo psicologo nella Casa della Salute" proposes an effective model of integrated health care. [ABSTRACT FROM AUTHOR]

Objective : This is the first study applying Clinimetric Patient-Reported Outcome Measures (CLIPROM) criteria to evaluate the construct validity, sensitivity, and clinical utility of the SCL-90-R in patients with Parkinson's disease (PD). Methods : A Rasch analysis was conducted using a sample of 488 PD outpatients. Results: Testing for dimensionality revealed that less than 5% of t -tests were significant, indicating that the SCL-90-R subscales entailed the property of construct validity. As to the total score, a Person Separation Reliability Index of.96 was found. Conclusions: The SCL-90-R total score is a sensitive screening measure that can be used not only to differentiate healthy stress reactions from symptoms of psychological distress but also to detect PD patients with an increased risk for psychiatric complications. As to the subscales, the brief versions that did not include misfitting items should be used to assess the severity of specific symptoms of psychological distress affecting PD patients. [ABSTRACT FROM AUTHOR]

Objective: The Patient Health Questionnaire-9 (PHQ-9) is a widely used self-report measure of depression whose psychometric properties were found to be merely acceptable. Insufficient attention has been devoted to its clinimetric validity, while its clinical utility is still debated, particularly for assessing depression severity. This is the first study to test the PHQ-9 construct validity and clinical utility based on clinimetric principles., Methods: An online survey of 3,398 participants was conducted. Item response theory models (Rasch and Mokken analyses) were used to assess the PHQ-9 validity and determine its clinical utility., Results: Fit to the Rasch model was achieved after adjusting the sample size. Items 2, 4, 6, and 9 over-discriminated, while items 1, 5, and 7 under-discriminated. Local dependency between items 2 and 6 was indicated. The PHQ-9 was not unidimensional. A Loevinger's coefficient of 0.49 was found, indicating an acceptable level of scalability., Conclusion: The PHQ-9 is an instrument with potential clinical utility as an overall index of depression, mainly for screening purposes. Substantial revision, particularly in the wording of over- and under-discriminating items, is needed., Competing Interests: The authors report no conflicts of interest.