Transcript PPTOutcome Measures - Scottish Eating Disorder Interest Group

Outcome Measures and Research at
Huntercombe Hospital Edinburgh
• Hannah Austin Payne (Clinical Psychologist)
• Jessica Lane (Research Placement Student)
• Emma Long (Assistant Psychologist)
Topics to be discussed
• Outcome measures
• Ravello profile
• Ongoing data analysis
Outcome Measures
What are outcome measures?
• Outcome measures are psychometric assessments that
the patients fill in both on admission and at discharge.
• Parents/Carers of adolescent patients are also given
questionnaires to complete
• Additional measures are completed by members of our
team.
Why do we complete outcome measures?
• It gives an indication of an individual patient’s
changes in symptoms and their progress during
admission– inform initial psychological formulation
by highlighting particular areas of difficulty. Helps to
inform treatment post discharge.
• To give an overall picture of the patient group as a
whole, and to look at average changes during
admission.
• To be used in research
What measures do we use?
Universal Measures
Adult Measures
•Child Depression
Inventory (CDI)
•Eating Disorder Examination
Interview (EDE-I)
•Beck Depression
Inventory (BDI-II)
•Spielberger State-Trait
Anxiety Inventory
(STAI)
•Eating Disorder Examination
Questionnaire (EDE-Q)
•Beck Anxiety
Inventory (BAI)
•Pros and Cons of Anorexia
Nervosa (PCAN)
•Clark-Beck Obsessive
Compulsive Inventory
(CBOCI)
Adolescent Measures
•Child Obsessive
Compulsive Inventory
(ChOCI)
•Strengths and
Difficulties
Questionnaire (SDQ)
•Children’s Global
Assessment Scale
(CGAS)
•Clinical Impairment
Assessment (CIA)
Parental Measures
•Parental Child
Obsessive Compulsive
Inventory (P-ChOCI)
• Parental Strengths
and Difficulties
Questionnaire (P-SDQ)
•Inventory of
Interpersonal
Problems (IIP-64)
•Global Assessment of
Functioning (GAF)
Diagnosis Breakdown – 2010 Patients
Diagnosis
On Admission
On Discharge
Anorexia Nervosa- Restrictive
subtype
30
29
Anorexia NervosaBinge/Purge subtype
4
3
Eating Disorder Not Otherwise
Specified
10
10
No Diagnosis Available
1
3
Total
45
45
How many patients completed outcome measures?
Adult Patients
83.3% completed both Admission and
Discharge Psychometrics
Adolescent Patients
76.4% completed both Admission and
Discharge Psychometrics
Overall
80.85% of patients completed Admission and
Discharge Psychometrics
Significant Differences Found between
Admission and Discharge
Universal Measures
Adult Measures
Adolescent Measures
EDE Questionnaire
GAF
CGAS
EDE Interview - No
change on ‘Shape
Concern’ subscale
BDI
SDQ- Emotional
Symptoms and Total
Difficulty Score
CIA
BAI
IIP- 5/8 Subscales
found to be different (e.g.
cold, socially inhibited,
non-assertive, selfsacrificing and intrusive)
CDI- Significant
Difference on Negative
Mood subscale
STAI
CHOCI- Significant
Difference found on
Obsessions Severity Score
Discussion Points
•No significant difference found on parental report vs adolescent self
report (SDQ/CHOCI). Possibly due to inpatient unit, parents/carers
not seeing direct change in patient and a smaller sample group
• No Significant Difference found on the CBOCI Questionnaire: Adult
patients may have underlying obsessive compulsive symptoms that
are not addressed during treatment.
•Shape concern subscale EDE-I significant difference only found in
adolescent group. Perhaps Adults likely to experience significant
weight gain which may lead to continued or increase in shape
concern.
Ravello Profile
The Ravello Profile
The Ravello Profile is a battery of neuropsychological
tests that tells us more about the cognitive profile of
patients with Anorexia Nervosa.
It is an international study run by Professor Bryan Lask,
Ian Frampton, and Mark Rose.
At Huntercombe Hospital – Edinburgh, we have been
collecting data since January 2007 and at present we
have assessed 111 patients. The Ravello Profile
contributes towards patient formulations, especially for
our adolescent patients.
What does the Ravello look at?
• Visual Spatial memory :– short term memory, long term memory, and
recognition.
(Rey Complex Figure)
• Central Coherence :– the ability to achieve a balance
between attention to detail and focusing on the bigger
picture.
– (Rey ~Complex Figure)
• Executive Functioning :– Vocabulary – estimated IQ.
(Wechsler Abreviated Scale of Intelligance (WASI):- Vocabulary & Matrix
Reasoning tests)
– Cognitive Flexibility - switching between more than one task.
(Brixton & Delis Kaplin Executive Functioning System (DKEFS):- Trail Making, &
Verbal Fluency tests)
– Inhibition – planning in a logical way Vs acting on impulse.
(Hayling & DKEFS:- Colour-Word Interference tests)
– Planning/Rule Learning – planning in advance Vs trial and error.
(DEKEFS:- Tower task)
Our observations
• Visual spatial memory is generally below
average, with most impairments found in
long term and short term memory.
• Central Coherence falls within the average
range for most patients.
• On average, all other scores seem to be
within the average range.
Discussion Points
• There have been queries within the Ravello Profile group regarding
the accuracy of some of the tests that are currently being used.
– Some patients tend to show signs of weak Central Coherence, yet the Rey
Complex Figure has not shown this to be true.
• Recent Publications:– Rose, Davis, Frampton & Lask (2011) The Ravello Profile: Development of a
global standard neuropsychological assessment for young people with anorexia
nervosa. Clinical Child Psychology and Psychiatry Volume 16 Issue 2.
DOI:10.1002/erv.1095.
– Rose, Frampton & Lask (2011) A case series investigating distinct
neuropsychological profiles in children and adolescents with anorexia nervosa.
European Eating Disorders Review. Published online in Wiley online Library
(wileyonlinelibrary.com) DOI:10.1002/erv.1095.
Ongoing Data Analysis
• Completing correlational analysis using the
following data:
- Outcome measures - EDE Interview, PCAN,
BAI/STAI, BDI/CDI, SDQ
- Cognitive assessment – visuospatial memory
(Rey figure)
- Psychiatric medication at discharge
- Weight change during admission