A test of concordance between patient and psychiatrist valuations of multiple treatment goals for schizophrenia

Background While much discussion has been placed on the problem of poor compliance in the treatment of schizophrenia, there has been little discussion on the concordance between patients and psychiatrists, an important contributing factor to patient‐centred care. Objective To estimate the concordance between patients’ and psychiatrists’ (ordinal and cardinal) valuations of multiple goals for schizophrenia treatment and to illustrate the utility of the self‐explicated method in valuing a large number of treatment goals. Design Twenty treatment goals were identified during focus groups and literature review and were presented to patients and psychiatrists during structured interviews. Respondents were asked to rank the multiple treatment goals and rate them on a 5‐point Likert scale. Three scores were calculated based on the ranking (1–20), rating (Likert scale) (1–5) and a self‐explicated method estimated as the product of rating and ranking score (1–100). Concordance was tested using Spearman’s rho for overall ordinal rankings and via anova and F‐test for the cardinal values assigned to a specific treatment goal. Participants A total of 105 outpatients diagnosed with schizophrenia and 160 psychiatrists in Germany. Results Patient and psychiatrist values were concordant when the ordinal properties of their valuations were assessed by rating (ρ = 0.63; P = 0.002), ranking (ρ = 0.51; P = 0.02) and self‐explicated methods (ρ = 0.54; P = 0.01). Significant discordances were found when comparing the cardinal value placed on any given treatment goal using all three approaches, but the self‐explicated method produced a more discerning statistic. Relative to patients, psychiatrists significantly (P < 0.05) overvalued reduced lack of emotion, improved sexual pleasure and improved communication while undervaluing reuptake of activities of daily living, improved satisfaction and recovered capacity for work. Conclusions While there is an overall concordance between patients’ and psychiatrists’ valuation, significantly different valuations on specific goals can be identified. Here, psychiatrists tend to focus on ‘textbook’ outcomes, while patients are more concerned with functioning and living a normal life. This study also demonstrates the importance of comparing the concordance in treatment goals and the importance of preference‐based methods, such as the self‐explicated method, in the study of concordance.     

Acute Dieldirin Toxicity: Biochemical Changes in the Blood

The effect of a single sublethal dose of dieldrin on values for plasma corticosterone (free), nonesterified fatty acids, blood glucose, glucose tolerance, blood pyruvic acid, blood lactic acid, and liver lactic acid has been investigated. The blood glucose level is elevated and glucose tolerance is lowered, Indicating an impairment in the utilization of glucose. A significant increase is observed in the levels of other constituents. A correlation of these effects with adrenocortical activity has been attempted.     

δ-Aminolevulinic Acid Dehydratase Test for Lead Exposure

The determination of δ-aminolevulinic acid dehydratase (ALA-D) in erythrocytes is one of the most reliable indicators for evaluating occupational exposure to a low concentration of lead. The ALA-D test is usually performed with incubation at the pH level found in normal blood. However, the optimum pH for determinations of ALA-D in occupational lead exposure is different from, and at a lower pH level compared with, the normal.

Accordingly, I undertook to perform the ALA-D assay by simultaneous incubation at the normal and at a lower pH value, and the results were expressed as the value of an activity ratio in addition to the activity. The activity ratio in the ALA-D test has a close correlation with the level of lead in blood.