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

Universal Measures

What measures do we use?

Adolescent Measures

Adult Measures•Eating Disorder Examination Interview (EDE-I)

•Eating Disorder Examination Questionnaire (EDE-Q)

•Pros and Cons of Anorexia Nervosa (PCAN)

•Clinical Impairment Assessment (CIA)

•Beck Depression Inventory (BDI-II)

•Beck Anxiety Inventory (BAI)

•Clark-Beck Obsessive Compulsive Inventory (CBOCI)

•Inventory of Interpersonal Problems (IIP-64)

•Global Assessment of Functioning (GAF)

•Child Depression Inventory (CDI)

•Spielberger State-Trait Anxiety Inventory (STAI)

•Child Obsessive Compulsive Inventory (ChOCI)

•Strengths and Difficulties Questionnaire (SDQ)

•Children’s Global Assessment Scale (CGAS)

Parental Measures•Parental Child Obsessive Compulsive Inventory (P-ChOCI)

• Parental Strengths and Difficulties Questionnaire (P-SDQ)

Diagnosis Breakdown – 2010 Patients

Diagnosis On Admission On Discharge

Anorexia Nervosa- Restrictive subtype

30 29

Anorexia Nervosa- Binge/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

EDE Questionnaire

EDE Interview - No change on ‘Shape Concern’ subscale

CIA

Adult Measures

GAF

BDI

BAI

IIP- 5/8 Subscales found to be different (e.g. cold, socially inhibited, non-assertive, self-sacrificing and intrusive)

Adolescent Measures

CGAS

SDQ- Emotional Symptoms and Total Difficulty Score

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