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This study focuses on Persistent Disturbing Behavior (PDB) and its implications within mental health care. Utilizing longitudinal and multivariate techniques, researchers at UHasselt and PZ Sancta Maria investigate the characteristics of a challenging group of patients exhibiting therapy-resistant behavior. The pilot and longitudinal studies reveal insights into patient demographics, symptom persistence over time, and the need for specialized treatment facilities. The findings underscore significant differences between PDB and non-PDB groups and suggest pathways for improved care management.
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Characterizing Persistent Disturbing Behavior Using Longitudinal and Multivariate Techniques Jan Serroyen, UHasselt Liesbeth Bruckers, UHasselt Geert Rogiers, PZ Sancta Maria Geert Molenberghs, UHasselt
Outline • Persistent Disturbing Behavior (PDB) • Research questions • Pilot study • Longitudinal analysis • Cluster analysis • Concluding remarks QMSS - UHasselt
Persistent Disturbing Behavior • Observation by mental health care professionals • Problematic group of patients: • Disturbing behavior • Therapy resistant • Living together is extremely difficult • Intensive supervision over 24h QMSS - UHasselt
Where do they belong? • Psychiatric hospital (PH): • Definition: non-residential institution for intensive specialist care • Problem: need for a prolonged stay • Psychiatric nursing home (PNH): • Royal Decree: chronic and stabilized psychiatric conditions • Problem: instable disease status QMSS - UHasselt
Research Questions • Distinguish PDB from non-PDB • Size of PDB group • Homogeneous group or subgroups QMSS - UHasselt
Minimal Psychiatric Data (MPD) • Imposed by the Ministry of Public Health • Started in 1996 • Goal : • Transparency in care • Diversity of patients • Variability in care • Items • Socio demographic • Diagnostic items (DSM IV) • Psycho-social problems • Received treatment QMSS - UHasselt
Pilot study • Cross-sectional study in 1998 (N = 611) • Discriminant analysis: • PDB screening by expert opinion • Discriminant function: based on MPD data • Sensitivity & Specificity: 72% - 85% • 80% correctly classified • Conclusion: PDB is a substantial group • Focus on disturbance aspect QMSS - UHasselt
Longitudinal analysis • Aim: study persistence dimension • Discriminant analysis -> PDB-score • Calculate score at other registration occasions-> PDB-score over time QMSS - UHasselt
Linear mixed-effects model QMSS - UHasselt
Linear mixed-effects model • Separate models for both types of institutions • Starting model: • Mean structure: PDB group, time, time² and pairwise interactions • Variance model: • 3 group-specific random effects: intercept, time, time² • PH: group specific power-of-mean structure • PNH: group specific Gaussian serial correlation structure QMSS - UHasselt
Linear mixed-effects model • Final model: • Mean structure: • Random-effects covariance matrix: QMSS - UHasselt
Cluster analysis • Identify subgroups within PDB group • Gower’s distance: can handle all outcome types • Ward’s minimum variance method • Result: 2 clusters QMSS - UHasselt
Concluding remarks • Differences PDB & non-PDB: • Mean profiles • Variance • Correlation structure • Numerous PDB patients • Need for specialized treatment facilities QMSS - UHasselt