Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-23T06:00:26.808Z Has data issue: false hasContentIssue false
  • English
  • Français

Experiments on clinical observation and judgement in the assessment of depression: profiled videotapes and Judgement Analysis

Published online by Cambridge University Press:  09 July 2009

P. Bech ,
A. Haaber  and
C. R. B. Joyce
P. Bech
Affiliation:
Psykiatrisk Afdeling, Frederiksborg Amts Centralsygehus, Hillerød, Denmark
A. Haaber
Affiliation:
Psykiatrisk Afdeling, Frederiksborg Amts Centralsygehus, Hillerød, Denmark
C. R. B. Joyce*
Affiliation:
Psykiatrisk Afdeling, Frederiksborg Amts Centralsygehus, Hillerød, Denmark
*
1Address for correspondence: Dr C. R. B. Joyce, Project Innovation Group, Medical Department, Ciba-Geigy AG, 4002 Basel, Switzerland.
Get access Rights & Permissions [Opens in a new window]

Synopsis

Variations within and between observer-judges reduce the accuracy of clinical research. Judgement Analysis allows strategies to be developed and applied which reduce variation in judgement. The prediction that the removal of important sources of error variance by this means would reduce the likelihood of committing a Type 2 Error was supported by the application of Judgement Analysis to assessments by 15 psychiatrists of 92 patients in a clinical trial of 2 antidepressive treatments. The statistical significance of differences between the effect of the treatments on the severity of depression was increased, and significant differences appeared earlier. Ten stimulated patient profiles were also converted into narrative case histories, enacted by experienced psychiatrists or psychologists and videotaped. The participants' judgements of the overall severity of the depression were in good agreement with those they had made on the original cases. Videotapes so prepared help training to reduce variation in observation, just as Judgement Analysis can lead to reductions in the variation of judgement.

Type
Research Article
Information
Psychological Medicine , Volume 16 , Issue 4 , November 1986 , pp. 873 - 883
Copyright
Copyright © Cambridge University Press 1986

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bartko, J. J. & Carpenter, W. T. (1976). On the methods and theory of reliability. Journal of Nervous and Mental Disease 163, 307–317.Google ScholarPubMed
Bech, P. (1981). Rating scales for affective disorders: their validity and consistency. Acta Psychiatrica Scandinavica 64, Suppl. 295, 1–101.Google Scholar
Bech, P. (1984). Citalopram versus clomipramine: a controlled clinical study. Clinical Neuropharmacology 7, Suppl. 1, 5471–5472.CrossRefGoogle Scholar
Bech, P. & Rafaelson, O. J. (1980). The use of rating scales exemplified by a comparison of the Hamilton and the Bech–Rafaelsen Melancholia Scale. Acta Psychiatrica Scandinavica 62, Suppl. 285, 128–132.CrossRefGoogle Scholar
Bech, P., Gram, L. F., Dein, E., Jacobsen, O., Vitger, J. & Bolwig, T. G. (1975). Quantitative rating of depressive states. Acta Psychiatrica Scandinavica 51, 161–170.CrossRefGoogle ScholarPubMed
Bech, P., Gjerris, A., Andersen, J., Bøjholm, S., Kramp, P., Bolwig, T. G., Kastrup, M., Clemmesen, L. & Rafaelsen, O. J. (1983). The Melancholia Scale and the Newcastle Scales. Item-combinations and inter-observer reliability. British Journal of Psychiatry 143, 58–63.CrossRefGoogle ScholarPubMed
Cronholm, B. & Ottosson, J.-O. (1960). Experimental studies of the therapeutic action of electroconvulsive therapy in endogenous depression. The role of the electrical stimulation and of the seizure studied by variation of stimulus and modification by lidocaine of seizure discharge. Acta Psychiatrica Neurologica Scandinavica Suppl. 145, 69–97.CrossRefGoogle Scholar
Deane, D. H., Hammond, K. R. & Summers, D. A. (1972). Acquisition and application of knowledge in complex inference tasks. Journal of Experimental Psychology 92, 20–26.CrossRefGoogle Scholar
d'Elia, G., Hällström, T., Nyström, C. & Ottosson, J.-O. (1981).Zimelidine versus maprotiline in depressed outpatients. A preliminary report. Acta Psychiatrica Scandinavica 63, Suppl. 290. 225–235.CrossRefGoogle Scholar
Fisch, H.-U., Hammond, K. R., Joyce, C. R. B. & O'Reilly, M. (1981). An experimental study of the clinical judgment of general physicians in evaluating and prescribing for depression. British Journal of Psychiatry 138, 100–109.CrossRefGoogle ScholarPubMed
Fisch, H.-U., Hammond, K. R. & Joyce, C. R. B. (1982). On evaluating the severity of depression: an experimental study of psychiatrists. British Journal of Psychiatry 140, 378–383.Google ScholarPubMed
Freiman, J. A., Chalmers, T. C., Smith, H. J. & Kuebler, R. R. (1978). The importance of β, the type II error and sample size in the design and interpretation of the randomized control trial: survey of 71 ‘negative’ trials. New England Journal of Medicine 299, 690–694.CrossRefGoogle ScholarPubMed
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Hammond, K. R. (1975). Social Judgment theory: its use in the study of psychoactive drugs. In Psychoactive Drugs and Social Judgment (ed. Hammond, K. R. and Joyce, C. R. B.), pp. 69–105. Wiley Interscience: New York.Google Scholar
Hammond, K. R., Stewart, T. R., Brehmer, B. & Steinmann, D. O. (1975). Social Judgment Theory. In Human Judgment and Decision Processes (ed. Kaplan, M. F. and Schwartz, S.), pp. 271–312. Academic Press: New York.CrossRefGoogle Scholar
Joyce, C. R. B. (1984). Judgment analysis and clinical trials. How to save the baby from the bathwater. Controlled Clinical Trials 5, 307–308.CrossRefGoogle Scholar
Joyce, C. R. B., Berry, H.,Chaput De Saintonge, D. M., Domenet, J., Fowler, P. & Mason, R. M. (1977). Judgment analysis of investigators' assessments: a way to reduce one important source of error in multi-centre trials. In International Co-ordination of Drug Trials (ed. Fehr, K., Huskisson, E. C. and Wilhelmi, E.). Eular Bulletin Monograph No. I.Google Scholar
Kirwan, J. R., Chaput de Saintonge, D. M., Joyce, C. R. B. & Currey, H. I. F. (1983 a). Clinical judgement in rheumatoid arthritis. I. Rheumatologists' opinions and the development of ‘paper patients’. Annals of the Rheumatic Disease 42, 644–647.CrossRefGoogle Scholar
Kirwan, J. R., Chaput de Saintonge, D. M., Joyce, C. R. B. & Currey, H. L. F. (1983 b). Clinical judgement in rheumatoid arthritis. II. Judging ‘current disease activity’ in clinical practice. Annals of the Rheumatic Diseases 42, 648–651.CrossRefGoogle Scholar
Kirwan, J. R., Chaput de Saintonge, D. M., Joyce, C. R. B. & Currey, H. L. F. (1983 c). Clinical judgment analysis – practical application in rheumatoid arthritis. British Journal of Rheumatology 22, (Suppl.), 18–23.CrossRefGoogle ScholarPubMed
Kirwan, J. R., Chaput de Saintonge, D. M., Joyce, C. R. B. & Currey, H. L. F. (1984). Clinical judgement in rheumatoid arthritis. III. British rheumatologists' judgments of ‘change in response to therapy’. Annals of the Rheumatic Diseases 43, 686–694.CrossRefGoogle Scholar
Mainland, D. (1963). Elementary Medical Statistics. W. B. Saunders:Philadelphia.Google Scholar
Montgomery, S. A. & Äsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134,382–389.CrossRefGoogle ScholarPubMed
Rack, P. H. (1973). A comparative clinical trial of oral clomipramine (Anafranil) against imipramine. Journal of International Medical Research 1, 332–337.CrossRefGoogle Scholar
Russell, M. L., Ghee, K. L., Probstfield, J. L. & Insull, W. (1983). Development of standardized simulated patients for quality control of the clinical interview. Controlled Clinical Trials 4, 197–208.CrossRefGoogle ScholarPubMed
Stewart, T. R., Joyce, C. R. B. & Lindell, M. K. (1975). New analyses: application of judgment theory to physicians' judgments of drug effects. In Psychoactive Drugs and Social Judgment (ed.Hammond, K. R. and Joyce, C. R. B.), pp. 249–262. Wiley Interscience: New York.Google Scholar
Tiplady, B. & Loudon, J. B. (1980). Assessment of depression and the non-psychiatrist.In Abstracts of the 12th CINP Congress, 340. Pergamon: Oxford.Google Scholar
Vere, D. W. (1984).Logic and valid inference. In Current Problems in Clinical Trials (ed. Chaput de Saintonge, D. W. and Vere, D. W.), pp. 35–40. Blackwell: Oxford.Google Scholar