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FRIMEDBIO-Fri prosj.st. med.,helse,biol

Supporting specialized psychiatric care in remote areas: A computer adaptive diagnostic interview for personality pathology

Alternative title: Styrking av psykisk helsevern i distriktene: Utvikling av et digitalt adaptivt kartleggingsverktøy for personlighetspatalogi

Awarded: NOK 7.9 mill.

The goal of this project is to develop an adaptive instrument for assessing personality disorders. The instruments that are currently available are relatively cumbersome, and may be a challenge to use; especially for clinicians who do not use them on a daily basis. The new instrument that we are developing is based on principles of computerized adaptive testing. This means that the instrument is governed by an algorithm and adapted real-time, so that only the questions that are relevant and contribute important information needed to make the diagnosis are selected. Using the adaptive algorithm will allow for delivering a relatively short, yet precise, personalized test; while ensuring adequate content coverage. The instrument will be more intuitive to use than the current generation of semi-structured interviews. This will facilitate assessment of personality disorders for clinicians who are not specialized in these disorders per se, such as clinicians working in remote areas. Since personality disorders are notoriously hard to treat, correct diagnosis is of paramount importance: using appropriate treatment designed especially for a particular personality disorder has been shown to help patients improve. Over the past year, we studied how scores are displayed graphically in various academic fields; and carried out an empirical study to investigate which types of graphical displays are best suited to communicate test results and the associated measurement error to clinicians in the context of diagnosis.

When personality traits are inflexible and maladaptive, and cause a clinically significant level of functional impairment and/or distress, they may be diagnostic markers for a personality disorder. Studies have shown that between 3 and 10% of the general population meet the diagnostic criteria of one or more personality disorders. Moreover, prevalence rates in psychiatric populations may be as high as 50 to 80%. Since personality disorders are notoriously hard to treat, correct diagnosis is of paramount importance: using appropriate treatment designed especially for a particular personality disorder has been shown to help patients improve. Establishing a personality diagnosis is not an easy feat; it typically requires a high amount of expertise and training. Furthermore, the current generation of semi-structured interviews are lengthy; are scored by hand; or may be perceived as highly complex. To address these issued and support mental healthcare professionals, especially those not specifically specialized in personality disorders, we aim to develop and validate a tool which is efficient, intuitive to use, and facilitates automatic scoring: a computerized adaptive test (CAT). CATs are governed by a combination of statistical and content-driven rules, and allow for delivering a relatively short yet precise personalized test while ensuring adequate validity. In this project, we will study how to best incorporate available information (theory, empirical information) to design a CAT that is as efficient and user-friendly as possible, while maintaining adequate levels of validity. Using our results, we will provide general guidelines for developing CATs supporting clinical diagnoses and CAT-based score reports for clinical purposes.

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Funding scheme:

FRIMEDBIO-Fri prosj.st. med.,helse,biol