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To examine if the current taught undergraduate psychiatry syllabus at an Irish University relates to what doctors in psychiatry consider to be clinically relevant and important.
Methods:
Doctors of different clinical grades were invited to rate their views on 216 items on a 10-point Likert scale ranging from ‘0 = not relevant’ to ‘10 = very relevant’. Participants were invited to comment on topics that should be excluded or included in a new syllabus. Thematic analysis was conducted on this free-text to identify particular themes.
Results:
The doctors surveyed rated that knowledge of diagnostic criteria was important for medical students. This knowledge attained high scores across all disorders with particularly high scores for a number of disorders including major depressive disorder (mean = 9.64 (SD = 0.86)), schizophrenia (mean = 9.55 (SD = 0.95)) and attention deficit hyperactivity disorder (Attention Deficit Hyperactivity Disorder (ADHD); mean = 9.26 (SD = 1.40)). Lower scores were noted for less frequently utilised management strategies (transcranial magnetic stimulation (mean = 4.97 (SD = 2.60)), an awareness of the difference in criteria for use disorder and dependence from psychoactive substances (mean = 5.56 (SD = 2.26)), and some theories pertaining to psychotherapy (i.e. Freud’s drive theory (mean = 4.59 (SD = 2.42)).
Conclusions:
This study highlights the importance of an undergraduate programme that is broad based, practical and relevant to student’s future medical practice. An emphasis on diagnosis and management of major psychiatry disorders, and knowledge of the interface between mental health services, other medical specialities and support services was also deemed important.
To examine the criteria utilised for detaining individuals under the Irish Mental Health Act 2001 (MHA 2001) and their association with clinical features.
Methods:
Demographic and clinical data of 505 involuntary admissions under the MHA 2001 between 2013 and 2023 were attained. Data included criteria utilised for detention and renewal, sociodemographic and clinical features associated with these criteria, and the use of coercive practices, such as seclusion and restraint.
Results:
The majority of patients who were involuntarily admitted (61.4%), or had their admission order affirmed by tribunal (78.2%), were not judged to pose an immediate risk to themselves or others. Patients admitted under the “impaired judgement criterion” were less likely to be secluded (χ2 = 15.8, p < 0.001) or restrained (χ2 = 11.6, p < 0.01). Patients admitted under the “risk criterion” were younger (KW = 12.7, p = 0.02), and less likely to have a psychotic disorder (χ2 = 5.9, p = <0.001) or have a previous involuntary admission (χ2 = 7.7, p = 0.02). Patients who were subject to coercive care were younger (U = 12739, p < 0.001), more likely to be male (χ2 = 4.6, p = 0.03), and have prolonged involuntary admissions (U = 18412, p = 0.02).
Conclusions:
Currently, the majority of the involuntary care provided for patients under the MHA 2001 is not related to the risk criterion of causing immediate and serious harm to themselves or others, but rather to the criterion of impaired judgement. Patients admitted under the risk criterion are more often subjected to restrictive practices, but are less likely to suffer from psychosis, than those receiving involuntary care due to their impaired judgement.
Through an extension of work by Guttman, common factor theory, image theory, and component theory are derived from distinct minimum subsets of assumptions chosen out of a set of five possible assumptions. It is thence shown that the problem of indeterminacy of factor scores in the common factor model is precisely reflected in the problem of the non-orthogonality of anti-images. Indeed, image scores are determinate for the same reason that the usual estimates of factor scores are determinate, and image scores cannot be used as though they were factor scores for the same reason that factor score estimates cannot be used as though they were factor scores.
An expression is given for weighted least squares estimators of oblique common factors, constrained to have the same covariance matrix as the factors they estimate. It is shown that if as in exploratory factor analysis, the common factors are obtained by oblique transformation from the Lawley-Rao basis, the constrained estimators are given by the same transformation. Finally a proof of uniqueness is given.
Maximum likelihood estimates of the free parameters, and an asymptotic likelihood-ratio test, are given for the hypothesis that one or more elements of a covariance matrix are zero, and/or that two or more of its elements are equal. The theory applies immediately to a transformation of the covariance matrix by a known nonsingular matrix. Estimation is by Newton's method, starting conveniently from a closed-form least-squares solution.
Numerical illustrations include a test for equality of diagonal blocks of a covariance matrix, and estimation of quasi-simplex structures.
A general model is developed for the analysis of multivariate multilevel data structures. Special cases of the model include repeated measures designs, multiple matrix samples, multilevel latent variable models, multiple time series, and variance and covariance component models.
The monotone regression function of Kruskal and the rank image function of Guttman and Lingoes were fitted to bivariate normal samples and their statistical properties contrasted.
A distinction is proposed between measures and predictors of latent variables. The discussion addresses the consequences of the distinction for the true-score model, the linear factor model, Structural Equation Models, longitudinal and multilevel models, and item-response models. A distribution-free treatment of calibration and error-of-measurement is given, and the contrasting properties of measures and predictors are examined.
“Determinate” solutions for the indeterminate common factor of p variables satisfying the single common factor model are not unique. Therefore an infinite sequence of additional variables that conform jointly with the original p variables to the original single common factor model does not determine a unique solution for the indeterminate factor of the p variables (although the solution is unique for the factor of the infinite sequence). Other infinite sequences may be found to determine different solutions for the factor of the original p variables. The paper discusses a number of theorems about the effects of additional variables on factor indeterminacy in a model with a single common factor and draws conclusions from them for factor theory in general.
Results obtained by Guttman [1955] on the determinacy of common factors have been thought to have disturbing consequences for the common factor model. It is argued that factors must be thought of as unobservable, and uniquely defined but numerically indeterminate. It follows that Guttman's measure of indeterminacy is inconsistent with the foundations of the factor model in probability theory, and the traditional measures of factor indeterminacy used by earlier writers should be reinstated. These yield no disturbing conclusions about the model.
In general, nonlinear models such as those commonly employed for the analysis of covariance structures, are not globally identifiable. Any investigation of local identifiability must either yield a mapping of identifiability onto the entire parameter space, which will rarely be feasible in any applications of interest, or confine itself to the neighbourhood of such points of special interest as the maximum likelihood point.
A general formulation is presented for obtaining conditionally unbiased, univocal common-factor score estimates that have maximum validity for the true orthogonal factor scores. We note that although this expression is formally different from both Bartlett's formulation and Heermann's approximate expression, all three, while developed from very different rationales, yield identical results given that the common-factor model holds for the data. Although the true factor score validities can be raised by a different non-orthogonal transformation of orthogonalized regression estimates—as described by Mulaik—the resulting estimates lose their univocality.
There is a unity underlying the diversity of models for the analysis of multivariate data. Essentially, they constitute a family models, most generally nonlinear, for structural/functional relations between variables drawn from a behavior domain.
A reparameterization is formulated that yields estimates of scale-invariant parameters in recursive path models with latent variables, and (asymptotically) correct standard errors, without the use of constrained optimization. The method is based on the logical structure of the reticular action model.
A general formulation of the latent structure principle is suggested, from which it is possible to derive Lazarsfeld’s accounting equations in their most general form. The basic equations of Gibson’s latent profile model can thence be derived in a single step.
The method presented attempts to allow for nonlinear, possibly nonmonotonic relations between manifest and latent variates. An attempt is made to provide a workable criterion for choosing between alternative models on the basis of observable data as well as for constructing the appropriate function. An idealized numerical example is given.
Procedures are given for determining identified parameters, finding constraints on the covariances, and checking equivalence, in acyclic (recursive) linear path models with correlated error terms (disturbances), by inspection of the path equations, aided by simple recursions. This provides a useful and general alternative to the employment of directed acyclic graph theory for such purposes.
The basic concepts of nonlinear factor analysis are introduced and some extensions of the general theory are developed. An elementary account of the class of multiple-factor polynomial models is presented, using more elementary algebraic methods than have been employed in earlier accounts of this theory. Working formulas are developed for the multiple-factor polynomial model without product terms.