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The British Journal of Psychiatry (1965) 111: 534-540. doi: 10.1192/bjp.111.475.534
© 1965 The Royal College of Psychiatrists
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A Comparison of Doctor and Patient Improvement Ratings in a Drug (Meprobamate) Trial

LEE C. PARK M.D.1, EBERHARD H. UHLENHUTH M.D.1, RONALD S. LIPMAN Ph.D.2, KARL RICKELS M.D.3, and SEYMOUR FISHER Ph.D.4

1 Assistant Professor of Psychiatry Johns Hopkins University School of Medicine, Baltimore, Maryland
2 Research Psychologist, Psychopharmacology Service Center, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
3 Associate Professor of Psychiatry, School of Medicine, University of Pennsylvania, and Director of Psychopharmacological Research, Philadelphia General Hospital, Philadelphia, Pennsylvania
4 Research Professor and Director, Psychopharmacology Laboratory, Division of Psychiatry, Boston University School of Medicine, Boston, Massachusetts

This is a comparison of doctor and patient ratings on three improvement measures in a six-week drug study involving 138 anxious, neurotic out-patients seen at The Johns Hopkins Hospital, The Hospital of the University of Pennsylvania and the Philadelphia General Hospital.

At the premedication interview, doctors rate their patients as significantly more distressed than the patients rate themselves on a Target Symptom measure and an Anxiety Scale. The correlations between doctor and patient ratings are particularly low at this interview.

At subsequent interviews, doctors and their patients do not differ reliably in rating the patients' distress on the Target Symptom and Anxiety measures. The raters also do not differ reliably on a Global Improvement measure (not scored at premedication interview).

The degree of agreement among the three measures in rating improvement (Global Improvement, pre-post difference in Target Symptoms and Anxiety) also was examined by means of correlations. These correlations are all significant, although generally of modest magnitude, at the 2, 4 and 6 week interviews. The correlations among the three ratings made by the patients are about the same as the correlations among the three ratings made by the doctors. (The correlations between raters on the same measures, however, are somewhat lower, particularly for the Anxiety Scale.)

Doctors' and patients' ratings are about equally sensitive in detecting drug-placebo differences. The Anxiety Scale appears less sensitive to these differences than the other two measures.

The use of several measures and different raters seems to offer advantages in tapping various facets of change in patients' distress.

Submitted on August 4, 1964






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Psychiatric Bulletin Advances in Psychiatric Treatment All RCPsych Journals
Copyright © 1965 The Royal College of Psychiatrists.