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PubMed2004

Taking the next steps in goal ascertainment: a prospective study of patient, team, and family perspectives using a comprehensive standardized menu in a geriatric assessment and treatment unit.

OBJECTIVES: To examine the performance of an expanded menu of goals in a geriatric rehabilitation setting incorporating patient, family, and team perspectives. DESIGN: Prospective comparative study. SETTING: Inpatient geriatric rehabilitation unit. PARTICIPANTS: Nineteen consecutive eligible inpatients and their family members and seven unit team members. MEASUREMENTS: Each participant independently reviewed a standardized menu of medical, functional, psychosocial, spiritual, and future planning goals, which were compared with the goals set by the healthcare team. RESULTS: On average, patients and their family members agreed on goals about half the time; family members tended to have more goals than patients. Agreement between the team and patients and families was poor (kappas=-0.11-0.33). The team was less likely to identify functional, psychosocial, spiritual, and future planning goals. CONCLUSION: Patients and families have a broad range of goals that are not always identified by the healthcare team. A comprehensive standardized menu is feasible and may be helpful in setting goals in a geriatric rehabilitation setting.

Aged↗

PubMed2002

[Self-evaluation of dental health by elderly people. Functional and psychosocial problems].

The purpose of the study was to establish personal estimation of population over 60 years of age of their dental health. The study was performed in 1999 and included 497 persons--206 male and 291 female. The results show that disorders in biting, chewing and taking solid food begin with the loss of 4-6 teeth. Disorders in speech start after the loss of 7 and more teeth. In case of 20 and more retained teeth, considerable part of persons do not feel disorders in main functions of chewing system. In case of acceptable shortened dental arches (missing some of all of the molars and retained all the rest teeth of dentition), together with lack of serious functional disorders, all persons with such status give good or satisfying self-rating of oral health.

Aged↗

PubMed2003

Cognitive impairment during epileptiform discharges: is it ever justifiable to treat the EEG?

Epileptiform EEG discharges are not confined to people with epilepsy, and their frequency is only weakly related to severity. A fundamental principle of EEG practice is, therefore, to avoid overinterpretation of epileptiform activity. Epileptiform discharges not accompanied by obvious clinical events are generally regarded as subclinical or interictal. However, in many patients sensitive methods of observation, notably continuous psychological testing, show brief episodes of impaired cognitive function during such discharges. This phenomenon of transitory cognitive impairment (TCI) is found in about 50% of patients who show discharges during testing. TCI is not simple inattention. The effects are material and site specific: lateralised discharges are associated with deficits of functions mediated by the hemisphere in which the discharges occur. Conversely, specific tasks can activate or suppress focal discharges over the brain regions that mediate the cognitive activity in question. TCI clearly contributes to the cognitive problems of some people with epilepsy and may cause deficits that pass unrecognised. TCI is demonstrable in many cases of benign partial epilepsy of childhood, a disorder once thought to have no adverse psychological effects. TCI can contribute to abnormalities of psychological test profiles and interferes with daily tasks, such as reading and driving. In children it may be associated with behavioural disorders. An important practical issue is whether TCI materially impairs psychosocial function and, if so, whether drug treatment is desirable or effective. Uncontrolled reports and two preliminary randomised controlled trials of antiepileptic treatment of TCI have suggested that suppression of discharges is associated with significant improvement in psychosocial function.

Animals↗

PubMed1999

Criteria defining refractory schizophrenia.

To date there has been no agreement with regard to the criteria that define refractory schizophrenia. In this study, we intended to clarify the criteria which psychiatrists use to judge schizophrenic patients as being refractory in Japan. Based on 258 schizophrenic in-patients (ICD-10) and their likelihood of discharge, level of psychosocial functioning, mental state and use of medication, the common features of patients who are viewed as non-dischargeable because of their severe mental state, compared to those of dischargeable patients, were extracted and used as the criteria. The criteria proposed necessitate (i) diagnosis of schizophrenia by standard operational criteria, (ii) continuous hospitalization for at least the past 2 years, (iii) a level of psychosocial functioning of < or = 40 as measured by the Global Assessment Scale, and (iv) an intensity score of 'marked' or 'severe' on at least three of the six Manchester Scale items (flattened affect, psychomotor retardation, delusions, hallucinations, incoherence of speech and poverty of speech).

Adult↗

PubMed1997

Satisfaction with facial appearance among subjects affected by a cleft.

OBJECTIVE: This study examined the satisfaction of patients with clefting and their parents with facial appearance and how this alters with age. The relationship between satisfaction with appearance and psychosocial functioning was also examined. DESIGN: Prospective SETTING: Subjects were recruited for the study from nine hospital-based clinics. PARENTS, PARTICIPANTS: All subjects has some type of cleft and were 10, 15 or 20 years of age. In all, 111 subjects with clefting and 62 parents were included. MAIN OUTCOME MEASURES: Facial appearance was rated on a subjective ordinal scale of 1 to 7; psychosocial adjustment was measured with the Childhood Experience Questionnaire. RESULTS: Self-satisfaction with appearance among the 10- and 15-year-old subjects correlated with their psychosocial adjustment (p = .027). The 20-year-old subjects were, on average, significantly more satisfied with their appearance than the 10- and 15-year-olds (p = .009 and p = .012, respectively). However, some 20-year-old subjects remained greatly dissatisfied with aspects of their facial appearance. Subjects with visible anomalies were significantly more dissatisfied with their appearance than subjects with invisible anomalies (p = .035). The 15-year-old subjects were identified as being significantly more dissatisfied with appearance than their parents (p = .005). CONCLUSIONS: Subjects affected by a cleft with visible impairments are more dissatisfied with their facial appearance than are subjects with invisible impairments. Satisfaction with facial appearance among 10- and 15-year-old subjects with a cleft may be associated with their self-reported levels of psychosocial functioning. Measuring self-satisfaction with appearance may help to identify subjects at risk from adjustment problems.

Adaptation, Psychological↗

PubMed1992

Cognitive correlates of interictal discharges.

Interictal discharges can occur silently without apparent simultaneous clinical manifestations. Nevertheless, formal testing during electroencephalographic (EEG) recording may demonstrate transitory cognitive impairment (TCI). The probability of demonstrating TCI is related to the nature of the test employed and the type of epileptiform discharge. Difficult tasks are more useful to detect TCI, and working memory and language tests may be particularly sensitive. Generalized 3-Hz spike-wave bursts lasting at least 3 s are most likely to produce demonstrable TCI, but they can also be found during briefer and even focal discharges. The latter exhibit some specificity: left-sided focal spiking more frequently produces errors in verbal tasks, whereas right-sided discharges are more often accompanied by impairment in handling nonverbal material. TCI may adversely affect the patient's psychosocial functioning in daily life, as has been shown by some studies pointing out an impairment of educational skill in epileptic children and of driving performance in motorists. Our study on benign childhood epilepsy with Rolandic spikes also detected TCI in the majority of the patients. Nevertheless, it is not possible to claim that everyone with subclinical EEG discharges has TCI that adversely affects their psychosocial functioning. It may be possible to treat TCI by antiepileptic drugs.

Anticonvulsants↗

PubMed2004

Improvement in health-related quality of life in children with ADHD: an analysis of placebo controlled studies of atomoxetine.

Despite significant functional impairments associated with attention-deficit hyperactivity disorder (ADHD) and the growing appreciation of the importance of health-related quality of life (HRQL) assessment in children with chronic disorders, relatively few studies have examined the impact of ADHD treatment on HRQL. This investigation examines the effect of atomoxetine, a nonstimulant treatment for ADHD, on HRQL and identifies factors that are predictive of HRQL improvements. The Child Health Questionnaire (CHQ), which is a multidimensional HRQL measure, was collected during three randomized, double-blind, placebo-controlled clinical trials. Children who received atomoxetine had significantly greater improvement in psychosocial functioning compared to the placebo group. No significant differences between once-a-day and twice-a-day dosing were found. Treatment with atomoxetine, lower HRQL baseline score, no history of stimulant use, and absence of oppositional defiant disorder were all associated with improvements in psychosocial functioning. Findings demonstrate the positive impact of atomoxetine on HRQL in children with ADHD.

Adolescent↗

PubMed1996

Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders.

OBJECTIVE: Major depression occurs with generalized anxiety disorder and panic disorder in up to 60% of psychiatric and primary care patients. This comorbidity has been associated with greater severity of depression, poorer psychosocial functioning, and poorer treatment outcomes in psychiatric samples. This study examined the clinical outcomes for depressed primary care patients with and without a lifetime anxiety disorder. METHOD: A total of 157 primary care patients who met criteria for major depression were randomly assigned to standardized interpersonal psychotherapy or pharmacotherapy with nortriptyline and were assessed at baseline and at 4 and 8 months on severity of depression, psychosocial functioning, and health-related functioning. RESULTS: Depressed patients with a comorbid anxiety disorder presented with significantly more psychopathology and tended to prematurely terminate treatment more frequently than patients with major depression alone. Both standardized depression-specific treatments were effective for depressed patients with and without a comorbid generalized anxiety disorder, although time to recovery was longer for the former. Patients with lifetime panic disorder showed poor recovery in response to psychotherapy or pharmacotherapy. CONCLUSIONS: Standardized psychotherapy and pharmacotherapy are effective for patients with major depression with and without a generalized anxiety disorder. However, the longer time to recovery for the former group and lack of response to these treatments by patients with lifetime panic disorder suggest that primary care physicians should carefully assess history of anxiety disorder among depressed patients so as to select a proper intervention.

Adolescent↗

PubMed2003

Diagnosis and treatment of dysthymia in children and adolescents.

Dysthymic disorder is a chronic depressive condition occurring in 0.6-4.6% of children and 1.6-8.0% of adolescents. Although symptoms are less severe than those observed in major depression, childhood-onset dysthymic disorder is characterised by a persistent and long-term depressed or irritable mood (mean episode duration 3-4 years), a worse outcome than major depression and, frequently, comorbid disorders (in around 50% of patients). Long-lasting depressive symptoms seem responsible for long-term disabling consequences on social skill learning, psychosocial functioning and consequent professional life, probably contributing to a higher risk of relapse or development of major depression. Consistently, the first episode of major depression occurs 2-3 years after the onset of dysthymic disorder, suggesting that the latter is one of the gateways to recurrent mood disorders. The primary aims of treatment for dysthymic disorder should be to resolve depressive symptoms, reduce the risk of developing other mood disorders over time and strengthen psychosocial functioning, especially in children and adolescents, in order to prevent the potentially serious sequelae of this disorder. As children with dysthymia often have multiple problems, interventions should involve multiple levels and measures: individual psychotherapy, family therapy/education and pharmacological treatment. Psychotherapeutic techniques, such as cognitive-behaviour therapy and interpersonal therapy, have been found to be efficacious interventions in treating children and adolescents with mild to moderate depression in studies including patients with either dysthmia or double depression. SSRIs are the first-line drug treatment for children and adolescents because of their safety, adverse effect profile and ease of use (the safety of paroxetine is currently under investigation). Several nonblind studies have shown the efficacy and good tolerability of SSRIs in children and adolescents with dysthymic disorder, but further research is needed to confirm their efficacy and that of newer antidepressants in the treatment of this disorder. Regardless of whether psychotherapeutic or medical treatments are planned, according to clinical experience, psychoeducational interventions and psychosocial support should be provided to parents and other caregivers during the acute treatment phase to help manage the child's irritable mood and foster a therapeutic alliance and better compliance with treatment. Unfortunately, no studies have focused on continuation treatment of paediatric dysthymic disorder. Given the chronicity, recurrence, psychosocial consequences and peculiar response pattern to treatment of dysthymic disorder, establishing effective 'acute' and 'continuation' interventions in this group of patients should be a priority in mental health management.

Adolescent↗

PubMed2004

Residual symptoms in depressed patients who successfully respond to short-term psychotherapy.

BACKGROUND: Most investigations of residual symptoms have focused on partial responders to antidepressant medications. Comparatively few have examined residual symptoms among patients who achieved a more successful response to treatment. In addition, few studies have assessed residual symptoms among patients treated with psychotherapy. The purpose of the present study was to assess residual symptoms of depression among psychiatric outpatients who successfully responded to psychotherapy and determine their association with other important clinical outcomes. METHODS: Sixty patients with major depression who participated in a randomized controlled trial of two forms of short-term, individual psychotherapy were studied. We examined the prevalence of residual symptoms among successful responders, as well as the relationships between residual symptoms, pre-therapy patient characteristics, relapse, and other outcomes. RESULTS: Thirty-three (55%) of the 60 patients responded successfully to psychotherapy. Of those, 82% had residual symptoms. Residual symptoms predicted relapse at 6-month follow-up, and were associated with less favorable psychosocial functioning at post-therapy and at 6-month follow-up. LIMITATIONS: The study consisted of post-hoc analyses of existing data, the number of asymptomatic patients was small, and a proxy measure of relapse was used. CONCLUSIONS: Residual symptoms are prevalent among depressed patients who successfully respond to psychotherapy. Greater residual symptoms appear to increase the risk for relapse and are associated with poorer psychosocial functioning.

Adult↗

PubMed2006

The effects of Guillain-Barré syndrome on the close relatives of patients during the first year.

OBJECTIVE: To study the impact of Guillain-Barré Syndrome (GBS) on the psychosocial functioning of the closest relative and on family functioning during the first year after GBS. METHOD: At 1 (=T1), 3 (=T3), 6 (=T6), and 12 months (=T12) after the onset of GBS, relatives of patients received the General Health Questionnaire (GHQ28) and the Family Assessment Device (FAD). Sixty-three relatives returned the GHQ28 at all four designated intervals. At T1 the relatives also received a questionnaire that contained questions on the impact on their daily life. The answers to these questions yielded a Daily Living Impact index. From the 110 relatives, 86 returned this questionnaire. RESULTS: 72% of the 86 relatives reported one or more problems in daily living. At T1 the scores of the GHQ subscales ranged from normal to mildly disturbed. The relatives showed significant improvement in their somatic complaints and anxiety during the first half year. Social dysfunction remained somewhat less than normal, severe depression was not found. At T1 and T3 the scores of the GHQ28 and some subscales differed significantly depending on the severity of the functional status of the patient, but not at T6 and T12. Relatives of patients with severe residua at 1 month score worse on the GHQ28 and most subscales at 6 months. The FAD was normal at all moments measured. CONCLUSIONS: Psychological morbidity of close relatives is significantly higher in the first months after the onset of GBS. The patient's condition has an important impact on the psychosocial functioning of close relatives. Therefore, a family approach is recommended to neurologist and other medical personnel during the first period of the disease. Also patient support groups may play a beneficial role for the relatives of GBS patients.

Anxiety Disorders↗

PubMed2006

Demographics, psychiatric diagnoses, and other characteristics of North American Deaf and hard-of-hearing inpatients.

This study examined demographic and clinical data from a specialty deaf inpatient unit so as to better understand characteristics of severely and chronically mentally ill deaf people. The study compares deaf and hearing psychiatric inpatients on demographic variables, psychiatric discharge diagnoses, a language assessment measure, a cognitive ability measure, and a measure of psychosocial functioning and risk of harm to self and others. Overall, findings indicate a broader range of diagnoses than in past studies with posttraumatic stress disorder being the most common diagnosis. Compared with hearing patients in the same hospital, deaf patients were less likely to be diagnosed with a psychotic or substance abuse disorder and more likely to be diagnosed with a mood, anxiety, personality, or developmental disorder. Psychosocial functioning of the deaf patients was generally similar to hearing psychiatric patients. Deaf patients presented significantly higher risks than hearing patients in areas of self-harm and risk of sexual offending. Cognitive scores show that both the deaf and hearing inpatient population is skewed toward persons who are lower functioning. An additional surprising finding was that 75% of deaf individuals fell into the nonfluent range of communication in American Sign Language.

Deafness↗

PubMed1998

Disability pensions in severely disturbed in-patient adolescents. Twenty-year prospective study.

BACKGROUND: Knowledge of working capacity from adolescence until adulthood among severely disturbed in-patients is scarce. METHOD: In a follow-up study of 61 adolescent in-patients, we studied associations between being on a disability pension 20 years after hospitalisation, and the patients' psychopathology and treatment-related factors during the hospitalisation and seven-year follow-up. RESULTS: Of the former in-patients, 27% had not been on a disability pension, 20% had short-term pension periods, and 53% were pensioned. Subjects whose overall psychosocial functioning had improved and who had not utilised in-patient services until the seven-year follow-up, had a better prognosis in terms of working capacity. Half of the subjects who had not been on pension during the follow-up had received a diagnosis of conduct disorder at discharge, and half of those pensioned had a psychotic disorder. CONCLUSIONS: The patients' level of psychosocial functioning and capability to work in young adulthood were associated with long-term prognosis in terms of working capacity. Adolescence seems to be the critical time for intensive psychiatric care combined with vocational rehabilitation programmes.

Adolescent↗

PubMed2001

Conditions of sibling support in adolescence.

This study examined the nature and extent of adolescent siblings' supportive roles and the conditions under which siblings provide support to one another about familial and nonfamilial issues. Data were collected from 185 adolescent firstborn (M age = 16 years) and second born (M age = 13 years) sibling pairs. In home interviews, siblings reported on family experiences and psychosocial functioning during the past year. In a series of 7 evening telephone interviews, siblings reported on their shared daily activities. Findings suggested that both older and younger siblings view older siblings as sources of support about nonfamilial issues such as social and scholastic activities and that siblings assume equally supportive roles about familial issues. Further, the results suggested that family background characteristics, sibling relationship qualities, and adolescents' psychosocial functioning were linked to the nature and extent of sibling support.

Adolescent↗

PubMed1997

Implantable cardioverter defibrillators: physical and psychosocial outcomes.

BACKGROUND: The long-term outcomes of living with an implantable cardioverter defibrillator are an important consideration in recovery. However, little is known about physical and psychosocial outcomes beyond 1 year after implantation. OBJECTIVE: To describe the long-term physical and psychosocial adaptation of persons who have had an implantable cardioverter defibrillator for approximately 2 years or more. METHODS: This nonexperimental cross-sectional study used telephone interviews to ascertain the responses of 80 recipients of implantable cardioverter defibrillators to physical and psychosocial questionnaires to explore the long-term outcomes of living with the devices. Subjects eligible for inclusion were selected from the files of an arrhythmia clinic. RESULTS: Hierarchical regression analysis showed that subjects who are not emotional are likely to be more physically active, especially if they are young and male, and that subjects who tend to be emotional are likely to be psychologically distressed and have poorer social and domestic adaptation. Furthermore, use of emotions was a positive predictor of psychological distress and poor social and domestic adaptation. Subjects reported the use of both emotion- and problem-focused coping. Subjects' scores on physical and psychosocial functioning were comparable to scores reported in the literature for patients who have had myocardial infarction or dysrhythmia. CONCLUSIONS: Emotional responses to distress were predictive of little physical activity and psychological distress. Furthermore, young recipients of implantable cardioverter defibrillators and men were predicted to be physically active. Persons who have had an implantable cardioverter defibrillator for approximately 2 years or more can anticipate that their physical and psychosocial functioning will be similar to that of patients who have myocardial infarction or dysrhythmia.

Adaptation, Psychological↗

PubMed2005

Sexual abuse history and treatment outcomes among women undergoing methadone treatment.

Women entering drug abuse treatment programs who report a history of sexual abuse are also likely to report poorer psychosocial functioning, more drug-related problems, and more family-of-origin problems. This study investigates outcome differences at follow-up between women with and those without sexual abuse histories who were treated at an outpatient methadone treatment program. Follow-up interviews were conducted with 98 women, 40% of whom reported prior sexual abuse. Those with a history of sexual abuse who reported problems at intake with psychosocial functioning and family support continued to report such problems at follow-up as compared with the women without a history of sexual abuse. However, no difference was found at follow-up between women with and those without sexual abuse histories in terms of drug use, employment, criminality, or HIV-risky behaviors. The findings suggest that sexual abuse history alone cannot predict treatment outcomes for women in methadone treatment. The implications of these findings are discussed in terms of treatment process and services.

Adult↗

PubMed2004

Schneiderian first rank symptoms predict poor outcome within first episode manic psychosis.

BACKGROUND: The validity of a sub-classification of affective psychosis according to the mood congruence of psychotic features has been questioned in the literature. While some authors have found a correlation between such symptoms and outcome, their predictive value was rather limited in these studies. METHOD: Prospective study of 108 subjects presenting with a first DSM-III-R manic episode with psychotic features to determine the frequency of different types of psychotic symptoms and to measure the predictive utility of mood incongruent psychotic symptoms (MIPS) and first-rank Schneiderian symptoms (FRSS) during the first episode for a 12-month outcome. Outcome was measured by the level of positive, negative, depressive symptoms, and psychosocial functioning. Duration of affective and psychotic symptoms was also assessed. RESULTS: Patients presented with a wide variety of psychotic symptoms. The presence of MIPS at baseline was significantly correlated with a longer persistence of psychotic symptoms, but not with poorer outcome at 12 months. By contrast, the presence of FRSS at baseline was significantly associated with earlier onset of psychosis as well as increased severity of negative symptoms and poorer psychosocial functioning after 12 months. CONCLUSION: The presence of FRSS during a first manic episode with psychotic features identifies a sub-group of patients with more severe presentation and poorer short-term outcome. These results question the prognostic utility of MIPS. LIMITATIONS: Despite the relatively large number of subjects compared with other studies, the statistical power to detect all but large effect sizes is limited by the sample size.

Adult↗

PubMed2004

Long-term negative impact on quality of life in patients with successfully treated Cushing's disease.

OBJECTIVE: A cohort of pituitary tumour patients, who had undergone definitive treatment within a 15-year period at a single neuroscience centre, were investigated as to whether there were differences in psychological well-being and psychosocial functioning, dependent on endocrine pathology and treatment variables. DESIGN: A detailed assessment of 114 patients with benign pituitary tumours in relation to primary diagnosis and mode of treatment was carried out. Psychological rating scales used were: the Hospital Anxiety and Depression Scale--UK version (HADS-UK), the World Health Organization Quality of Life Scale--abbreviated version (WHOQOL-BREF), General Health Questionnaire 28 (GHQ-28), the Functional Assessment of Cancer Therapy (FACT) and the Social Adjustment Scale--modified (SAS1 and SAS2; the former completed by the patient and the latter by another person who knows the patient well). All Cushing's patients were biochemically cured as defined by a normal 24-h urine free cortisol excretion within the previous 6 months. RESULTS: Patients with treated Cushing's disease had significantly impaired psychological well-being and psychosocial functioning across all tested domains compared with all other pituitary tumours, where scores were similar. When participants with Cushing's disease were excluded, patients who had undergone transfrontal surgery scored significantly higher on GHQ and HADS ratings than transsphenoidally treated patients. CONCLUSION: Cushing's disease even when biochemically stable has long-term adverse effects on mood and social functioning. We hypothesize that this may be related to irreversible changes in central neural function. Further studies are necessary to define the precise pathways involved.

Adenoma↗