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Results for “Psychosocial functioning”

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PubMed2004

Thirty month outcome from early childhood head injury: a prospective analysis of neurobehavioural recovery.

Traumatic brain injury (TBI) is a common cause of acquired disability during childhood. While much is now known about outcome following TBI in the school-aged population, recovery in infants and young children is less well documented. The aim of this study was to examine neurobehavioural function following TBI during early childhood, to plot recovery over the 30 months post-injury and to identify predictors of outcome. The study compared three groups of children, sustaining injuries of different severity (mild = 14, moderate = 46, severe = 24), aged 2.0-6.11 years at injury, with a healthy control group (n = 33). The groups were similar with respect to pre-injury adaptive and behavioural function, psychosocial characteristics, age and gender. Using a prospective, longitudinal design, intellectual, language and memory functions were investigated acutely post-injury and again at 12 and 30 months post-injury. Results suggested a strong association between injury severity across all neurobehavioural domains. Further, 30 month outcome was predicted by multiple factors including injury severity, socio-economic status, pre-injury adaptive abilities and age, with pre-injury child behaviour and specific lesion characteristics playing surprisingly little role. In conclusion, children with more severe injuries, lower pre-injury adaptive abilities and lower socio-economic status are at greatest risk of long-term neurobehavioural impairment, even several years post-injury.

Child↗

PubMed2000

Patients' own reasons and patient-perceived recommendations for orthognathic surgery.

In an attempt to learn more about patients' decision-making processes, an analysis was performed to examine patients' reasons for undergoing orthognathic surgery and their understanding of the reasons surgery was recommended. Before surgery, 105 females and 38 males completed an open-ended questionnaire in which they listed their reasons for choosing orthognathic surgery and their perceptions of their orthodontists' recommendations. Three raters classified the responses into 7 categories: esthetics, psychosocial, functional, TMJ/pain, authority, prevention, and other. Rater agreement ranged from a kappa of.55 to 1.00. Patients reported undergoing orthognathic surgery primarily for esthetic, functional, and TMJ improvements, 71%, 47%, and 28%, respectively. Females reported more TMJ-related reasons than males (P <.05). Patients reporting function (P <. 05), TMJ (P <.05), and prevention of future problems (P <.05) were older than patients not reporting these reasons. Mexican American patients indicated more psychosocial reasons (P <.05) than European Americans. Patients understood that orthognathic surgery was recommended primarily for esthetic, functional, and TMJ improvements, 52%, 44%, and 18%, respectively. Males reported receiving more preventative recommendations (23%) than females (10%). Mexican American patients reported receiving more psychosocial recommendations (P <.05) than European Americans. Agreement between each paired patient/patient-perceived reason was highest for TMJ problems (kappa = 0.588). In conclusion, patients underwent orthognathic surgery to improve esthetic, functional and TMJ problems and interpreted orthodontists' recommendations for similar reasons. On a case-to-case basis, agreement between patient and orthodontist-represented reasons was modest, suggesting differences between patients' own reasons and their perceptions of orthodontists' recommendations.

Adolescent↗

PubMed2002

Emotional Disturbances Following Traumatic Brain Injury.

Mood disturbances are common sequelae of traumatic brain injury (TBI), but the scientific database for such disorders is very limited in descriptive, prognostic, and treatment data. Post-TBI symptoms often cross diagnostic boundaries and include cognitive loss, amotivation, psychosis, mood, changes, or other domains. The treating physician must be mindful that clear diagnostic boundaries may not exist. Premorbid level of functioning commonly affects post-TBI level of functioning. When setting treatment goals, this must be considered. Patients who had lower levels of psychosocial functioning before the injury may not fare as well afterwards. Treatment of post-TBI mood symptoms should proceed after a full diagnostic work-up including imaging and electroencephalographic (EEG) studies, neuropsychologic testing, and physical and laboratory examinations. Once the diagnostic picture is established, treatment should then proceed with a multidisciplinary team (physician, social worker, neuropsychologist, and others). For the medications, consider both target symptoms and side effects; start medications with low doses and raise slowly, give full therapeutic trials before switching or adding second agents, avoid benzodiazepines if possible, limit anticholinergic or antidopaminergic agents, and avoid providing large quantities of lethal medications. When starting medications for the treatment of mood disorders following TBI, several general principles of treatment in this population should be considered, including: balancing treatment of target symptoms with the potential for adverse effects; making use of side effects to treat comorbid problems when present (ie, relatively antidepressant for depression and marked insomnia); using a "start low, go slow" approach; continuing dose escalation to full therapeutic levels (ie, completing therapeutic trials) before switching or adding augmenting agents; avoiding agents with predictable and functionally important adverse effects (ie, benzodiazepines, strongly anticholinergic or antidopaminergic agents); and avoiding prescription of large and potentially lethal quantities of medications.

Journal Article↗

PubMed2001

West syndrome: long-term prognosis and social aspects.

West syndrome (WS) is commonly associated with a poor long-term outcome including a small but significant mortality, infantile spasms that are resistant to treatment, the development of other seizure types and impaired cognitive and psychosocial functioning. It is important to understand that the families of these children also experience significant psychosocial morbidity, which is usually, but not invariably, correlated with persisting seizures beyond the first or second year of life. One of the fundamental points about the prognosis of this epilepsy syndrome is that the natural history (i.e. the outcome of spasms without any medical or surgical intervention) is not known. Numerous factors have been implicated as being important in influencing the long-term prognosis of children with WS. However, the majority of these factors have been identified from retrospective and markedly heterogeneous studies, including different populations and different treatment regimes. The most important prognostic factors are generally recognised to be the underlying aetiology of the syndrome and the presence or absence of pre-existing seizures and/or developmental abnormalities. The rapidity with which the diagnosis is made and treatment started from the onset of spasms (often termed the 'treatment lag') is a possible, though controversial and as yet unproven, factor in the prognosis of WS.

Humans↗

PubMed2000

Older adult treatment outcome following elder-specific inpatient alcoholism treatment.

This study examined multidimensional 6-month outcomes of elder-specific inpatient alcoholism treatment for 90 participants over the age of 55. At baseline, physical health functioning was similar to that reported by seriously medically ill inpatients in other studies while psychosocial functioning was worse, and nearly one third of the sample had comorbid psychiatric disorders. Based on 6-month outcomes, participants were classified into the following groups: Abstainers, Non-Binge Drinkers, and Binge Drinkers. The groups did not differ on any baseline measures (demographics, drinking history, alcohol symptoms and age of onset, comorbidity, or length of treatment). General health improved between baseline and follow-up for all groups. Psychological distress decreased for Abstainers and Non-Binge Drinkers, but did not change for Binge Drinkers. Results suggest that a large percentage of older adults who receive elder-specific treatment attain positive outcomes across a range of outcome measures.

Aged↗

PubMed2005

Review article: psychosocial factors in the quality of life of patients with inflammatory bowel disease.

Information on quality of life in inflammatory bowel disease is limited. Despite the clear importance of this topic to patients, quality of life measurement is seldom undertaken in day-to-day management of patients or included in clinical trials. Although previous reviews have dealt with quality of life, the area of psychosocial functioning has not been specifically addressed. The aim of this study was to review the psychosocial factors affecting quality of life in patients with inflammatory bowel disease, using an electronic search of MEDLINE, EMBASE, CINAHL and psycINFO. Of the 751 articles identified by the search, 107 were considered relevant and included in the review. A number of psychosocial factors appear to be important, including gender, socioeconomic status, ethnicity and perceived stress. To improve the quality of life in patients with inflammatory bowel disease, clinicians' attention needs to be drawn towards this subject, with an awareness of those patient groups more vulnerable to impaired quality of life. These identified variables also represent important factors, which should be adjusted for when conducting research into quality of life in these patients.

Adaptation, Psychological↗

PubMed1988

The management of children with spinal dysraphism.

Improvements in technology have dramatically increased the survival of children with spinal dysraphism. Because this complex condition affects multiple organ systems as well as the psychosocial functioning of the child and family, these children require care from a host of specialists in order to achieve optimum functioning. This article reviews the pathophysiology and discusses the current management of the medical and psychosocial effects of spinal dysraphism. It also briefly discusses strategies for intervention, long-term outcomes, and some controversies regarding care and screening.

Child↗

PubMed2002

Posttraumatic stress disorder and quality of life: results across 64 weeks of sertraline treatment.

OBJECTIVE: The goal of the current study was to characterize the quality of life (QOL) and functional impairment associated with posttraumatic stress disorder (PTSD) and to report the QOL/functional response over the course of long-term treatment. METHOD: QOL and psychosocial functioning were analyzed in 359 randomly assigned patients across a 3-phase study of sertraline in the treatment of chronic DSM-III-R-defined PTSD: (1) 12 weeks of double-blind, placebo-controlled acute treatment with sertraline in flexible doses of 50 to 200 mg/day, (2) 24 weeks of open-label continuation treatment with sertraline among all study completers (regardless of initial study drug assignment or endpoint responder status), and (3) 28 weeks of double-blind, placebo-controlled maintenance treatment with sertraline in continuation phase responders. Assessments included the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), emotional role functioning and mental health subscales of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), as well as the occupational and social functioning items on the Clinician-Administered PTSD Scale, Part 2 (CAPS-2). RESULTS: At acute phase baseline, QOL was significantly impaired as reflected by a mean Q-LES-Q score of 56% of the total possible score and a CAPS-2 social/occupational impairment composite score of 4.4. Sertraline treatment was associated with marked improvement on all QOL/functional measurements: at the end of the acute treatment phase, 58% of responders on treatment with sertraline had achieved Q-LES-Q total scores within 10% of community norms. Twenty-four weeks of continuation treatment led to an additional 20% improvement in QOL and measures of functioning. Double-blind discontinuation of sertraline resulted in recurrence of PTSD symptoms and a worsening of QOL and functional measures, although the degree of exacerbation in symptomatology and psychosocial impairment was notably less than at study entry. CONCLUSION: Sertraline treatment of chronic PTSD is associated with rapid improvement in quality of life that is progressive and sustained over the course of more than 1 year of treatment.

Adaptation, Psychological↗

PubMedDate not supplied

Psychosocial factors and perceived severity of functional dyspeptic symptoms: a psychosocial interactionist model.

OBJECTIVE: A psychosocial interactionist model was presented to provide a systematic account of individual differences in perceived functional dyspeptic symptom severity. METHODS: In a population-based survey, 4038 Hong Kong subjects (age 18-80 years) were interviewed. Five hundred ninety interviewees (14.6%) met the diagnostic criteria for functional dyspepsia (FD), and 396 of them participated in this study. RESULTS: Results from multiple regression analyses revealed significant main effects of monitoring, emotional support, and coping flexibility on perceived FD symptom severity. A significant emotional support by coping flexibility interaction effect was also found. CONCLUSIONS: The present findings provided support for the psychosocial interactionist model in showing that (1) monitoring is a risk factor related to greater perceived symptom severity, (2) emotional support and coping flexibility are resource factors related to lower perceived symptom severity, and (3) the beneficial role of emotional support is present only among those higher in coping flexibility but not among those lower in coping flexibility.

Adolescent↗

PubMed2004

A randomized control trial of group counseling in a naltrexone treatment program.

This study evaluated the additional effectiveness of a 12-week manualized group counseling program over a structured naltrexone treatment program. The randomized controlled trial, the first of its kind in Australia, was conducted at Turning Point Alcohol and Drug Centre, Melbourne, Australia. Ninety-seven participants received a 50 mg dose of naltrexone daily and were randomized to either the experimental (n = 52) or control (n = 45) conditions. The experimental group received a structured group counseling program, which used a cognitive-behavioral relapse prevention approach. Using intention-to-treat analyses, there was only one statistically significant difference between the groups, with the control group reporting a significantly higher level of physical functioning at Week 6. All participants improved significantly in their level of heroin use and in psychosocial functioning between Baseline and Weeks 6, 12, and 24. It is not possible to conclude from these results whether or not group counseling provides additional benefit to naltrexone treatment.

Adult↗

PubMed2004

Reductions in stress and depressive symptoms in mothers of substance-exposed infants, participating in a psychosocial program.

OBJECTIVE: Depression profoundly impairs psychosocial functioning. Depression can have disruptive effects on a person's family, with significant impact on the psychosocial development of the children. Recent research suggests that a mother's depressive symptoms may increase parenting stress and that parenting stress may, in turn, increase depressive symptoms, with a possible negative cycle to this process. Little is known about how these two factors interact in drug-involved mothers. This study examines how the NEW CONNECTIONS intervention (a parental education and support program for drug-involved parents) acts on parental stress and symptoms of depression. METHODS: The study site was the NEW CONNECTIONS Infant Intervention Program. The Beck Depression Inventory-II (BDI-II) and the Parenting Stress Index (PSI) were administered to drug- and alcohol-involved mothers (N = 120) at baseline and after the intervention (Week 12). RESULTS: Four of the seven PSI domains of parenting stress showed a significant reduction (Demandingness, Competence, Isolation, and Role Restriction). Changes in four domains were significantly correlated with reductions in depressive symptoms (Competence, Isolation, Attachment, and Role Restriction). There was a significant reduction in depressive symptoms as measured by the BDI-II. CONCLUSION: Reduction in some aspects of parenting stress is associated with reduction in depressive symptoms in mothers of substance-exposed infants who participated in the NEW CONNECTIONS psychosocial intervention targeting the parent-child relationship.

Adult↗

PubMed1991

A biopsychosocial examination of symptomatic and asymptomatic HIV-infected patients.

This study evaluated twenty-nine symptomatic and asymptomatic HIV-infected homosexual/bisexual men between eighteen and forty-five in the areas of psychiatric/psychosocial, neuropsychological, family, and immunological functioning. The subjects were referred by physicians, nurses, and mental health professionals from the Tulane/Louisiana State University AIDS Clinical Trials Unit and the C-100 outpatient Primary Care Clinic for HIV-infected patients served within the Charity Hospital of Louisiana at New Orleans. All subjects and their significant others were evaluated between November 1987 and October 1988 at the C-100 Clinic. The outcome measures were mood disturbance, psychological distress, and CD4 cell count. The most significant other family member, as selected by each subject, completed family measures. The subjects experienced psychological distress and neuropsychological problems. Active-behavioral coping appeared adaptive (related to enhanced mood) as did perceived social support (related to positive mood and lower psychological distress). Higher levels of neuropsychological functioning (verbal memory, visual memory, motor speed, and visual-motor sequencing) were associated with enhanced psychosocial functioning and/or immunological status. The findings from this study highlight the importance of conducting longitudinal studies using a multidimensional approach in which HIV-infected persons and their most significant other family members are evaluated within a biopsychosocial model.

AIDS Dementia Complex↗

PubMed1989

Psychosocial screening in pediatric practice: identifying high-risk children.

The purpose of this study was to evaluate the effectiveness of the Pediatric Symptom Checklist (PSC) as a psychosocial screening instrument. Using the PSC, the researchers screened 212 patients, ages 6-12 years, at a military outpatient pediatric clinic. Twenty-one children with scores in the "high-risk" range were randomly selected and matched with children scoring in the normal, "not-high-risk" range. Two trained interviewers, blind to individual PSC scores, independently interviewed and rated each subject's level of psychosocial functioning on the Children's Global Assessment Scale (CGAS). The Child Behavior Checklist (CBCL), a standardized psychosocial measure, was also completed by each subject's mother. PSC scores were compared to the CGAS and CBCL scores in terms of sensitivity and specificity. Additional analyses compared data from the study sample with that of previous studies. Results suggest that the PSC is a valid pediatric psychosocial screening instrument for multiethnic patient populations.

Child↗

PubMed1992

Psychiatric and family functioning in children with leukemia and their parents.

The present study reports data from a cross-sectional investigation of the psychiatric and psychosocial functioning of 55 children diagnosed with acute lymphocytic leukemia and their families at three points in time: diagnosis (newly diagnosed), 1 year postdiagnosis, and 1 year after the completion of chemotherapy (off-therapy). Results reveal minimal psychopathology in these children and their parents based on self- and informant-reports and structured diagnostic interviews. These families appear to be functioning adequately and report more family cohesiveness and marital satisfaction after chemotherapy was completed. Coping strategies commonly used by children and their parents include problem-solving, a positive outlook, and good communication. Implications for psychiatric consultation are presented.

Adaptation, Psychological↗

PubMed1990

Quality of life in elderly patients with chronic nonspecific lung disease seen in family practice.

We studied the quality of life of elderly patients with chronic nonspecific lung disease (CNSLD) in family practice. We also investigated the relationship between patients' somatic condition and their quality of life. Seventy patients, aged 40 years or older, with a diagnosis or symptoms of CNSLD completed the Sickness Impact Profile (SIP) and the list of daily activities (DAL). Pulmonary function (FEV1, IVC) and respiratory symptoms were assessed. The results indicated that patients were more impaired in their physical and psychosocial functioning than healthy control subjects. Most lung function parameters showed no correlation with the SIP scores. The respiratory symptoms of wheezing and dyspnea were related to patients' quality of life. Patients with chronic obstructive pulmonary disease (COPD) were more restricted in their daily functioning than patients with asthma. Since the relationship between patients' somatic condition and their quality of life is weak, we recommend comprehensive care that encompasses psychosocial as well as somatic interventions.

Activities of Daily Living↗

PubMed1993

Measuring the impact of epilepsy: the development of a novel scale.

The impact of a chronic illness is experienced not only through its physical symptoms, but also as a result of its effect on psychosocial functioning. In the case of an illness such as epilepsy, where the physical manifestations are transient, the psychosocial consequences may, with time, come to be of greater concern. We have been involved in developing a quality of life model for epilepsy. As part of the refinement of the initial model, we have devised a novel scale to measure the impact of the condition on a number of different aspects of daily life. The scale was administered to 75 patients attending an epilepsy out-patient clinic. Initial analysis of its psychometric properties is encouraging, although the inclusion of an item relating to employment reduced the scale's reliability. As a result, the wording of the existing item has been amended and an additional item has been incorporated. We hope the scale will be useful in investigations of treatment for epilepsy and of its psychosocial aspects.

Adolescent↗

PubMed2004

Educational disadvantage impairs functional recovery after hospitalization in older persons.

PURPOSE: To determine whether low educational level is associated with poor functional recovery after hospitalization in older adults. METHODS: We followed 862 patients (374 with low education, defined as <high school) for 6 months after hospitalization. Poor functional recovery was defined as an Activities of Daily Living score that was lower 6 months after hospitalization than 1 month before hospitalization. People who died were also considered to have poor recovery. RESULTS: Of the 862 participants, 351 (41%) experienced poor functional recovery: 124 died and 227 had declines in activities of daily living. There was a graded, statistically significant relation between level of education and poor functional recovery, regardless of impairment of activities of daily living at baseline. Poor functional recovery was more common in subjects with baseline impairment (50% [147/296]) than in those without baseline impairment (36% [204/566]). Independent predictors of poor functional recovery were low education, cognitive impairment, lack of social support, poor self-rated health, and high comorbidity. Sequential addition of demographic, economic, functional, psychosocial, and clinical factors to low education only modestly affected the association between low education and poor functional recovery. CONCLUSION: Educational disadvantage impairs functional recovery after hospitalization in older persons.

Activities of Daily Living↗

PubMed2003

A short psychosocial questionnaire for patients with Parkinson's disease: the SCOPA-PS.

The purpose of this study was to develop a short questionnaire for psychosocial functioning in patients with Parkinson's Disease (PD). The SCales for Outcomes in Parkinson's disease-PsychoSocial questionnaire (SCOPA-PS) was tested in a survey and compared with other instruments and with medical information. This survey was sent to 205 patents with idiopathic PD. Eighty-six percent of the questionnaires were returned. Cronbach's alpha was 0.83. Two-week test-retest reliability was 0.85 (intraclass correlation coefficient). Construct validity with other scales (Spearman's rho) was 0.82 for the Parkinson's Disease Questionnaire-39-item version (PDQ-39), 0.76 for the PDQ-8, 0.69 for the Hospital Anxiety and Depression Scale, -0.61 for the Euroqol, and -0.60 for a visual analogue scale evaluating Quality-of-Life. The summary index revealed a significant increase with increasing disease severity. The SCOPA-PS is a new, short psychosocial questionnaire for patients with PD with good clinimetric properties.

Activities of Daily Living↗