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Results for “Psychosocial functioning”

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PubMed2004

Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder.

OBJECTIVE: The study aims were to address neuropsychological functioning across different states of bipolar illness and to determine relationships among clinical features, neuropsychological performance, and psychosocial functioning. METHOD: Several domains of cognitive function were examined in 30 depressed bipolar patients (DSM-IV criteria for major depression, Hamilton Depression Rating Scale score > or = 17), 34 manic or hypomanic bipolar patients (DSM-IV criteria for manic or hypomanic episode, Young Mania Rating Scale score > or = 12), and 44 euthymic bipolar patients (6 months of remission, Hamilton depression scale score < or = 8, and Young Mania Rating Scale score < or = 6). The comparison group consisted of 30 healthy subjects without history of neurological or psychiatric disorders. A neuropsychological battery assessed executive function, attention, and verbal and visual memory. RESULTS: The three groups showed cognitive dysfunction in verbal memory and frontal executive tasks in relation to the comparison group. Low neuropsychological performance was associated with poor functional outcome. Impairment of verbal memory was related to the duration of illness and the numbers of previous manic episodes, hospitalizations, and suicide attempts. CONCLUSIONS: A poorer performance was observed in all bipolar groups regarding executive function and verbal memory in relation to the healthy comparison subjects. These cognitive difficulties, especially related to verbal memory, may help explain the impairment regarding daily functioning, even during remission. Further studies should focus on testing, whether optimizing prophylactic pharmacological treatment and psychoeducation might reduce cognitive impairment, and whether bipolar patients would benefit from neuropsychological rehabilitation in order to reduce the impact of cognitive impairment in their overall functioning.

Adult↗

PubMed1991

Differences in the impact and management of heart disease between older women and men.

Findings are presented from an exploratory study of differences in the impact and management of heart disease between men and women aged 60 and over (N = 323). The sample consisted of ambulatory, non-institutionalized, cardiac patients who had agreed to participate in a self-management intervention study. Differences between men and women were found regarding symptom experience, physical functioning, exercise compliance, use of prescribed drugs, and physician/clinic visits. Differences in emotional well-being and psychosocial functioning were not found; however, women reported more stress and limitation in the area of household management. Implications for future research and practice are discussed.

Activities of Daily Living↗

PubMed1997

Relationship between self-rated functional status and psychosocial stress in patients suffering from rheumatoid arthritis.

BACKGROUND: To assess relationship between psychosocial factors and self-rated functioning in rheumatoid arthritis (RA). METHODS: In 66 RA patients (mean age +/- SD = 50.8 +/- 12.6 years, women 49 (74%), illness duration mean +/- SD = 13.4 +/- 10.5 years) aspects of developmental psychosocial stress thought to influence human behavior were assessed in an in depth interview using structured biographical history. Furthermore evaluation included Trait anxiety, global functional status according to the ACR criteria, radiological staging of illness and patients' self-ratings of functioning obtained by the Health Assessment Questionnaire (HAQ). Bivariate correlations were performed using psychosocial and somatic factors and self-rated functional status. RESULTS: Scores of developmental psychosocial stress significantly correlated with interviewers scoring of nurture (r = -0.722, p < 0.001) indicating good internal consistency of interview data. Significant correlations were found between patients' scoring of functional status (HAQ) and (i) ACR criteria (r = 0.490, p < 0.0001) and (ii) score of Trait anxiety (r = 0.367, p < 0.003). There was no significant correlation between developmental psychosocial stress and HAQ score. CONCLUSION: Developmental psychosocial stress does not significantly contribute as to how RA patients perceive their functional ability. In a proportion of RA patients self-rated functional status may depend on the patients disposition (e.g. neuroticism) probably promoting impaired illness behavior (e.g. regressive tendencies) which should be considered in assessing treatment procedures.

Anxiety↗

PubMed2007

Factors associated with health-related quality of life in pediatric cancer survivors.

BACKGROUND: Childhood cancer survivors are at risk for late effects of disease and treatment that may be attributed to multiple causes. This study describes health-related quality of life (HRQOL) in childhood cancer survivors and identifies factors related to poor quality of life outcomes. PROCEDURE: Patients age 8-18 years, who attended the long-term information, follow-up, and evaluation (LIFE) clinic at Childrens Hospital Los Angeles during a 1-year time-period were eligible for the study. Eighty-six survivors (mean time off-treatment=7.8 years) completed the Pediatric Quality of Life Inventory 4.0 Generic Core Scales, a LIFE Clinic Intake Questionnaire and rated their fatigue using a 10-point scale. Oncology nurses independently rated subjects' late effects using a 3-point severity scale. Linear regression procedures were used to evaluate the association between demographic and medical factors and HRQOL. RESULTS: Fatigue and more severe late effects were associated with poorer physical functioning (fatigue, P<0.02; late effects, P<0.01). Fatigue, ethnic minority status, and a brain tumor diagnosis were associated with poorer psychosocial functioning (fatigue, P<0.0001; minority status, P<0.04; brain tumor, P<0.01). Fatigue was the only factor related to both poor physical and psychosocial HRQOL. CONCLUSIONS: Long-term follow-up clinics for childhood cancer survivors are in a unique position to monitor HRQOL over time. Factors associated with poorer HRQOL include fatigue, ethnic minority status, a brain tumor diagnosis, and more severe late effects. Future studies need to clarify relationships between ethnicity, socioeconomic status (SES), and HRQOL in cancer survivors.

Activities of Daily Living↗

PubMed2001

Age and functioning after mild traumatic brain injury: the acute picture.

HYPOTHESIS: There will be acute harbingers of poor outcome following mild traumatic brain injury (TBI) in the elderly. PARTICIPANTS: Twenty-six subjects age 60 and over were compared to 30 subjects aged 18-59, seen within 1 month, on average, following a mild TBI. MAIN OUTCOME MEASURES: Functioning was assessed using the Glasgow Outcome Scale (GOS), a global measure of outcome, as well as self-report measures of psychosocial functioning, physical symptoms and psychological distress. RESULTS: Contrary to the hypothesis, the older group did better than their younger counterparts on the GOS (p = 0.002), and reported less psychosocial impairment (p < 0.0001), less psychological distress (p = 0.002), and less physical symptoms (p = 0.005). However, once employment was controlled for, these results only approached statistical significance. DISCUSSION: The assumption that elderly subjects have a worse outcome following TBI needs to be reconsidered, at least within the acute recovery period. The importance of psychosocial factors as modifiers of outcome according to age are emphasized. Whether this finding holds true over a longer follow-up period is the subject of ongoing research.

Acute Disease↗

PubMed2005

Dimensional representations of DSM-IV personality disorders: relationships to functional impairment.

OBJECTIVE: This study compared three-dimensional representations of DSM-IV personality disorders and standard categories with respect to their associations with psychosocial functioning. METHOD: Six hundred sixty-eight patients with semistructured interview diagnoses of schizotypal, borderline, avoidant, or obsessive-compulsive personality disorders or with major depressive disorder and no personality disorder completed questionnaires assessing three-factor and five-factor dimensional models of personality. Personality disorder categories, dimensional representations of the categories based on criteria counts, and three- and five-factor personality dimensions were compared on their relationships to impairment in seven domains of functioning, as measured by the Longitudinal Interval Follow-up Evaluation-Baseline Version. RESULTS: Both the categorical and dimensional representations of DSM-IV personality disorders had stronger relationships to impairment in functioning in the domains of employment, social relationships with parents and friends, and global social adjustment and to DSM-IV axis V ratings than the three- and five-factor models. DSM-IV dimensions predicted functional impairment best of the four approaches. Although five-factor personality traits captured variance in functional impairment not predicted by DSM-IV personality disorder dimensions, the DSM-IV dimensions accounted for significantly more variance than the measures of personality. CONCLUSIONS: Scores on dimensions of general personality functioning do not appear to be as strongly associated with functional impairment as the psychopathology of DSM personality disorder. A compromise in the ongoing debate over categories versus dimensions of personality disorder might be the dimensional rating of the criteria that comprise traditional categories.

Adaptation, Psychological↗

PubMed2006

Functional dyspepsia: are psychosocial factors of relevance?

The pathogenesis of Functional Dyspepsia (FD) remains unclear, appears diverse and is thus inadequately understood. Akin to other functional gastrointestinal disorders, research has demonstrated an association between this common diagnosis and psychosocial factors and psychiatric morbidity. Conceptualising the relevance of these factors within the syndrome of FD requires application of the biopsychosocial model of disease. Using this paradigm, dysregulation of the reciprocal communication between the brain and the gut is central to symptom generation, interpretation and exacerbation. Appreciation and understanding of the neurobiological correlates of various psychological states is also relevant. The view that psychosocial factors exert their influence in FD predominantly through motivation of health care seeking also persists. This appears too one-dimensional an assertion in light of the evidence available supporting a more intrinsic aetiological link. Evolving understanding of pathogenic mechanisms and the heterogeneous nature of the syndrome will facilitate effective management. Co-morbid psychiatric illness warrants treatment with conventional therapies. Acknowledging the relevance of psychosocial variables in FD, the degree of which is subject to variation, has implications for assessment and management. Available evidence suggests psychological therapies may benefit FD patients particularly those with chronic symptoms. The rationale for use of psychotropic medications in FD is apparent but the evidence base to support the use of antidepressant pharmacotherapy is to date limited.

Adaptation, Psychological↗

PubMed2006

Home treatment for children and adolescents with psychiatric disorders.

The study examines the effectiveness of home treatment in 70 children and adolescents (aged 6-17 years) with heterogeneous psychiatric disorders. Home treatment was offered to parents/children as an alternative to inpatient treatment (no randomized group assignment). Interventions were carried out by psychiatric nurses (n = 38) and medical students (n = 32) under the supervision of experienced child psychiatrists. Assessment of treatment effects was based on a structured parent interview and parents', children's and therapists' ratings of various aspects of psychosocial functioning. Pre- or post-treatment comparisons indicate significant improvement of psychiatric symptoms, severity of the disorder, and psychosocial adjustment after three months of home-based interventions. Outcome of behavioral interventions carried out by experienced nurses was superior, compared to treatment effects achieved by advanced medical students. Post-treatment comparison of home-based (n = 70) and inpatient-based (n = 35) treatment effects suggests that inpatient treatment all in all was more effective. At one-year follow-up, however, the effects of home treatment were maintained in a higher number of patients, compared to the stability of effects seen after psychiatric hospitalization. Thus, home treatment appears to be an effective treatment setting. Motivation and compliance of patient and parents, and high skills of the therapists are key ingredients for the success of a home-based treatment program.

Adolescent↗

PubMed2004

Neuropsychological outcome of infant heart transplant recipients.

OBJECTIVE: To assess long-term neuropsychological outcomes of infant heart transplant recipients. STUDY DESIGN: Fifty-five children (mean age, 6.4 years) with a primary diagnosis of hypoplastic left heart syndrome or other cardiac disorders participated in the study. Six areas of risk were assessed (birth; preoperative, intraoperative, and postoperative status; long-term medical complications; and socioeconomic factors). Neuropsychological evaluations included the following: Wechsler Scales of Intelligence, Wechsler Individual Achievement Test, Berry Visual Motor Integration Scale, Comprehensive Evaluation of Language Function, and Achenbach Child Behavioral Checklist. RESULTS: Intellectual functioning scores revealed a mean full-scale IQ of 81 +/- 19. Intraoperative and postoperative variables (bypass time, hospital course, and lowest posttransplant pH), long-term medical complications (serious infections and posttransplant surgical procedures), and socioeconomic factors were associated with cognitive functioning. Visual-motor functioning was also related to bypass and total support time. CONCLUSIONS: Long-term outcomes reveal low-average neuropsychological functioning and are related to intrasurgical-postsurgical, long-term medical, and socioeconomic factors. The neuropsychological and psychosocial functioning of infant heart transplant recipients will be important to address as they mature during adolescence and adulthood.

Child↗

PubMed1985

Cystic fibrosis in adult life: a study of coping patterns.

Despite comparable degrees of physical disability, some patients with cystic fibrosis (CF) cope more successfully than others with the difficulties of competitive adult life. This study found substantial differences between a coping and non-coping sample of adult CF patients. Non-copers had twice as many hospital admissions as copers over a year, even though their ventilatory function was better. The non-coping sample compared unfavourably with the copers in four main spheres of psychosocial functioning--their vocational records; level of family support; awareness of anomalies in sexual function; and knowledge about CF.

Adolescent↗

PubMed1998

Two-year outcome in first-episode schizophrenia: predictive value of symptoms for quality of life.

OBJECTIVE: Many studies have validated the grouping of schizophrenic symptoms into three independent dimensions: negative, psychotic, and disorganized. Negative symptoms are considered to be an important prognostic indicator, but this clinical observation requires further empirical study, especially with respect to psychosocial functioning. When present at the onset of the first episode, negative symptoms suggest that the patient will develop significant psychosocial impairment. The predictive values of the psychotic and disorganized symptom dimensions, on the other hand, have been less certain. METHOD: In this study of 50 first-episode schizophrenic patients, who were mostly neuroleptic-naive at intake, the authors examined the relationship between the severity of these three symptom dimensions (measured by using the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms) at index hospitalization and quality of life at 2-year follow-up. RESULTS: Negative symptom severity was positively and significantly correlated with later occupational impairment, financial dependence on others, impaired relationships with friends, impaired ability to enjoy recreational activities, and global assessment of functioning. The magnitudes of correlation between the levels of psychotic symptoms or disorganized symptoms and 2-year quality of life measures were comparatively lower. Analyses using multivariate regression statistics also revealed similar findings. CONCLUSIONS: Severity of negative symptoms at index hospitalization may be a portent of poor outcome. In general, severity of psychotic or disorganized symptoms at intake does not appear to predict subsequent quality of life.

Adult↗

PubMed2004

Defining remission on the Montgomery-Asberg depression rating scale.

OBJECTIVE: In antidepressant efficacy trials, it is common to define treatment remission as a score below a cutoff on symptom severity measures. No consensus has emerged regarding an appropriate cutoff for defining remission on the Montgomery-Asberg Depression Rating Scale (MADRS). The goal of the present study was to establish an empirically based cutoff on the MADRS for defining remission. METHOD: 303 psychiatric outpatients being treated for a DSM-IV major depressive episode were rated on the Standardized Clinical Outcome Rating for Depression, an index of DSM-IV remission status; the MADRS; and the Global Assessment of Functioning (GAF) scale. We examined the sensitivity, specificity, and overall classification rate of the MADRS for identifying a broad and narrow interpretation of the DSM-IV definition of remission, as well as the association between the breadth of the definition of remission and psychosocial functioning. RESULTS: On the basis of a narrow definition of remission, which requires a complete absence of clinically significant symptoms of depression, the optimal MADRS cutoff was < or = 4. On the basis of a broader definition, the optimal cutoff was < or = 9. Compared with patients scoring 5 through 9 on the MADRS, those who met the narrow definition of remission were rated higher, indicating better functioning, on the GAF and reported significantly less psychosocial impairment (p <.05). CONCLUSION: Our results support the use of a low cutoff on the MADRS to define remission. Because the choice of cutoff will impact the percentage of patients who are considered to be in remission and thus impact conclusions about treatment effectiveness, more empirical study should be directed toward this issue.

Activities of Daily Living↗

PubMed1999

Two-year outcomes of psychosocial rehabilitation of black patients with chronic mental illness.

OBJECTIVE: Outcome as measured by psychosocial functioning was examined in a two-year follow-up study of 46 patients with chronic mental illness, 44 of whom were African American, who participated in an intensive psychosocial rehabilitation program based in a community mental health center. METHODS: Patients attended a program that operated seven days a week in a predominantly urban, black section of Baltimore. Level of functioning was determined at baseline and at six and 12 months using a scale based on data from the 1972 International Pilot Study of Schizophrenia. Parameters assessed included the length of time patients stayed out of the hospital, the frequency and depth of social relationships, dysfunction in work, the presence of symptoms, the ability to maintain personal hygiene, and the ability to participate in leisure activities. RESULTS: The sample was divided into three diagnostic groups: patients with schizophrenia alone (N=27), patients with a mood disorder (N= 12), and patients with a dual diagnosis of schizophrenia and a substance use disorder (N=7). Scores on the level-of-functioning measure were significantly correlated between baseline and six months, between six months and 24 months, and between baseline and 24 months. Statistical tests indicated a substantial and significant increase in level of functioning from baseline to 24 months for all groups. CONCLUSIONS: The results provide evidence for the effectiveness of an intensive psychosocial rehabilitation program for urban, black patients with chronic psychiatric illness, including those with a dual diagnosis.

Adult↗

PubMed2003

Follow-up data their use in evidence-based decision-making.

Experience with certain perinatal interventions, such as supplemental oxygen and dexamethasone, leads to the conclusion that follow-up data are needed to be well informed about the safety of certain perinatal interventions. Experience with indomethacin suggests that follow-up data also are regarded by some clinicians as a necessary aspect of evidence about effectiveness. Ideally, clinical trials of perinatal interventions might involve collection of data about neonatal predictors of outcome (such as a neuroimaging study and a standardized neurologic assessment); several developmental and neurologic assessments before school entry; a comprehensive evaluation of the child's cognitive function, behavioral competencies, and academic performance at 7 to 8 years of age; serial detailed assessments of the family psychosocial functioning; and an inventory of resources available for the child. Many clinical trials have not included follow-up after the neonatal period, and in such cases information about the effect of the intervention on participants' HRQL is incomplete. The approach taken in several recent trials, in which the outcome of interest is neurodevelopmental outcome at 18 months, attempts to strike a balance between a theoretical ideal (a comprehensive, longitudinal follow-up through school age) and a follow-up regimen that is not prohibitively expensive. Such trials include follow-up during the first 1 to 3 years of life, when major disabilities can be identified reliably, thereby providing moderately informative data about participants' eventual quality of life, related to the presence or absence of major disability. If, however, there is reason to suspect that the intervention has effects on the developing brain, follow-up after school entry may provide additional evidence pertinent to the risks and benefits of the intervention.

Child Development↗

PubMed2002

The application of computer touch-screen technology in screening for psychosocial distress in an ambulatory oncology setting.

The objective of the study was to evaluate the acceptability and feasibility of computer touch-screen technology as a method for patients to report psychosocial functioning in an ambulatory cancer clinic. Patients participating in a randomized trial evaluating the use of self-reported psychosocial information in the clinical encounter were surveyed. The patients completed the Cancer Needs Questionnaire (CNQ), European Organization for the Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) and the Beck Depression Inventory - Short Form (BDI) using a touch-screen computer. The time taken to complete the questionnaires was recorded electronically. Patients completed a seven-item pen and paper survey to assess acceptability of the process. Of the 450 patients, 244 (54%) were 60 years or older. Although over half the patients had no prior computer experience, nearly all found the touch screen easy to use and the instructions easy to understand. Each question was answered by at least 447 (99.3%) patients. The average time to complete the CNQ was 9.1 min, EORTC QLQ-C30 4.0 min and BDI 3.1 min. Factors influencing time to completion were prior use of computers, physical condition, education and overall level of needs. The study found that the use of computer touch-screen technology is an acceptable and efficient method for obtaining self-reported information on quality of life, cancer needs and psychological distress.

Adaptation, Psychological↗

PubMed1994

Measuring the functional impact of fatigue: initial validation of the fatigue impact scale.

The fatigue impact scale (FIS) was developed to improve our understanding of the effects of fatigue on quality of life. The FIS examines patients' perceptions of the functional limitations that fatigue has caused over the past month. FIS items reflect perceived impact on cognitive, physical, and psychosocial functioning. This study compared 145 patients referred for investigation of chronic fatigue (ChF) with 105 patients with multiple sclerosis (MS) and 34 patients with mild hypertension (HT). Internal consistency for the FIS and its three subscales was > .87 for all analyses. Fatigue impact was highest for the ChF group although the MS group's reported fatigue also exceeded that of the HT group. Discriminant function analysis correctly classified 80.0% of the ChF group and 78.1% of the MS group when these groups were compared. This initial validation study indicates that the FIS has considerable merit as a measure of patient's attribution of functional limitations to symptoms of fatigue.

Adult↗

PubMed1999

Brief report: parent report about health care use: relationship to child's and parent's psychosocial problems.

OBJECTIVE: To investigate the potential utility of asking parents about health care utilization as a means of identifying individuals at risk for psychosocial problems. METHOD: Parents of 366 children ages 2 to 16 completed questionnaires about their own, their child's, and their family's psychosocial functioning and health care utilization. RESULTS: Children and parents with high health care utilization were more likely to have psychosocial problems than those with low health care utilization. Sensitivity and specificity of health care utilization as a marker for psychosocial problems ranged from 43.8% to 68.8%. CONCLUSIONS: Although high rates of child health care utilization are related to the presence of psychosocial problems, use of this measure alone could result in many false-positive and false-negative identifications. Rather, use of health care utilization data in conjunction with other screening measures may be useful for alerting physicians to the possibility of both child and parent psychosocial problems.

Adolescent↗

PubMed1993

Adaptation to chronic illness: a program of research for testing nursing theory.

The adaptation to chronic illness framework, an elaboration of the Roy adaptation model for chronic illness, provided direction for a program of nursing research. The purposes of investigations within the program were (a) to identify predictors of adaptation to chronic illnesses and (b) to determine whether the relationships between the variables differed by diagnostic group. A total of 597 adults, representing various chronic illness groups, participated in longitudinal studies during a seven-year period. Health-related hardiness and engagement in health promotion activities consistently predicted both physiological and psychosocial adaptation in all chronic illness groups. In addition, the individual's perception of the degree of disability caused by the illness was related to psychosocial functioning. Comparison of adaptive responses between the groups revealed significant differences in physiological adaptation but no significant differences in psychosocial adaptation. Results clarify relationships posited using the theoretical framework and support the value of using nursing models to guide nursing research.

Adaptation, Psychological↗