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PubMedDate not supplied

The use of defenses and physician health care costs: are physician health care costs lower in persons with more adaptive defense profiles?

BACKGROUND: The objective of the present study was to determine if persons who use more adaptive defenses have lower physician health care costs compared to those who use less adaptive defenses. METHODS: We randomly selected 667 persons from the 1995 population-based Nova Scotia Health Survey who completed a videotaped structured interview. Each interview was rated for typical defense use by the Defense-Q. We obtained physician health care costs for 3 months before and after the interview, as well as medical diagnoses and measures of psychological functioning. RESULTS: A more adaptive defense profile significantly predicted lower future physician health care costs. These results were found when controlling for other psychosocial variables, before and after controlling for previous physician health care costs, and when testing only within a physically healthy subsample. Results of secondary analyses showed that a more adaptive defense profile was positively related to a number of psychosocial variables, such as nurse's rating of competence, lack of depressive symptoms, and days at work. CONCLUSIONS: The adaptiveness of a person's defense use in managing affect is important in predicting physician health care costs as well as psychosocial functioning.

Adaptation, Psychological↗

PubMed1999

Fatigue and quality of life in breast cancer patients undergoing autologous stem cell transplantation: a longitudinal comparative study.

As more individuals are being treated for cancer with high-dose therapy and autologous stem cell rescue (ASCR), there is growing interest in treatment side effects and their impact on quality of life. The primary aim of this study was to determine if the severity of fatigue and its impact on quality of life is significantly greater in women undergoing ASCR for breast cancer than in women of similar age with no history of cancer. A group of women being treated with ASCR for breast cancer (n = 31) and a group of women of similar age with no history of cancer (n = 49) participated in this study. Patients completed measures of fatigue and psychosocial functioning prior to treatment, midway through treatment, and toward the end of treatment. Healthy comparison subjects completed the same measures three separate times. Breast cancer patients undergoing ASCR reported significantly more frequent fatigue and more severe fatigue than women with no cancer history. In addition, fatigue had a significantly greater impact on daily functioning and quality of life in patients than in women with no cancer history. Fatigue during ASCR for breast cancer was related to both medical factors (i.e., time since transplant) and psychosocial factors. During ASCR for breast cancer, women experience fatigue which is worse than what is "normally" experienced and which interferes with daily functioning and quality of life. Future research should focus on identifying the biological correlates of fatigue, psychological and physiological mechanisms by which fatigue is produced, and interventions to alleviate fatigue.

Adult↗

PubMed1994

The psychological impact of microvascular free toe transfer for children and their parents.

This paper is based on a prospective study of microvascular toe transfers which examined psychosocial, functional and aesthetic outcome for children with congenital hand anomalies and their parents. 14 families were assessed both pre-operatively and 2 years post-operatively. There were five boys and nine girls. Their ages ranged from 6 months to 13 years (mean age = 5.08 years). The parents were assessed on the basis of a parental adjustment measure, a detailed semi-structured interview and a measure of anxiety and depression. The children were assessed on the basis of behaviour and social competence, social experience, self-consciousness about the hand and the perceptions of their own functional competence. Both parents and children were asked to rate their satisfaction with the hand. In addition, function and appearance was assessed using an independent professional panel. It was found that parental adjustment to the hand was an important independent variable in determining psychosocial outcome. The children of poorly-adjusted parents had more social and psychological problems prior to surgery, and showed an increase in behavioural problems after surgery. Their parents were less anxious and happier after surgery and it was of particular benefit to them. The children of well-adjusted parents had fewer pre-operative problems and showed a general slight improvement after surgery. For all the children, there was a significant improvement in both function and appearance of the hands after surgery.

Adolescent↗

PubMed1992

Clozapine in the treatment of dysphoric mania.

Seven patients with bipolar disorder, characterized by dysphoric mania with psychotic features and chronic disability, refractory to standard treatments and anticonvulsants, all showed marked symptomatic and functional improvement when given the atypical antipsychotic clozapine. During follow-up over 3-5 years, most of the patients sustained substantial gains in psychosocial function; and of the six patients remaining on clozapine, no further hospitalizations were needed. This remarkable improvement in a severely ill group of patients suggests that clozapine may have utility in the treatment of bipolar disorder as well as schizophrenia.

Adult↗

PubMed1995

Patient expectations and postoperative depression, anxiety, and psychosocial adjustment after temporal lobectomy: a prospective study.

This study examined the effects of patient expectations on short-term postoperative psychological adjustment alter surgery for epilepsy. Twenty-seven subjects (17 operative, 10 nonoperative controls) agreed to participate. A prospective longitudinal design assessed whether changes in psychosocial functioning had occurred at a mean of 7 weeks after surgery relative to the presurgical assessment. The study also examined the relation between postoperative psychosocial adjustment and preoperative patient expectations. It was found that seizure-free outcomes were associated with significant declines in depression and anxiety. Patients who exhibited preoperative optimistic expectations had lower levels of postoperative depression and anxiety, as long as they were rendered seizure-free. Conversely, those who had optimistic preoperative expectations but were not rendered seizure-free postsurgically continued to exhibit moderate to high levels of depression and anxiety. The theoretical significance of optimistic expectations and their effects on individual self-efficacy are discussed to support the notion that postsurgical adjustment is related to personal coping, even in those patients who are seizure-free after surgery.

Journal Article↗

PubMed2003

Daily pain and symptoms in children with polyarticular arthritis.

OBJECTIVE: To analyze patterns of daily pain, stiffness, and fatigue related to juvenile arthritis; to examine the relationships of demographics, disease severity, and psychological adjustment to daily disease symptoms; and to examine daily disease symptoms as predictors of reduced participation in school and social activity. METHODS: For a 2-month period, 41 children with polyarticular juvenile arthritis completed daily diaries that included measures of symptoms and function. Children also underwent an initial evaluation and 4 followup evaluations that included a joint count, laboratory testing, and completion of questionnaires assessing physical and psychosocial functioning. RESULTS: Children reported having pain an average of 73% of days, with the majority of children (76%) reporting pain on >60% of all days. On average, children described the intensity of their daily pain as being in the mild to moderate range; however, a significant subgroup (31%) reported pain in the severe range. Higher physician global assessment ratings, increased functional disability, and increased anxiety were significantly associated with increased daily pain and other daily symptoms. Multilevel random-effects analyses indicated that increased daily symptoms of pain, stiffness, and fatigue were significant predictors of reduced participation in school and social activities. CONCLUSION: Physicians should consider treating pain more aggressively in children with arthritis, in order to preserve function in school and social domains, as well as physical function. Moreover, optimal pain management in children with arthritis should include therapeutic regimens addressing anxiety as well as standard pharmacologic interventions.

Activities of Daily Living↗

PubMed2005

Fifteen-year follow-up of hand eczema: persistence and consequences.

BACKGROUND: Hand eczema is a skin disease often with a long-lasting and relapsing course. The long-term prognosis in the general population is unknown. OBJECTIVES: The aims were to examine the extent to which hand eczema had persisted and the medicosocial consequences of the disease. METHODS: In a 15-year follow-up of hand eczema, patients diagnosed in a previous population-based study were sent a questionnaire with 20 questions concerning the persistence and course of the disease, and its occupational and medicosocial consequences. RESULTS: Addresses were available for 1115 persons, of whom 868 answered the questionnaire. Sixty-six per cent of the respondents reported periods of hand eczema and 44% reported symptoms during the previous year, with no sex difference. Twelve per cent reported continuous eczema. However, 74% of those reporting symptoms considered that their hand eczema had improved; of these more were women than men (78% vs. 66%, P < 0.01). Twenty people, 3% of those who were gainfully employed in 1983, reported a change to another occupation because of their hand eczema, 15 of these reporting improvement after the job change. A considerable need for medical consultation was reported, as was the influence on psychosocial functions among those who had eczema the previous year, e.g. sleep disturbances (36%) and hampered leisure activities (72%). Job changes related to hand eczema and psychosocial impairment were also reported by individuals who had not sought medical help for their hand eczema. CONCLUSIONS: This study demonstrates a variable and poor long-term prognosis for hand eczema in the general population. One-third sought medical care during follow-up, while the vast majority with ongoing hand eczema experienced negative psychosocial consequences. For about 5%, the hand eczema gave far-reaching consequences including long sick-leave periods, sick pension and changes of occupation.

Activities of Daily Living↗

PubMed1992

Psychosocial adjustment of post-poliomyelitis ventilator assisted individuals.

The effect of severe disability, tracheostomy, and ventilator use on psychosocial functioning, gainful employment, life satisfaction, and perceived well-being were studied for a population of 395 ventilator assisted post-poliomyelitis individuals (PVAIs). Standard psychosocial survey instruments and other general questioning were used. Two-hundred-seventy-three physically intact health care professionals served as controls. They were surveyed about their own life satisfaction and perceived well-being and were asked to judge how severely disabled ventilator assisted individuals would respond to such questioning. The relative distress associated with ventilator use was also evaluated in a similar manner. Fifty six of 380 responding PVAIs (14.7%) expressed dissatisfaction with their lives in general. This compares with 8.5% of the controls and 7% of a previously studied general population. The controls significantly underestimated the patients' life satisfaction and well-being scores and significantly overestimated the relative hardship associated with ventilator use. The post-polio individuals using noninvasive methods of assisted ventilation were also significantly more satisfied with their lives than were those ventilated via tracheostomy. Fifty-seven of 148 (39%) individuals married and 165 of 395 (42%) individuals were gainfully employed during long-term ventilator use. We conclude that many severely disabled post-poliomyelitis ventilator users lead productive lives. The vast majority have a positive affect and are satisfied with life. Noninvasive ventilatory support alternatives may lend to greater life satisfaction for these individuals than ventilation delivered via an indwelling tracheostomy. Health care professionals may significantly underestimate their patients' satisfaction with life and this may have a bearing on patient management.

Adult↗

PubMed2005

The role of behavioral sleep medicine in the assessment and treatment of sleep disordered breathing.

With the dramatic rise in obesity in the United States, comorbid medical issues, such as sleep apnea and other forms of sleep disordered breathing (SDB), are becoming increasingly prevalent. Individuals with SDB have impairments in social, cognitive, and emotional functioning and an overall reduction in quality of life. Continuous positive airway pressure (CPAP) is the first-line treatment for SDB. CPAP use is associated with improvements in psychosocial functioning when individuals use the machine regularly. Unfortunately, CPAP adherence rates are often low. Patients sometimes discontinue CPAP therapy due to undesirable side effects, such as anxiety, insomnia, and nasal discomfort, or inconvenience. The goal of this review is to highlight the growing role of behavioral sleep medicine in the assessment and treatment of SDB and psychosocial impairments comorbid with SDB. More than any other health specialty, psychologists with behavioral sleep medicine experience are in the best position to treat psychiatric symptoms exacerbated by SDB-related sleep disturbances. Behavioral sleep medicine specialists also possess the expertise to address psychological obstacles to CPAP use. The assimilation of behavioral sleep medicine specialists into sleep clinics is likely to improve the overall quality of care for patients with SDB.

Behavior Therapy↗

PubMed1990

Impact of supervised apartments on the functioning of mentally disordered adults.

The impact on the mentally disordered of living in supervised residences remains unclear. The present investigation followed a group of supervised apartment residents and a matched comparison group for two years. Symptomatology, psychosocial functioning, stress, social support, quality of life, and life satisfaction were measured at six month intervals. Readmission and consultations in the emergency room were documented for all subjects for the two year period. Neither readmission rates, emergency room consultations, nor measures of functioning, other than symptomatology, differed for the two groups. It is argued that supervised apartments are stressful environments that may lead to deterioration in mentally disordered persons.

Adolescent↗

PubMed2006

Use of extreme weight control behaviors with and without binge eating in a community sample: implications for the classification of bulimic-type eating disorders.

OBJECTIVE AND METHOD: To inform the classification of bulimic-type eating disorders not meeting formal diagnostic criteria for bulimia nervosa (BN), levels of eating disorder psychopathology and functional impairment associated with subjective and objective bulimic episodes (SBEs and OBEs) and purging and nonpurging methods of weight control were examined in a large community-based sample of women (n = 5,232). RESULTS: Participants who reported recurrent bulimic episodes had significantly higher levels of eating disorder psychopathology and functional impairment than those who did not and this was the case whether the episodes were objective or subjective. Similarly, participants who reported the use of extreme weight control behaviors had higher levels of eating disorder psychopathology and functional impairment than those who did not, and this was the case whether purging or nonpurging behaviors were employed. The combination of bulimic episodes and extreme weight control behaviors was associated with particularly high levels of eating disorder psychopathology and functional impairment. CONCLUSION: The combination of bulimic episodes, objective or subjective, and extreme weight control behaviors, purging or nonpurging, is significant in terms of impairment in psychosocial functioning among individuals affected by eating disorders not meeting formal diagnostic criteria for BN. The combination of SBEs and extreme weight control behaviors, in particular, warrants further investigation.

Adolescent↗

PubMed2005

Correlates of subjective and functional outcomes in outpatient clinic attendees with schizophrenia and schizoaffective disorder.

Outcome in schizophrenia is multidimensional and, thus, consists of clinical,humanitarian, rehabilitative and cost domains. Accordingly, recovery is conceptualized as the ability to function in the community, socially and vocationally, as well as being relatively free of disease-related psychopathology. The present cross-sectional study examined the relationship of premorbid functioning, psychopathology, insight, attitudes toward medication and side-effects, as well as sociodemographic factors with treatment outcomes in terms of quality of life (QOL) and psychosocial functioning among 60 regular attendees of a specialized schizophrenia outpatient clinic. Both insight into the illness as well as attitudes toward treatment indicated satisfactory compliance. Premorbid school and social functioning were positively correlated with actual employment status, and premorbid social functioning was further positively correlated with QOL and global functioning. Attitudes toward treatment were positively associated with global QOL, and with the patients' living situation. Both positive and negative symptoms as well as asthenia were negatively associated with QOL, while cognitive symptoms negatively influenced occupational functioning. Older patients lived independently and/or in a partnership more often, but had a lesser likelihood of competitive employment. Our observations suggest that subjective and functional outcomes in highly compliant patients are mainly predicted by psychopathological symptoms and unchangeable sociodemographic variables.

Activities of Daily Living↗

PubMed2006

Insight, symptoms and neurocognition in bipolar I patients.

BACKGROUND: Level of insight and its relationship to clinical variables and neurocognitive functions was assessed in bipolar I patients. METHODS: Verbal memory, executive functioning, sustained attention, general intelligence and other neurocognitive functions were compared between 37 chronic in- and outpatients and 31 matched normal controls. Detailed psychiatric interviews were completed to define the level of symptomatology and psychosocial functioning. Insight was assessed by the Scale to Assess Unawareness of Mental Disorder (SUMD). RESULTS: Seventy percent of the patients were classified as having impaired insight. Prevalence of impaired insight was 47% and 94% in remitted and symptomatic patients, respectively. Symptomatic patients scored significantly below remitted patients on insight and neurocognition. Illness and symptom unawareness were related to overall level of symptoms, measures of memory, conceptual ability and right hand psychomotor speed and accuracy. Misattribution of symptoms and signs was correlated to visuomotor speed and visuospatial performance in addition to affective symptoms and thought disturbance. CONCLUSIONS: Our findings support the hypothesis that impaired insight and other neurocognitive dysfunctions were present in a large percentage of cases among symptomatic as well as remitted bipolar patients. This may be of clinical relevance and raises important questions about the course and outcome of the illness.

Adult↗

PubMed1999

Psychosocial adjustment after traumatic brain injury: what are the important variables?

BACKGROUND: The common legacy of severe degrees of traumatic brain injury is varying degrees and types of impairments, which impact significantly upon the individual's resumption of pre-morbid psychosocial roles. Yet there are few data to indicate the relative contribution of these and other non-injury related variables. METHODS: Seventy individuals with varying levels of disability after severe traumatic brain injury were examined neurologically and neuropsychologically, on average at 6 years post-trauma. A range of biographical, injury, impairment and psychological variables were examined with multiple regression analyses to identify those that contributed to successful psychosocial reintegration. RESULTS: Severity of injury and impairments, along with chronicity and level of self-esteem were significant predictors of psychosocial adjustment. Further analyses revealed that within the neuropsychological domain, the variable measuring behavioural regulation of abilities was the most significant. Examination of specific domains of psychosocial functioning (occupational activities, interpersonal relationships and independent living skills) revealed different patterns of significant predictor variables, in addition to indices of the severity of initial injury: neurophysical impairments and memory functioning predicted successful occupational activities; chronicity, cognitive speed and behavioural regulation predicted success in interpersonal relationships; and neurophysical impairments, behavioural regulation and memory functioning predicted independent living skills. CONCLUSIONS: These results reinforce the overriding importance of injury severity and neurological factors (both neurophysical as well as neuropsychological) in predicting psychosocial adjustment after traumatic brain injury. Support for the contribution of non-neurological factors was also found.

Adaptation, Psychological↗

PubMed2003

Comparison of the psychosocial typology of children with below average IQ to that of children with learning disabilities.

This study investigates the subtypal patterns of psychosocial functioning of children with below average IQ (BAIQ) using the application of both Q-factor analysis and profile-matching. The results suggest that the psychosocial dimensions of children with BAIQ are quite similar to those of children with LD in a general sense. Many of the same subtypes were derived, and the proportions of children displaying normal, mild, and severe levels of psychopathology were not significantly different from those of children with LD. There were some minor differences, however: For example, children with BAIQ exhibited a greater tendency to display psychopathology with internalizing features. Consistent with previous research involving children with LD, there were no changes in either type or severity of psychopathology with advancing years.

Adolescent↗

PubMed2001

Comparison of patient and spouse assessments of health related quality of life in men with metastatic prostate cancer.

PURPOSE: We examined the extent of agreement in health related quality of life ratings provided by patients with metastatic prostate cancer and their spouses. This agreement is important for determining the feasibility of using spouses as potential proxy raters in quality of life studies in this patient population. MATERIALS AND METHODS: The study sample consisted of 72 pairs of patients with metastatic prostate cancer in remission or progression and their spouses. Patients and spouses independently completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 and a prostate cancer specific questionnaire module. Together the 2 questionnaires assess a wide range of symptoms and functional limitations for a total of 21 quality of life outcomes. RESULTS: For 5 of the 21 patient-proxy comparisons we noted systematic differences in the mean score with spouses rating more impairment in patients than patients indicated. Most patient-proxy correlations were 0.40 to 0.75, indicating moderate to good agreement in patient and spouse ratings. A low patient-proxy correlation of less than 0.40 was noted only for the 2 measures of sexual function. CONCLUSIONS: Our findings suggest that the spouses of men with metastatic prostate cancer evaluate with a fair degree of accuracy how patients experience physical and psychosocial functioning, symptoms and overall quality of life. However, caution should be exercised when relying on proxy raters for assessing sexual functioning and satisfaction.

Disease Progression↗

PubMed1992

Family violence and the evaluation of behavioral concerns in a pediatric primary care clinic.

The goals of this study were to determine 1) the prevalence of exposure to intrafamilial violence among children attending a pediatric primary care clinic; 2) the prevalence of psychosocial distress among mothers bringing their children to the clinic; 3) the extent to which pediatricians are aware of family violence and maternal distress among their patients; and 4) whether families reporting violence are more likely to report behavioral or emotional problems with their children. The study focused on 243 mothers and their children who made scheduled visits to an inner-city, hospital-based pediatric residents' continuity clinic. The children ranged in age from 6 months to 14 years, with 69% of the children 2 years of age or younger. Parents answered questions about their own and their child's psychosocial functioning, including a modified version of the Conflict Tactics Scale, an instrument used to measure the prevalence of intrafamilial violence. Physicians independently rated parent and child psychosocial health and the likelihood of violence in the family. Forty percent of mothers said their family in the past year had experienced at least one episode of the five most serious types of violence described on the Conflict Tactics Scale. Mothers reporting these levels of violence were more likely to report psychosocial distress in their own lives as well as those of their children. Furthermore, family violence predicted maternal concern for child behavior even after accounting for the increased maternal distress associated with violence. Physicians had difficulty predicting which mothers would report violence (sensitivity 27%, specificity 81%) or which mothers would report concern about child behavior and emotional health. The authors concluded that an instrument like the Conflict Tactics Scale might both add to physicians' awareness of family violence and help explain some parental concerns about the behavior or emotional health of apparently asymptomatic children.

Adolescent↗

PubMed2004

Is pubertal timing associated with psychopathology in young adulthood.

OBJECTIVE: This investigation tested whether the timing of puberty continued to be associated with experiences of psychopathology (symptoms and disorders) from mid-adolescence into young adulthood. METHOD: At age 24, 931 participants from a large community sample, who had been interviewed twice during adolescence, completed a telephone interview (assessing Axis I disorders and elevated antisocial and borderline personality traits) and a mailed questionnaire battery. RESULTS: Analyses tested whether pubertal timing was associated with lifetime and current history of mental disorders and psychosocial functioning in young adulthood. As expected, young women who had been early maturers had higher rates of lifetime history of disorder along with current elevation of psychosocial symptoms compared with women who were on-time maturers. Young men who had been late maturers, compared with other men, had elevated onset of disruptive behavior and substance use disorders during the transition to adulthood. CONCLUSIONS: Early maturing females are at unique risk of persistent difficulty during adolescence and should be targeted for preventive efforts. Late maturation among males may be associated with a late-onset pathway for deviant behavior or substance abuse.

Adaptation, Psychological↗