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Results for “Psychosocial functioning”

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PubMed2000

The relationship between insight and medication adherence in severely mentally ill clients treated in the community.

OBJECTIVE: To study the relationship between aspects of insight and medication adherence and elements of psychopathology. METHOD: Clients completed insight and adherence measures in interview; doctors and case managers independently completed ratings of adherence and psychopathology. Other client information was obtained from the clinical file. RESULTS: The subscale structure of the insight scale was well reproduced. Clients endorsed items relating to need for treatment more than items relating to relabelling of symptoms and awareness of illness. Self-reported insight was lower in those clients for whom either the treating doctor or the case manager or both thought the client was non-adherent. Insight was related positively to clinician ratings of depressed mood, and negatively to clinician ratings of personal functioning. CONCLUSION: Our data support the subscale structure of the insight questionnaire used, and previous suggestions that insight is positively related to depressive affect, and inversely related to impaired psychosocial functioning.

Adult↗

PubMed1996

The relationship of epileptic auras and psychological attributes.

Studies suggest a high frequency of epileptic auras with intellectual content among epileptic patients with psychopathology and personality disorders. This study compared measures of personality and psychosocial functioning between epileptic patients with cognitive auras and epileptic patients with noncognitive auras. Ten patients with complex partial seizures who experienced cognitive auras had consistently more depressive traits and psychosocial difficulties than 50 patients with other psychic or nonpsychic auras, particularly if the patients with cognitive auras had left hemisphere epileptiform foci. Cognitive auras may be associated with depressive traits among epileptic patients. The findings were also in agreement with studies that relate the left hemisphere to depression.

Adult↗

PubMed1993

Arithmetic disabilities, specific and otherwise: a neuropsychological perspective.

From a neuropsychological perspective, this article summarizes research that addresses some of the developmental interactions of disabilities in reading, spelling, and mechanical arithmetic. The focus is on two subtypes of children with learning disabilities who exhibit equally impaired levels of arithmetic achievement, but with vastly different patterns of neuropsychological assets and deficits. Qualitative as well as quantitative analyses lead to the conclusion that one of these patterns of neuropsychological assets and deficits (i.e., the nonverbal learning disabilities syndrome; NLD) leads--at the same time and in much the same manner--to specific patterns of impairment in mechanical arithmetic and in psychosocial functioning. The other pattern (Group R-S) is found to lead to particular patterns of academic deficits (including arithmetic), but not to any particular level or type of psychosocial dysfunction. The manifestations of the NLD profile in various types of neurological disease, disorder, and dysfunction are also explored.

Child↗

PubMed2006

Cognitive impairment in bipolar II disorder.

BACKGROUND: Persistent impairments in neurocognitive function have been described in bipolar disorder. AIMS: To compare the cognitive performance of patients with bipolar II disorder with that of patients with bipolar I disorder and a healthy control group. METHOD: The study included 71 euthymic patients with bipolar disorder (38 bipolar I, 33 bipolar II), who were compared on clinical and neuropsychological variables (e.g. executive function, attention, verbal and visual memory) and contrasted with 35 healthy controls on cognitive performance. RESULTS: Compared with controls, both bipolar groups showed significant deficits in most cognitive tasks including working memory (DigitSpan Backwards, P=0.002) and attention (DigitSpan Forwards, P=0.005; Trail Making Test, P=0.001). Those with type II disorders had an intermediate level of performance between the bipolar I group and the control group in verbal memory (P<0.005) and executive functions (Stroop interference task, P=0.020). CONCLUSIONS: Cognitive impairment exists in both subtypes of bipolar disorder, although more so in the bipolar I group. The best predictors of poor psychosocial functioning in bipolar II disorder were subclinical depressive symptoms, early onset of illness and poor performance on a measure related to executive function.

Adult↗

PubMed2005

Voluntary vs. involuntary hospital admission in acute mania of bipolar disorder: results from the Swiss sample of the EMBLEM study.

BACKGROUND: Patients with acute mania in bipolar disorder require pharmacological treatment to reduce symptoms. In addition, it is recognised that admission status is a clinically relevant aspect of bipolar disorder. There is, however, a lack of published data assessing the association of admission status with clinical or functional outcomes. The European-Mania-in-Bipolar-Longitudinal-Evaluation-of-Medication (EMBLEM) study has been designed to describe outcomes associated with medication therapies. Baseline data from this study are now available and we used these data to examine the characteristics of patients with acute mania in the Swiss EMBLEM cohort who were admitted involuntary and voluntary, respectively, and their functional and clinical status. METHODS: Ninety-five patients with an acutely manic or mixed episode of bipolar disorder were included in the Swiss cohort of the study. Patients' history, psychosocial functioning, clinical measures of mania and depression, pharmacological and compliance variables were assessed. Statistical methods comprised univariate analyses of variance and logistic regression analyses to elucidate associations between variables of interest. RESULTS: Patients with involuntary hospital admission (n = 55) were more aggressive and had less insight. They had a more frequent history of substance abuse and were less likely to take anticonvulsants or lithium. Furthermore, these patients showed lower compliance, which also guided physicians' decision on pharmacotherapy. LIMITATION: The EMBLEM study had an observational and non-interventional design; therefore it was not possible to compare treatment groups by means of stringent between-group analyses. However, a main target of this study was to gather clinically relevant information on outcomes of acute mania associated with currently available medication therapies. CONCLUSIONS: Involuntary admission status was significantly associated with clinical status, especially aggression and also compliance. Admission status in bipolar patients plays a clinically important role.

Acute Disease↗

PubMedDate not supplied

Psychiatric disorders and functioning in hepatitis B virus carriers.

The authors compared asymptomatic hepatitis B virus carriers and healthy subjects in terms of their psychological state. Participants (43 asymptomatic hepatitis B virus carriers and 43 healthy comparison subjects) completed self-report questionnaires. Psychiatric disorders and psychosocial functioning were evaluated with structured clinical interviews and the Global Assessment of Functioning scale. Hepatitis B virus carriers were more likely to have psychiatric disorders than comparison subjects (30.2% vs. 11.6%). Also, carriers had significantly higher depression and anxiety scores and lower Global Assessment of Functioning scores than did comparison subjects. Worries about contamination and illnesses related to hepatitis B infection were associated with the presence of psychiatric disorder. The results suggest that asymptomatic hepatitis B virus carriers need emotional support.

Adult↗

PubMedDate not supplied

Emotional adjustment and school functioning of young adolescents with multiple versus single learning disabilities.

Early adolescents (Grades 6-8) with multiple learning disabilities (LD; reading and math) in inclusive settings were compared to adolescents with single LD (reading or math) and typically achieving (TA) peers regarding their psychosocial functioning in two areas of adolescent well-being: emotional adjustment and school functioning. The Behavior Assessment System for Children (Reynolds & Kamphaus, 1998) Self-Report of Personality for adolescents was used to determine well-being. One hundred twenty middle school students-15 boys and 15 girls in each group-were included in the current study. The results confirmed that adolescents with multiple LD (reading and math) reported poorer functioning (i.e., higher T scores) on school maladjustment, clinical maladjustment, emotional symptoms index, attitude to school, atypicality, and depression when compared to TA peers but not when compared to peers with a single LD (reading or math). All three groups differed from the TA group (but not from each other) on sense of inadequacy, with the multiple LD group reporting the highest T scores. Additional analyses indicated significant differences between girls and boys, regardless of disability status. Girls reported higher T scores on the emotional symptoms index, social stress, and depression, but boys reported greater school maladjustment and sensation seeking. Implications for practice and recommendations for future research are discussed.

Adaptation, Psychological↗

PubMed2003

Schizophrenic patients in different treatment settings during the era of deinstitutionalization: three-year follow-up of three discharge cohorts in Finland.

OBJECTIVE: We investigated differences in psychosocial and clinical characteristics, as well as the use of services, of schizophrenic patients in different treatment settings three years after their discharge from a psychiatric hospital. Furthermore, we examined secular changes in these phenomena during the era of rapid deinstitutionalization in Finland. METHOD: Three nationally representative samples comprised 3257 schizophrenic patients who had been discharged in 1986, 1990 and 1994. The patients were interviewed three years after discharge by each district's psychiatric professionals using a structured interview schedule specifically designed for the purposes of the present study. Psychosocial functioning was assessed on the Global Assessment Scale and on a modified version of the Medical Research Council Practices Profile. RESULTS: In the 1990s, more patients with a poor clinical and psychosocial state were transferred from hospital to alternative outpatient facilities, such as sheltered workshops or supported residences. In successive cohorts, the proportion of patients who had dropped out of treatment decreased and the psychiatric and somatic state of the drop-outs improved. CONCLUSION: In general, the psychiatric treatment system has worked well for most deinstitutionalized patients. In the future, however, it is important that the quality of care and adequate resources in the alternative outpatient facilities are ensured.

Adolescent↗

PubMed1983

The psychosocial evaluation of the hospice patient.

A psychosocial evaluation of a patient is an important first step in the provision of care to hospice patients and their families. It serves as a guide for intervention, communicates social work concerns to other caregivers, and articulates important features of the patient/family system from an interdisciplinary perspective. The psychosocial evaluation addresses the patient's problems in a historical framework by identifying important developmental features as they pertain to the tasks of dying. It identifies physical resources and needs and evaluates the patient's psychosocial functioning, with particular emphasis on the patient's roles within a family system. Hospice recognizes the uniqueness of each individual as he or she confronts life's final challenge. An adequate psychosocial evaluation brings that uniqueness into focus.

Family↗

PubMed1986

The psychological assessment of cochlear implant patients.

The use of a cochlear implant (CI) to restore some acoustical input to patients with complete acquired hearing loss may be expected to result in changes in their psychological functioning. CI programmes should therefore include a careful psychological screening of all candidates and subsequent psychological assessments of patients who receive implants. Procedures used in the psychological assessment of CI candidates and patients outlined in the literature, as well as those used in the Royal Ear Hospital (REH) programme, are discussed. It is concluded that standard psychological tests of personality and intellectual functioning are of limited value in the screening of CI candidates and the postoperative evaluation of patients. It is proposed that more useful information be obtained by an analysis of the possible functional value of the implant to each individual candidate and by assessment of actual postoperative changes in the patient's behaviour. Unless an implant leads to improvements in the patient's psychosocial functioning, the device is unlikely to be used. Examples of this approach in assessing the REH candidates and patients are given.

Cochlear Implants↗

PubMed1992

Occupational adaptation: toward a holistic approach for contemporary practice, Part 2.

This paper introduces a practice model based on the occupational adaptation frame of reference (Schkade & Schultz, 1992). The occupational adaptation practice model emphasizes the creation of a therapeutic climate, the use of occupational activity, and the importance of relative mastery. Practice based on occupational adaptation differs from treatment that focuses on acquisition of functional skills because the practice model directs occupational therapy interventions toward the patient's internal processes and how such processes are facilitated to improve occupational functioning. The occupational adaptation practice model is holistic. The patient's occupational environments (as influenced by physical, social, and cultural properties) are as important as the patient's sensorimotor, cognitive, and psychosocial functioning and the patient's experience of personal limitations and potential is validated. The integration of these concepts drives the treatment process. Through a description of treatment with a variety of patients, this paper presents the model's diversity and illustrates the relationship between the concepts. The occupational adaptation practice model reflects the uniqueness of occupational therapy and integrates the profession's historical practice with contemporary interventions and methods.

Activities of Daily Living↗

PubMed1991

Burn injuries in children.

The overall outcome for every patient is to attain the maximum level of physical and psychosocial functioning possible within their capacity. This is individualized and impacted by the severity of injury, interventions, and subsequent outcomes along the critical path to recovery. Identification of issues, whether physical or psychosocial, in a timely manner and the development of an individualized plan of care maximize the quality of care each patient receives. As the health care giver in most frequent contact with the patient and family, the nurse must serve as the coordinator of all ancillary services and the plan of care.

Adolescent↗

PubMed1991

Functional outcomes of children with sickle-cell disease affected by stroke.

The nature and degree of functional recovery after stroke in children with sickle-cell disease (SCD) has not been extensively investigated. The purpose of this study was to evaluate retrospectively the functional status of 14 SCD children who had had strokes and to compare them with age-matched and gender-matched SCD children who had not had strokes. By doing so, we would be able to quantify the eventual physical and cognitive functional outcomes of survivors of stroke secondary to SCD and assess the impact of stroke on these patients. These children (five boys and nine girls) with SCD and stroke(s) were 11.6 +/- 4.3 years of age (range five to 18 years). They experienced one to three strokes at a mean age of 6.1 +/- 5.2 years (range one to 17 years). A series of tests were administered to these subjects to evaluate physical and psychosocial functions. These tests were performed at least one year after the latest stroke. This study showed that all of the SCD-stroke children were physically independent. Only a few had impairments of hand functions and mild difficulties in self-care activities. However, most of these children demonstrated intellectual deficits ranging from borderline to moderate mental retardation, reduced language functions ranging from low normal to retarded range, and problems in adjustment. Intelligence quotient of the children with SCD-stroke(s) was significantly lower than those of age-matched and gender-matched nonstroke SCD children, suggesting that stroke caused an adverse effect on the cognitive functioning of these children. The results indicate that in the SCD-stroke children psychosocial deficits outweighed physical disabilities.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

PubMed1996

Maximizing function in Alzheimer's disease: what role for tacrine?

As the number of elderly persons continues to increase, family physicians will be caring for more patients with Alzheimer's disease. The treatment plan for patients with this incurable illness should be directed at optimizing their physical and psychosocial functioning and supporting their caregivers. Tacrine is the first medication proven to ameliorate the symptoms of Alzheimer's disease. This drug has been approved by the U.S. Food and Drug Administration for use in patients with mild to moderate Alzheimer's disease as evidenced by a score between 10 and 26 on the Mini-Mental State Examination. Tacrine can produce modest dose-related improvements in cognitive function and global measures of patient function. Such improvements only occur in 25 percent of patients treated with tacrine. On discontinuation of the drug, the patient's cognitive function returns to the level that would be expected if no treatment had been given. Both the degree of cognitive improvement and the severity of cholinergic symptoms increase with higher doses of tacrine. Thus, patients receiving tacrine therapy must be monitored for both clinical efficacy and adverse effects of the medication.

Alzheimer Disease↗

PubMed2005

Sustained sleep restriction reduces emotional and physical well-being.

BACKGROUND: Chronic insufficient sleep is a common finding in many pain-related and other medical diseases and is frequently experienced in the general population. Prolonged curtailment of nocturnal sleep has been studied for its adverse effect on cognitive functioning and subjective tiredness, but relatively little is known about its effect on mood and physical symptoms. OBJECTIVE: In order to test whether sleep restriction to 50% of the habitual time over 12 days affects diurnal and day-to-day variation of subjective ratings of mood and physical symptoms, 108 adjectives and statements were self-rated using visual analog scales every 2h during the waking period. DESIGN: Randomized, 16-day controlled in-laboratory study. SETTING: General Clinical Research Center (GCRC). PARTICIPANTS: Forty healthy subjects aged 21-40 years (14 females, 26 males). INTERVENTION: Subjects were randomized to either 4h of sleep per night (11 pm-3 am, N=22) or 8h of sleep per night (11 pm-7 am, N=18) for 12 consecutive days. MAIN OUTCOME MEASURE: Changes in the factor-derived variables optimism-sociability, tiredness-fatigue, anger-aggression, bodily discomfort, and items constituting bodily discomfort were compared between groups. RESULTS: Optimism-sociability progressively declined over consecutive days of sleep restriction by 15%. Bodily discomfort showed a slight, but significant interindividual increase of 3% across days of sleep restriction due to significant increases of generalized body pain, back pain, and stomach pain. Optimism-sociability and tiredness-fatigue showed diurnal variations with a quadratic function period within each day in both conditions. CONCLUSION: The data suggest that chronic insufficient sleep may contribute to the onset and amplification of pain and affect health by compromising optimistic outlook and psychosocial functioning.

Adult↗

PubMed1999

Effectiveness of treatments for major depression in primary medical care practice: a post hoc analysis of outcomes for African American and white patients.

OBJECTIVE: To retrospectively determine whether race differentially influences treatment adherence and clinical outcomes among 68 African Americans and 92 whites treated for major depression in four urban, primary care settings. METHOD: Study participants were randomly assigned to standardized interpersonal psychotherapy or pharmacotherapy with nortriptyline, and were assessed at baseline, and successive time points up to 8 months for severity of depression, and mental and physical health-related functioning. RESULTS: Intent-to-treat analyses revealed no treatment or race-specific differences in symptomatic recovery when both groups were provided standardized psychotherapy or pharmacotherapy. However, African Americans had poorer functional outcomes than whites. CONCLUSIONS: African American and white primary medical care patients are effectively treated with standardized psychotherapy and pharmacotherapy. Future research should assess the impact of cultural context on symptom presentation, psychosocial functioning, and treatment adherence and response.

Adolescent↗

PubMed1988

Evaluation of functional capacity after stroke with special emphasis on motor function and activities of daily living.

In a multidisciplinary study comprising 280 patients with acute cerebrovascular disease (median age 76, range 30-96 years), instruments for functional assessment in stroke care were developed. The improvements of motor function and activities of daily living were investigated during a period of up to one year after a stroke. A new chart for motor capacity assessment, which includes both the paretic and the non-paretic side, modified after that of Fugl-Meyer et al, was tested for its reliability and validity. At the same time the Activity Index of Hamrin & Wohlin was further tested. The internal consistency reliability measured with the standardized item alpha method confirmed that the two instruments have high homogeneity. Construct validity was investigated by factor analysis and showed a logical structure. The predictive validity of the scores on admission was significant and the two tools had a satisfactory predictive capacity for survival and later functional outcome. The improvements in different motor functions were followed up for up to one year after the stroke among the 183 one-year survivors. In patients with minor impairment, the improvement occurred mostly during the first week. Patients with moderate or moderately severe impairment improved more continuously for up to three months, while the few surviving patients with very severe impairment continued to recover to some extent even after three months. Older patients with severe functional loss seemed to improve more slowly and not as well as younger patients with equivalent impairment. The patterns of instrumental activities of daily living (I-ADL), such as household work, locomotion, psychosocial functions and intellectual activities, were investigated in the 207 three-month survivors and the 183 one-year survivors. At both the three-month and the one-year follow-ups the scores had decreased considerably, compared with before the stroke, for all activities except locomotion, and many patients were dependent on somebody else for help. The same group of patients was also examined by a Standardized Practical Equipment (SPE) test constructed by Tömquist three months and one year after the stroke. The construct validity of the SPE test was estimated through factor analysis. Three factors emerged, one concerning mainly cognitive factors and co-ordination, one concerning hand function and one concerning mainly mobility and balance. The instruments developed in the course of this study have proved to be reliable and valid, and useful in assessing functional losses and following progress. The tools are well suited for any clinical settings and for home care examinations as well as research.

Activities of Daily Living↗

PubMed2001

Illness-related concerns of mothers of children with congenital heart disease.

OBJECTIVE: This study examined concerns expressed by mothers of children with congenital heart disease (CHD). The relationships among mothers' concerns, medical severity, and mother's emotional state were examined at two points in time. METHOD: Thirty-eight mothers of children with CHD aged 3 to 16 completed semistructured interviews and rating scales during hospitalization and 2 to 4 weeks after discharge. Mothers rated their distress about illness-related concerns, as well as their own depressed mood and anxiety. Mothers and two cardiologists rated the medical severity of each child's disease. RESULTS: Mothers' concerns were reliably grouped into five categories: medical prognosis, quality of life, psychosocial functioning, effects on family, and financial issues. During hospitalization, mothers were most concerned about medical prognosis. Distress about most concerns decreased postdischarge, as did mother's anxiety and depressed mood. Mothers' perceptions of medical severity were associated with distress about psychosocial issues postdischarge. Mother's anxiety was not associated with number of concerns reported, or with distress about those concerns. Maternal depressed mood was associated with fewer illness-related concerns, but greater distress about those concerns. CONCLUSIONS: Illness-related concerns can be meaningfully categorized and are not necessarily a function of disease severity or mother's emotional state. An awareness of common concerns will improve clinical care by enabling practitioners to anticipate and address concerns in a proactive way. The results may inform the development of supportive mental health interventions for families of children with CHD.

Adaptation, Psychological↗