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Results for “Psychosocial functioning”

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PubMed1997

[Psychosexual and psychosocial development of patients with hypospadias].

Recently results were published concerning the long-term effects of surgical correction of hypospadias on psychosexual and psychosocial development and on genital perception. Hypospadias patients (9-38 years) were compared with age-matched males operated for inguinal hernia. A semi-structured interview and standardised psychological questionnaires were used. Hypospadias patients did not show a disturbed psychosexual adjustment, but they reported significantly more inhibitions with seeking sexual contacts as a result of embarrassment about their penile appearance. Also, hypospadias patients were significantly less satisfied with their penile appearance, mostly because of the circumcised appearance and a smaller length. No differences were found between psychosocial functioning of hypospadias patients and the control males. Following the investigations 8% of the patients were reoperated because of a poor functional or cosmetic operative result. It is recommended that all hypospadias patients be seen at least once during adolescence as a standard therapeutic procedure, to give optimal care to the small group of patients with psychosexual or psychosocial problems.

Adolescent↗

PubMed2004

Patterns of obsessive-compulsive symptoms and social function in schizophrenia.

Research has alternately found that obsessive and compulsive (OC) symptoms in schizophrenia are associated with graver and lesser levels of negative symptoms. One possible explanation is that there are two distinct groups of persons with OC symptoms: those with cognitive deficits and high levels of negative symptoms and those who generally function well and have low levels of negative symptoms. To examine this question, we performed a cluster analysis on 66 persons with schizophrenia spectrum disorders on the basis of their level of obsessive-compulsive phenomena and global psychosocial function. Four groups were found: high OC/good function (n=9), non-OC/poor function (n=25), non-OC/moderate function (n=20), and high OC/poor function (n=12). A MANCOVA controlling for age found significant group differences on assessments of negative symptoms, executive function and attention among groups. As predicted, the high OC/poor function group had significantly poorer attention than any other group and poorer executive function than either non-OC group. The high OC/good function had lower levels of negative symptoms than either non-OC group. Implications for research and rehabilitation are discussed.

Cluster Analysis↗

PubMed1988

Antecedents and consequences of cocaine abuse among opioid addicts. A 2.5-year follow-up.

During a 2.5-year follow-up of opioid addicts, we examined psychosocial antecedents and consequences of the onset and remission of cocaine abuse. Patients who never used cocaine were compared with those whose use increased or decreased along several dimensions of treatment outcome including drug abuse, legal, employment, family, social, psychological, and medical problems. Cocaine abuse had a marked impact on almost every outcome area except medical problems. Patients whose cocaine use increased during follow-up had more severe problems than either those whose use decreased or those who never used cocaine. Furthermore, the attainment of cocaine abstinence among abusers was associated with improved psychosocial functioning, whereas the onset of cocaine abuse was associated with increased problem severity. Compared with drug-free and detoxification alone treatments, methadone maintenance may minimize legal complications of cocaine abuse, but otherwise it did not significantly reduce psychosocial morbidity from increasing cocaine abuse. These findings suggest that treatment-seeking opioid addicts are vulnerable to wide-ranging deterioration when they become increasingly involved with cocaine but that with the attainment of abstinence many problem areas improve.

Adult↗

PubMed1995

Attachment organization and adaptation in sexually-abused women.

OBJECTIVE: To explore the possible associations among attachment organization, current functioning and Axis II personality disorder. METHOD: Attachment organization was assessed using the Adult Attachment Interview in a clinical sample of 40 women with a history of childhood sexual abuse. The Global Assessment Scale yielded measures of current psychosocial functioning and the Structured Clinical Interview for Diagnosis on DSM-III-R was used to assess presence of personality disorder. RESULTS: Preoccupation with attachment issues was evident in 68% of the subjects; 60% of the subjects were unresolved in respect to loss and/or trauma; and 88% of the subjects met criteria for one or more Axis II disorders. A relationship between Borderline Personality Disorder and the Unresolved attachment classification is suggested. CONCLUSIONS: Women who have experienced childhood sexual abuse require intervention that focuses on resolution of trauma and loss and responds to individual differences in attitudes toward attachment issues.

Adaptation, Psychological↗

PubMed1997

[Multidimensional geriatric assessment in the acute hospital and ambulatory practice].

Comprehensive geriatric assessment (CGA) is defined as a multidimensional medical, functional, psychosocial and environmental evaluation of an older person's problems and resources, linked with an overall plan for treatment and follow-up. It is well established that CGA implemented in specialized geriatric evaluation and management units improves function and survival in frail older patients. The results of new randomized controlled trials, however, show that the application of CGA does not only improve outcomes in selected older persons, but probably in most. A randomized controlled study in unselected older patients admitted to an acute care hospital found that patients function at hospital discharge was improved, and the risk of nursing home admissions decreased, in patients receiving integrated geriatric care as compared to patients receiving the usual acute hospital care. Another trial examined the impact of follow-up geriatric home-visits in patients with unstable cardiac failure discharged from the hospital. This trial found a statistically significant reduction of hospital readmissions and cost savings in the intervention group as compared with controls. A new application for CGA emerges in the preventive arena. Annual comprehensive geriatric assessments with preventive home visits in older people living at home resulted in fewer nursing home admissions and delayed or prevented the onset of disability in the activities of daily living in persons of the intervention group as compared to controls. One of the roles of geriatricians is teaching CGA and conducting further research with a view to refining CGA methodology and its application. Practical application of the principles of geriatric assessment and management, however, should not remain in the hand of specialists alone, but should become an integrated part of primary care medicine in the ambulatory and hospital settings.

Aged↗

PubMed1986

Mental deterioration in epilepsy.

A variety of factors could potentially influence the occurrence of mental deterioration in epilepsy, including seizure type, age of seizure onset, seizure duration, and seizure severity. The available literature suggests that measures of severity are more predictive of progressive decreases in intellectual functioning. There is also evidence suggesting that seizure severity and cognitive deterioration might both be the result of underlying pathophysiologic abnormalities in some cases. In the majority of patients with epilepsy, however, with relatively less severe disease, there is little evidence for cognitive deterioration. Total seizure number also has an inverse correlation with level of psychosocial functioning in some studies, whereas others have found that patients with emotional difficulties have fewer seizures. In the case of emotional deterioration, the impact of interpersonal relationships and other environmental factors upon psychosocial outcome seems clear, and the evidence for specific pathophysiologic explanations for emotional deterioration, less convincing.

Adult↗

PubMed2006

Is cosmetic surgery an effective psychotherapeutic intervention? A systematic review of the evidence.

PURPOSE: Elective cosmetic surgery (ECS) in the absence of physical indications is often performed to improve psychosocial function. Third-party funders need evidence of its effectiveness if they are to respond in an evidence-based way to increasing demand in the context of constrained resources. Our first aim was to review recent evidence of psychosocial outcome in a way that was systematic with respect to study inclusion and methodological evaluation. Our second aim was to review evidence for the validity of currently used selection criteria. METHOD: Electronic and manual literature and database search identified prospective cohort or controlled studies of psychosocial outcomes of surgery performed for appearance reasons reported in English from 1992 to 2004. Data were extracted to describe outcomes and evaluate methodological quality. RESULTS: Twenty-three reports of 22 separate studies were reviewed. All were prospective observational studies and most provided low standards of evidence because of the absence of comparison groups, short follow-up periods and loss to follow-up. The evidence suggests that breast reduction improves health-related quality of life, but does not indicate enduring improvement in quality of life after other procedures, or enduring improvement in mental health, self-esteem or body image after any procedure. Similarly, there was insufficient evidence for the validity of criteria for patient selection. The negative conclusions reflect, not the existence of negative evidence, but methodological limitations of published research. CONCLUSION: The problem for third-party funders is that, although evidence does not justify the continued general provision of ECS in the absence of physical need, it is not strong enough to justify withholding such treatment. Even though randomised controlled trials are probably impractical, we identify several improvements in design whereby future prospective cohort studies could provide higher standards of evidence.

Body Image↗

PubMed2006

Body mass index and functioning in long-term schizophrenia. Results of the DSP project.

OBJECTIVE: The study evaluates the association of body mass index (BMI) with functioning in male and female patients with long-term schizophrenia. METHOD: 722 long-term schizophrenia patients were interviewed three years after discharge from hospital. Their weight and height were recorded and data on their background, illness history, psychosocial functioning (Global Assessment Scale; GAS), health behaviour, daily doses of neuroleptics, and psychiatric symptoms were collected. RESULTS: BMI correlated significantly with GAS scores in male (r=0.202, p=0.000) but not in female patients. In male patients, BMI associated significantly (p=0.005) with GAS scores even when the effects of psychiatric symptoms and other confounding variables were taken into account. CONCLUSIONS: In male but not in female long-term patients with schizophrenia, low BMI associates with poor functioning. It is suggested that among male schizophrenia patients, low BMI may be an indicator of poor functioning.

Adult↗

PubMed2001

"Schizotaxia": clinical implications and new directions for research.

We sought to show that (1) schizotaxia (Meehl's term for the predisposition to schizophrenia) is a clinically consequential condition, and (2) distinguishing it from schizotypal personality disorder may be useful from both clinical and scientific perspectives. We review the features of schizotaxia that may be relevant in clinical settings and discuss their implications for the diagnosis, psychosocial functioning, family intervention and treatment of people in schizophrenia families. Our review indicates that prior work finds some of the nonpsychotic and nonschizotypal relatives of schizophrenia patients to have a psychiatric syndrome characterized by negative symptoms, neuropsychological impairment, and psychosocial dysfunction. Following Meehl, we call this constellation of clinical and neurobiological features schizotaxia. The studies we review suggest it may be worthwhile to consider schizotaxia as a separate diagnostic class. Doing so would alert clinicians to a neurobehavioral syndrome not adequately covered by current diagnostic criteria and would motivate researchers to develop diagnostic and therapeutic approaches aimed at helping schizotaxic individuals and, perhaps, preventing the onset of schizophrenia.

Diagnosis, Differential↗

PubMed1999

The validity of nutritional status as a marker for future disability and depressive symptoms among high-risk older adults.

OBJECTIVE: To measure the validity of the DETERMINE Checklist as a marker for future functional disability, depressive symptoms, and mortality among high-risk older adults. DESIGN: A Cohort study. SETTING: An Urban-suburban Midwestern community. PARTICIPANTS: Community-dwelling Medicare beneficiaries at high risk for hospital admission who received geriatric evaluation and management (GEM) (n = 251). MEASUREMENTS: Demographic, health-related, functional, psychosocial, survival, and nutritional data were collected through telephone and in-home interviews. RESULTS: GEM recipients with baseline Checklist scores of four or higher were found to be significantly more likely than those with lower scores to have functional disability or high levels of depressive symptoms a year later. Checklist scores did not predict mortality. CONCLUSIONS: The 10-item Checklist could be used as a secondary screen to identify older persons who, without treatment, are at especially high-risk to have disability or depression a year later.

Activities of Daily Living↗

PubMed1992

Impact of self-management education on the functional health status of older adults with heart disease.

This paper presents findings from the evaluation of a self-management education program based on self-regulation principles. Older men and women (N = 324) were randomly assigned to program and control groups. Outcomes were measured using the Sickness Impact Profile. Twelve months following baseline data collection, psychosocial functioning of program participants was significantly better than that of controls. Different program effects were noted when results were analyzed by participant gender.

Activities of Daily Living↗

PubMed2004

Long-term prognosis of cerebral venous sinus thrombosis in childhood.

Cerebral venous sinus thrombosis (CVST) is a rare but potentially serious disorder in children. There is no literature on the long-term neuropsychological and emotional sequelae and implications for quality of life. We studied 17 children who had CVST after the neonatal period, aged between 1 month and 16 years at the time of CVST (mean age at CVST was 6 years, median 4 years 8 months). Five children died during follow-up. The cause of death was related to CVST in one child. Twelve children participated in a clinical follow-up assessment. Mean follow-up was 2 years 8 months. One child had physical sequelae with impairment of skilled movement. All children had average or high intelligence scores. Two children with CVST due to an uncomplicated mastoiditis had mild cognitive deficits: one child had difficulty with written language; the other had diminished cognitive efficiency with concentration and attention problems associated with decreased psychosocial functioning. Decreased physical well-being was reported in three of 12 children. We conclude that children who had survived CVST had a fair prognosis. Most had normal cognitive and physical development, although mild cognitive deficits or decreased physical and psychosocial well-being can occur.

Adolescent↗

PubMedDate not supplied

Comparing the experiential and psychosocial dimensions of chronic pain in african americans and Caucasians: findings from a national community sample.

OBJECTIVES: To ascertain whether non-Hispanic African American and Caucasian chronic pain sufferers differ or converge in their self-reports of pain experience and pain adjustment. RESEARCH DESIGN: A telephone survey of U.S. English-speaking adults selected via random-digit dialing procedures and constrained to locate persons with chronic pain within selected gender by age groupings. SUBJECTS: A national sample of 2,407 participants contained a total of 214 non-Hispanic African Americans. A sample of 214 non-Hispanic Caucasians was randomly selected from the larger set of 1,935 Caucasian participants to serve as a comparison group for the present study. MEASURES: Participants provided responses to interviewer questions that assessed pain experience (severity, interference, and emotional burden) and psychosocial outcomes (coping, attitudes and beliefs, catastrophizing, social support and hindrance, pain's interference with daily life activities, treatment status, and medication taking). RESULTS: Although African American and Caucasian adults with chronic pain did not differ significantly in pain severity, interference, emotional burden, or current treatment status, multivariate analyses revealed differences in several domains of psychosocial functioning. Compared to Caucasians, African Americans reported greater pain-related interference with daily living, deficiencies in coping, and counterproductive attitudes and beliefs. African Americans also reported greater impatience and insensitivity from the most important person in their lives. CONCLUSIONS: Psychosocial dimensions of chronic pain differed between community-residing African American and Caucasian adults surveyed as part of a national sample.

Activities of Daily Living↗

PubMed2003

The clinical significance of binge eating disorder.

OBJECTIVE: Current controversy exists regarding the status of binge eating disorder (BED) as a diagnostic entity. A critique of the literature is provided to address the question of whether BED represents a clinically significant syndrome. METHOD: The scientific evidence is considered through addressing five questions that are key in evaluating the clinical utility of any mental disorder. RESULTS: Individuals with BED meaningfully differ from individuals without eating disorders, and share important similarities to, yet are distinct from, individuals with anorexia nervosa (AN) and bulimia nervosa (BN). BED is associated with co-occurring physical and mental illnesses, as well as impaired quality of life and social functioning. Questions about the course of the disorder and the optimal treatment regimen for the syndrome need to be explored further. DISCUSSION: BED's distinctive combination of core eating disorder psychopathology, and other co-occurring physical and psychiatric conditions, impaired psychosocial functioning, and overweight constitute an eating disorder of clinical severity and a significant public health problem.

Bulimia↗

PubMed2002

A multidimensional, case-control study of women with self-identified chronic vulvar pain.

OBJECTIVE: The purpose of the present study was to conduct a multidimensional evaluation of women with chronic vulvar pain. DESIGN: Fifty-seven women with self-identified vulvar pain were contrasted with 74 healthy control women. Measures were selected based on a multidimensional perspective and included questionnaires related to the core aspects of chronic pain: Pain severity, physical disability, affective distress, and marital satisfaction. RESULTS: In comparison with controls, women with vulvar pain reported significantly greater physical disability and affective distress. In women with vulvar pain, pain severity was not related to physical disability and affective distress. While women with vulvar pain scored in the normal range for marital satisfaction, they reported significantly less marital satisfaction than controls. CONCLUSIONS: Findings suggest that the experience of persistent vulvar pain in general, rather than the level of intensity of the pain, accounts for disturbances in functioning and emotional well-being. In comparison with their peers, but not with norms, women with vulvar pain reported less marital satisfaction. A multidimensional approach to the assessment of chronic vulvar pain will lead to a greater understanding of the psychosocial functioning of women with this condition.

Journal Article↗

PubMed2002

Role models, ethnic identity, and health-risk behaviors in urban adolescents.

BACKGROUND: The assumption that role models or mentors constructively influence adolescent psychological functioning has prompted societal investment in mentoring programs. However, there has been little empirical evaluation of the relationship between role model or mentor characteristics and health behaviors. OBJECTIVES: To describe role model selection in urban adolescents and examine the relationships between role model characteristics, psychosocial functioning, and health-risk behaviors. DESIGN: Cross-sectional survey. PARTICIPANTS: A population-based, multiethnic sample of Los Angeles County adolescents aged 12 to 17 years was generated from a 3-stage, area-probability sampling frame. Of 877 adolescents identified, 749 are included in this analysis. METHODS: In-person, in-home interviews were conducted. MAIN OUTCOME MEASURES: Substance use, academic performance, and self-perception (measures of ethnic identify and self-esteem). Ethnic identity was measured by an adaptation of a scale developed by Phinney (J Adolesc Res. 1992;7:156-176) to assess commonalities across ethnic groups. RESULTS: Fifty-six percent of adolescents identified a role model. Higher levels of ethnic identity were associated with moving from identifying no role model to identifying a figure primarily available through the media to identifying a known individual, familial or nonfamilial (P<.001). Having a role model, particularly an individual known to the adolescent, was also associated with higher self-esteem (P<.001) and higher grades (P<.05). For white males without custodial fathers, having a role model was associated with decreased substance use (P<.05). CONCLUSION: Role model selection is associated with protective psychosocial characteristics.

Adolescent↗

PubMed2000

Depression, psychosocial resources, and functional ability in older adults.

The purpose of this study was twofold: to examine the differences between two groups of older adults (depressed, nondepressed) for physical health impairment, psychosocial resources, and functional abilities, and to describe the impact of depression, physical health impairment, and psychosocial resources on functional ability. Seventy-eight community-dwelling older adults, age 60 to 75 years, were divided into two groups based on their depression scores. Depressed and nondepressed participants were not significantly different for demographic and illness characteristics, except for income. Depressed participants reported greater physical health impairment, decreased social resources, diminished feelings of economic well-being, and decreased functional abilities when compared to nondepressed participants. Mastery, physical health impairment, and social support were significant predictor variables of functional ability. Mastery was a particularly salient psychological resource for total functional abilities and interventions should be targeted to increasing mastery in older adults.

Activities of Daily Living↗

PubMed1993

Dimensions and predictors of change during brief psychiatric hospitalization.

The effects of brief psychiatric hospitalization on patient functioning remain controversial and poorly defined. In this study, 217 subjects were evaluated for the changes they experienced during a brief admission (average length of stay 23.0 +/- 16.2 days). Significant improvements occurred in symptoms, global functioning, self-esteem, perceptions of others, and ego functioning. Better multidimensional outcome correlated with symptomatic improvement and preadmission functioning. No effects were found for age, gender, Axis I diagnosis, presence of an Axis II or Axis III disorder, prior hospitalization, severity of symptoms, length of stay, or payor group. During brief hospitalization, patients appear to improve in several areas of psychosocial functioning.

Adolescent↗