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Results for “Psychosocial functioning”

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PubMed2007

Computerized assessment of cognition in schizophrenia: promises and pitfalls of CANTAB.

OBJECTIVE: Over the last decade, the Cambridge Neuropsychological Test Automated Battery (CANTAB), which comprises visuo-spatial tasks, has been utilized in cognitive studies of schizophrenia. A clear approach concerning the usage of CANTAB for the appraisal of neurocognitive dysfunction in schizophrenia is currently lacking. METHOD: In this paper, we have first reviewed the overall applications of CANTAB and then evaluated methodological strengths and weaknesses of CANTAB as a neurocognitive battery for schizophrenia. We carried out a systematic search and assessment of studies where CANTAB was utilized to measure cognitive function in schizophrenia. We have also attempted to quantify the available data and perform a meta-analysis, but this approach turned out to be still premature. RESULTS: CANTAB has enabled researchers to highlight significant deficits affecting broad cognitive domains in schizophrenia, such as working memory, decision-making, attention, executive functions and visual memory. So far, the most consistent deficit observed with CANTAB testing has been attentional set-shifting, suggestive of fronto-striatal dysfunctions. In addition, preliminary evidence points towards the potential use of CANTAB to identify cognitive predictors of psychosocial functioning, to describe the relationships between symptoms and cognition, and to measure the impact of pharmacological agents on cognitive functioning. CONCLUSION: CANTAB has been used successfully to highlight the range of visuo-spatial cognitive deficits in schizophrenia, producing similar results to those obtained with some traditional neuropsychological tests. Further studies validating the use of CANTAB following the standard set by Measurement And Treatment Research to Improve Cognition in Schizophrenia (MATRICS) are warranted.

Cognition Disorders↗

PubMed2002

Care of the patient requiring invasive mechanical ventilation.

Patients who require prolonged invasive mechanical ventilation pose a unique set of circumstances to the pulmonary and critical care practitioner. This requires a delineation of the primary cause for respiratory failure, and, in most cases, a comprehensive multidisciplinary approach to the treatment of not only the primary disturbance causing respiratory failure, but the consequences that immobility, illness, and prolonged ventilation have on swallowing and ambulatory function, psychosocial interaction, and the ability to wean from mechanical ventilation. The development of multidisciplinary rehabilitative units for patients requiring prolonged mechanical ventilation have showed not only a reduction in hospital costs and lengths of stay, but also an improvement in patient survival, functional status, reduction in ventilator days or need for mechanical ventilation at discharge, and, overall, the achievement of a satisfactory quality of life.

Critical Care↗

PubMed2004

[How effective are interventions in children and adolescents with antisocial behavior? A utilization study].

OBJECTIVE: Anti-social behavior in childhood and adolescence represents a frequent behavior disorder in this age group and its prognosis is predominantly unfavourable. The purpose of this study was to analyze the outcome and predictors of outpatients and inpatients with conduct disorders and internalizing disorders. METHOD: We compared a 10 year follow-up history of in- and outpatients with conduct disorders and internalizing disorders. The sample of patients with conduct disorders was divided into three groups ("I": F90.1; "E": F91.2, F92; "D": F91.1, F91.3). The outcome was defined as an improvement of psychosocial functioning (SGKJ). Statistical analysis consisted of Fisher exact test and logistical regression. RESULTS: Our findings showed the best results in patients with the ICD 10 diagnosis F90.1. Inpatient treatment was superior to outpatient treatment. Cooperation of parents and children, severeness of disease, psychosocial risk factors and pharmacotherapy were found to be the most important predictors. CONCLUSIONS: Effectiveness of an outpatient treatment of children and adolescents with conduct disorders can be increased by training of parents, home treatment or pharmacotherapy.

Adolescent↗

PubMedDate not supplied

Relation of childhood socioeconomic status and family environment to adult metabolic functioning in the CARDIA study.

OBJECTIVE: Low SES and a conflict-ridden, neglectful, or harsh family environment in childhood have been linked to a high rate of physical health disorders in adulthood. The objective of the present investigation was to evaluate a model of the pathways that may help to explain these links and to relate them to metabolic functioning (MF) in the Coronary Artery Risk Development In Young Adults (CARDIA) dataset. METHODS: Participants (n = 3225) in the year 15 assessment of CARDIA, age 33 to 45 years, completed measures of childhood socioeconomic status (SES), risky early family environment (RF), adult psychosocial functioning (PsyF, a latent factor measured by depression, hostility, positive and negative social contacts), and adult SES. Indicators of the latent factor MF were assessed, specifically, cholesterol, insulin, glucose, triglycerides, and waist circumference. RESULTS: The overall prevalence of metabolic syndrome was 9.7%. Structural equation modeling indicated that childhood SES and RF are associated with MF via their association with PsyF (standardized path coefficients: childhood SES to RF -0.13, RF to PsyF 0.44, PsyF to MF 0.09, all p < .05), but also directly (coefficient from childhood SES to MF -0.12, p < .05), with good overall model fit. When this model was tested separately for race-sex subgroups, it fit best for white women, fit well for African-American women and white men, but did not fit well for African-American men. CONCLUSIONS: These results indicate that childhood SES and early family environment contribute to metabolic functioning through pathways of depression, hostility, and poor quality of social contacts.

Adult↗

PubMed2005

Effect of structured interviews on evaluation time in pediatric community mental health settings.

OBJECTIVE: The purpose of this study was to determine whether a structured interview administered by a master's-level clinician and reported to physicians before an initial evaluation would reduce physicians' evaluation time without compromising diagnostic accuracy or clinical outcomes in a pediatric sample. METHODS: A sample of 225 children and adolescents who were seen in public-sector community facilities was randomly assigned either to receive a structured interview (the Schedule for Affective Disorders and Schizophrenia for School-aged Children-Present and Lifetime Versions) by a trained interviewer before the initial physician visit or to receive assessment as usual. Clinical outcome data were collected prospectively, with follow-up at four months. RESULTS: Physicians' evaluation time was reduced by approximately half among physicians who were given preliminary diagnostic information. Physicians' diagnoses were strongly related to the results of the structured interview. Physicians' having access to previously obtained diagnostic information was associated with better psychosocial functioning at follow-up in terms of peer relations and spare-time activities compared with assessment as usual. CONCLUSIONS: Adding a trained diagnostic interviewer to the clinical team could reduce physicians' initial diagnostic evaluation time and improve diagnostic reliability and psychosocial outcomes.

Adolescent↗

PubMed2002

Neuropsychological performance in depressed and euthymic bipolar patients.

INTRODUCTION: Recent studies have suggested that the presence of persistent cognitive dysfunctions in bipolar patients is not restricted to acute episodes, but they persist even during remission states. Nevertheless, there are several methodological pitfalls in most studies, such as unclear remission criteria, diagnostic heterogeneity or small sample sizes. PATIENTS AND METHODS: Several domains of cognitive function were examined in 30 depressed bipolar patients [DSM-IV criteria for major depression, Hamilton Depression Scale (HDRS) > or =17] and 30 euthymic bipolar patients (at least 6 months of remission, HDRS < or =8 and Young Mania Rating Scale, YMRS < or =6). Psychosocial functioning was assessed through General Assessment of Functioning. RESULTS: The two groups showed a similar pattern of neuropsychological performance. However, the depressed group was significantly impaired on the Controlled Oral Word Association Test, FAS (COWAT), a measure of verbal fluency, compared with the euthymic group. On the other hand, functional outcome in euthymic patients was related to verbal fluency, even after controlling for residual depressive symptoms. CONCLUSIONS: Neuropsychological performance was similar in both groups, except for verbal fluency, which was lower in the depressed group. Poor verbal fluency was related to a poor social outcome in euthymic patients. Further research including longitudinal designs aimed at evaluating changes in cognition in these patients is warranted.

Adult↗

PubMedDate not supplied

[The possibilities of neurocognitive rehabilitation in schizophrenia].

INTRODUCTION: Schizophrenia is a severely disability causing syndrome, what tend to chronically alter living project of great number of young people and its families. It is affected multiple cognitive functions, as executive capacity, explicit memory, working memory or perceptive integration. In the last years, neurocognitive rehabilitation techniques of this functions coming from the experience with brain damage patients has been applied to schizophrenia. DEVELOPMENT: Present work revised: a). cognitive deficits that can be considered as nuclear in the genesis of schizophrenia symptoms and b). recovery or substitution strategies of that deficits, that can be generalized to a better psychosocial functioning of the patient. It is proposed that attention control deficit (ACD), defined as the inadequate assignation of attention recourses during cognitive processing, results in attention processing of redundant information and a lack of attention recourses to process new information. Some explaining models are presented for subjective and perceptive symptoms, language disorders and executive disorders in schizophrenia. Possibilities of neurocognitive rehabilitation in schizophrenia are discussed, especially by the utilisation of implicit learning methods, that don't need attention processing. Some recommendations are made for the implementation of cognitive rehabilitation in the general framework of psychosocial and occupational rehabilitation.

Attention↗

PubMed2001

Different trait markers for schizophrenia and bipolar disorder: a neurocognitive approach.

BACKGROUND: The aim of this study was to assess visual information processing and cognitive functions in unaffected siblings of patients with schizophrenia, bipolar disorder and control subjects with a negative family history. METHODS: The siblings of patients with schizophrenia (N = 25), bipolar disorder (N = 20) and the controls subjects (N = 20) were matched for age, education, IQ, and psychosocial functioning, as indexed by the Global Assessment of Functioning scale. Visual information processing was measured using two visual backward masking (VBM) tests (target location and target identification). The evaluation of higher cognitive functions included spatial and verbal working memory, Wisconsin Card Sorting Test, letter fluency, short/long delay verbal recall and recognition. RESULTS: The relatives of schizophrenia patients were impaired in the VBM procedure, more pronouncedly at short interstimulus intervals (14, 28, 42 ms) and in the target location task. Marked dysfunctions were also found in the spatial working memory task and in the long delay verbal recall test. In contrast, the siblings of patients with bipolar disorder exhibited spared performances with the exception of a deficit in the long delay recall task. CONCLUSIONS: Dysfunctions of sensory-perceptual analysis (VBM) and working memory for spatial information distinguished the siblings of schizophrenia patients from the siblings of individuals with bipolar disorder. Verbal recall deficit was present in both groups, suggesting a common impairment of the fronto-hippocampal system.

Adult↗

PubMed1995

Psychological adjustment of children evaluated for short stature: a preliminary report.

Since synthetic growth hormone became available in the mid-1980s, there has been debate about its use for non-growth-hormone-deficient short children. Justification for this use of growth hormone often is based on a presumed association of short stature with significant psychosocial maladjustment. However, systematic evaluation of psychosocial functioning in short children has been limited, and our understanding of this area is scant. In this study, we have used a combination of interview and self-report measures to examine self-esteem, personality characteristics, affective functioning, coping style, and stature-related stresses in 41 children (5 to 16 years) referred to a pediatric endocrinology service because of short stature. Parent-report and child measures of self-esteem and psychological functioning indicated no evidence of maladjustment in comparison with norms. Furthermore, within the subject sample, the degree of short stature was not related to poor psychological functioning. We found limited evidence linking increased age with increased distress, suggesting that short stature may pose greater difficulties for children as they enter adolescence. Taken as a whole, however, the results do not support the contention that short stature is generally associated with psychosocial maladjustment in children referred for evaluation of their short stature.

Adaptation, Psychological↗

PubMed2004

Cognitive, psychosocial, and family function one year after pediatric epilepsy surgery.

PURPOSE: Assumptions regarding the benefits of seizure control after pediatric epilepsy surgery for cognitive, psychosocial, and family function were explored in a prospective study of 51 children with intractable epilepsy. METHODS: Thirty children who underwent surgery were studied before and 1 year after surgery, and a comparison group of 21 children with medically refractory seizures was examined at comparable times. RESULTS: One year after surgery, 57% of the surgical group was seizure free. Seizure status after surgery did not predict change over time in any of the areas measured. Cognitive and psychosocial status did not change over time in either group, and the strongest predictor of individual change in psychosocial status in the surgical group was baseline level of function. Within the surgical group, a trend toward an increase in independence promotion was noted in the family, but the children's satisfaction with the family declined. CONCLUSIONS: These findings challenge the assumption that elimination of seizures will result in improved cognitive, psychosocial, and family functioning, at least within the first year after surgery.

Adaptation, Psychological↗

PubMedDate not supplied

[Insight, neurocognition and psychopathology in schizophrenia].

INTRODUCTION: In recent years, research has been aimed at finding variables mediating between neurocognition and psychosocial functioning in schizophrenia, proposing insight as one of these variables. Some authors have found associations between insight and functional outcome, and between insight and symptomatology, although these associations remain unclear. These different findings could be explained by the insight definition used. The current study evaluates insight unidimensionally and multidimensionally and studies its relationship with cognitive and psychopathological variables. METHODS: The sample consisted of 94 subjects admitted to an outpatient Psychosocial Rehabilitation Program, all diagnosed of schizophrenia according to ICD-10 diagnostic criteria. A brief version of the Neuropsychology Battery Test Barcelona and the Wisconsin Card Sorting Test were used to evaluate cognitive variables. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate psychopathology. Insight was assessed with the PANSS item ((lack of judgment and insight)), and with a semi-structured interview. RESULTS: Two insight factors were found, one including more specific knowledge about the disease and its consequences (cognitive factor), that is related to executive functions, and another referring to unspecific knowledge about suffering from an illness and the need for treatment (psychotic factor). Each factor was statistically related to positive symptoms and superior cognitive functions. CONCLUSIONS: These findings support a relationship between insight and low cognitive performance.

Adult↗

PubMed2007

Protective resources and long-term recovery from alcohol use disorders.

AIMS: This study examined indices of personal and social resources drawn from social learning, behavioral economics, and social control theories as predictors of medium- and long-term alcohol use disorder outcomes. DESIGN AND MEASURES: Individuals (N = 461) who initiated help-seeking for alcohol-related problems were surveyed at baseline and 1, 3, 8, and 16 years later. At baseline and each follow-up, participants provided information about their personal and social resources and alcohol-related and psychosocial functioning. FINDINGS: In general, protective resources associated with social learning (self-efficacy and approach coping), behavioral economics (health and financial resources and resources associated with Alcoholics Anonymous), and social control theory (bonding with family members, friends, and coworkers) predicted better alcohol-related and psychosocial outcomes. A summary index of protective resources associated with all three theories significantly predicted remission. Protective resources strengthened the positive influence of treatment on short-term remission and partially mediated the association between treatment and remission. CONCLUSIONS: Application of social learning, behavior economic, and social control theories may help to identify predictors of remission and thus to allocate treatment more efficiently.

Adaptation, Psychological↗

PubMedDate not supplied

Psychosocial consequences of postoperative seizure relief.

To address the question of whether complete seizure relief has a positive effect on psychosocial functioning in patients with temporal lobe epilepsy, a follow-up study was conducted at the Montreal Neurological Institute. The approach was one of "before-after" study, with focus on the successfully operated patients, those in whom complete seizure relief was obtained. The Washington Psychosocial Seizure Inventory, specifically developed and validated for use with epilepsy patients, was used for psychosocial assessments. Of 30 surgically treated patients screened for the study, 15 gained complete relief from seizures. At 1-year postoperative follow-up, they showed reductions in their problems scores on all but one of eight psychosocial scales; the average reduction ranged from 24% in Vocational Adjustment to 60% in Adjustment to Seizures. In the areas of Emotional Adjustment and Interpersonal Adjustment reductions were 37 and 48%, respectively. Among the component items, improvement was greatest in ability to concentrate and make decisions, confidence in interpersonal skills, ability to express personal opinions, and perception by others. No appreciable changes occurred in the 15 patients who did not gain complete relief of seizures; indeed, on six of the eight scales they showed a modest increase in their problem scores. This study provides evidence that complete relief from seizures leads to appreciable improvements in psychosocial well-being, manifest as early as 1-year postoperatively, in young adult patients.

Adaptation, Psychological↗

PubMed1996

Functional status and well being in chronic obstructive pulmonary disease with regard to clinical parameters and smoking: a descriptive and comparative study.

BACKGROUND: Self-assessment questionnaires which measure the functional and affective consequences of chronic obstructive pulmonary disease (COPD) give valuable information about the effects of the disease and may serve as important tools with which to evaluate treatment. METHODS: A cross sectional comparative study was performed between patients with COPD (n = 68), stratified according to pulmonary function, and a healthy control group (n = 89). A battery of well established clinical and quality of life measures (the Sickness Impact Profile (SIP), Mood Adjective Check List (MACL), and Hospital Anxiety and Depression scale (HAD)) was used to examine in which functional and affective aspects the patient group differed from the control group and how these measures related to pulmonary function and smoking habits. RESULTS: Compared with the controls, COPD affected functional status in most areas, not just those requiring physical activity. Forty six patients with forced expiratory volume in one second (FEV1) below 50% predicted showed particularly high levels of dysfunction in ambulation, eating, home management, and recreation/ pastimes (SIP). Despite this, their level of psychosocial functioning and mood status was little different from that of the healthy controls. Among the patients, a subgroup reported substantial psychological distress, but mood status was only weakly, or not at all, related to pulmonary function. Smoking habits did not affect functional status or well being. CONCLUSIONS: Quality of life is not significantly affected in patients with mild to moderate loss of pulmonary function, possibly due to coping and/or pulmonary reserve capacity. This suggests that generic self-assessment questionnaires are of limited value for detecting the early consequences of COPD. However, in later stages of the disease they are sensitive enough to discriminate between patients with different levels of pulmonary dysfunction. The low correlations between the indices of pulmonary function and the indices of affective status suggest that well being depends, to a large extent, on factors outside the clinical domain.

Affect↗

PubMedDate not supplied

Rehabilitation outcomes of long-term survivors treated for head and neck cancer.

BACKGROUND: Little is known about the rehabilitation outcomes of long-term survivors following treatment for head and neck cancer. There are, for example, no studies on physical and psychosocial rehabilitation outcomes of T1 glottic larynx carcinoma, despite the fact that these form the majority of head and neck cancer sites. Thus, this investigation afforded a unique opportunity for examining similarities and differences among T1 glottic larynx patients, laryngectomy patients, and those who had surgery for cancer of the oral cavity and/or oropharynx along a variety of physical and psychosocial dimensions. METHODS: To describe the impact of these three types of head and neck cancer and their treatment on the physical and psychosocial functioning of long-term survivors, a self-report questionnaire was completed by 110 patients treated between 2 and 6 years previously in a major cancer center. RESULTS: Data indicate that a higher percentage of patients treated with laryngectomy or commando procedures still experience severe psychosocial distress between 2 and 6 years after their last treatment than do patients treated with radiotherapy for a T1 carcinoma of the glottic larynx. Psychosocial and physical complaints are still reported by many laryngectomy patients, apparently the result of problems in effective communication with others. Many commando procedure patients experience problems with respect to food intake, and with disfigurement and its consequences. T1 larynx patients mainly experience a considerable number of physical complaints. The greater the time that had elapsed since treatment, the fewer the psychosocial problems associated with head and neck tumors. Open discussion of the illness in the family, social support, and perceptions of adequate information from the specialist are the most important predictors of positive rehabilitation outcomes. CONCLUSIONS: This study indicates that T1 larynx patients report many physical complaints even though several years had elapsed since treatment. Also, laryngectomy patients may need psychosocial guidance for a longer posttreatment period and that health care personnel must involve the partner as much as possible in all communications. Commando procedure patients in particular feel hindered by their disfigurement and its consequences. Future research with respect to validation of the specific head and neck modules is needed.

Adaptation, Psychological↗

PubMed2006

Leaders and followers in adolescent close friendships: susceptibility to peer influence as a predictor of risky behavior, friendship instability, and depression.

Adolescents' susceptibility to peer influence was examined as a marker of difficulties in the general process of autonomy development that was likely to be related to deficits across multiple domains of psychosocial functioning. A laboratory-based assessment of susceptibility to peer influence in interactions with a close friend was developed and examined in relation to corollary reports obtained from adolescents, their mothers, and close peers at ages 13 and 14. As hypothesized, observed susceptibility to peer influence with a close friend predicted future responses to negative peer pressure, but it was also related to broader markers of problems in functioning, including decreases in popularity, and increasing levels of depressive symptoms, over time. Susceptibility to peer influence was also linked to higher concurrent levels of substance use, externalizing behavior, and sexual activity. Results are interpreted as reflecting the central role of establishing autonomy with peers in psychosocial development.

Adolescent↗

PubMed1997

Dietary adherence in children with familial hypercholesterolemia.

We examined nutritional and psychosocial factors associated with adherence to the recommended diet (< or = 30% of energy from fat and < 10% from saturated fat) in children with familial hypercholesterolemia. Ninety-eight boys and 74 girls aged 7-17 y treated for > or = 18 mo responded to a quantitative food-frequency questionnaire that was self- (ages 13-17 y) or dietitian-(ages 7-12 y) administered. One hundred nine subjects also completed a weighed food record. Psychosocial assessments included the Child Behavior Checklist, Youth Self Report, and Children's Global Assessment Scale. The weighed record showed better adherence to dietary guidelines than the food-frequency questionnaire, but energy intake was underestimated. Low energy reporters had a healthier diet than the rest with the weighed record. According to the questionnaire, energy intake was underreported in only 9% of subjects and was not associated with a healthier diet, thus, further analyses were based on the questionnaire. Intakes of vitamin C (P = 0.0001), folate (P = 0.0001), riboflavin (P = 0.03), thiamine (P = 0.0001), and magnesium (P = 0.0001) per megajoule increased as quartile of total fat intake (as a % of total energy) decreased, reflecting increased intakes of cereals (P = 0.002), pasta (P = 0.01), fruit (P = 0.0001), pure meat (not minced or meat products; P = 0.047), skim milk (P = 0.0001), and skim cheese (P = 0.005). Energy and sugar (% of total energy) intakes were not significantly different across all fat intakes; energy density decreased with decreasing fat quartile. Overall psychosocial function score and parental educational level were associated with lower fat intake in multivariate analysis, explaining 11% of the variance in fat intake. We conclude that adherence to fat restriction among children treated for familial hypercholesterolemia is associated with increased micronutrient density, decreased energy density, and psychosocial factors that facilitate adherence.

Adolescent↗

PubMed1994

Comparison of a community dysthymia sample at screening with a matched group of nondepressed community controls.

The primary goal of the study was to compare the psychosocial functioning of an untreated, community sample of DSM-III-R dysthymia subjects (N = 24) at screening to that of a matched sample of community nondepressed volunteers (N = 18) with no lifetime or current history of axis I disorders. Subjects were compared across a number of psychosocial indices. The dysthymics were found to be less sociable (introversion) and clinically high on neuroticism-instability, external in regard to their causal attributions, less stable for positive uncontrollable events and more stable and global for negative uncontrollable events, relying more on coping strategies such as wishful thinking and self-blame, more interpersonally submissive and hostile, and to have a poorer social support-resource network. In addition, the dysthymics reported more family dysfunction and a higher rate of negative major life events.

Adaptation, Psychological↗