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Results for “Psychosocial functioning”

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PubMed2006

The scope and nature of pain in persons with multiple sclerosis.

Much remains unknown about the scope, nature, and impact of pain on the lives of persons with multiple sclerosis (MS). In the present study, 180 community dwelling adults with MS completed a postal survey that included demographic measures, MS disease measures, and several standardized measures of pain, including pain intensity, variability, location, and pain-related interference. Some 66% of the sample reported pain, 25% of whom reported severe pain. Persons with pain reported an average of 6.6 distinct pain sites. Using the Brief Pain Inventory Interference Scale, the average level of overall pain interference was 3.33 (0-10 scale) in the group reporting pain. The highest levels of pain interference were reported for sleep, recreational activities, and work in and outside the home. Persons with pain were more likely to report greater MS disease severity, poorer psychological functioning, and poorer health than persons with MS but not pain. Persons with pain were also less likely to be employed. These findings are consistent with previous research that shows that pain is common in MS, that it is severe in a substantial subset of these individuals and has the potential to negatively impact physical and psychosocial functioning over and above the effects of MS itself.

Adult↗

PubMed1994

Insight and psychosocial treatment compliance in schizophrenia.

Research has suggested that poor insight in patients with schizophrenia is associated with poorer medication compliance and heightened levels of psychopathology. This study examined the relationship of insight to compliance with a work rehabilitation program and with levels of psychopathology and psychosocial functioning. Poor insight was found to be positively associated with fewer weeks of participation and with poorer social skills and personal presentation in the fifth week of work. Poor insight was also associated with cognitive disorganization and a lower intelligence quotient, but not with heightened levels of psychopathology. Results suggest that poor insight may predict noncompliance with psychosocial treatment and may be related to a constellation of cognitive deficits.

Adult↗

PubMed2003

Psychosocial outcomes of alcohol involvement and dysphoria in women: a 16-year prospective community study.

OBJECTIVE: Alcohol involvement, dysphoria, and their combined effects, may have long-term psychosocial consequences. However, because of weaknesses in existing literature, the exact relationships are unclear, as are the relative contributions of either construct or their combined effects to later psychosocial outcomes. This study tests the relationships between these conditions during late adolescence andyoung adulthood as predictors of adult marital, relational and job satisfaction; divorce; perceived opportunity; and job stability. We also test the influence of a change (increase or decrease) in alcohol involvement, dysphoria, or their combined association, on adult psychosocial functioning. METHOD: This study used three waves of data from an ethnically diverse, longitudinal community sample (N = 305 women) assessed over a 16-year span. The measures used have established validity and reliability. RESULTS: Structural equation models revealed that a second-order factor reflecting alcohol involvement and dysphoria during young adulthood was a stronger predictor of psychosocial maladjusument in adulthood than either alcohol involvement or dysphoria alone, predicting decreased satisfaction in multiple psychosocial domains (marriage, relationships and employment). An increase in the shared association between alcohol involvement and dysphoria from late adolescence to young adulthood reduced adult perceived opportunity. CONCLUSIONS: Early intervention is crucial. Clinicians should emphasize the screening for and treatment of alcohol involvement, dysphoria, and their combined effects, in late adolescence and young adulthood. Psychoeducational and treatment efforts to raise awareness of long-term consequences of these conditions are critical.

Adult↗

PubMedDate not supplied

Optimal insulin delivery in adolescents with diabetes: impact of intensive treatment on psychosocial adjustment.

The psychosocial effects of recent advances in the management of diabetes mellitus are unknown and could conceivably be adverse, particularly during the critical period of adolescence. Seven teenagers were evaluated by standard psychosocial scales and a detailed questionnaire before and on completion of a 6-mo intensive management program utilizing home glucose monitoring and multiple injections or the insulin infusion pump. All achieved improved metabolic control with inpatient glucose values (during 24-h monitoring) falling from 244 +/- 58 to 108 +/- 10 mg/dl, glycosylated hemoglobin levels falling from 11.8 +/- 2.9% to 8.4 +/- 1.7%, and home glucose levels averaging 121 +/- 16 mg/dl. Standardized scales evaluating depression, diabetic adjustment, self-esteem, and social adjustment indicated no deterioration in psychosocial functioning. There was a statistically significant increase in locus of control scores, suggesting an improved sense of internal control of life events. The program questionnaire revealed a positive response to both the program and the control devices used. This study suggests that the positive metabolic benefits of intensive diabetic management during adolescence are not offset by adverse psychosocial effects and indeed positive psychosocial benefits may result.

Adaptation, Psychological↗

PubMed2005

Nefazodone treatment of cocaine dependence with comorbid depressive symptoms.

AIMS: In the current study, nefazodone, an antidepressant with dual action on serotonin and norepinephrine reuptake as well as 5-HT(2A) receptor antagonist effects, was studied in subjects with cocaine dependence and depressive symptoms, to determine its efficacy in reducing cocaine use. DESIGN: An 8-week, double blind, placebo-controlled design was used. SETTING: The study was conducted at the Medication Development Research Unit (MDRU) at the VA Boston Healthcare System and the Manhattan Department of Veterans Affairs (DVA) Medical Center. PARTICIPANTS: Subjects (n = 69) met Diagnostic and Statistical Manual version IV (DSM-IV) criteria for cocaine dependence and had Hamilton Depression Scores of 12 or higher. INTERVENTION: Subjects were assigned randomly to receive nefazodone 200 mg twice daily (n = 34) or matching placebo (n = 35). All subjects received individual counseling. MEASUREMENTS: Urinary measurements of benzoylecgonine (BE, three times per week) and self-reports of cocaine use were the primary outcome measures. Secondary outcome measures included assessments of psychiatric functioning, cocaine craving and social functioning. FINDINGS: Median weekly BE declined more rapidly in the nefazodone than in the placebo group. Median urine BE at baseline was, however, significantly greater in nefazodone than in the placebo group. Scores for strength of cocaine craving also decreased more rapidly in the nefazodone group compared to the placebo group. Both groups had equivalent improvement in mood, psychosocial functioning and self-reported cocaine use. CONCLUSIONS: These results suggest that nefazodone administration can reduce cocaine craving after it has been administered for several weeks. Although the nefazodone group had a greater rate of decrease in BE levels than the placebo group, the interpretation of this finding is obscured by significant group differences in baseline BE levels.

Adult↗

PubMed1994

Rate and prediction of relapse in bulimia nervosa.

OBJECTIVE: The purpose of this study was to provide an estimate of the rate of relapse in patients with bulimia nervosa and to attempt to identify indexes of functioning before or after treatment that predicted subsequent relapse. METHOD: The subjects were 48 female patients with bulimia nervosa who achieved symptom control while attending a specialized day hospital treatment program for eating disorders. The subjects were assessed before treatment, after treatment, and at a 2-year follow-up interview with respect to their eating symptoms and psychosocial functioning. RESULTS: A relapse rate of 31% was observed during the 2-year follow-up period, and the vast majority of relapses occurred within the first 6 months after treatment. The strongest predictors of relapse were younger age, higher vomiting frequency, and a higher score on the bulimia subscale of the 26-item Eating Attitudes Test before treatment and higher vomiting frequency and a higher score on the interpersonal distrust subscale of the Eating Disorder Inventory at the end of treatment. Measures of binge eating frequency, self-esteem, depression, and social adjustment were not significant predictors of relapse. CONCLUSIONS: Vomiting frequency, even at subthreshold levels, appears to be an important prognostic indicator and may be one of the best barometers of residual symptoms in these patients.

Adolescent↗

PubMed2000

Chronic pain in neurorehabilitation populations: Prevalence, severity and impact.

Extensive data document the adverse impact chronic pain can have on physical and psychosocial functioning. However, only recently has chronic pain received attention as a secondary complication in neurorehabilitation populations such as spinal cord injury, multiple sclerosis, and cerebral palsy. It is not unreasonable to expect that chronic pain might exacerbate impairments already present due to a chronic, disabling condition. The current paper reviews what is known about the prevalence, severity, and psychosocial impact of chronic pain in neurorehabilitation populations. Although there is variation among different conditions, available data suggest that considerable proportions of these patient populations experience chronic pain and associated sequelae similar to that reported in the extant chronic pain literature (e.g., psychological distress). Research needs to continue investigating the impact of chronic pain in neurorehabilitation populations and work toward development of effective interventions to manage pain and disability in these patients. It is likely that effective pain management will lead to more effective rehabilitation and improved quality of life.

Journal Article↗

PubMedDate not supplied

The functioning of single women with breast cancer and their school-aged children.

Although there are significant numbers of single women with breast cancer who are rearing children, there is no known study of their own or their school-aged children's adjustment to the illness. The purposes of this study are: 1) to describe the adjustment of single women to early stage breast cancer; 2) to contrast their responses to a comparable sample of married/partnered women; 3) and to document the psychosocial functioning of school-aged children when their single mother has breast cancer. Results obtained from questionnaire data from 22 single and 101 married/partnered women revealed that single women had significantly higher rates of depression; reported significantly higher numbers of illness-related pressures on their family; had a significantly higher proportion of young children scoring in the abnormal range on measures of self-worth and social acceptance; and reported lower quality in parenting their children. Interviews with single women revealed that many were burdened by feelings of self-deprecation because of their breast cancer, and many felt alone with the disease through the initial diagnosis period, during treatments, and through recovery. Evidence from this pilot study suggests that single women need early and immediate linkage into an informational and educational network and a viable adult support network.

Adaptation, Psychological↗

PubMedDate not supplied

Growth hormone therapy in children with short stature: is bigger better or achievable?

The introduction of recombinant DNA-synthesized human growth hormone in the mid-1980s, and its attendant unlimited supply, have led to wider application of growth hormone therapy in children. Over the past decade, the efficacy of growth hormone treatment in patients with Turner syndrome and chronic renal insufficiency, two conditions in which growth hormone secretion is normal, in improving growth velocity and final height, has also led to the consideration of growth hormone therapy in children with idiopathic short stature. Although thousands of patients with idiopathic short stature are currently being treated with growth hormone, the limited overall results available at this time do not show a significant improvement in final adult height despite an improvement in short-term growth velocity. Potential reasons for this outcome include 1) skeletal age advancing more rapidly than height age, 2) heterogeneity of the patient population comprising idiopathic short stature, 3) inherent inaccuracies of methodological tools, such as measurement of predicted adult height, and 4) a subset of children with idiopathic short stature who may, in fact, have partial growth hormone insensitivity. From a psychological perspective, the consensus of investigations in non-clinic-referred populations of psychosocial function in children with short stature do not indicate a disadvantage compared with children of normal height when socio-economic status is taken into consideration. These results, in conjunction with the minimal gains reported in behavioural measurements in idiopathic short children treated with growth hormone, question the traditional rationale that augmentation of growth velocity results in improvement in psychosocial well-being.

Adolescent↗

PubMed2004

Neurological, neuropsychological, and psychosocial outcome following treatment of unruptured intracranial aneurysms: a review and commentary.

Thirty studies published between 1977 and 2001 that focus on outcome following unruptured intracranial aneurysm (UIA) treatment are reviewed. Although findings from these studies suggest outcome from UIA treatment is reasonably good (between 5% and 25% morbidity and between 0-7% mortality), many of the complex issues associated with the treatment of UIAs remain controversial. Most of the studies reviewed address outcome in terms of mortality and neurological morbidity. Very few studies exist which include measures of outcome such as cognitive status, psychosocial functioning and quality of life. Given that patients facing treatment tend to be healthy middle-aged adults with many years of active working and social life ahead of them, it is important to take into account the long-term consequences of either harboring an UIA, or having it treated. The small number of studies that include cognitive, psychosocial and quality of life outcomes are reviewed in some detail and suggestions made for improving future UIA outcome research.

Brain↗

PubMed2001

Patients' expectations of knee surgery.

BACKGROUND: Patients' expectations of medical care are linked to their requests for treatment and to their assessments of outcome and satisfaction. Our goals were to measure patients" preoperative expectations of knee surgery and to develop and test patient-derived knee expectations surveys. METHODS: An initial sample of 377 patients (mean age, 54.6 18.2 years; 52% women) was enrolled in the survey-development phase. One hundred and sixty-one (43%) of these patients subsequently underwent total knee arthroplasty; seventy-five (20%), cruciate ligament repair; eighty-five (23%), meniscal surgery; and fifty-six (15%), surgery for another knee condition. Preoperatively, these patients were asked open-ended questions about their expectations of knee surgery. Their responses were grouped with use of qualitative research techniques to generate categories of expectations. Categories were transformed into specific questions and were formatted into two draft surveys, one for patients undergoing total knee arthroplasty and one for patients undergoing other surgical procedures on the knee. A second sample of 163 patients (mean age, 55.1 17.5 years; 49% women) was enrolled in the survey-testing phase, and they completed the draft surveys on two separate occasions to establish test-retest reliability. Items were selected for the final surveys if they were cited by 5% of the patients, if they represented important functional changes resulting from surgery, or if they represented potentially unrealistic expectations. All selected items fulfilled reliability criteria, defined as a kappa (or weighted kappa) value of 0.4, or were deemed to be clinically relevant by a panel of orthopaedic surgeons. RESULTS: From the survey-development phase, a total of fifty-two categories of expectations were discerned; they included both anticipated items such as pain relief and improvement in walking ability and unanticipated items such as improving psychological well-being. Expectations varied by diagnosis and patient characteristics, including functional status. Two final surveys were generated: the seventeen-item Hospital for Special Surgery Knee Replacement Expectations Survey and the twenty-item Hospital for Special Surgery Knee Surgery Expectations Survey. Each required less than five minutes to complete. CONCLUSIONS: Patients have multiple expectations of knee surgery in the areas of symptom relief and improvement of physical and psychosocial function, and these expectations vary according to the diagnosis. We developed two valid and reliable surveys that can be used preoperatively to direct patient education and shared decision-making and to provide a framework for setting reasonable goals. Reexamining patients' responses postoperatively could provide a way to assess fulfillment of expectations, which is a crucial patient-derived measure of outcome and satisfaction.

Adult↗

PubMed2000

[Can sports and physical activity promote young peoples' psychosocial health?].

BACKGROUND: Sport and physical activity is generally believed to be beneficial to young people's psychosocial health, but the scientific evidence seems equivocal. This article gives a narrative review of recent developments in the literature on psychosocial health effects of physical activity and sport among children and adolescents. MATERIAL AND METHODS: Based on a narrative review of a selection of metaanalytical and key studies, results in four areas of psychosocial functioning are presented. RESULTS: Findings support an association between involvement in physical activity and sport and well-being. Physical activity is associated with lower levels of mental health problems, and seems to promote self-esteem. Physical activity as a treatment of mental health problems for this age group is underexplored and no firm conclusions can be made. The evidence with respect to effects on cognitive and academic functioning is weak. Further, the evidence that juvenile delinquency and antisocial development could be counteracted is equivocal. INTERPRETATION: There is a paucity of studies that can confirm any causal effects. Future research would benefit particularly from studying the role of sports and physical activity mode as well as the psychological and social context in which it may produce beneficial psychosocial outcomes.

Adolescent↗

PubMed2002

Hearing impairment.

The purpose of this chapter is to review the literature on hearing impairment, specifically the impact of hearing impairment on the functioning of elders, interventions that minimize the impact of hearing loss on functioning, and identification of issues raised by the review for nursing research. Computerized (MEDLINE, PsychINFO, and CINAHL) and manual searches were used to obtain research reports from a range of disciplines. Research articles including elders (> or = 60) and published between 1989 and 2001 were included. Twenty-five articles were selected for critical review, four written by nurses. The diversity of methodologies, the criteria used to define hearing impairment, the range of sample characteristics, and the assessment measures make comparisons across studies difficult. Most studies, however, support the negative impact of hearing impairment, especially on psychosocial functioning. Measures that are condition specific are generally more effective in capturing the impact of hearing loss than generic measures. Findings related to physical disability are less consistent. The results of intervention studies suggest that hearing devices can improve psychosocial and communication outcomes, but behavioral interventions have not shown long lasting benefit. For nurses to assist elders and their families manage the impact of hearing impairment, further research is needed in several areas that have been poorly explored. These include the dyadic experience of hearing impairment, the way in which culture influences the experience of hearing loss, the needs of hearing impaired individuals across settings, the long-term impact of ototoxic medications, and strategies to assist elders in coping with hearing impairment and utilizing available technologies.

Aged↗

PubMed1996

Attention-deficit hyperactivity disorder and juvenile mania: an overlooked comorbidity?

OBJECTIVE: To evaluate the psychiatric, cognitive, and functional correlates of attention-deficit hyperactivity disorder (ADHD) children with and without comorbid bipolar disorder (BPD). METHOD: DSM-III-R structured diagnostic interviews and blind raters were used to examine psychiatric diagnoses at baseline and 4-year follow-up in ADHD and control children. In addition, subjects were evaluated for cognitive, academic, social, school, and family functioning. RESULTS: BPD was diagnosed in 11% of ADHD children at baseline and in an additional 12% at 4-year follow-up. These rates were significantly higher than those of controls at each assessment. ADHD children with comorbid BPD at either baseline or follow-up assessment had significantly higher rates of additional psychopathology, psychiatric hospitalization, and severely impaired psychosocial functioning than other ADHD children. The clinical picture of bipolarity was mostly irritable and mixed. ADHD children with comorbid BPD also had a very severe symptomatic picture of ADHD as well as prototypical correlates of the disorder. Comorbidity between ADHD and BPD was not due to symptom overlap. ADHD children who developed BPD at the 4-year follow-up had higher initial rates of comorbidity, more symptoms of ADHD, worse scores on the CBCL, and a greater family history of mood disorder compared with non-BPD, ADHD children. CONCLUSIONS: The results extend previous results documenting that children with ADHD are at increased risk of developing BPD with its associated severe morbidity, dysfunction, and incapacitation.

Adolescent↗

PubMed1998

Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome.

OBJECTIVES: Despite considerable progress in intensive care management of the acute respiratory distress syndrome (ARDS), little is known about health-related quality of life in long-term survivors. In addition, intensive care treatment can be extremely stressful, and many survivors of ARDS report adverse experiences such as respiratory distress, anxiety, or pain during intensive care unit (ICU) treatment. This study was performed to assess health-related quality of life in survivors of ARDS and to test the hypothesis that adverse experiences during ICU treatment result in posttraumatic stress disorder (PTSD) and negative effects on health-related quality of life. DESIGN: Retrospective, cohort, case-controlled analyses. SETTING: A 12-bed multidisciplinary ICU of a tertiary care university hospital, capable of providing extracorporeal life support for adults with severe ARDS. PATIENTS: We studied 80 patients who were admitted to our hospital from 1985 to 1995 and who survived an episode of ARDS. ARDS was defined according to the criteria of the American-European Consensus Conference on ARDS. INTERVENTIONS: Health-related quality of life was measured using the Health Status Questionnaire of the self-administered Medical Outcomes Study Short Form Survey that consists of 36 questions (SF-36) and the German version of the Post Traumatic Stress Syndrome 10-Questions Inventory (PTSS-10), a self-report scale for the diagnosis of posttraumatic stress disorder based on the Diagnostic and Statistical Manual (Third Edition) criteria (American Psychiatric Association). The number of adverse experiences (anxiety, respiratory distress, pain, and nightmares) during intensive care was evaluated by means of a structured questionnaire. For each patient with ARDS, three age- and gender-comparable controls were randomly selected from databases providing normal values for the SF-36 and PTSS-10 scores in populations at risk for posttraumatic stress disorder. MEASUREMENTS AND MAIN RESULTS: Survivors of ARDS showed statistically significant impairments in all eight health dimensions of the SF-36 when compared with normal controls (median reduction 21.3%, p < .006) with maximal impairments in physical function (median reduction 28.9%, p = .000) and a 38% higher frequency of chronic pain (p = .0001). Three of 34 patients reporting none, or one, adverse experience had evidence of posttraumatic stress disorder vs. 19 of 46 patients remembering multiple traumatic episodes (p = .007). Patients reporting multiple adverse experiences described the lowest health-related quality of life, with maximal impairments in psychosocial functioning (p < .005) and only small limitations in physical function. CONCLUSIONS: Long-term survivors of ARDS describe a good overall health-related quality of life. Major impairments in mental health domains of health-related quality of life are associated with the development of posttraumatic stress disorder and are a possible result of traumatic experiences during ICU therapy.

Adolescent↗

PubMed1997

Relationship between respiratory muscle function and quality of life in sarcoidosis.

In sarcoidosis, pulmonary and general symptoms often do not correlate with radiographic stage and routinely performed lung function tests. Asymptomatic muscle involvement in sarcoidosis is common, but little is known about respiratory muscle involvement. The aim of this study was to investigate any relationships between persistent complaints and/or quality of life and respiratory muscle strength and endurance, respectively. Measurements of maximal inspiratory and expiratory mouth pressures (PI,max and PE,max), respiratory muscle endurance and routine lung function were made in 18 patients with sarcoidosis. To assess health status and quality of life, patients completed the Sickness Impact Profile (SIP). Respiratory muscle strength and endurance time were lower in the patient group than in a group of healthy controls (p=0.05). Compared to a general population, the patients with sarcoidosis were found to be limited in physical and psychosocial functioning. The respiratory muscle endurance time correlated with the SIP subscales "mobility" (r=-0.56; p<0.01), and "body care and movement" (r=-0.79; p<0.001). The total lung capacity (TLC), inspiratory vital capacity (IVC) and forced expiratory volume in one second (FEV1) were normal in all subjects. In conclusion, patients with sarcoidosis and normal lung function showed reduced respiratory muscle strength and endurance time. Correlations were found between these indices and both symptoms and certain Sickness Impact Profile domains. Therefore, we suggest inclusion of measurements of respiratory muscle strength in the assessment and follow-up of patients with sarcoidosis.

Adult↗

PubMed1994

Rehabilitation experiences of patients receiving dialysis.

The concept of "rehabilitation" contains physical, psychosocial, and vocational elements. An exploratory study was developed by ESRD Network 18 regarding patient rehabilitation experiences in Southern California. A questionnaire was developed, and data collected from 248 randomly selected work-eligible ESRD patients in the network. Results showed relatively few significant differences between employed and unemployed ESRD patients in terms of demographics, and on many aspects of physical function, psychosocial adaptation, and vocational rehabilitation potential. However, unemployed patients reported lower energy levels, less stamina for working, greater benefits for not working, and problems with vocational rehabilitation programs. Unemployed patients also had more negative attitudes about achieving life goals and former job experiences. To help patients overcome barriers to rehabilitation, facility staff can focus on management of ESRD complications, assisting patients with support groups, connecting patients to rehabilitation resources early, and encouraging employed patients to continue working as long as possible.

Activities of Daily Living↗

PubMed1990

Assessing psychosocial adjustment of children with chronic illnesses: a review of the technical properties of PARS III.

Four groups of investigators in the Research Consortium on Chronic Illness in Childhood have used the Personal Adjustment and Role Skills Scale (PARS) III to assess the psychosocial adjustment of children with chronic physical illnesses and no mental impairment. The PARS III consists of 28 items that measure psychosocial functioning in six areas: peer relations, dependency, hostility, productivity, anxiety-depression, and withdrawal. Analyses of the measure's reliability and validity, using a total combined sample of 450 school-age children (ages 5-18 years) with a variety of chronic illnesses and three comparison samples of healthy children, provide evidence that the PARS III can be used successfully to assess psychosocial adjustment of children with chronic illnesses and no cognitive impairments.

Adolescent↗