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Results for “Psychosocial functioning”

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PubMed1996

Phenomenology and severity of major depression and comorbid lifetime anxiety disorders in primary medical care practice.

The psychiatric history and presenting clinical characteristics of 276 depressed primary care patients with and without a lifetime comorbid anxiety disorder were studied in a randomized control trial of treatments for major depression. Our findings indicate that distinctive patterns of depressive symptoms and severity, functional impairment, comorbidity of other DSM-III-R Axis I and Axis II disorders, and treatment participation are associated with lifetime histories of panic and generalized anxiety disorder. The most consistent differences are evident between patients with major depression alone and those with major depression and a lifetime panic disorder. The latter presented with greater depressive severity, greater impairment in physical and psychosocial functioning, and were more likely to have a history of alcohol dependence, somatization disorder, and avoidant personality disorder. Discriminant function analysis indicated that 66% of depressed patients with lifetime panic disorder could be correctly distinguished from those without such comorbidity on the basis of the severity of somatic and affective symptoms but not cognitive symptoms of depression. Further, depressed patients with lifetime panic disorder were more likely to prematurely terminate both pharmacotherapy and psychotherapy during each treatment's acute phase. Implications for the diagnosis and treatment of major depression with comorbid anxiety disorder in primary care patients are discussed.

Adolescent↗

PubMed2002

Characteristics of Korean-Americans with schizophrenia: a cross-ethnic comparison with African-Americans, Latinos, and Euro-Americans.

The purpose of this study was (1) to identify the demographic and psychosocial characteristics of Korean-Americans with schizophrenia, and (2) to compare the demographic and psychosocial characteristics of Korean-Americans with schizophrenia to African-American, Latino, and Euro-American individuals with schizophrenia. Based on current models of psychosocial functioning in schizophrenia, four dimensions--clinical status, functional status, subjective experience, and community risk--were examined and compared across the ethnic groups. Data on 223 individuals diagnosed with schizophrenia who were Korean-American (n = 40), Euro-American (n = 95), African-American (n = 60), and Latino (n = 28) were gathered in face-to-face interviews. All of the subjects were engaged in outpatient treatment. After controlling for sociodemographic variables, the main findings were as follows: (1) while the Korean-Americans were the least acculturated, their symptom levels and clinical status were highly comparable with those of the other ethnic groups; (2) based on living situation, family contact, social functioning, activities of daily living, and vocational data, the Korean-Americans showed a stronger familial orientation, lower social initiation, and higher affiliative qualities than other groups; (3) the Korean-American sample had comparable levels of self-esteem but reported lower satisfaction with life than the other ethnic groups. Minority status did not confound these findings. It is concluded that the psychosocial profile of the Korean-Americans was strongly influenced by their traditional and collectivistic cultural orientation. At the same time, the lower levels of life satisfaction could indicate that they experience difficulties in adjusting to Western society. Considering the Korean-Americans' strong tendency to maintain a collectivistic cultural orientation, mental health services need to be congruent with their cultural expectations. Interventions should also identify risk factors associated with lower life satisfaction. Several research implications are discussed.

Acculturation↗

PubMed1995

Pain coping mechanisms in fibromyalgia: relationship to pain and functional outcomes.

OBJECTIVE: To evaluate the factor structure of the Coping Strategies Questionnaire (CSQ) in patients with fibromyalgia (FM) and to compare the factors derived from this measure, along with the active and passive pain coping scales of the Pain Management Inventory (PMI) in predicting pain, depression, quality of well being (QWB), and pain behavior concurrently and over time. METHODS: One hundred twenty-two patients with FM were recruited from medical clinics, the community, and support groups. Eligible patients completed a battery of self-report measures of pain and psychosocial functioning at baseline assessment before random assignment to a clinical trial. A subset of 69 patients who completed the clinical trial were readministered the same battery 3 mo later. Data were analyzed within the baseline period, and from the baseline period to posttreatment to evaluate the predictive effects of coping strategies on clinical outcomes. RESULTS: Principal components analysis of the CSQ revealed Coping Attempts (CA) and Pain Control and Rational Thinking (PCRT) factors, which have been found in other patient populations with chronic pain. Hierarchical multiple regression analyses revealed that high active coping and low PCRT contributed to higher concurrent pain, while low active coping and high passive coping were related to greater concurrent depression and pain behavior, respectively. Controlling for baseline scores on criterion measures, longitudinal multiple regression analyses demonstrated that high active coping and low PCRT scores contributed to greater pain, greater depression, and lower QWB at posttreatment, while low PCRT alone predicted greater pain behavior. CONCLUSION: The results show the import of the pain coping construct in FM and highlight the negative contribution of low perceived control over pain and high active coping to a range of pain outcomes. The findings on low perceived control converge with data on other chronic pain populations, while the role of active coping appears to be detrimental in FM, in contrast to its positive effects in patients with rheumatoid arthritis.

Adaptation, Psychological↗

PubMed2003

Treatment of chronic intractable neuropathic pain with dronabinol: case report of two adolescents.

OBJECTIVE: To evaluate the effectiveness of dronabinol for the treatment of neuropathic pain refractory to previous treatment. METHODS: We studied the response (reduction of pain intensity and functional improvement) to dronabinol (5 mg/day to 25 mg/day) in two adolescents with neuropathic pain and depression refractory to previous treatments over two and five years, respectively. RESULTS: Reduction in pain intensity (45%) was achieved in patient 2 and was unchanged in patient 1. Functional improvement was markedly increased in terms of academic performance, mood and sleep in both patients over four to five months, without major adverse effects. While these improvements dissipated over time, the patients were more reconnected with rehabilitation and focused less on the intrusiveness of their pain problem in their every day lives. CONCLUSIONS: Dronabinol appeared to be effective in improving pain affect and psychosocial functioning in the treatment of refractory neuropathic pain and may be considered as an adjuvant medication in the rehabilitation process. Well-controlled placebo studies are required for further evaluation.

Adolescent↗

PubMed1993

Education in geriatrics: a required curriculum for medical students.

The mandatory geriatrics and gerontology curriculum at The Mount Sinai School of Medicine in New York includes two modules for first- and second-year students and a four-week block experience for fourth-year students. The first-year curriculum emphasizes socioeconomic, psychosocial, biomedical, and attitudinal issues. The second-year experience serves as an introduction to clinical geriatrics. The fourth-year clerkship allows students to further develop their fund of geriatric knowledge, learn specific geriatric skills, and build on their internal medicine foundation, integrating new knowledge and skills and developing into comprehensive practitioners who can apply the team approach to address all the medical, functional, psychosocial, and ethical aspects of caring for the elderly.

Curriculum↗

PubMed2006

Relationship of early life stress and psychological functioning to adult C-reactive protein in the coronary artery risk development in young adults study.

BACKGROUND: Low socioeconomic status (SES) and a harsh family environment in childhood have been linked to mental and physical health disorders in adulthood. The objective of the present investigation was to evaluate a developmental model of pathways that may help explain these links and to relate them to C-reactive protein (CRP) in the Coronary Artery Risk Development in Young Adults (CARDIA) dataset. METHODS: Participants (n = 3248) in the CARDIA study, age 32 to 47 years, completed measures of childhood SES (CSES), early family environment (risky families [RF]), adult psychosocial functioning (PsyF, a latent factor measured by depression, mastery, and positive and negative social contacts), body mass index (BMI), and C-reactive protein. RESULTS: Structural equation modeling indicated that CSES and RF are associated with C-reactive protein via their association with PsyF (standardized path coefficients: CSES to RF, RF to PsyF, PsyF to CRP, CSES to CRP, all p < .05), with good overall model fit. The association between PsyF and CRP was partially mediated by BMI (PsyF to BMI, BMI to CRP, both p < .05). CONCLUSIONS: Low childhood SES and a harsh early family environment appear to be related to elevated C-reactive protein in adulthood through pathways involving psychosocial dysfunction and high body mass index.

Adult↗

PubMedDate not supplied

Impact of a telehealth intervention to augment home health care on functional and recovery outcomes of elderly patients undergoing coronary artery bypass grafting.

OBJECTIVE: This pilot study examined the effect of a home communication intervention (HCI) to augment home health care (HHC) on functioning and recovery outcomes of elderly patients undergoing coronary artery bypass graft. DESIGN: A randomized, experimental two-group (N = 50) repeated-measures design was used. Both HCI and control subjects received HHC, and the HCI group also received the 12-week HCI delivered by a telehealth device, the Health Buddy (Health Hero Network). The Medical Outcome Study Short Form-36 measured physiologic and psychosocial functioning at baseline, 6 weeks, and 3 months after surgery. Follow-up subject interviews ascertained self-report of postoperative problems and health care use. SAMPLE: Subjects had an average age of 75.3 years and included males (56%) and females (44%). RESULTS: By using repeated-measures analyses of covariance, covariating for the total number of HHC visits, HCI subjects, compared with the HHC group only, had a significantly higher adjusted mean general health functioning score (F = 8.41 [1, 36], P < .01). There were significant time effects on physical, role-physical, and mental health functioning, indicating that both groups improved over time. The groups reported similar postoperative problems; however, the control group had more emergency department visits than the HCI group. CONCLUSIONS: Findings demonstrate the potential benefit of using an HCI to further augment outcomes of high-risk patients undergoing coronary artery bypass graft surgery referred to HHC after hospitalization.

Adaptation, Physiological↗

PubMed2002

Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments to improve psychological outcome--a systematic review.

BACKGROUND: Routine administration of Health Related Quality of Life (HRQoL) and needs assessment instruments has been advocated as part of clinical care to aid the recognition of psychosocial problems, to inform clinical decision making, to monitor therapeutic response and to facilitate patient-doctor communication. However, their adoption is not without cost and the benefit of their use is unclear. METHOD: A systematic review was conducted. We sought experimental studies that examined the addition of routinely administered measures of HRQoL to care in both psychiatric and non-psychiatric settings. We searched the following databases: MEDLINE, EMBASE, CINAHL, PsycLIT and Cochrane Controlled Trials Register (to 2000). Data were extracted independently and a narrative synthesis of results was presented. RESULTS: Nine randomized and quasi-randomized studies conducted in non-psychiatric settings were found. All the instruments used included an assessment of mental well-being, with specific questions relating to depression and anxiety. The routine feedback of these instruments had little impact on the recognition of mental disorders or on longer term psychosocial functioning. While clinicians welcomed the information these instruments imparted, their results were rarely incorporated into routine clinical decision making. No studies were found that examined the value of routine assessment and feedback of HRQoL or patient needs in specialist psychiatric care settings. CONCLUSIONS: Routine HRQoL measurement is a costly exercise and there is no robust evidence to suggest that it is of benefit in improving psychosocial outcomes of patients managed in non-psychiatric settings. Major policy initiatives to increase the routine collection and use of outcome measures in psychiatric settings are unevaluated.

Communication↗

PubMed1997

The impact of service characteristics on functional outcomes from community support programs for persons with schizophrenia: a growth curve analysis.

A total of 172 individuals diagnosed with a schizophrenia spectrum disorder were followed for 36 months in 3 distinct models of community-based care. Functional outcome data gathered every 6 months were combined with service implementation data to test hypotheses concerning the impact of service characteristics on prospective client outcomes. The results using hierarchical linear modeling supported associations between the intensity, specificity, and longitudinality of services and improved client outcomes. Specifically, more intense services were associated with higher levels or rates of improvement on all indices of clinical and psychosocial functioning. The specificity results suggested that services needed to be targeted to specific areas of functioning in order for improvement to occur. The effect of longitudinality was contingent on the outcome domain examined.

Adult↗

PubMed2004

Recommendations for resistance exercise in cardiac rehabilitation. Recommendations of the German Federation for Cardiovascular Prevention and Rehabilitation.

Aerobic endurance training has been an integral component of the international recommendations for cardiac rehabilitation for more than 30 years. Notwithstanding, only in recent years have recommendations for a dynamic resistance-training program been cautiously put forward. The perceived increased risk of cardiovascular complications related to blood pressure elevations are the primary concern with resistance training in cardiac patients; recent studies however have demonstrated that this need not be a contraindication in all cardiac patients. While blood pressure certainly may rise excessively during resistance training, the actual rise depends on a variety of controllable factors including magnitude of the isometric component, the load intensity, the amount of muscle mass involved as well as the number of repetitions and/or the load duration. Intra-arterial blood pressure measurements in cardiac patients have demonstrated that that during low-intensity resistance training [40-60% maximum voluntary contraction (MVC)] with 15-20 repetitions, only modest elevations in blood pressure are revealed, similar to those seen during moderate endurance training. When properly implemented by an experienced exercise therapist, in specific patient groups an individually tailored, medically supervised dynamic resistance training program carries no inherent higher risk for the patient than aerobic endurance training. As an adjunct to endurance training, in selected patients, resistance training can increase muscle strength and endurance, as well as positively influence cardiovascular risk factors, metabolism, cardiovascular function, psychosocial well-being and quality of life. According to present data, resistance training is however not recommended for all patient groups. The appropriate training method and correct performance are highly dependent on each patient's clinical status, cardiac stress tolerance and possible comorbidities. Most studies have used middle-aged men of average normal aerobic performance capacity and with good left-ventricular (LV) function. Data are lacking for high-risk groups, women and older patients. With the current knowledge it is reasonable to include resistance training without any restraints as part of cardiac rehabilitation programs for coronary artery disease (CAD) patients with good cardiac performance capacity (i.e., revascularised and with good myocardial function). As patients with myocardial ischaemia and/or poor left ventricular function may develop wall motion disturbances and/or severe ventricular arrhythmias during resistance exercise, the following criteria are suggested for resistance training: moderate-to-good LV function, good cardiac performance capacity [>5-6 metabolic equivalents of oxygen consumption (METS)=1.4 watt/kg body weight], no symptoms of angina pectoris or ST segment depression under continued maintenance of the medical therapy. Based on available data, this article presents recommendations for risk stratification in cardiac rehabilitation programs with respect to the implementation of dynamic resistance training. Additional recommendations for specific patient groups and detailed directions showing how to structure and implement such therapy programs are presented as well.

Cardiac Rehabilitation↗

PubMedDate not supplied

[The use of lamotrigine in the psychosocial readaptation of patients with epilepsy].

INTRODUCTION AND OBJECTIVES: Epilepsy is a chronic illness which causes psychosocial problems in the patients affected. These disorders may be investigated by using the Washington Psychosocial Inventory (WPSI). We wish to show the variables which affect the WPSI most and also the changes seen in the results of this test and the control of seizures after treatment with lamotrigine for a year. PATIENTS AND METHODS: Using the WPSI, we studied 70 patients in the epilepsy outpatient clinic of the Psychiatric Hospital in La Habana during the period February-March 1998. The results of the WPSI were analysed according to the following variables: cerebral lesion, age of onset of epilepsy, frequency of seizures, more than one seizure per patient, and the antiepileptic drug used. The patients were followed-up during one year of treatment with lamotrigine, and the WPSI was repeated after one year (in March 1999). The following statistical tests were used to find the level of significance: variance analysis, standard deviation, chi deviation and difference between means. RESULTS: The WPSI showed initially, at almost all levels, poor scoring; 48.86% had generally poor psychosocial function (FPG). Only the greater frequency of seizures significantly altered the WPSI. After treatment with lamotrigine for one year there was better seizure control, a better WPSI result and only 11.43% had poor FPG. CONCLUSIONS: We consider that the high frequency of seizures is the variable which most affects the WPSI and that lamotrigine is useful both for control of epileptic seizures and to obtain psychosocial rehabilitation.

Adaptation, Psychological↗

PubMed1981

Psychosocial disability during maintenance hemodialysis.

Overall psychosocial functioning was assessed in 21 maintenance hemodialysis patients. The Ruesch Social Disability Scale, which provides an overall Social Disability (DS) score as well as subscores for Physical Impairment (PI), Behavioral Impairment (BI), and Social Modifiers (MS), was utilized. A majority of the patients (13) experienced Major Social Disability and the mean DS score of this sample was in the Major Social Disability range (mean = 52.1 +/- 10.9). There were no differences between the mean DS score of men and women. Married patients had DS scores significantly lower than those who were divorced or never married (P less than .05). Patients with more than five years of maintenance hemodialysis had a mean DS score significantly higher than those with less then five years of maintenance hemodialysis (P less than .03). In those patients with more than five years of hemodialysis, the MS scale was significantly elevated (P less than .01) in comparison with their counterparts, whereas the BI and PI scores were not different. The data suggest that serious psychosocial impairment is a common sequela of maintenance hemodialysis, especially for long-term patients and those who are not married. Therapeutic approaches directed toward improved social functioning are indicated.

Disability Evaluation↗

PubMed1993

Medical slang and its functions.

Medical slang is analyzed in the developmental perspective of the physician's career. More than 300 terms gathered by ethnographic methods are classified by social categories: (1) the setting--various types of hospitals and facilities, (2) the players--care-givers and care-receivers, (3) the social processes--patient admission, diagnosis, treatment and discharge, and (4) death and dying. Slang usage generally begins during the third year of medical school when students rotate among clinical services and peaks during the internship year. Male and female clinicians are similar in slang usage. Five psychosocial functions of medical slang are discussed.

Adult↗

PubMed1997

Psychosocial factors in children with idiopathic musculoskeletal pain: a prospective, longitudinal study.

To explore the role of psychosocial factors in the development and persistence of idiopathic musculoskeletal pain (IMP) in children, 23 children with IMP and 52 children with juvenile chronic arthritis (JCA) were compared at first admission to hospital and at 9 y follow-up. Semistructured interviews were performed at both assessments. At first admission, the prevalence of psychiatric diagnoses was high both in patients with IMP and patients with JCA, but patients with IMP more often had pain models, reported more school stress and more often lived with one biological parent. At follow-up, overall psychosocial functioning and level of chronic family difficulties were improved in both groups, but patients with IMP had a higher prevalence of psychiatric diagnoses and more chronic family difficulties and life events than patients with JCA. The persistence of IMP at follow-up was related to pain models, school stress, less parental education and more chronic family difficulties at first admission. Findings support the association between psychosocial factors and childhood IMP.

Adolescent↗

PubMedDate not supplied

Validity of a self-report depression symptom scale for identifying remission in depressed outpatients.

In treatment studies of depression, remission is usually defined by scoring less than a threshold value on an interview-based measure of depression severity such as the Hamilton Rating Scale for Depression (HRSD). Although it has been recommended that measures such as the HRSD be used by clinicians in clinical practice to evaluate remission status, the time demands of clinical practice limit the feasibility of this suggestion. Self-report questionnaires are a cost-effective option to thoroughly, systematically, reliably, and validly evaluate clinical status because they are inexpensive in terms of professional time needed for administration and do not require special training for administration. In a previous report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we derived a cutoff on a self-report depression questionnaire corresponding to the widely used definition of remission on the HRSD (ie, < or = 7). In the present report, we examined the validity of this questionnaire as an indicator of remission among patients who responded to antidepressant treatment. Specifically, we examined psychosocial functioning in treatment responders who were and were not in remission according to the self-report symptom scale. In a sample of 371 depressed outpatients who were judged by their treating psychiatrists as having responded to treatment, 250 scored in the remission range on the symptom scale. Compared with treatment responders whose depression was not in remission, the patients who were in remission reported significantly less psychosocial impairment and significantly better quality of life and were significantly more likely to assert that they are in remission from their depression. These findings support the validity of a self-report depression questionnaire as an index of remission status among treatment responders.

Adult↗

PubMed2001

Change in pain and function while waiting for major joint arthroplasty.

The objective of this study was to examine the change in pain and physical function that occurs while waiting for major arthroplasty. Data were collected prospectively from a cohort of 313 patients who were waiting > 1 month for total hip arthroplasty or total knee arthroplasty. The WOMAC and the SF-36 health status instruments were administered at the time the patient was placed on the waiting list and again just before surgery. Minimal amounts of change in pain and physical and psychosocial function occurred for hip and knee arthroplasty patients while they waited. Overall, waiting time did not appear to have a negative impact on the amount of pain and dysfunction experienced.

Adult↗

PubMed1999

[Occupational therapy in the diseases of the locomotor system].

The spectrum of occupational therapy (OT) services in rheumatology includes the restoration of disturbed muscle function, psychosocial aspects, instruction and training in joint protection and manufacturing of orthotic devices as well as advice and training with technical aids and adapting the home and workplace according to the patient's disability. OT is especially indicated in inflammatory rheumatic diseases with polyarticular involvement, but also in degenerative joint diseases, various forms of soft tissue rheumatism and spinal disorders. It should be prescribed by a physician and functional therapist together with regard to the specific location of functional derangement and is to be dosed individually according to the work-load applied. A wide range of techniques involving different materials--including textiles, leather, wood, clay--enable individual joints or functional entities to be exercised specifically. Integration and coordination of OT with the other elements of multidisciplinary therapy, e.g. pharmacological treatment, physiotherapy, orthopedic surgery is the important task of the rehabilitation team. The objective measurement of therapeutic effects serve the purposes of demonstrating the quality of the results and also of motivating the patient. The methods used will depend on the clinical picture, the structures damaged, and the time available for the therapist.

Humans↗

PubMed2001

Assessing expressed need and satisfaction in complete denture wearers.

OBJECTIVES: The need to assess both lay and professional views of oral health is believed to be at the centre of success when providing dental health care for older patients. Self-perceived physical (oral) health and perceptions of psychosocial functioning must be included if expressed need is to be assessed. The aim of this work was to construct an expressed need schedule and to assess the ability of this assessment to predict older community-based patients' satisfaction with complete dentures. DESIGN: Survey of 260 people aged 65 years and over. SETTING: Community setting. MAIN OUTCOME MEASURES: The participants were interviewed using a 55 item modified version of the Oral Health Impact Profile (OHIP) to assess their psychological, social and perceptions of their oral health. All participants were subjected to an oral examination. RESULTS: The results showed that complete denture wearers compared had greater experience of difficulties associated with oral health and psychological functioning. Factor analysis allowed the identification of three dimensions associated with psychological, social and self-perceived physical (oral) health. When these factors were regressed with normative denture treatment need against satisfaction with complete dentures, satisfaction was characterised by high self-perceived physical (oral) health, low social health problems and no identifiable normative need. CONCLUSION: This work supports the inclusion of self-perceived physical (oral) health and psychosocial health (expressed need) questions in a schedule when predicting satisfaction with complete dentures.

Activities of Daily Living↗