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Results for “Psychosocial functioning”

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PubMedDate not supplied

Disability and rehabilitation in head and neck cancer patients after treatment.

In an effort to obtain quantitative and qualitative information regarding the extent of disability sustained following definitive treatment for head and neck cancer, 51 patients--28 who had had laryngectomy and 23 who had had other major surgery--were interviewed. Also examined were the types of rehabilitation measures taken. In all cases, the following areas in which disability could occur were identified and explored: physical appearance, speech, deglutition, mastication, salivation, sensory deficits, cranial motor-nerve deficits, pain, nutrition, activities of daily living, psychosocial functioning, vocational status, environmental parameters, and delayed complications. Where appropriate, ratings and delineations of severity were compiled. Nine methods of rehabilitation were assessed with regard to frequency of utilization: surgical reconstruction, dental-maxillofacial prosthetics, speech therapy, physical therapy, rehabilitation nursing, occupational therapy, vocational rehabilitation, rehabilitation counseling, and social service. Our conclusions were that half of the patients studied had sustained significant disability in three to four areas, while 43% had moderate or severe disability in five to nine areas. Additionally, the head and neck surgeon was found to have used surgical reconstruction and dental-maxillofacial prosthetic measures, as well as the services of seven categories of allied health professionals, to provide rehabilitation.

Deglutition↗

PubMed2004

Dosage finding and outcome in the treatment of schizophrenic inpatients with amisulpride. Results of a drug utilization observation study.

OBJECTIVES: Amisulpride is an unique neuroleptic drug insofar as it has a dual pharmacodynamic effect. At low doses it blocks selectively presynaptic autoreceptors, and at high doses it blocks postsynaptic D(2)/D(3) receptors. This allows the dosage to be adjusted and the treatment tailored to various clinical situations. It is unknown whether this pharmacological property has any bearing for routine treatment. The questions are: which dosages of amisulpride are chosen by physicians in the treatment of schizophrenic inpatients and does this dosage handling deviate from prescription guidelines?; which factors can explain dosage selection, and what is the treatment outcome with different dosages? The study pertains to drug management and dosage finding as principal factors in explaining positive and negative medication results. METHODS: In a drug utilization observation study the prescribing of amisulpride for 811 schizophrenic inpatients from 240 psychiatric hospitals was monitored for 8 weeks. Standardized assessment included dosage, the positive and negative symptom scale (PANSS), the clinical global impression rating (CGI), the patients' subjective reaction to amisulpride, psychosocial functioning, EPS and other adverse events. The mean observation period was 49 days. RESULTS: The mean initial daily dose of amisulpride was 361 mg/day. The mean daily dose at day 56 was on average 550 (SD 266) mg/d, ranging from 100 mg to 1600 mg. 17.9% of patients received a maximum dose up to 399 mg/d, 48.1% between 400 and 799 mg/d, and 25.5% 800 mg/d and higher. Higher doses were preferably prescribed for males, patients with involuntary admission, patients with paranoid schizophrenia with acute exacerbation, high CGI and high PANSS-positive scores. Patients with higher doses of amisulpride at the same time received higher rates of additional other neuroleptic drugs. Higher doses yield better results in very severe cases. CONCLUSIONS: Prescribed dosages were in the lower range of what is recommended for acute cases. Dosage was significantly influenced by the severity of the illness. Polypharmacy was the rule rather than the exception. Efficacy rates under conditions of routine care were similar to the results from controlled clinical trials, which speaks for their generalizability. Very severe cases profit from higher doses.

Adult↗

PubMed2003

Pharmacotherapy for chronic depression.

This article reviews the current status of the treatment of chronic depression with antidepressant medications. Short and longer term clinical trials that have investigated the efficacy of several classes of antidepressants are summarized. The important outcomes of treatment in these studies, including response category, symptom reduction, and improved psychosocial function, are elaborated. Short-term trials seem reasonably conclusive in establishing the effectiveness of antidepressants for dysthymia and double depression, although rates of remission fall short of 50%.

Antidepressive Agents↗

PubMed2004

The Diagnostic Inventory for Depression: a self-report scale to diagnose DSM-IV major depressive disorder.

In this report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we describe the development and validation of the Diagnostic Inventory for Depression (DID), a new self-report scale designed to assess the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994) symptom inclusion criteria for a major depressive episode, assess psychosocial impairment due to depression, and evaluate subjective quality of life. A large sample of 626 psychiatric outpatients completed the DID and were interviewed with the Structured Clinical Interview for DSM-IV (SCID). The measure's test-retest reliability, discriminant and convergent validity, and sensitivity to clinical change were investigated. The DID subscales achieved high levels of internal consistency and test-retest reliability. The DID was more highly correlated with another self-report measure of depression than with measures of anxiety, substance use problems, eating disorders, and somatization, thereby supporting the convergent and discriminant validity of the scale. The DID also was highly correlated with interviewer ratings of the severity of depression and psychosocial functioning, and DID symptom severity scores were significantly different in depressed patients with mild, moderate, and severe levels of depression. The DID was a valid measure of symptom change. Finally, the DID was significantly associated with a diagnosis of major depressive disorder.

Adolescent↗

PubMed2004

Cognitive-behavioral therapy for children who have obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a relatively chronic and impairing disorder in children and adolescents. Whereas childhood OCD was largely ignored in the past, major advances in the identification and treatment over the past 20 years have led to a significant upsurge in the prevalence of youngsters seeking treatment for this problem. The present article describes the use of exposure-based cognitive-behavioral therapy (CBT) for the treatment of childhood OCD. Although the phenomenology of OCD is largely consistent across the age span, traditional adult CBT approaches have been modified for use with children and adolescents in order to address those developmental differences that do exist. The case example describes the use of CBT for a child who has OCD and highlights these developmental considerations, including age-appropriate techniques to address family involvement in the disorder and the impact of symptoms on the psychosocial functioning of the patient.

Adolescent↗

PubMed1998

Measuring outcome after liver transplantation: a critical review.

As the number of liver transplantations performed around the world and the survival rates increase, attention is turning to the broad impact this procedure has on patients' quality of life (QOL), including their physical and psychosocial functioning and their perceived sense of well-being. There exists a small body of literature that examines the global effects of liver transplantation on QOL. The purpose of this article is to discuss the general framework used to assess QOL and to critically review the studies that have broadly examined QOL outcomes after liver transplantation. The reviewed studies used measures that led to broad assessment of the various domains of QOL. Although the instruments used to measure QOL in these studies are largely validated, there is significant heterogeneity in this literature in terms of the instruments used, leading to difficulties in making generalizable conclusions among the studies. Although limited by internal validity problems, the available data suggest improvement in QOL by liver transplantation. Additionally, a large recent study that used the Liver Transplant Database Quality of Life Questionnaire also reported a subset of patients in whom QOL seemed to worsen after liver transplantation. Knowledge of the factors related to QOL outcome after liver transplantation is important because it might allow development of new interventions that may have an impact on future allocation decisions.

Humans↗

PubMed2003

Effects of stress management on PNI-based outcomes in persons with HIV disease.

A pretest-posttest, repeated-measures design was used to evaluate the effects of two stress management interventions on a battery of outcomes derived from a psychoneuroimmunological (PNI) framework. The effects of cognitive-behavioral relaxation training groups (CBSM) and social support groups (SSG) were compared with a WAIT-listed control group on the outcomes of psychosocial functioning, quality of life, neuroendocrine mediation, and somatic health. Participants were 148 individuals (119 men, 29 women), diagnosed with HIV disease; 112 (76%) completing the study groups. Using analysis of covariance, the CBSM group was found to have significantly higher postintervention emotional well-being and total quality-of-life scores than did either the SSG or WAIT groups. SSG participants had significantly lower social/family well-being scores immediately postintervention and lower social support scores after 6 months. The findings point to a pressing need for further, well-controlled research with these common intervention modalities.

Adaptation, Psychological↗

PubMed2007

Using Q-methodology to understand perceived fatigue reported by adolescents with cancer.

Although fatigue is an unpleasant symptom commonly experienced by pediatric oncology patients, it also tends to be under-recognized and under-treated. A conceptual understanding of how patients perceive fatigue is beneficial for better identification and treatment planning. The purpose of this study was to understand how adolescents with cancer perceive their fatigue and to explore potential factors influencing their perceptions by using Q-methodology. The sample included 15 patients (ages 12-18 years) from the Chicago metropolitan area who were receiving cancer treatment. All participants completed a 37-statement Q-sort task. Data were analyzed by using PQMethod computer software. Results identified three descriptors of perceived fatigues reported by adolescents: energy and related capacity for physical functioning, psychosocial effects, and anemia-specific concerns. Appropriate referral for patients with the latter two descriptors of fatigue was recommended.

Activities of Daily Living↗

PubMed1999

Relational support and person characteristics in adolescence.

In this paper, an heuristic model of the personality characteristics of adolescents and the supportive dimensions of interactions, relationships and groups is presented. The model takes the concept of developmental tasks as its starting point and it is assumed that developmental tasks can be characterized in terms of four modalities: intentions, behaviour, cognitions and affect. The same four modalities can also be used to characterize dimensions of personality and aspects of interactional and relational support. The results of several empirical studies are presented to illustrate the model. Together, these studies present a transactional picture of the personality of adolescents and their relationships in which personality and relationships influence each other and jointly determine psychosocial functioning.

Adolescent↗

PubMed1996

Neuropsychological sequelae of the treatment of children with medulloblastoma.

When a malignant tumor invades the child's cerebellum, the cost of successful treatment is often significant cognitive morbidity. A review of neuropsychological outcome revealed that survivors of childhood medulloblastoma (MB) have long-term deficits in intelligence, memory, language, attention, academic skills, psychosocial function, and a compromised quality of life. These deficits varied with chronological age at tumor diagnosis and/or adjuvant treatment, type and duration of presenting symptoms, tumor extension beyond the cerebellum, a history of adjuvant radiation treatment, and time since treatment. The effects on neuropsychological outcome of other factors, such as post-surgical hydrocephalus, were less clear. To understand the interaction between two factors predictive of outcome, age at diagnosis and time since treatment, we analyzed IQ results for a new sample of 25 surgically-treated and radiated MB survivors, and found that age at diagnosis and time since treatment made separable contributions to intellectual morbidity. PIQ appeared to measure some general effects of diffuse cerebral insult because it varied with chronological age of the child at tumor diagnosis but was relatively constant in magnitude, once established. VIQ, in contrast, was somewhat less sensitive to age at diagnosis in treated MB survivors, but declined with time since treatment. These results are important for understanding the academic attainments and continuing rehabilitation needs of childhood MB survivors, because they suggest that these children progressively fail to assimilate new verbally-based knowledge at a developmentally-appropriate rate.

Age Factors↗

PubMed1995

The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability.

After head injuries, particularly mild or moderate ones, a range of post-concussion symptoms (PCS) are often reported by patients. Such symptoms may significantly affect patients' psychosocial functioning. To date, no measure of the severity of PCS has been developed. This study presents the Rivermead Post Concussion Symptoms Questionnaire (RPQ) as such a measure, derived from published material, and investigates its reliability. The RPQ's reliability was investigated under two experimental conditions. Study 1 examined its test-retest reliability when used as a self-report questionnaire at 7-10 days after injury. Forty-one head-injured patients completed an RPQ at 7-10 days following their head injury and again approximately 24 h later. Study 2 examined the questionnaire's inter-rater reliability when used as a measure administered by two separate investigators. Forty-six head-injured patients had an RPQ administered by an investigator at 6 months after injury. A second investigator readministered the questionnaire approximately 7 days later. Spearman rank correlation coefficients were calculated for ratings on the total symptom scores, and for individual items. High reliability was found for the total PCS scores under both experimental conditions (Rs = + 0.91 in study 1 and Rs = + 0.87 in study 2). Good reliability was also found for individual PCS items generally, although with some variation between different symptoms. The results are discussed in relation to the major difficulties involved when looking for appropriate experimental criteria against which measures of PCS can be validated.

Adolescent↗

PubMed1985

Effects of community placement on chronic mental patients.

Patients judged ready for release from a state mental hospital were interviewed to determine their levels of depression and psychosocial functioning. This interview was repeated for 31 of the patients 8 weeks after their release and simultaneously repeated for 31 similar patients who remained in the hospital. In comparison with the matched controls, released patients became less depressed, less socially isolated, and less irritable. No differential improvement was found in their self-image. These findings, controlled for certain potential biases in a quasi-experimental design, identify some specific benefits of community placement for chronic mental patients.

Adult↗

PubMed1988

The social behavior of depressed children: an observational study.

Few investigations have examined directly the psychosocial functioning of depressed children. In the present study, 20 depressed and 20 nondepressed fourth- and fifth-grade children were observed in free play during their recess period at school, and their self-perceptions were assessed in subsequent individual sessions. The 10 boys and 10 girls in each group were selected according to their scores on both the Child Depression Inventory and the Peer Nomination Inventory of Depression. Analyses conducted on the eight categories of behavioral observations revealed significant differences between the social behavior of the depressed and the nondepressed children. Although the depressed children made more overtures for social contact than did the nondepressed children and were approached by other children more frequently, they spent more time alone and engaged in a higher frequency of negative interactions with their peers. Consistent with these results, the depressed children's responses to the Self-Perception Profile for Children indicated that they experienced themselves as less socially competent in general, as well as less competent across several specific domains of functioning. These findings are discussed as they relate to developmental processes, theories of adult depression, and recent studies on socially isolated children, and directions for future research in this area are offered.

Child↗

PubMed1976

Chronically ill children. A psychologically and emotionally deviant population?

The study evaluated the psychosocial functioning levels of a group of chronically ill (diabetic, asthmatic, cystic fibrotic, and hearing-impaired) children across a battery of standardized personality instruments. The assessments were performed to provide a rigorous test of the popular hypothesis that chronically ill children are especially vulnerable to psychopatholgy. In contrast to this sterotype, results across measures demonstrated the normalcy rather than the deviance of these children. Although exceptions were noted, the children's functional strengths and coping abilities noticeably outweighed their weaknesses.

Achievement↗

PubMed1988

Multivariate approaches to the identification of delinquency proneness in adolescent males.

A sample of 337 adolescent male students were surveyed for demographic, individual, school, and familial functioning and delinquency status to investigate two questions relevant to prediction of adolescent delinquency proneness. First, three methods of scoring a delinquency self-report measure (frequency, variety, and seriousness) were compared to assess their differential relevance to the prediction of delinquency proneness. Second, a multivariate model was examined to assess its explanatory ability for identification of delinquency proneness. Findings, replicated through a series of regression analyses, demonstrate that age of onset is the best predictor. Other than family functioning, psychosocial indicators add little to the predictive model. Third, a specific factor model was preferable to a "risk count" method. Finally, the advantage of self-reports of delinquent behavior over official records is discussed as is the comparability of self-report scoring procedures. How self-reported delinquency is scored is not as critical as previously thought.

Achievement↗

PubMed1996

Treatment of traumagenic beliefs among sexually abused girls and their mothers: an evaluation study.

The objective of this study was to evaluate and compare the efficacy of two short-term individual therapy interventions for sexually abused girls and their nonoffending female caretakers. Thirty-two girls, ages 8 to 13, and their caretakers from primarily low-income, African-American families were randomly assigned to a theoretically based, structured experimental treatment program or to a relatively unstructured comparison intervention. Measures of child outcome were completed before and after the treatment program by each parent and child, and by a clinician blind to treatment condition. Pre- and postmeasures of maternal outcome were completed by the caretaker and a clinician not involved in the treatment. Both treatment programs yielded decreases in children's posttraumatic stress disorder symptoms and traumagenic beliefs reflecting self-blame and powerlessness, and increases in children's overall psychosocial functioning. The experimental intervention was more effective than the comparison program in increasing abuse-related caretaker support of the child and in decreasing caretaker self-blame and expectations of undue negative impact of the abuse on the child. Clinical implications of these findings include the development of interventions targeting sexually abused children's traumagenic beliefs and nonoffending parents' support of their victimized children.

Adolescent↗

PubMedDate not supplied

Children's use of mental health services in different Medicaid insurance plans.

This study examined the effect of different Medicaid insurance plans on children's mental health service use through survey, claims, and encounter data collected between February 1998 and February 1999. Participants were assigned to 1 of 3 insurance plans: fee-for-service, a Health Maintenance Organization and a prepaid carve-out. Logistic and stratified logistic regression were used to examine the effect of plan on service utilization, adjusting for caregiver report of need for services and psychosocial functioning. There was no difference in service use by plan controlling for demographic characteristics; however, when psychopathology and caregiver report of need for services were included in the model, the odds of using services in the Health Maintenance Organization was half of and the odds in the carve-out 29% less than the odds of using services in fee-for-service. Characteristics of the interaction between need, psychopathology, and insurance plan that may be associated with the reduction in service use are discussed.

Adolescent↗

PubMed1998

Recruitment for complementary/alternative medicine trials: who participates after breast cancer.

BACKGROUND: Despite the popularity and widespread practice of complementary/alternative medicine (CAM), researchers may face problems accruing patients to randomized clinical trials, considered the gold standard of biomedical research. Strict exclusion criteria and barriers to participation may limit accrual. Inadequate numbers of subjects decrease the ability of studies to detect an effect that exists and generalize their findings. This article describes the recruitment experience of a CAM trial, details reasons for non-participation, and contrasts participants and non-participants on demographic, clinical, and treatment-related variables. METHODS: Women who were Houston area residents and spoke English, had primary breast cancer (excluding Stage IV), and were 1 to 30 months posttreatment with no steroids, tamoxifen, substance abuse, psychiatric or heart disease, or immune deficiency were eligible. The enrollment process involved three contacts (i.e. introductory letter and brochure, telephone calls, and reminder post cards). Potential participants were told that the study would require blood samples (30 cc) to assess immune function; psychosocial measures to assess emotional well-being, quality-of-life, social support, and coping strategies; and possible assignment to six weekly support or imagery sessions. Factors influencing recruitment and reasons for non-participation were assessed by stratified analysis and multivariate logistic regression. RESULTS: Of 158 eligible participants, 30% (N = 47) consented to participate. Primary reasons for non-participation included work/childcare (33.3%), transportation/travel (30.6%), and lack of interest (24.3%). Participants were more likely to be 40-54 years of age versus younger or older, divorced/separated, and able to pay some/all medical expenses. Divorced or separated women appeared to be more likely to participate, regardless of financial status. CONCLUSIONS: Researchers must assess the impact of exclusion criteria on accrual and recognize the special needs of their target population. Although age, marital status, and pay status were the strongest predictors of participation, these factors are not amenable to intervention. Based on this study, researchers might boost accrual by providing interventions available during the day and evening to accommodate working women, child care services, transportation, or reimbursement for travel costs.

Adult↗