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PubMedDate not supplied

Holocaust survivors coping with open heart surgery decades later: posttraumatic symptoms and quality of life.

OBJECTIVE: History of prolonged traumatization has been associated with reduced quality of life (QoL) and difficulties in coping with major life-threatening conditions. We assessed the association between the impact of Holocaust experience (posttraumatic symptoms) and QoL of patients before and after an open heart surgery. METHOD: Sixty-three Holocaust survivors were interviewed before open heart surgery (at admission), 52 at follow-up at 1 week, and 58 at follow-up at 6 months. The interview included background data, Impact of Event Scale (IES), Mastery scale, and QoL measured by the Nottingham Health Profile. Medical data were retrieved from the patients' charts. RESULTS: The total IES score indicate a high level of posttraumatic symptoms at all the time points (close to a mean of 18), but there was a clear trend of changes in the avoidance subscale: At admission, the patients manifested lower avoidance compared with the levels after the surgery and at the follow-up. No significant differences in IES were found by Holocaust experiences. Significant improvements in most components of QoL were found at the follow-up. In multivariate analyses at each time point, the findings show that those with higher levels of posttraumatic symptoms are more at risk for problems in pain and mobility domains of QoL at admission, for emotional reaction after the surgery, and at the follow-up, these associations are only at trend level, while lower sense of mastery became significant. CONCLUSIONS: The improvement in QoL despite persistence of the impact of the Holocaust may indicate that past severe prolonged traumatization does not necessarily reduce the survivors' ability to cope with and regain physical and psychosocial functioning after a severe life-threatening medical condition. This may be further generalized to other significant crisis situations in life, such as prolonged periods of stress, suffered by many populations throughout the world.

Adaptation, Psychological↗

PubMed2004

Does adjunctive family therapy enhance recovery from bipolar I mood episodes?

BACKGROUND: Family therapy is sometimes used as adjunctive treatment to pharmacotherapy to help patients recover from mood episodes of bipolar I disorder. However, the efficacy of this practice is not known. METHODS: Ninety-two patients meeting criteria for a current bipolar I mood episode were randomly assigned to family therapy plus pharmacotherapy, multifamily psychoeducational group therapy plus pharmacotherapy, or pharmacotherapy alone. Time to recovery was analyzed with survival analysis. RESULTS: The proportion of subjects within each treatment group who recovered did not significantly differ, nor did time to recovery. LIMITATIONS: The analyses did not include other outcomes such as psychosocial functioning, prophylaxis against recurrences of mood episodes, or compliance with pharmacotherapy. CONCLUSIONS: Neither adjunctive family therapy nor adjunctive multifamily psychoeducational group therapy significantly improves the rate of recovery from mood episodes of bipolar I disorder, compared to treatment with pharmacotherapy alone.

Adult↗

PubMed2005

The high prevalence of bipolar spectrum disorders in young adults with recurrent depression: toward an innovative diagnostic framework.

BACKGROUND: Young adults with early-onset major depressive disorder (MDD) may be at high risk of progression to bipolar disorder. Although hypomanic symptoms are common in young people with depression, many do not reach the strict DSM-IV and ICD-10 criteria for hypomania. We used an emerging innovative framework for bipolar spectrum to evaluate this question. METHODS: Consecutive referrals to a psychiatric outpatient clinic at a university health service were assessed for recurrent episodes of depression. DSM-IV diagnoses were based on a SCID-1 interview. We used two approaches to delineate bipolar spectrum. The first focused on bipolar spectrum disorder (BSD, as defined by Ghaemi et al. [Can. J. Psychiatry 47 (2002) 125]), and the second on a symptoms perspective based on MDD with a history of hypomanic symptoms, using a 15-point hypomanic symptoms checklist with a cut-off > or =8 or more symptoms (modified from J. Affect. Disord. 73 (2003) 39 and J. Affect. Disord. 73 (2003) 73). Data were also obtained on family history of affective disorder, course and number of episodes of depression, symptom severity, psychosocial functioning, suicidality and deliberate self-harm, and drug and alcohol use. RESULTS: High rates of bipolar and bipolar spectrum disorder were identified. Under DSM-IV, 14 subjects (16.1%) had bipolar affective disorder and 73 subjects (83.9%) had recurrent MDD. Depending on the method used to diagnose bipolar spectrum, between 47.1% and 77.0% of the total cohort could be so diagnosed. Hypomanic symptom counts, irrespective of duration, yielded the highest estimates for bipolar spectrum. High rates of pharmacological hypomania were also identified: 12 subjects (16.4%) with recurrent MDD group reported this, and all could be diagnosed with bipolar spectrum. LIMITATIONS: The reliability of using the 15-point hypomanic scale for the diagnostic assignments was not tested. All subjects were recruited from a university health service and, given the affluence of their parents, findings may not generalise to other populations. Most importantly, because bipolar family history and pharmacological hypomania were part of the diagnostic criteria of the BSD group, they could not be used as external validators for Ghaemi's BSD construct. CONCLUSIONS: Bipolar disorders emerge as extremely common in this cohort of young adults with recurrent depression. Antidepressant-induced hypomania and high scores on a hypomanic symptoms checklist help to identify patients who are likely to have a bipolar spectrum illness, but who do not meet DSM-IV criteria for bipolar disorder. This is a preliminary study, and further evidence from external validating strategies are needed to verify the bipolar status of these patients in a larger and unselected cohort representing a broader socio-economic demographic profile.

Adult↗

PubMed2004

Further evidence of unique developmental phenotypic correlates of pediatric bipolar disorder: findings from a large sample of clinically referred preadolescent children assessed over the last 7 years.

BACKGROUND: A comparison of the prevalence, clinical correlates, and patterns of comorbidity among children with bipolar disorder (BPD) assessed in the early 1990s (1st cohort) with those evaluated over the last 7 years (2nd cohort). METHOD: Subjects in both cohorts were children aged <or=12 years referred to a child psychiatry service and evaluated with identical assessment methods. Children with a DSM-III-R BPD diagnosis (1st cohort, n=43; 2nd cohort, n=129) were identified. For comparison purposes, we used attention-deficit/hyperactivity disorder (ADHD) children without BPD referred to the same clinic during the same time period (1st cohort, n=164; 2nd cohort, n=450). RESULTS: Analogous to 1st cohort findings, 2nd cohort results showed that (1) mania was identified in 17% of subjects; (2) the clinical picture was predominantly irritable and mixed, and the course was chronic; (3) BPD children frequently met criteria for major depression, ADHD, psychosis, and anxiety disorders; and (4) BPD children had high rates of psychiatric hospitalization and had evidence of severely impaired psychosocial functioning. CONCLUSION: These findings confirm that pediatric BPD is a severe clinical disorder afflicting a sizable number of referred preadolescent children. Its unique phenotypic features and patterns of comorbidity support the hypothesis that clinically referred pediatric bipolar disorder represents a very severe developmental subtype of bipolar disorder.

Age of Onset↗

PubMed2006

Comorbidity of PTSD and depression following myocardial infarction.

BACKGROUND: This study examines comorbidity of posttraumatic stress disorder (PTSD) and depression following myocardial infarction (MI). It has two aims: (a) to examine whether this comorbidity is predicted by the objective severity of the MI and the patients' initial appraisal and stress responses; and (b) to determine whether this comorbidity is associated with PTSD symptomatology, depression, physiological adjustment, and psychosocial adjustment seven months post-MI. METHOD: 116 MI patients were examined twice. At Time 1, within a week of the MI, initial appraisal, stress responses, and depressive reactions were assessed, and medical measures were obtained from patients' hospital records. At Time 2, seven months later, PTSD, depression, psychosocial functioning, and physical adjustment were assessed. RESULTS: Seven months post-MI, 16% of the patients were identified with PTSD; 8% with comorbid PTSD and depression; and 14% with high levels of depression without full PTSD. Initial level of depression was associated with comorbidity of PTSD and depression. While initial stress reactions did not predict comorbidity, they did predict depression, with or without comorbid PTSD. Comorbidity of PTSD and depression was associated with higher levels of adjustment difficulties. DISCUSSION: Comorbidity of PTSD and depression has some clinical significance. While initial level of depression predicts subsequent comorbidity of PTSD and depression, early stress reactions do not differentiate between MI patients who suffer from depression, with or without comorbid PTSD.

Activities of Daily Living↗

PubMed2004

Further validation of the multidimensional fatigue symptom inventory-short form.

A growing body of evidence is documenting the multidimensional nature of cancer-related fatigue. Although several multidimensional measures of fatigue have been developed, further validation of these scales is needed. To this end, the current study sought to evaluate the factorial and construct validity of the 30-item Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). A heterogeneous sample of 304 cancer patients (mean age 55 years) completed the MFSI-SF, along with several other measures of psychosocial functioning including the MOS-SF-36 and Fatigue Symptom Inventory, following the fourth cycle of chemotherapy treatment. The results of a confirmatory factor analysis indicated the 5-factor model provided a good fit to the data as evidenced by commonly used goodness of fit indices (CFI 0.90 and IFI 0.90). Additional evidence for the validity of the MFSI-SF was provided via correlations with other relevant instruments (range -0.21 to 0.82). In sum, the current study provides support for the MFSI-SF as a valuable tool for the multidimensional assessment of cancer-related fatigue.

Adult↗

PubMed2005

Clinical correlates of bipolar disorder in a large, referred sample of children and adolescents.

OBJECTIVE: To compare the prevalence, clinical correlates, and comorbidity among children and adolescents with bipolar disorder (BPD) assessed in the early 1990s (first cohort) with those evaluated over the last 7 years (second cohort). METHODS: Subjects were consecutively referred children (N=108) and adolescents (N=197) with a DSM-III-R BPD diagnosis, referred to a child psychiatry service and evaluated with identical structured assessment methods. RESULTS: Mania was identified in 16% of referred youth in both age groups and cohorts; in both age groups and cohorts, the clinical picture was predominantly irritable and mixed, and the course was chronic. Youth with BPD in both age groups and cohorts frequently had comorbidity with ADHD, psychosis and anxiety disorders. They also had high rates of psychiatric hospitalization and evidence of severely impaired psychosocial functioning. CONCLUSIONS: The consistency of clinical features of bipolar disorder seen across age groups (children vs. adolescents) and cohorts (early and late cohorts) over the past decade supports the hypothesis that BPD in the young is a severe condition afflicting a sizeable minority of referred youth. These findings replicate and extend our previous characterization of an early onset mania, which may represent a developmental subtype of BPD.

Adolescent↗

PubMed2005

Verbal and physical non-aggressive agitated behaviors in elderly persons with dementia: robustness of syndromes.

OBJECTIVE: More than a decade ago, different syndromes of agitation were identified in elderly nursing home residents, and it was found that these syndromes correlate with medical, cognitive, and psychosocial functioning. The present study was conducted to examine the robustness of two major syndromes, verbal agitation and physical non-aggressive agitation, as assessed via direct observations. METHODS: Study participants were 175 elderly persons with dementia recruited from 11 nursing home facilities in Maryland. Observations of the participants' behavior were conducted using the agitated behaviors mapping instrument. RESULTS: The profiles that emerged for physically agitated residents and for verbally agitated residents were remarkably similar to those originally reported. Specifically, verbally agitated behaviors correlated with female gender, with cognitive decline, poor performance of activities of daily living, impaired social functioning, and signs of depressed affect. Physically non-aggressive agitated behaviors correlated with cognitive impairment and with fewer concurrent medical diagnoses. CONCLUSIONS: Examining correlates of different syndromes of agitated behaviors may provide researchers with valuable information that can be used for in-depth analysis of both the characterization and etiology of agitation, thus paving the way for the development of interventions that target particular types of problem behaviors.

Activities of Daily Living↗

PubMed2005

Effectiveness of intensive residential treatment (IRT) for severe, refractory obsessive-compulsive disorder.

OBJECTIVE: The aim of this study was to determine the effectiveness of an innovative Intensive Residential Treatment (IRT) program for severe refractory Obsessive-Compulsive Disorder (OCD). No formalized OCD IRT outcome studies have been completed to date in North America. METHOD: Subjects admitted to the Massachusetts General Hospital/McLean OCD Institute (OCDI) between February 1997 and June 2003 comprised the intent-to-treat sample. Measures of OCD severity, depression severity and psychosocial well-being were determined at admission, interim and discharge points, and were subsequently compared via t-tests using a last-observation-carried-forward approach. Initial OCD severity subgroups and treatment length subgroups were created and analyzed. Correlations and stepwise linear regressions were conducted to determine treatment length predictors. RESULTS: The sample of 403 individuals (58.7% male) had an average 66 day treatment length. Mean YBOCS scores decreased by 30.1%, from 26.6 (SD 6.1) at admission to 18.6 (SD 7.2) at discharge, reflecting a clinically meaningful improvement (p<0.001). Psychosocial functioning, depression severity scores and self-report global functioning ratings also indicated significant improvement. Subgroups with longer treatment lengths tended to have earlier ages of OCD onset and increased OCD severity scores at admission. CONCLUSION: IRT deserves recognition as a therapeutic approach for severe, refractory OCD. In the largest study to date for IRT significant improvements of OCD severity, depression severity and quality of life were determined. IRT should be considered prior to more invasive approaches for severe refractory OCD.

Adult↗

PubMed2005

Extending the demand-control model to informal caregiving.

OBJECTIVE: Karasek's demand-control model of job strain was used in an attempt to extend previous work examining the psychological impact of informal caregiving in stroke. METHOD: Data were gathered from 138 informal caregivers/patient dyads at two time points. The dependent variables were the caregiver's anxiety and depression [Hospital Anxiety and Depression Scale (HADS)]. The predictor variables were caregiver demand (stroke survivor's assessment of their physical and psychosocial functional limitations) and control (caregiver's perceived control over stroke survivor's recovery). RESULTS: In a cross-sectional analysis of Times 1 and 2 data, main effects for demand and/or control were detected for anxiety and depression. Contrary to prediction, in longitudinal analysis of change, it was found that decreasing control, along with increasing demand, was associated with reduced distress. CONCLUSION: The model was moderately successful in predicting emotional distress. The relative importance of caregiver demand and control in predicting outcomes changed over time in these data. Attempts to replicate these findings are recommended.

Adaptation, Psychological↗

PubMed2006

Randomized treatment trial in mild traumatic brain injury.

OBJECTIVE: To determine whether multidisciplinary treatment of mild traumatic brain injury (MTBI) improves neurobehavioral outcome at 6 months postinjury. METHODS: Subjects with MTBI were randomly assigned to treatment (n=97) or nontreatment (control, n=94) groups. Treated patients were assessed within 1 week of injury and thereafter managed by a multidisciplinary team according to clinical need for a further 6 months. Control subjects were not offered treatment. Six-month outcome measures included: severity of postconcussive symptoms (Rivermead Post-Concussion Disorder Questionnaire), psychosocial functioning (Rivermead Follow-up Questionnaire), psychological distress (General Health Questionnaire), and cognition (neurocognitive battery). RESULTS: Treatment and control subjects were well-matched for demographic and MTBI severity data. In addition, the two groups did not differ on any outcome measure. However, in individuals with preinjury psychiatric difficulties (22.9% of the entire sample), subjects in the treatment group had significantly fewer depressive symptoms 6 months postinjury compared with untreated controls (P=.01). CONCLUSIONS: These findings suggest that routine treatment of all MTBI patients offers little benefit; rather, targeting individuals with preinjury psychiatric problems may prove a more rational and cost-effective approach.

Adult↗

PubMed2006

A new conceptualization of alexithymia in the general adult population: implications for research involving older adults.

OBJECTIVE: The purpose of this study is to test the validity of existing conceptualizations of the alexithymia concept, with particular reference to aging. METHODS: Two hundred and forty-eight healthy adults completed measures of alexithymia and psychosocial functioning; younger and older adults (n=121) also completed a measure of emotional responsiveness. RESULTS: Older adults engaged in less introspective thought traditionally thought to denote increased alexithymia. However, reduced introspection was associated with improved mental wellbeing, and, thus, could not be construed as a deficit. Difficulty identifying and describing emotions did not differentiate older and younger adults, but were both associated with heightened depression, anxiety, and poor perceived quality of life. CONCLUSIONS: In clinical practice and research, the Toronto Alexithymia Scale (TAS) is almost exclusively used, with "total" score typically used to index alexithymia. As one of the subscales of the TAS measures reduced introspection, calculating total scores may not be appropriate and may particularly overestimate levels of alexithymia in older adulthood.

Adolescent↗

PubMed2007

Coping, affective distress, and psychosocial adjustment among people with traumatic upper limb amputations.

OBJECTIVE: This study investigated the prevalence of symptoms of depression and anxiety in a sample of predominantly elderly males with acquired upper limb amputations (n=138) and examined the contribution of coping strategies to the prediction of psychosocial adjustment. METHOD: One hundred and thirty-eight men with injury-related upper limb amputations completed self-report questionnaires assessing coping strategies, symptoms of anxiety and depression, and psychosocial adaptation to prosthesis use. RESULTS: Prevalence of significant depressive symptoms was 28.3% [Hospital Anxiety and Depression Scale, Depression subscale (HADS-D) score > or =8]. Prevalence of significant anxiety symptoms was 35.5% [HADS Anxiety subscale (HADS-A) score > or =8]. Coping styles emerged as important predictors of psychosocial adaptation. In particular, avoidance was strongly associated with psychological distress and poor adjustment. CONCLUSIONS: These findings suggest the potential benefits of interventions to reduce reliance on avoidant coping and stimulate more problem-focused approaches to coping with difficulties and challenges in order to facilitate adaptation and prevent problems in psychosocial functioning postamputation.

Adaptation, Psychological↗

PubMed2005

Gender differences in long-term drug treatment outcomes in Chicago PETS.

Few long-term follow-up studies of substance abusers have examined gender differences. In the current study, gender differences were examined at 36 months following residential or outpatient drug-free treatment among 951 participants in the Chicago Target Cities Project, the majority of whom were female (62%) and African American (93%). There were no differences in the proportion of men and women who reported any alcohol or drug use at the 36-month follow-up, with an overall reduction of 41% from intake. Greater proportions of men were incarcerated or employed, whereas greater proportions of women had returned to treatment, lived with their children, lived with a substance user, or had interpersonal problems. Women, as a group, had greater increases over time in self-help participation, free time spent with family, non-using family/friends, and employment. Although both men and women showed significant improvements following treatment, gender differences persisted in several areas of psychosocial functioning related to recovery.

Adult↗

PubMed2006

Pain-related catastrophizing as a risk factor for suicidal ideation in chronic pain.

Living with chronic pain is associated with many deleterious outcomes, including a substantially increased risk of suicide. While many general risk factors for suicidal ideation and behavior have been identified, few studies have examined pain-related factors that confer increased or decreased risk for suicidality. The present study assessed individual differences in the use of pain-related coping strategies and pain-related catastrophizing as correlates of suicidal ideation in patients with chronic pain. A total of 1512 patients seeking treatment for chronic pain completed a variety of questionnaires assessing pain, coping, and psychosocial functioning. On written questionnaires, approximately 32% of this clinic sample reported some form of recent suicidal ideation. The two most consistent predictors of the presence and degree of suicidal ideation were the magnitude of depressive symptoms and the degree of pain-related catastrophizing, a maladaptive cognitive/emotional pain-coping strategy. Demographic and other pain-related variables such as pain severity and duration were not generally robust predictors of suicidal ideation in this sample of patients with chronic pain. These are the first findings to suggest a unique (e.g., independent of pain severity or depressive symptomatology) association between pain-coping strategies and suicide-related cognitions in the context of chronic pain. Further research in this area, including the addition of suicide prevention materials to pain-coping skills training programs, may benefit large numbers of individuals who are at elevated suicide risk as a consequence of chronic pain.

Adaptation, Psychological↗

PubMed2004

Social support in diabetes: a systematic review of controlled intervention studies.

Systematic, computerized search in Medline, the Cochrane Library, Eric, PsychINFO and Embase files, 1980-2003, selecting descriptions of prospective intervention trials with good methodological design, testing effects of social support interventions on health outcomes in primary and outpatient care for type 2 diabetes. Six controlled trials were reviewed. They defined, modified, and measured social support in various ways, and scored outcomes with varying measures. Gender differences and the right amount of support seem important. Promising new forms of social support: group consultations (better HbA1c and lifestyle), Internet or telephone-based peer support (improved perceived support, increased physical activity, respectively), and social support groups (improved knowledge and psychosocial functioning). No improved diabetes control by classic forms of support, e.g. from spouse (but weight loss in women) and family and friends (no differences). It is tentatively concluded that this review supports the hypothesis that specific social support interventions affect patient self-care and diabetes outcomes. New forms of social support may be discussed and incorporated in the work of diabetes teams, and offered to patients as new possibilities to help them adjust to a life with (type 2) diabetes and make information-based decisions. Only in the group consultations study, diabetes control was protected. More well-designed research testing the effects of specific social support interventions on patient self-care, lifestyle adaptations, and outcomes of diabetes care, is warranted.

Counseling↗

PubMed2004

Extratemporal resection for childhood epilepsy.

There have been relatively few studies reporting the safety, efficacy, and outcome in children undergoing extratemporal resection for epilepsy. We reviewed the pediatric cases of extratemporal resection for intractable epilepsy performed by the Comprehensive Epilepsy Program at the University of Alberta Hospitals between 1988-1998. Thirty-five patients were studied, 14 male and 21 female. The age at operation ranged from 6 months to 16 years. The operations included frontal excisions (12), parietal (8), occipital (4), hemispherectomies or multilobar resections (10), and one removal of a hypothalamic hamartoma. The pathology at surgery included patients with focal cortical dysplasia (8), brain tumors (6), neurocutaneous syndrome (7), Rasmussen's encephalitis (2), porencephalic cysts (4), hypothalamic hamartoma (1), and nonspecific gliosis (6). Twenty-four of 35 patients (68.5%) had an Engel Class I outcome after surgery and an additional six patients (11%) had a significant decrease in seizure frequency (Engel Class III). Complications were observed in two patients (5%) and there were no deaths. Extratemporal resection is a safe and effective treatment for children with intractable epilepsy. Overall, 68% of patients were seizure-free after surgery, although outcome may be dependent on site and pathology. A wide range of developmental pathology was observed including focal cortical dysplasia, brain tumors, and lesions with neurocutaneous syndromes. Many families reported improvement in behavior and psychosocial function after surgery.

Adolescent↗

PubMed2006

Multidisciplinary and interdisciplinary management of chronic pain.

Multidisciplinary and interdisciplinary pain management programs incorporate a biopsychosocial model in assessing and treating pain and result in pain reduction, improved quality of life, and psychosocial functioning. Additionally, return-to-work and vocational outcomes may be seen in selected patients. Treatment teams may include a physiatrist, a physical or occupational therapist,a pain psychologist, a relaxation (biofeedback) therapist, vocational and therapeutic recreational therapists, social workers, and nurses. The key component to program success is collaborative ongoing communication among team members, the patient, and the case manager.

Chronic Disease↗