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PubMedDate not supplied

Posttraumatic stress disorder in older adults: a conceptual review.

Issues that are salient in understanding posttraumatic stress disorder (PTSD) in older adults are examined in this review. Although this issue has received scattered attention in the literature since introduction of the diagnosis of PTSD to the Diagnostic and Statistical Manual (DSM) in 1980, it is clear that numerous conceptual and defining questions exist in our understanding of the aftermath of trauma exposure in older adults. In approaching this issue, studies pertaining to diagnostic status as well as broader dimensions of psychosocial functioning are examined. Concerns that are unique to older adults are highlighted throughout, with particular attention to areas where additional research is warranted.

Adaptation, Psychological↗

PubMed1996

Health hazards of obesity.

Several health hazards and social disabilities are associated with obesity. Increased mortality is associated with increased body weight. A high rate of mortality results from heart disease, diabetes mellitus, gallbladder disease, high blood pressure, and cancer. Physiologic cardiovascular changes occur, leading to left ventricular hypertrophy and lipid abnormalities. Hypertension, stroke, and venous stasis are increased. Pulmonary abnormalities include obstructive sleep apnea, which can be associated with secondary polycythemia and right ventricular hypertrophy. Gallstones, gallbladder disease, and accumulation of fat on the liver are significantly increased. Gout and reproductive abnormalities in women are common. Osteoarthritis of the knees and spine occur, although osteoporosis is rare. Risk for endometrial and breast cancer is increased, particularly in the presence of increased central fat. Changes in the skin include stretch marks, acanthosis negricans, hirsutism, intertrigo, and multiple papillomas. Impaired psychosocial function is manifested as social isolation, loss of job mobility, increased employee absenteeism, and economic and social discrimination.

Female↗

PubMed1990

A norm-referenced longitudinal study of medical student drinking patterns.

The alcohol consumption patterns of a single class of 121 medical students was assessed at six points over the course of 4 years of medical school training, along with other measures of drinking-related impairment, family history of alcoholism, personality, and psychosocial functioning. Research Diagnostic Criteria were applied to make diagnoses of alcoholism. Eleven percent of the class reported drinking at a level considered "heavy" by class social norms, most transiently. Eighteen percent of the class met criteria for alcohol abuse by virtue of drinking-related impairment during medical school; they were likely to evidence a prior history of alcohol abuse and a family history of alcoholism. Half the excessive drinkers abused alcohol, but two-thirds of the abusers were not excessive drinkers. Alcohol abusers describe themselves as less warm, kind, gentle, and emotionally expressive than their classmates, and were more preoccupied with themes of power in spontaneous fantasy productions. These findings suggest that interpersonal strategies to intervene with alcohol abusing medical students may encounter predictable resistances, and suggest another intervention approach better suited to their psychological concerns.

Adult↗

PubMed1994

Substance use clusters in a college sample: a multitheoretical approach.

Substance use factors were examined and cross-validated in a cluster analytic approach in two independent samples of college students: N = 291 and N = 602. Reported frequency, intensity, and amount of substance use were examined for beer, hard liquor, marijuana, amphetamines, barbiturates, psychedelics, cocaine, and heroin. Variables were reduced using Principal Components Analysis (PCA) to form four substance use composites. Composite scores were entered into two different methods of cluster analysis that each identified four distinct clusters of substance use groups. External validity was obtained by showing that these four groups differed on a set of relevant variables. The four groups served as levels of the independent variable, substance use type, in four MANOVAs examining group differences on peer and family influence, psychosocial functioning, habit acquisition, and self-efficacy. Findings indicate that as frequency and intensity of substance use increased, individuals reported more problems in living, although a causal direction cannot be established. The findings are of potential value in early identification, prevention, and education regarding substance use among college populations.

Adaptation, Psychological↗

PubMed2002

The relationship between cognitive dysfunction and coping abilities in schizophrenia.

Cognitive dysfunction is a core feature of schizophrenia [Psychiatr. Clin. North Am., 16 (1993) 295; Psychopharmacology: The fourth generation of progress, Raven Press, New York (1995) 1171; Clinical Neuropsychology, Oxford University Press, New York (1993) 449] and is related to psychosocial functioning in this population [Am. J. Psychiatry, 153 (1996) 321]. It is unclear whether cognitive dysfunction is related to specific areas of functioning in schizophrenia, such as coping abilities. Individuals with schizophrenia have deficient coping skills, which may contribute to their difficulties dealing with stressors [Am. J. Orthopsychiatry, 62 (1992) 117; J. Abnorm. Psychol., 82 (1986) 189]. The current study examined the relationship between coping abilities and cognitive dysfunction in a community sample of individuals with schizophrenia. It was hypothesized that executive dysfunction and mnemonic impairments would be positively related to deficiencies in active coping efforts involving problem solving and self-initiation (e.g. advocating for oneself and others with mental illness and becoming involved in meaningful activities, such as work), independent of the contributions of the general intellectual deficits associated with the disorder and psychiatric symptoms. The results indicated that both executive dysfunction and mnemonic impairments were related to decreased usage of active coping mechanisms after controlling for general intellectual deficits. Further, recognition memory made independent contributions to the prediction of coping involving action and help seeking after controlling for the effects of negative symptoms. These findings suggest that individuals with schizophrenia may be less flexible in their use of coping strategies, which may in turn contribute to their difficulties in coping with mental illness and its consequences.

Adaptation, Psychological↗

PubMed2002

Switching from conventional to novel antipsychotic drugs: results of a prospective naturalistic study.

OBJECTIVE: We examined the long-term consequences of switching patients from conventional to novel antipsychotic drugs, from a patient's perspective. METHODS: In a prospective, single-blinded, naturalistic study, a cohort of subjects (n=150) with schizophrenia or schizo-affective disorder (DSM-IV) were switched from conventional neuroleptic drugs to either risperidone (n=50), olanzepine (n=50) or quetiapine (n=50), and monitored for a period of 2 to 6 years. The ensuing natural history of transitions in treatments was charted, and the outcomes including symptoms, side effects, subjective tolerability of drugs and their impact on quality of life were documented with standardized rating scales. RESULTS: Majority (85%) of the subjects benefited from a switch to the novel antipsychotic drugs, though some preferred to return to their original neuroleptic (8%), and others eventually required clozapine (7%) therapy. Novel antipsychotic drugs were significantly tolerated better, and had a positive impact on treatment-adherence, psychosocial functioning and quality of life. Among the novel drugs, risperidone was significantly better in improving negative symptoms, while olanzepine was particularly well tolerated and effective against comorbid anxiety and depressive symptoms. Patients treated with quetiapine reported fewer side effects, and showed a significantly greater improvement in neurocognitive deficits. CONCLUSION: Novel antipsychotics emerged as the drug of choice in view of their overall effectiveness, though conventional neuroleptics and clozapine will continue to have a limited but distinct role in the management of schizophrenia. The challenge for clinicians lies in matching a patient's clinical and biochemical profile with that of a drug's pharmacological actions, in order to achieve optimum outcomes.

Adult↗

PubMed2000

Comparative evaluation of conventional and novel antipsychotic drugs with reference to their subjective tolerability, side-effect profile and impact on quality of life.

This study compared the effectiveness of conventional and novel antipsychotic drugs from a patient's perspective. Five comparable groups of schizophrenic patients (n=230) clinically stabilized on conventional antipsychotic drugs, risperidone, olanzepine, quetiapine or clozapine for a period of 6months or longer were cross-sectionally evaluated. Patients' clinical symptom profile, subjective responses and attitudes toward drugs, prevalence of dysphoria, akathisia, abnormal involuntary movements and Parkinsonian symptoms, and quality of life were ascertained using standardized rating scales. Between-group differences were examined with analysis of variance and chi-square tests. Patients receiving novel antipsychotic drugs experienced fewer side-effects, reported positive subjective responses and favourable attitudes toward their treatment, and revealed a lower prevalence of neuroleptic dysphoria. The differences were statistically significant (p<0.05) with the risperidone, olanzepine and quetiapine groups. Self-rated quality of life, measured with the sickness impact profile, was also significantly better among patients receiving novel antipsychotic drugs. These perceived benefits, however, were not reflected in the clinician rated (objective) measures of psychosocial functioning and quality of life. These findings substantiate the general notion that novel antipsychotic medications are uniformly better tolerated as indicated by the measures of subjective responses, side-effects and self rated quality of life.

Adolescent↗

PubMed2002

Predictors of improvement in quality of life of long-term mentally ill individuals receiving case management.

One hundred and thirteen long-term mentally ill clients receiving case management were investigated with regard to psychosocial and clinical predictors of changes in subjective quality of life during an 18-month follow-up. Better psychosocial functioning and fewer psychiatric symptoms at baseline predicted a greater improvement in quality of life. A larger decrease in symptom severity and a greater improvement in the social network during the follow-up were identified as the most important predictors of a greater improvement in subjective quality of life. The results of the study suggest that an emphasis should be put on effective symptom management, a reduction of needs for care and social support in order to fulfill the aims of improving subjective quality of life in patients receiving case management.

Adult↗

PubMed2003

Depression and anxiety in coronary artery bypass grafting patients.

PURPOSE: Heart surgery is a factor triggering off specific emotional and physiological responses of a patient. In spite of positive somatic effects of surgery, depression and anxiety can persist or appear for the first time after the operation worsening the patient's psychosocial functioning and quality of life. The aim of this study is to offer a prospective view on the incidence and course of self-reported depression and anxiety in coronary artery bypass graft (CABG) patients. SUBJECT AND METHODS: After informed consent, 53 patients who submitted to CABG were examined a few days before and after the operation and 3 months after CABG. They completed the Spielberger Anxiety Questionnaire and Beck Depression Inventory. RESULTS: Approximately 55% of the patients had high a level of anxiety preoperatively. Shortly after the surgery, 34% of patients and after 3 months 32% of them had clinically relevant level of anxiety. Thirty-two percent of patients before the surgery, 28% immediately after CABG and 26% at follow-up were depressed. CONCLUSIONS: High preoperative depression, state and trait anxiety scores appear to be predictors of postoperative psychological outcome. Preoperative assessment can identify patients at risk for clinical levels of postoperative anxiety and depression. Psychological preventive counseling and psychiatric intervention can reduce patients' emotional distress, medical and economic costs.

Aged↗

PubMed1997

Baseline quality of life of patients with advanced prostate cancer. European Organization for Research and Treatment of Cancer (EORTC), Genito-Urinary Tract Cancer Cooperative Group (GUT-CCG)

Quality of life (QoL) is now commonly studied in prostate cancer. However, little is known about the appropriateness of the various QoL instruments in this group of patients. The purpose of this work was to study the baseline QoL assessment of patients with prostate cancer who were randomised into three EORTC phase III studies. The three trials included locoregional prostate cancer patients, poor prognosis metastatic patients and hormone resistance patients, respectively. In the three trials, patients were asked to complete a questionnaire assessing their physical and psychosocial functioning and their symptom levels. These questionnaires included questions from the EORTC QLQ-C30 (version 1): the physical functioning, role functioning, global health/QoL scales and a single pain item. The psychometric properties of the scales were assessed and an analysis was performed to investigate if differences existed in the scale scores between the three groups of patients, 638 baseline questionnaires were available for patients entered into the three trials. The Gutman coefficients of reproducibility and scalability were 0.94 and 0.71, respectively, for the physical functioning scale and 0.97 and 0.90, respectively, for the role functioning scale. The Cronbach's alpha reliability coefficients were 0.68, 0.48 and 0.90 for the physical functioning, role functioning and global health/QoL scales, respectively. The four scales were able to distinguish clearly between the patient populations under study. The physical functioning, role functioning, global health/QoL scales and the single pain item scale from the EORTC QLQ-C30 (version 1) are valid measures when used in the setting of prostate cancer.

Activities of Daily Living↗

PubMed2002

The relationship among violence victimization, witnessing violence, and youth distress.

PURPOSE: To explore whether violence victimization and witness experiences of predominantly African-American, low-income, urban adolescents were associated with distress and whether psychosocial factors contributed to symptomatology. METHODS: Data for this study were obtained from a cross-sectional survey of 349 youth between the ages of 9 and 15 years who resided in any of 10 low-income public housing communities in an East Coast city. Survey instruments assessed exposure to violence, distress symptomatology, youth psychosocial functioning, and family dynamics. Data were analyzed by computing Pearson correlation coefficients and a series of multiple linear regression models. RESULTS: Witnessing violence was related to youth reports of intrusive thoughts and feelings, difficulties with concentration, and vigilant or avoidant behavior. Violence victimization was correlated with feelings of despondency about having either a happy or long life, as well as feelings of being unloved, uncared for, and afraid. Younger youth, boys, and active problem solvers were more likely to report intrusive thoughts. Problematic family communication was related to intrusive thoughts, distraction, feeling a lack of belonging, and expressions of emotional numbing. CONCLUSIONS: The act of witnessing violence may be associated with a set of distinct symptoms. Youth who witness violence also need to be identified so they may be aided in dealing with their distress. Family communication, particularly problematic family communication, and problem solving also contribute to symptomatology.

Adolescent↗

PubMed2002

The development of romantic relationships and adaptations in the system of peer relationships.

In this review, it is proposed that a systems approach to the study of the development of romantic relationships might enhance our understanding of the nature of social relationships, and the links between social relationships and individual psychosocial functioning. First, a selected literature review is provided on the normative development of romantic relationships during adolescence, antecedents of different romantic involvement pathways, and positive and negative qualities of these relationships. Second, the focus is placed on the how the development of romantic relationships occurs within existing systems of relationships including peer networks and close friendships. It is suggested that the development of romantic relationships may change the peer network and nature of relationships with friends and others, and particular types of transitions in social relationships will likely occur. The timing of these transitions and an understanding of the entire peer system as romantic relationships develop will likely improve our understanding of individual developmental processes such as identity formation and the development of externalizing and internalizing problems. Finally, it is proposed that adolescents are faced with a complicated task that includes developing romantic interests and relationships but managing their changing social networks.

Adolescent↗

PubMed2002

Children of parents with bipolar disorder. A population at high risk for major affective disorders.

Children of parents who suffer from bipolar disorder are largely ignored by psychiatric services despite the fact that they constitute a population at very high risk for major depression and bipolar disorder in adulthood and a wide variety of disorders in childhood and adolescence. Major depression and bipolar disorder are chronic, recurrent disorders that seriously impair psychosocial functioning across the life-span. Evidence suggests that in this population bipolar disorder is preceded by externalizing disorders in childhood in many cases, and by depression in some cases. While heredity provides the vulnerability for the development of these characteristics, being raised by parents who model inappropriate coping skills, create a stressful family environment, and provide inadequate support and structure, contribute to consolidating these characteristics.

Adolescent↗

PubMed1997

Behavioral and educational modalities.

General agreement has emerged in the scientific literature that behavioral and educational modalities are useful and effective in the management of chronic pain conditions. Behavioral and educational treatment modalities constitute a component of virtually every established chronic pain treatment program. It has been demonstrated that management of temporomandibular disorders has benefited from such behavioral interventions as well. The label "biobehavioral" refers to proven, safe methods that emphasize self-management and acquisition of self-control over not only pain symptoms but also their cognitive attributions or meanings and maintaining a productive level of psychosocial function, even if pain is not totally absent. A large collection of treatment modalities is subsumed under the label of biobehavioral treatments; the most commonly studied of these include biofeedback, stress management, relaxation, hypnosis, and education. An NIH Technology and Assessment Conference held in 1995 comprises the best available summary of the state of the art concerning the suitability of biobehavioral methods as useful approaches to ameliorate chronic pain, including TMD. Educational methods have also been demonstrated to be efficacious in the self-management of headache and back pain, but only limited data are available for TMD. By and large, when biobehavioral treatments are used in the management of TMD, effects are virtually always positive and in the hypothesized beneficial direction. While effects are often moderate in size, these methods show the potential for producing long-lasting benefits when compared with usual clinical treatment for TMD. Research has as yet failed to establish one biobehavioral modality as superior to another. It is important to note that much the same situation is present with regard to the scientifically established validity of many biomedically based TMD treatments.

Behavior Therapy↗

PubMed2001

The impact of childhood food allergy on quality of life.

BACKGROUND: Food allergy affects >6% of children, but the impact of this disease on health-related quality of life has not been well studied. METHODS: Parental perceptions of physical and psychosocial functioning were measured with the Children's Health Questionnaire (CHQ-PF50). This tool and an additional allergy-related questionnaire were sent to 400 members of the Food Allergy and Anaphylaxis Network with children aged 5 to 18, an age group on which the tool has been validated. RESULTS: Surveys were completed by 253 parents (63%). The mean age of the food-allergic children was 10.8 years (range, 5 to 18 yrs); 59% were male. Sixty-eight percent were allergic to one or two foods, the remainder to more than two foods. Concomitant chronic atopic diseases included: asthma with atopic dermatitis (33%), atopic dermatitis alone (13%), asthma alone (33%), and 21% had neither asthma nor atopic dermatitis. In comparison to previously established norms, the families scored significantly lower (more than 10 scale score points lower and P < 0.0001) for general health perception (GH), emotional impact on the parent (PE), and limitation on family activities (FA). Associated atopic disease, influenced primarily by those with both asthma and atopic dermatitis, accounted for a significant reduction in the GH scale (analysis of variance, P = 0.0001), but not for measures of PE and FA. Within the study group, food-allergic individuals with several (more than two) food allergies had significantly lower (P < 0.05) scores for 7 of 12 scales compared with individuals with few (one or two) food allergies. However, those with one or two food allergies scored significantly lower (P < 0.0001) than established norms on scales for GH, PE, and FA. CONCLUSIONS: Childhood food allergy has a significant impact on GH, PE, and FA. Factors that influence reductions in these scales include associated atopic disease and the number of foods being avoided.

Adolescent↗

PubMed1999

The psychosocial effects of amblyopia study.

PURPOSE: The purpose of this study was to assess the psychosocial effects of growing up with and living with amblyopia and to determine whether patients with amblyopia but without strabismus encounter psychosocial problems similar to those encountered by individuals with strabismus. METHODS: A 20-question survey focusing on medical background, education, self-image, history of amblyopia, treatment of amblyopia, and effects of amblyopia on work, school, friendships, and self-esteem was provided to patients with amblyopia but not strabismus at Saint Louis University Eye Institute and at the University of Iowa Department of Ophthalmology. In addition, patients were evaluated in terms of somatization, obsession-compulsion, interpersonal sensitivity, depression, and anxiety. Results for patients with amblyopia were compared with those of strabismic, normative, and psychopathologic groups using the Hopkins Symptom Checklist (HSC). RESULTS: Twenty-five patients with amblyopia but without strabismus or previous surgery responded. A significant number of patients felt that amblyopia interfered with school (52%) and work (48%) to some degree and were generally affected in their lifestyle (50%). Fewer were affected in their play of sports (40%) or were influenced as to their job choice (36%). Patients with amblyopia as a whole had a greater degree of somatization, obsessive-compulsive behavior, interpersonal sensitivity, depression, and anxiety than patients with strabismus and HSC control subjects. Differences between patients with amblyopia and those with strabismus were not statistically significant (P > .05), but differences between patients with amblyopia and HSC control subjects were significant (P < .05) in each category. Patients with amblyopia, however, were less symptomatic in these areas than HSC Anxious and HSC Depressed groups. CONCLUSION: Psychosocial difficulties related to amblyopia affect individuals' self-image, work, school, and friendships. Amblyopia has a significant effect on psychosocial functioning and warrants aggressive screening, prevention and treatment during the amblyogenic years.

Adolescent↗

PubMed2002

Neuropsychological effects of hyperbaric oxygen therapy in cerebral palsy.

We conducted a double-blind placebo study to investigate the claim that hyperbaric oxygen treatment (HBO2) improves the cognitive status of children with cerebral palsy (CP). Of 111 children diagnosed with CP (aged 4 to 12 years), only 75 were suitable for neuropsychological testing, assessing attention, working memory, processing speed, and psychosocial functioning. The children received 40 sessions of HBO2 or sham treatment over a 2-month period. Children in the active treatment group were exposed for 1 hour to 100% oxygen at 1.75 atmospheres absolute (ATA), whereas those in the sham group received only air at 1.3 ATA. Children in both groups showed better self-control and significant improvements in auditory attention and visual working memory compared with the baseline. However, no statistical difference was found between the two treatments. Furthermore, the sham group improved significantly on eight dimensions of the Conners' Parent Rating Scale, whereas the active treatment group improved only on one dimension. Most of these positive changes persisted for 3 months. No improvements were observed in either group for verbal span, visual attention, or processing speed.

Attention↗

PubMed1984

Institutional rearing, parenting difficulties and marital support.

A prospective follow-up study was undertaken of two groups of women first studied in the mid 1960s when they were children: 94 girls reared in institutions to which they had been admitted because of a breakdown in parenting, and 51 girls in a general population comparison group. Both groups were interviewed in detail when aged 21-27 years and home observations were undertaken for those with young children. The institution-reared women showed a markedly increased rate of poor psychosocial functioning and of severe parenting difficulties in adult life. However, the support of a non-deviant spouse and of good living conditions in adult life provided a powerful protective effect.

Adult↗