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Cognitive impairment, dementia and psychosocial functioning in human immunodeficiency virus infection. A prospective study based on DSM-III-R and ICD-10.

Progressive cognitive impairment in human immunodeficiency virus (HIV) infection, called acquired immunodeficiency syndrome (AIDS) dementia complex (ADC), significantly influences the social prognosis of afflicted patients. The frequency and character in different stages of the infection are controversially discussed. In previous studies, differences in the selection of patients and methods of testing led to widely differing results. For these reasons, in the present prospective study on 45 HIV-infected patients, a structured psychiatric interview (SIDAM) was conducted based on the algorithm of diagnosing dementia in DSM-III-R and the ICD-10 guidelines. The psychopathological findings are expressed in syndrome scores; the results are summarized in a total score (SISCO). The interview contains the Mini-Mental State Examination. The degree of psychosocial functioning was estimated on the global assessment of functioning, Axis V of DSM-III-R. In stages preceding AIDS, only slight cognitive dysfunction was found compared with age- and education-matched normal controls, and this caused no relevant disturbance of psychosocial functioning. In 9 patients with manifest AIDS, dementia was diagnosed with DSM-III-R criteria and ICD-10 guidelines (30% of the AIDS patients). They showed marked impairment of intellectual ability, memory, verbal ability and calculation and constructional ability and fewer cortical focal symptoms (aphasia and apraxia). Corresponding to previous studies, major cognitive dysfunction in HIV infection can be characterized as subcortical dementia.

AIDS Dementia Complex↗

Neuropsychological, physical, and psychosocial functioning of individuals with end-stage renal disease.

Individuals (N = 24) being treated for end-stage renal disease (ESRD) were compared to healthy control participants (N = 20) on measures of neuropsychological, physical, and psychosocial functioning. ESRD patients scored significantly lower than controls (p < .03) on Trail Making Test--Part B; 37.5% of ESRD patients were classified as impaired versus 15% of controls. ESRD patients scored lower than controls on SF-36 measures of Physical Functioning (p < .001). Psychosocial deficits were on the Affect Balance Scale (p < .04) and in employment (p < .04). The hypotheses that neuropsychological status would be associated with psychosocial differences in terms of decrements in both affect and employment rates were also supported. Mediational analysis suggested that neuropsychological status plays a role in the lower employment rates seen among ESRD patients. Clinical and research implications are discussed.

Adult↗

Psychosocial functioning of young adults with cystic fibrosis and their families.

BACKGROUND: The psychosocial functioning of adolescents and young adults with cystic fibrosis still living in the parental home was investigated. With its proven genetic aetiology cystic fibrosis is an ideal model with which to assess the impact of a chronic and life threatening disorder on family and individual psychological and social functioning. METHODS: Twenty nine patients with cystic fibrosis and their families were compared with those of 27 patients with anorexia nervosa and 31 well controls. Assessments were made using self reporting, interview, and observational methods. RESULTS: Most patients with cystic fibrosis were in robust psychological health and only differed from their healthy peers in that they were much less likely to be in employment. Mothers of patients with cystic fibrosis or anorexia nervosa were more likely than the mothers of the well group to be emotionally distressed, although this was not so for fathers. Young people in both illness groups were more likely to have parents with high levels of expressed emotion. Most families of patients with cystic fibrosis had good problem solving abilities. CONCLUSIONS: In spite of the burden of illness in cystic fibrosis psychological functioning in many respects matches that of well young people.

Adolescent↗

Effects of a multidimensional cardiopulmonary rehabilitation program on psychosocial function.

The effects of participation in a structured, outpatient cardiac rehabilitation program on psychosocial function after acute myocardial infarction or coronary artery bypass surgery, or both, were evaluated prospectively in 141 patients who were married or living with "a significant other" (89% men, mean [+/- standard deviation] age 63 +/- 9 years old). Forty-one patients who were participants in a 3-month cardiac rehabilitation program were compared with 100 patients who did not participate in a formal program. On average, patients in both groups were well educated, older Caucasians who had minimal cardiac dysfunction (New York Heart Association class I or II). Patients in the 2 groups were not different at baseline in sociodemographic or clinical characteristics or in any of the dependent measures of anxiety, depression, psychosocial adjustment to illness or marital adjustment. Six months after initial testing, patients who attended cardiac rehabilitation were significantly less anxious (F[1,139] = 5.09, p = 0.03), less depressed (F[1,139] = 8.39, p = 0.004), had better psychosocial adjustment (F[1,139] = 5.87, p = 0.02), and were more satisfied with their marriages (F[1,139] = 8.6, p = 0.004) than nonparticipants. The findings support the effectiveness of group cardiac rehabilitation for this subgroup of patients in facilitating their psychosocial recovery after an acute cardiac event.

Adult↗

Psychosocial functioning in a prepubertal and early adolescent bipolar disorder phenotype.

OBJECTIVE: To compare psychosocial functioning (PF) in a prepubertal and early adolescent bipolar disorder phenotype (PEA-BP) sample to two comparison groups, i.e., attention-deficit/hyperactivity disorder (ADHD) and community controls (CC). METHOD: There were 93 PEA-BP (with or without comorbid ADHD), 81 ADHD, and 94 CC subjects who were participants in an ongoing study, the Phenomenology and Course of Pediatric Bipolar Disorders. Cases in the PEA-BP and ADHD groups were outpatients obtained by consecutive new case ascertainment, and CC subjects were from a survey conducted by the Research Triangle Institute. To fit the study phenotype, PEA-BP subjects needed to have current DSM-IV mania or hypomania with elation and/or grandiosity as one criterion. Assessments for PF were by experienced research nurses who were blind to group status. Mothers and children were separately interviewed with the Psychosocial Schedule for School Age Children-Revised. RESULTS: Compared with both ADHD and CC subjects, PEA-BP cases had significantly greater impairment on items that assessed maternal-child warmth, maternal-child and paternal-child tension, and peer relationships. CONCLUSIONS: Clinicians need to consider PF deficits when planning interventions. In the PEA-BP group, there was a 43% rate of hypersexuality with a <1% rate of sexual abuse, supporting hypersexuality as a manifestation of child mania.

Adaptation, Psychological↗

The psychosocial function of reincarnation among Druze in Israel.

To gain an understanding of the psychosocial function of reincarnation among Druze, interviews were conducted with nine male subjects who had experienced reincarnation (Notq) and with one or two of their family members. Analysis of these interviews revealed that the onset of Notq typically occurs at between two and five years of age. Five of the subjects had displayed psychological distress in their childhood that was alleviated after the Notq. Once the child has displayed initial indications of reincarnation, such as mentioning names that the family construes as being from a past life, the family takes an active role in constructing the past-life story and matching it to a known real story involving a tragic death. This match creates a new order in the life of the child, the family, and the past-life family. All parties benefit from this new order: the child receives new special attention and love and becomes able to control and manipulate the parents; the parents are relieved because they see the child happy, and benefit from the social attention and regard they receive; and the grieving of the bereaved past-life family is alleviated by the realization that the soul of their lost son still lives. The findings support the sociocognitive notion of the constructing of past memories by the social environment. Additional research that should include data collection from the past-life family and examination of the affinity of reincarnation with dissociation and child abuse is recommended.

Adolescent↗

The psychosocial functioning inventory.

The derivation and psychometric analyses of a general purpose outcome/survey instrument--the Psychosocial Functioning Inventory (PFI)--are described. The instrument contains scales designed to measure a wide array of constructs, including subjective well-being, social functioning, stressful events, treatment dependency/aftercare, and consumer satisfaction. Extensive reliability and validity analyses are reported, indicating reasonable reliability and validity for the PFI scales.

Evaluation Studies as Topic↗

Parent-youth concordance regarding violence exposure: relationship to youth psychosocial functioning.

PURPOSE: To examine the relationship between parent-youth concordance with regard to youth exposures to violence and youth psychosocial functioning, including perpetration of violence, distress symptomatology, and social skillfulness. METHODS: A battery of self-report questionnaires were completed by 333 parent-youth dyads residing in urban public housing developments. Concordance status (<50%, 50-80%, and >80%) was based on dyad agreement regarding youth's violence exposures. The relationship between concordance and psychosocial factors was assessed by a series of analyses of covariance tests. RESULTS: Parents underestimated the extent to which their children were victims of or witnesses to violence and suffered from distress symptoms. Low concordance status was associated with youth perpetration of violence and distress symptomatology, as well as lower self-esteem and problem-solving skillfulness. Youth in the low concordance group characterized their families as exhibiting less involvement, open communication, and parental monitoring. CONCLUSIONS: Concordance between parents and youth is associated with youth psychosocial competence and strong family functioning. Findings underscore the need to incorporate a parent component in primary and secondary violence-prevention programs. Further examination of the processes which contribute to concordance may enhance our ability to prevent youth engagement in violence and its untoward psychosocial sequelae.

Adolescent↗

A comparative study of the long term psychosocial functioning of childhood acute lymphoblastic leukemia survivors treated by intrathecal methotrexate with or without cranial radiation.

BACKGROUND: Although previous research has delineated medical, cognitive, and neuropsychologic late effects of central nervous system (CNS) prophylaxis for childhood acute lymphoblastic leukemia (ALL), it has been difficult to draw conclusions about the long term psychosocial sequelae of these treatments due to methodologic problems that led to inconclusive results in past studies. In the current study, the authors examined the long term psychosocial functioning of childhood ALL survivors who had been treated on a Phase III clinical protocol (Cancer and Leukemia Group B [CALGB] 7611) between 1976 and 1979, in which they were randomized to receive either 2400 centigray of cranial radiation (CRT) with intrathecal methotrexate (IT-MTX) or intermediate dose systemic methotrexate (IV-MTX) with IT-MTX. METHODS: One hundred ten survivors of childhood ALL (mean age, 20.8 years) treated on CALGB 7611 who were age 14 years or older and disease free for at least 1 year were studied a mean of 14.7 years after their entry on CALGB 7611. In a telephone interview, a psychosocial assessment battery was administered to the patients, consisting of measures that assessed psychologic, sexual, social, and vocational functioning as well as any delayed physical effects. RESULTS: Survivors who had received CRT + IT-MTX had significantly poorer academic achievement (P = 0.0001), poorer self-images with regard to their bodies (P = 0.001), and greater psychologic distress (P = 0.005). CONCLUSIONS: Cranial radiation used to treat children with ALL has significant long term sequelae in terms of poorer academic achievement and psychosocial functioning. These data add weight to the conclusion that CRT prophylaxis should only be used to treat children who are at high risk of CNS relapse.

Achievement↗

Psychosocial functioning at 1 month after head injury.

The authors examined the psychosocial sequelae of head trauma at 1 month after injury in a group of 102 adult head-injured patients representing a broad range of severity of trauma. One hundred two control subjects selected from friends of the head-injured patients were used for comparison purposes. Outcome was determined with a battery of psychosocial measures assessing a number of different areas of daily functioning. The results support the following conclusions: (a) at 1 month after injury, head-injured patients experience difficulties in a number of areas of psychosocial functioning, especially the resumption of major role activities (i.e., work, school, and home management) and leisure/recreational activities; (b) the relationship between head injury severity level and the adequacy of psychosocial functional differs for the various measures; and (c) in determining the psychosocial consequences of head trauma, the use of an appropriate control group is essential.

Activities of Daily Living↗

Severity of gambling problems and psychosocial functioning in older adults.

This study examined the relationship between severity of gambling problems and psychosocial functioning in older adults. Twenty-one current pathological gamblers and 10 current problem gamblers over 60 years of age completed the Addiction Severity Index (ASI), Geriatric Depression Scale (GDS), Brief Symptom Inventory (BSI), UCLA Loneliness Scale (UCLA-LS), and Social Provisions Scale (SPS). Compared with problem gamblers, pathological gamblers reported increased severity of gambling and family/social problems on the ASI; scored higher on the GDS, BSI, and UCLA-LS; and scored lower on the SPS. Although they were not seeking treatment at the time of the interview, three fourths of pathological gamblers and 30% of problem gamblers were interested in gambling treatment. These results suggest that severity of gambling problems is associated with increased psychosocial distress in older adults and that a significant proportion of older adults with a gambling disorder may be cognizant of their gambling problem and interested in treatment.

Aged↗

Impact of anal incontinence on psychosocial function and health-related quality of life.

The relationship among the frequency of anal incontinence (AI), psychosocial factors, and health-related quality of life (HRQOL) was evaluated. Consecutive patients (n=280) completed a bowel symptom questionnaire, the Symptom Checklist 90 -- Revised (SCL 90-R), and an assessment of HRQOL. Group 1 had no incontinence, Group 2 had AI less than once per week, and Group 3 experienced AI more than once per week. Multivariate analyses were used to evaluate the relationship among symptoms, the SCL-90-R subscales, and HRQOL. Group 3 reported more frequent stools than the other groups. Significant psychological distress was present in both incontinent groups compared to Group 1 (P=0.002). A reduction in overall HRQOL was also seen in the incontinent groups. Depression was inversely correlated with QOL-Satisfaction and QOL-Ratings and positively correlated with QOL-Interference. AI was associated with impaired psychosocial function and decreased HRQOL. The frequency of AI was associated with increased HRQOL-Interference, but minimally with the degree of psychosocial impairment.

Adult↗

Childhood experiences and adult psychosocial functioning.

Various studies have shown statistically significant associations between adverse experiences in childhood and abnormal psychosocial functioning in early adult life. It should not be assumed that this finding necessarily means an enduring effect of early experience. Part of the explanation is that adverse environments tend to be persistent and, hence, that what is being reflected is simply continuity in risk factors. But even when such continuity is taken into account, substantial associations over time remain. Using data from two long-term longitudinal studies a variety of possible mediating mechanisms are considered and shown to be operative. These include: an immediate effect leading to emotional/behavioural disturbance in childhood that then persists into adult life (this mechanism may be more important than appreciated hitherto, because heterotypic continuity has concealed the strength of the persistence of disturbance); one risk environment increasing the likelihood of occurrence of a second, different risk environment; the establishment of patterns of behaviour that bring about later risk environments; and the development of an increased vulnerability to later risk environments.

Adult↗

Attachment and adolescent psychosocial functioning.

To explore the meaning and function of attachment organization during adolescence, its relation to multiple domains of psychosocial functioning was examined in a sample of 131 moderately at-risk adolescents. Attachment organization was assessed using the Adult Attachment Interview; multiple measures of functioning were obtained from parents, adolescents, and their peers. Security displayed in adolescents' organization of discourse about attachment experiences was related to competence with peers (as reported by peers), lower levels of internalizing behaviors (as reported by adolescents), and lower levels of deviant behavior (as reported by peers and by mothers). Preoccupation with attachment experiences, seen in angry or diffuse and unfocused discussion of attachment experiences, was linked to higher levels of both internalizing and deviant behaviors. These relations generally remained even when other attachment-related constructs that had been previously related to adolescent functioning were covaried in analysis. Results are interpreted as suggesting an important role for attachment organization in a wide array of aspects of adolescent psychosocial development.

Adolescent↗

Neuropsychological and psychophysiological correlates of psychosocial functioning in schizophrenia.

This study tested hypothesized relationships between neuropsychological and psychophysiological variables and concurrent levels of clinical and psychosocial functioning in schizophrenia. The sample consisted of 40 subjects diagnosed with a chronic schizophrenia spectrum disorder and living in community-based settings. The psychophysiological variables were tonic skin conductance (SC) level, SC reactivity to stressors, and SC response to orienting stimuli. The neuropsychological measures were the Stroop, the Controlled Word Association Test, and four subtests of the Wechsler Adult Intelligence Scale-Revised (block design, digit symbol, digit span, and arithmetic). The psychosocial variables were measures of symptomatology, independent living, work, and social functioning. The results suggested that higher symptoms were associated with higher resting arousal, lower stress reactivity, status as an electrodermal responder, and deficits in verbal fluency and visuo-motor functioning. The pattern for better social functioning was higher resting arousal, lower stress reactivity, and more responses to orienting stimuli. Higher levels of independent living were associated with better visuo-motor and verbal processing. Increased work functioning was associated with better complex visuo-spatial processing. These findings are discussed in terms of (1) the specificity of associations between psychosocial, psychophysiological, and neuropsychological variables and (2) a holistic perspective toward understanding these relationships and their relevance to rehabilitation in schizophrenia.

Activities of Daily Living↗

A comparison of the psychosocial functioning of children with drug-versus alcohol-dependent fathers.

The present study compared the psychosocial functioning of children whose fathers primarily abused illicit drugs other than alcohol (n = 51 ) to children from a demographically matched sample of families whose fathers abused alcohol (n = 51). Children with drug-abusing (DA) fathers exhibited significantly more negative child behaviors on a standardized child-rating scale than did children from homes with alcohol-abusing fathers. In addition, a significantly greater proportion of children with DA fathers met clinical cutoffs indicative of psychosocial impairment (n = 23: 45%) than did children whose fathers abused alcohol (n = 5; 10%). Mediation analyses indicated that severity of drug, legal, medical, employment, and family problems partially mediated the relationship between type of family (i.e., families with fathers who had an alcohol problem versus families with fathers who had a drug problem) and children's psychosocial adjustment.

Adolescent↗

Assessment of psychosocial functioning of patients with sickle cell disease.

The Chronic Illness Problem Inventory (CIPI) was used to assess level of psychosocial functioning in 89 patients with sickle cell disease. The results indicated that sickle cell patients have significant psychosocial distress in the areas of employment and finances, sleeping and eating, and performance of normal daily activities. Fear and anxiety regarding body deterioration, and lack of assertiveness in social relationships were also found. These findings suggest that depression may be a common problem among sickle cell patients. Treatment alternatives that address these areas are reviewed.

Activities of Daily Living↗

Quality of life after coronary artery bypass grafting: evaluating the influence of preoperative physical and psychosocial functioning.

OBJECTIVE: The aim of this study was to determine the influence of preoperative physical and psychosocial functioning on quality of life 1 and 6 months after coronary artery bypass grafting (CABG). METHODOLOGY: The study used a prospective design. A total of 157 patients admitted for elective CABG in a Greek city hospital participated in the study. RESULTS: Results showed significant improvements in the quality of life of the patients after CABG [F(2, 95)=36.337; P<.001]. Structural equation modeling analyses showed that preoperative psychological distress was the only preoperative predictor of quality of life at 1 month (beta=-.22; P<.01) and at 6 months (beta=-.28; P<.001) after the operation. CONCLUSION: Results highlight preoperative distress as a screening criterion to identify patients likely to benefit less from cardiac surgery.

Adaptation, Psychological↗