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Results for “Psychosocial functioning”

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PubMed1991

Child psychopathology and environmental influences: discrete life events versus ongoing adversity.

Patterns of exposure to distinct types of life stressors were compared between 134 children attending a military child psychiatric clinic and a matched military community control sample. Compared with the community sample, clinic-referred children had experienced significantly higher levels of normative stressful events as well as events confounded with their own adjustment and events related to parental psychosocial functioning. Differences in levels of normative stressful events were no longer significant, however, when controlling for events related to parental functioning. Ratings of stressful events during the past year significantly underestimated the lifetime stress exposure differences between clinic and community control children. Although normative stressful events, parent-related events, and parent symptomatology ratings were significantly related to child behavior problem ratings, normative stressful events did not contribute to predictions of child behavior problems beyond the variance attributable to parent-related events and parent symptomatology. Implications of these findings for life stress and child maladjustment research are discussed.

Adaptation, Psychological↗

PubMed1993

Parental psychopathology and children's adjustment to leukemia.

OBJECTIVE: The primary purpose of this study was to examine the relationship between parental psychopathology and psychosocial functioning of children in whom acute lymphocytic leukemia (ALL) has been diagnosed. METHOD: The sample consisted of 61 mother-child dyads. Twenty-one (34%) mothers met DSM-III-R criteria for at least one psychiatric disorder based on a Structured Clinical Interview for Diagnosis (SCID). RESULTS: Findings revealed that compared with children whose mothers did not meet DSM-III-R criteria for a psychiatric disorder, children with mothers who evidenced a psychiatric disorder self-reported more anxiety and a maladaptive attributional style and were reported by their mothers as evidencing more depression and a range of internalizing behavioral symptoms. CONCLUSIONS: Although our earlier research suggested that ALL children show relatively few symptoms of psychopathology, the present report reveals high rates of psychiatric difficulties in the mothers of ALL youth. These findings and their implications are discussed within a model that incorporates behavioral pediatrics and developmental psychopathology.

Acute Disease↗

PubMed1994

Ages of onset of psychiatric disorders in a community population of older adolescents.

OBJECTIVE: Ages of onset of psychiatric disorders, as well as the link between early onset and later psychosocial functioning, were examined in a community population of older adolescents. METHOD: Subjects were 386 adolescents who were participants in an ongoing 14-year longitudinal study. At age 18, lifetime diagnoses and ages of onset of major depression, phobias, post-traumatic stress disorder, and substance disorders were assessed using the NIMH Diagnostic Interview Schedule, Revised Version. Behavioral, emotional, and academic functioning in later adolescence were evaluated through self-report measures and school records. RESULTS: Almost one fourth of the adolescents met criteria for at least one disorder by age 14. Simple phobias emerged earliest (by early childhood), whereas for major depression and substance disorders the peak risk periods for onset were midadolescence. The early onset (by age 14) of disorders was associated with continued impairments in behavioral and emotional functioning in late adolescence (at age 18). Furthermore, the early onset of disorders, compared to later onset (ages 15 through 18), increased the risk for additional co-occurring disorders. CONCLUSIONS: The striking levels of early psychopathology and associated long-term deficits in functioning found in this community population underscore the need for programs of early intervention.

Adaptation, Psychological↗

PubMed1995

Mania-like symptoms suggestive of childhood-onset bipolar disorder in clinically referred children.

OBJECTIVE: To examine the prevalence, characteristics, and correlates of mania among referred children aged 12 or younger. Many case reports challenge the widely accepted belief that childhood-onset mania is rare. Sources of diagnostic confusion include the variable developmental expression of mania and its symptomatic overlap with attention-deficit hyperactivity disorder (ADHD). METHOD: The authors compared 43 children aged 12 years or younger who satisfied criteria for mania, 164 ADHD children without mania, and 84 non-ADHD control children. RESULTS: The clinical picture was fully compatible with the DSM-III-R diagnosis of mania in 16% (n = 43) of referred children. All but one of the children meeting criteria for mania also met criteria for ADHD. Compared with ADHD children without mania, manic children had significantly higher rates of major depression, psychosis, multiple anxiety disorders, conduct disorder, and oppositional defiant disorder as well as evidence of significantly more impaired psychosocial functioning. In addition, 21% (n = 9) of manic children had had at least one previous psychiatric hospitalization. CONCLUSIONS: Mania may be relatively common among psychiatrically referred children. The clinical picture of childhood-onset mania is very severe and frequently comorbid with ADHD and other psychiatric disorders. Because of the high comorbidity with ADHD, more work is needed to clarify whether these children have ADHD, bipolar disorder, or both.

Attention Deficit Disorder with Hyperactivity↗

PubMed1995

Traumas and posttraumatic stress disorder in a community population of older adolescents.

OBJECTIVE: The prevalence of DSM-III-R traumas and posttraumatic stress disorder (PTSD) and their impact on psychosocial functioning were examined in a community population of older adolescents. METHODS: Subjects were 384 adolescents participating in an ongoing longitudinal study. When subjects were aged 18 years, the NIMH Diagnostic Interview Schedule, Version IIIR, was used to identify lifetime traumatic events and diagnoses of PTSD, major depression, phobias, and substance dependence. Behavioral, emotional, and academic functioning in later adolescence was evaluated through self-report measures and school records. RESULTS: More than two fifths of adolescents experienced at least one DSM-III-R trauma by age 18 years; PTSD developed in 14.5% of these affected youths or 6.3% of the total sample. Youths with PTSD demonstrated widespread impairment at age 18, including more overall behavioral-emotional problems, interpersonal problems, academic failure, suicidal behavior, and health problems, as well as an increased risk for additional disorders. An equally striking finding was that youths who experienced traumas but did not develop PTSD also showed deficits in many of these areas when compared with their peers who had not experienced traumas. CONCLUSIONS: The substantial risk faced by youths in community settings for experiencing traumas and PTSD, along with associated impairments in later adolescence, underscores the need for programs of prompt intervention.

Achievement↗

PubMed1996

Long-term consistency in speech/language profiles: II. Behavioral, emotional, and social outcomes.

OBJECTIVE: This study examined the 7-year behavioral, emotional, and social outcome of speech/language-impaired and control children selected from a community sample. METHOD: Speech/language and psychosocial measures were administered to the children at ages 5 and 12.5 years. Using children's age 5 speech/language test results, a cluster analysis was performed to ascertain whether specific linguistic subgroups would emerge. The association between speech/language cluster at age 5 and psychosocial functioning at age 12.5 was examined. RESULTS: Children with receptive and pervasive speech/language problems at age 5 demonstrated greater behavioral disturbance than children without such impairment. Controlling for initial behavioral status, early childhood language profile was still associated with behavioral and social competence ratings, 7 years later. Children without receptive language problems showed superior social adjustment. CONCLUSIONS: Empirically supported speech/language classifications identified as early as age 5 were associated with behavioral disturbance in late childhood. Receptive and pervasive speech/language impairment in early childhood was associated with the greatest risk at follow-up. Early auditory comprehension problems may be a specific risk factor for later aggressive and hyperactive symptoms. These findings identify the need for effective intervention with speech/language-impaired children.

Affective Symptoms↗

PubMed1997

Is psychopathology associated with the timing of pubertal development?

OBJECTIVE: This investigation tested whether the timing of pubertal development was associated with concurrent and prior experiences of psychopathology (symptoms and disorders) in adolescent boys and girls. METHOD: A large (N = 1,709) community sample of high school students were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children as adapted for use in epidemiological studies. Adolescents also completed a questionnaire battery covering a range of psychosocial variables. RESULTS: Analyses tested whether pubertal timing was associated with present and lifetime history of mental disorders, psychological symptoms, and psychosocial functioning. As hypothesized, early-maturing girls and late-maturing boys showed more evidence of psychopathology than other same-gender adolescents. CONCLUSIONS: Early-maturing girls had the poorest current and lifetime history of adjustment problems, indicating that this pattern of pubertal development merits attention by mental health providers and researchers.

Adolescent↗

PubMed1999

The context of depression in clinic-referred youth: neglected areas in treatment.

OBJECTIVE: To review the empirical, methodological, and conceptual limitations of psychotherapy and pharmacotherapy for childhood and adolescent depression and to present descriptive data on key characteristics of a depressed sample to illustrate gaps in treatment. METHOD: Interview-based assessment of psychiatric features and psychosocial functioning, family psychopathology and marital adjustment, and child and parent stressful life events was performed in a sample of 43 depressed youngsters seeking outpatient treatment. RESULTS: The empirical and conceptual review indicated that treatments based on downward extensions of adult procedures are limited in number and success. Also, the treatments generally neglect the following characteristics revealed in the descriptive data: depressed youngsters have high rates of recurrent depression and comorbid conditions, impaired academic and social functioning, exposure to high rates of parental psychopathology, parental assortative mating, severe marital dysfunction, and high rates of severe stressors. CONCLUSIONS: Treatments need to be informed by and address the actual characteristics of depressed youngsters and their environments, which are highly dysfunctional.

Adolescent↗

PubMed1999

Psychiatric comorbidity and the 16-month trajectory of substance-abusing and substance-dependent juvenile offenders.

OBJECTIVES: To examine the concurrent correlates of internalizing and externalizing disorders among substance-abusing and substance-dependent juvenile offenders and to determine the association between psychiatric comorbidity and psychosocial functioning of the youths 16 months later. METHOD: Participants were 118 juvenile offenders meeting DSM-III-R criteria for substance abuse or dependence and their families. A multisource measurement battery was used to assess drug use, criminal activity, family relations, peer relations, school functioning, and out-of-home placements. RESULTS: Comorbidity for externalizing disorders was associated with high rates of antisocial behavior and predicted worse 16-month outcomes than substance abuse alone or substance abuse with comorbid internalizing disorders. For criminal activity and drug use, the presence of internalizing disorders buffered the deleterious effect of externalizing disorders on substance-abusing and substance-dependent juvenile offenders. CONCLUSIONS: Even in substance-abusing delinquents, a population already extreme in antisocial behavior, the presence of externalizing disorders indicates high risk for deterioration.

Adolescent↗

PubMed2000

Natural outcome of ADHD with developmental coordination disorder at age 22 years: a controlled, longitudinal, community-based study.

OBJECTIVE: There is a need for controlled longitudinal studies in the field of attention disorders in the general population. METHOD: In a community-based follow-up study, 55 of 61 subjects aged 22 years, who had attention-deficit/hyperactivity disorder (ADHD) with and without comorbid developmental coordination disorder (DCD) at initial workup at age 7 years, were compared, on a multitude of outcome variables, with 46 of 51 age-matched subjects without such diagnoses. None of the subjects had received stimulant treatment. Psychiatrists performing the follow-up study were blind to original diagnostic group status. RESULTS: In the ADHD/DCD group 58% had a poor outcome compared with 13% in the comparison group (p < .001). Remaining symptoms of ADHD, antisocial personality disorder, alcohol abuse, criminal offending, reading disorders, and low educational level were overrepresented in the ADHD/DCD groups. The combination of ADHD and DCD appeared to carry a particularly gloomy outlook. CONCLUSIONS: Childhood ADHD and DCD appears to be a most important predictor of poor psychosocial functioning in early adulthood. It would seem appropriate to screen for such disorders in schools and clinics so that therapies may be started early.

Adolescent↗

PubMed2001

Adult psychosocial outcome of prepubertal major depressive disorder.

OBJECTIVE: To compare adult psychosocial functioning (PSF) of subjects with prepubertal major depressive disorder (PMDD) to a normal comparison (NC) group. METHOD: PSF of subjects with PMDD (n = 72) and of NC subjects (n = 28) was compared after prospective follow-up to adulthood. These 100 subjects were 90.9% of the baseline 110 subjects who participated in the "Nortriptyline in Childhood Depression: Follow-up Study." Research nurses who were blind to group status conducted telephone interviews using the Longitudinal Interval Follow-up Evaluation (LIFE) to obtain PSF data. RESULTS: At follow-up, the PMDD group was 20.7+/-2.0 and the NC subjects were 20.9+/-2.2 years old. The PMDD subjects were 10.3+/-1.5 years old at baseline. Time between baseline and follow-up was 9.9+/-1.5 years. In the PMDD group, subjects with MDD, bipolar disorder, or substance use disorders during the previous 5 years had significantly worse PSF than NC subjects. These PSF impairments included significantly worse relationships with parents, siblings, and friends; significantly worse functioning in household, school, and work settings; and worse overall quality of life and global social adjustment. CONCLUSIONS: Although combined treatments for PMDD have little scientific basis, multimodality regimens seem prudent until definitive treatment data become available.

Adaptation, Psychological↗

PubMedDate not supplied

The 1997 Clinical Research Award. Health outcome for burn survivors.

Little is known concerning health outcome for patients who survive burn injuries, and how their health outcome compares with that of other medical populations. Such information is important given that the current direction of health care policy decision making is toward outcomes-driven decision models. We compared the health status of 91 patients 1 month after severe burn injury with the published reports of the health status of 39 medical comparison samples, and two reports of health status for the general population. Additionally, we collected longitudinal data on a subsample of our surviving patients with burn injuries at 1 year. Our findings suggest that people who survive a severe burn experience a stable and relatively good health status after their injury compared with other medical samples. However, their health status remains worse than that of the general population over time. Further, people who survive a major burn indicate that the areas of vocational and psychosocial functioning are often the most troublesome for them.

Adult↗

PubMed2006

Emotion regulation in children and adolescents.

Within the past two decades, an "affect revolution" [Fischer and Tangney, Self-conscious Emotions: The Psychology of Shame, Guilt, Embarrassment, and Pride 1995:3-22] in research has revolutionized the ways in which emotion processes have been conceptualized and subsequently studied. This review discusses the literature on emotion regulation (ER) in childhood and adolescence by first summarizing the trajectory of emotional development from infancy through adolescence, followed by a discussion of the biological and environmental influences on ER, and then a review of the literature linking ER to psychosocial functioning. The penultimate section offers practical suggestions for identifying ER difficulties in children and strategies for intervention efforts. Potential areas for future research conclude the review.

Adolescent↗

PubMed2002

Treatment of compulsive sexual behaviour with naltrexone and serotonin reuptake inhibitors: two case studies.

Although there is no universally accepted definition of compulsive sexual behaviour (CSB), the term is generally used to indicate excessive sexual behaviour or sexual cognitions that lead to subjective distress, social or occupational impairment, or legal and financial consequences. Similar to impulse control disorders, CSB is characterized by a failure to resist the impulse for sex. Opioid antagonists have been effective in treating urge-driven disorders, such as pathological gambling disorder, alcoholism, borderline personality disorder with self-injurious behaviour, cocaine abuse, mental retardation with self-injurious behaviour and eating disorders. Based upon the efficacy of opioid antagonists in treating disorders associated with urges, we hypothesized that naltrexone would reduce both the urges associated with CSB and therefore reduce the sexual behaviour. We present two case reports of individuals with CSB treated successfully with naltrexone, a novel treatment for CSB. In both cases, symptoms dramatically decreased and psychosocial functioning improved with the use of naltrexone. Although more research is needed to determine the mechanism that leads to the excessive sexual behaviour in individuals with CSB, the present case reports suggest that naltrexone may be effective in treating some cases of CSB.

Adult↗

PubMed1984

Follow-up of females with gender identity disorders.

The present paper reports on the course of 15 young female-to-male transsexual applicants followed for 1 to 9 years after initial evaluation. Each patient completed a lengthy evaluation process including detailed semistructured interviews and a battery of psychological tests. Of the 15 applicants, 10 went on to live full time in the male role; however, one of these later returned to living as a female. This woman and three others were living as lesbians at last follow-up, while the two other patients continued to live in a more ambiguously male-female role. Psychosocial functioning at the time of follow-up in terms of employment, partners, and psychiatric status is reviewed. A supportive problem-solving psychotherapy program was offered to all of these patients and seven became actively involved in therapy. The potential benefits and limitations of psychotherapy with female gender dysphoric patients are discussed.

Adolescent↗

PubMed1993

Effects of cocaine on hospital course in schizophrenia.

The authors selected at random every fourth inpatient chart (N = 79) of patients enrolled in a schizophrenia clinic for analysis of substance use patterns and psychiatric hospitalizations. Patients were divided into three groups based on operationally defined lifetime drug use histories: a) cocaine and other substance use; b) substance use without cocaine; and c) no substance use. All available hospital records were examined for presenting symptoms and psychosocial functioning at admission, neuroleptic dosing, and hospital management. Cocaine-using schizophrenics had significantly higher hospitalization rates than other substance-using or non-using patients. No differences were found in hospital presenting symptoms among any cohort. However, the cocaine-using schizophrenic patients demonstrated significantly higher rates of suicidal ideation after cocaine use compared with their own non-cocaine-associated hospitalizations or the other groups. The cocaine group also received higher neuroleptic doses by the fifth and sixth weeks of hospitalization compared with their own non-cocaine-associated hospitalizations and with the other groups. This suggests that cocaine use in schizophrenia is associated with poorer illness course and increased hospitalization, including higher rates of suicidal ideation and greater neuroleptic dose.

Adult↗

PubMed1994

Effectiveness and costs of inpatient versus day hospital cocaine rehabilitation.

We compared the effectiveness and costs of day hospital (DH) versus inpatient (INP) rehabilitation for cocaine dependence. The research subjects were 111 inner city, lower socioeconomic, primarily African-American male veterans who qualified for a diagnosis of cocaine dependence and presented no acute medical or psychiatric conditions requiring inpatient treatment. Fifty-six men were randomly assigned to 1 month of DH rehabilitation (27 hours of weekday treatment weekly), and 55 were assigned to 1-month INP rehabilitation (48 hours of scheduled treatment weekly). Treatment outcome was evaluated 7 months after admission into treatment (92% of the subjects), and a cost analysis was performed. A significantly greater proportion of INP subjects (89.1%) completed treatment than did DH subjects (53.6%). Significant improvements in substance use, psychosocial functioning, and health status were found 7 months postadmission for both groups, but there was little evidence of differential improvement between groups. Urine toxicology findings were consistent with the self-report data in showing improvement from baseline, but no group differences in cocaine use. The groups did not differ significantly in post-rehabilitation aftercare participation or in relapse to additional treatment. DH treatment costs were 40% to 60% of INP treatment costs, depending upon the measure used.

Adult↗

PubMed2000

Factors associated with compliance of alcoholics in outpatient treatment.

Predictors of compliance with psychosocial treatment were examined in a clinical sample of 150 patients seeking outpatient treatment for alcohol problems. Predictor variables were as follows: a) patient characteristics at the beginning of treatment and b) treatment characteristics of a matching model developed from the Conceptual System Theory. This model was based on the conceptual level of patients and therapists, and on the structure of the treatment. Using logistic regression analysis, we identified predictors of compliance in the motivation phase (first four consultations) and the active treatment phase (the remainder of the agreed treatment period of 12 months). Predictors of compliance in the motivation phase were a) therapists with a high conceptual level, characterized by an attitude toward the patients of empathetic and reflective listening; b) disulfiram; and c) psychopharmacological treatment. The only patient-related predictors of compliance in the active treatment phase were a) age below 40 and b) the presence of family and social problems, both factors predicting noncompliance. The only treatment-related predictor variables were a) the matching of patients with the structure of treatment and b) disulfiram during the first month of treatment, both factors predicting compliance. Two years after the beginning of treatment, those patients who completed the motivation phase as well as the active treatment phase had a significantly better psychosocial function than the noncompliant patients.

Adult↗