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Results for “Psychosocial functioning”

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PubMed1997

Promoting wellness in cardiac rehabilitation: exploring the role of altruism.

Coronary artery disease continues to be the primary cause of mortality in the United States. Recent studies have significantly advanced the ability to improve outcomes in this disorder by demonstrating that intensive risk factor modification programs with diet, lipid-lowering drugs, exercise, and psychosocial interventions can reverse atherosclerosis and reduce events by 40% to 60%. Of all the interventional arms, psychosocial interventions have been the least studied despite research demonstrating that depression and social isolation are potent risk factors for events in patients with coronary artery disease. The few studies that have examined psychosocial interventions in patients with coronary artery disease have demonstrated a reduction in mortality and recurrent events, suggesting that this treatment strategy may be beneficial. Use of volunteer, patient-driven support groups may provide a cost-effective way to improve social support and enhance altruism in patients with coronary artery disease. Although the psychophysiology of altruism is not well defined, it is possible that altruistic activities might have positive health benefits in patients with coronary artery disease. Studies are needed to explore the roles of low-cost, patient-driven support programs in improving psychosocial functioning and outcomes in patients with coronary artery disease.

Altruism↗

PubMed1999

Assessment of quality of life in the younger child: the use of an animated computer program.

BACKGROUND: In the past, quality of life was primarily assessed using objective measurements of the condition of the patient. Today, most quality-of-life measurements include several aspects regarding the patient's opinions and feelings. There has been an extensive development of quality-of-life instruments particularly in adults, including those for people with inflammatory bowel disease (IBD). However, only a few instruments, mostly questionnaires, have been developed for the pediatric population. It has been noted, even in young patients with IBD, that there is reduced self-esteem and more anxiety and depression. Altogether, these are important aspects for early measurement of psychosocial functioning and possibly intervention during the treatment of children with IBD. METHODS: For the current study, an instrument was developed for young children aged 5 years or more in which a computer-based animated program was used to measure quality of life in children with inflammatory bowel disease. The instrument was designed to be similar for boys and girls with no reference to racial identity. In addition, it was culturally acceptable for all Dutch children. The program was in the form of a story of a bear and a clown playing in an attic of an old house where they come across many objects with which they play and where many adventures occur. All 35 questions were interwoven in this story. RESULTS: The animated computer program was well accepted and easily used by 16 children between the ages of 5 and 12 in a small pilot study. In those older than 11 years, another approach is probably necessary, using an age-appropriate animated program. CONCLUSIONS: The computer program can easily be used in an outpatient setting and thus ensures that quality-of-life measurement will become a routine part of a medical visit.

Child↗

PubMed2004

Patient perception of comorbid conditions after acoustic neuroma management: survey results from the acoustic neuroma association.

OBJECTIVES/HYPOTHESIS: Based on survey results of the Acoustic Neuroma Association, the patient ratings of the most difficult aspects of acoustic neuroma management were reported and a review of the literature was made regarding comorbid conditions associated with acoustic neuroma treatment and their impact on patient quality of life. STUDY DESIGN: Cohort study of 1940 patients who were members of the Acoustic Neuroma Association. METHODS: A detailed questionnaire was mailed to 2372 members of the Acoustic Neuroma Association to identify preoperative and postoperative symptoms, complications, and long-term effects on physical and psychosocial function. For 1940 respondents (81.8%) who reported the "most difficult aspect of the AN [acoustic neuroma] experience," the responses were analyzed by tumor size, surgical approach, and patient age and sex. Statistical analysis was performed using SPSS software. RESULTS: Respondents reported that the most difficult aspect of the acoustic neuroma experience was hearing loss (25.8%), followed by facial weakness (17.9%), eye problems (10.8%), and headache (10.5%). In order of frequency, men reported hearing loss, balance problems, perioperative surgical experience, and eye and facial weakness, and women reported hearing loss, facial weakness, eye problems, and headache. Facial weakness was a morbidity more often reported for men and women who had large tumors, who were young, or who had undergone the retrosigmoid approach. Balance dysfunction was significant in patients older than 75 years of age. In patients with small tumors, headaches and balance problems were frequently reported. CONCLUSION: In the large cohort study of patients with acoustic neuroma, perceptions regarding the impact of treatment illustrated why it is incumbent on physicians to understand the sentiments of patients with acoustic neuroma when counseling them and recommending optimal management strategies.

Aged↗

PubMedDate not supplied

Adjustment issues related to bilateral prophylactic mastectomy in women at elevated risk of developing breast cancer.

Breast cancer is the most common cancer diagnosis for North American and Western European women. Increased knowledge in availability of genetic testing has helped to identify those women at high risk of eventually developing breast cancer. This has resulted in more women considering bilateral prophylactic mastectomy as a viable preventative option. Although the efficacy of the procedure has been established, much less is known about the psychological impact of undergoing this procedure. In order to assess these factors, we reviewed what is currently known about the psychological impact of undergoing bilateral prophylactic mastectomy. Searches were conducted and inclusion criteria revealed articles that focused on the psychological components involved with undergoing a bilateral prophylactic mastectomy. The findings are summarized and fell broadly into one or more of the following three areas: (1) satisfaction or regret following the surgery, (2) psychosocial functioning after the surgery, and (3) predictors of quality of life. Plastic surgery nurses have a unique opportunity to impact important psychological considerations, such as expectations of the early postoperative period, body image concerns, and psychological distress.

Activities of Daily Living↗

PubMed2002

After plastic surgery: adolescent-reported appearance ratings and appearance-related burdens in patient and general population groups.

The aim of this study was to determine the effects of appearance-related surgery on psychosocial functioning during adolescence. To this end, changes in bodily attitudes and appearance-related burdens in adolescents undergoing corrective (for aesthetic deformities) and reconstructive (for congenital or acquired deformities) surgery were compared with those in a general population sample.A group of 184 adolescent plastic surgery patients (corrective, n = 100; reconstructive, n = 84), and a comparison group of 83 adolescents at random selected from three municipalities (corrective, n = 67; reconstructive, n = 16), aged 12 to 22 years, were studied at two time points with a 6-month interval. The plastic surgical patients were studied presurgically and postsurgically. Using fully structured telephone interviews and postal questionnaires, adolescents' ratings of their appearance, bodily satisfaction and attitudes, and appearance-related burdens were obtained. All patients reported a significant decrease in burdens after surgery compared with the comparison group, indicating a much more prominent improvement in the patient sample compared with the developmental changes that may be expected to occur in adolescence. The corrective patient group reported least burdens after the operation. More specifically, the "breasts" group benefited most from the operation, indicating that breast corrections are rewarding interventions. The findings of this study imply that adolescents can be regarded as good candidates for plastic surgery. They gain bodily satisfaction, and they are relieved of many appearance-related burdens. Physical, social, and psychological burdens related to appearance satisfaction improve considerably in both corrective and reconstructive adolescent patients.

Adolescent↗

PubMedDate not supplied

Long-term follow-up of anorexia nervosa.

This study compared the long-term outcome of restricting and bulimic anorexic women using standardized psychometric instruments in addition to global clinical ratings. Results indicated that, in general, restricting and bulimic anorexic subtypes did not differ in their long-term outcome according to clinical ratings and standardized assessments of anorexic symptoms, psychiatric diagnoses, and psychosocial functioning. The only exception to this pattern was that the bulimic group had a higher incidence of substance use disorders during the last year compared with the restricting group. Findings also indicated that relative to a matched comparison group of women of average weight, a significant percentage of anorexics from both subtypes met DSM-III criteria for an affective or anxiety disorder at some point in their lives as well as at long-term follow-up. Results are discussed in terms of theoretical and methodologic issues involved in the long-term follow-up of anorexia nervosa.

Adult↗

PubMedDate not supplied

Anorexia nervosa in a long-term perspective: results of the Heidelberg-Mannheim Study.

The long-term outcome of 84 anorexia nervosa patients was studied over a period of 12 years using global clinical ratings and differential physical findings in addition to standardized psychometric measurements. An unusual polarization into good and fatal outcomes was found, with a high recovery rate of 54% and a high mortality rate of 11%. When psychiatric and somatic comorbidity and psychosocial functioning were included in the assessment, the recovery rate was only 41% after 12 years. Clear cases of anorexia decreased steadily from 100% at clinical presentation to 67% after 2 years, 40% after 4 years, and 23% after 6 years. There was almost no further decline after the ninth year of follow-up (17%). Purging, physical symptoms, advanced age at clinical presentation, and a high social status were predictors for an unfavorable course. About 22% of the patients had suffered a relapse after remission. At first presentation, they were young and had a short duration of illness but showed severe psychiatric disorders. Results are discussed in terms of methodological and clinical issues involved in the long-term follow-up of anorexia nervosa patients.

Adult↗

PubMed1998

Hypospadias.

The incidence of hypospadias is increasing. Decreased androgen sensitivity, 5alpha-reductase deficiency and chromosomal abnormalities are causes of the disease. Nonirritant suture material, coverage of the urethral reconstruction by additional tissue and perioperative care positively influence the outcome. Complication rates after repair of distal hypospadias are low. For severe hypospadias staged procedures provide good results. Buccal mucosa is promising for initial repair and repeat cases. Psychosocial function in patients with severe hypospadias is normal.

Journal Article↗

PubMed2002

Acute care of the elderly units: a positive outcomes case study.

Acute care of the elderly patient is a specialty area of practice. The elderly have a spectrum of needs including physiologic, psychosocial, functional, and financial needs that will alter their response to physiologic illness and the acute care experience in general. Acute care units specifically designed to meet the needs of elderly adults can have a dramatic impact on recovery from acute illness and long-term, postdischarge outcomes. This report describes the experience of one elderly patient hospitalized for the treatment of pneumonia. This elderly patient manifested a response to the acute care experience that was typical of his age cohort, including confusion and incontinence. Subsequent transfer to an acute care for the elderly unit maximized this patient's recovery and postdischarge placement.

Aged↗

PubMedDate not supplied

Neuropsychological profile of children and adolescents with the 22q11.2 microdeletion.

PURPOSE: Patients with one of the 22q11.2 deletion syndromes provide a unique opportunity to research the interface between genetics and brain-behavior relationships. This study investigates the neuropsychological characteristics and behavioral phenotype of children with this deletion syndrome. METHODS: We report updated findings from descriptive and nonparametric analyses of neuropsychological data from 80 children with the 22q11.2 deletion. RESULTS: The subjects showed higher verbal than nonverbal IQ scores, assets in verbal memory, and deficits in the areas of attention, story memory, visuospatial memory, arithmetic performance relative to other areas of achievement, and psychosocial functioning. CONCLUSION: Children with 22q11.2 deletion syndromes exhibit a behavioral phenotype reflective of nonverbal learning disabilities, concomitant language deficits, and social-emotional concerns.

Adolescent↗

PubMed2006

Catastrophizing, pain, and social adjustment in scleroderma: relationships with educational level.

OBJECTIVES: Low educational attainment is related to numerous adverse health outcomes, and some evidence suggests that psychosocial variables may mediate education's effects. Moreover, the relationship between psychosocial functioning and health-related outcomes may be moderated by educational level, with individuals lower in formal education being more susceptible to the deleterious effects of negative cognitive and affective states. The present study sought to characterize such interrelationships between educational level and pain-related catastrophizing. METHODS: We investigated the association of self-reported educational level with pain and social disability, we evaluated catastrophizing's potential mediating role in those associations, and we also investigated education as a moderator of catastrophizing's effects on pain and social disability in a sample of patients with scleroderma, a frequently painful autoimmune disorder. RESULTS: First, education-related differences in pain report were accounted for by catastrophizing and depression. Second, after controlling for demographic factors, disease severity, and depressive symptoms, education moderated the relationship between catastrophizing, pain affect, and social function. Specifically, catastrophizing was more highly associated with greater reporting of affective pain among those with less formal education. In addition, catastrophizing inversely correlated with social disruption among individuals with less formal education. DISCUSSION: Collectively, study findings support multiple models of interaction between education and pain-related cognitive/affective functioning, though in both mediational and moderational analyses, lower levels of formal education act as a risk factor for adverse pain-related outcomes.

Adaptation, Psychological↗

PubMed2004

Effectiveness of naltrexone in a community treatment program.

OBJECTIVE: In several large, well-designed, randomized, double-blind studies, the opiate antagonist naltrexone demonstrated efficacy in the treatment of alcohol dependence. Specifically, when combined with certain psychosocial therapies, naltrexone reduces the number of drinking days, heavy drinking, and time to relapse to alcohol use in alcohol-dependent individuals. Whether this efficacy can be generalized to individuals who have alcohol use disorders and present for treatment at front-line community treatment programs has not been well established. METHODS: A total of 145 patients who presented for treatment at a rural community substance abuse treatment center were randomized to receive naltrexone 50 mg daily plus usual program treatment (n = 54), placebo plus usual treatment (n = 43), or usual treatment alone (n = 48) for 12 week. A total of 133 participants had at least one follow-up visit. Primary outcome measures included percent days drinking, average drinks per drinking day, average drinks per day, heavy drinking days (four or more for women and six or more for men), and time to first heavy drinking day. Secondary measures included changes in serum biological markers (alkaline phosphatase, alanine transaminase, aspartate transaminase, and gamma-glutamyltransferase), craving, and psychosocial functioning. RESULTS: In the intention-to-treat analysis, there were no between-group differences for any of the primary drinking outcomes at 12 weeks. In post hoc exploratory analyses, the entire sample of participants was divided into two new groups: (1) people who drank during the 2 weeks before the start of medication (entry drinkers) and (2) people who did not drink during this interval (entry abstainers). Entry abstainers were at an advantage at study entry in that they were significantly more likely to have an inpatient hospitalization immediately before entry into outpatient treatment. Mixed-model analysis of variance revealed a main effect for entry group at the 12-week treatment endpoint on the primary outcome measures of percent days drinking, average drinks per drinking day, average drinks per day, heavy drinking days, and time to first heavy drinking day. Participants in any of the randomized groups who were entry abstainers had significantly better improvement on all of the primary outcome measures. The abstainer groups that were randomized to placebo and usual treatment had significantly better outcomes than the entry drinkers in those perspective groups. However, for the naltrexone-treated group, entry drinkers and entry abstainers had similar improvement in drinking-related outcomes. CONCLUSIONS: These data suggest that naltrexone may offer particular benefit to patients who continue to drink during the early stages of the trial as compared with those who have achieved abstinence before treatment entry.

Adult↗

PubMed2004

Relapse prevention in pediatric patients with ADHD treated with atomoxetine: a randomized, double-blind, placebo-controlled study.

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is typically treated over extended periods; however, few placebo-controlled, long-term studies of efficacy have been reported. METHOD: In a global multicenter study, children and adolescents who responded to an initial 12-week, open-label period of treatment with atomoxetine, a nonstimulant treatment for ADHD, were randomized to continued atomoxetine treatment or placebo for 9 months under double-blind conditions. RESULTS: A total of 416 patients completed acute atomoxetine treatment and were randomized. At end point, atomoxetine was superior to placebo in preventing relapse defined as a return to 90% of baseline symptom severity (proportion relapsing: atomoxetine 65 of 292 [22.3%], placebo 47 of 124 [37.9%], p =.002). The proportion of patients with a 50% worsening in symptoms post-randomization was also lower on atomoxetine (atomoxetine 83 of 292 [28.4%], placebo 59 of 124 [47.6%], p <.001). Compared with patients in the placebo group, atomoxetine-treated patients had superior psychosocial functioning at end point. Discontinuations for adverse events were low in both groups, and tolerability was similar to that observed in acute treatment trials. CONCLUSIONS: In patients who responded favorably to 12 weeks of initial treatment, atomoxetine was superior to placebo in maintaining response for the ensuing 9 months. This result supports the value of maintenance treatment with atomoxetine in patients with ADHD who respond to initial treatment.

Atomoxetine Hydrochloride↗

PubMed2004

Is the party over? Cannabis and juvenile psychiatric disorder: the past 10 years.

OBJECTIVE: To critically review cannabis research during the past 10 years in relation to rates of use, behavioral problems, and mental disorders in young people. METHOD: Studies published in English between 1994 and 2004 were identified through systematic searches of literature databases. The material was selectively reviewed focusing on child and adolescent data. RESULTS: In the 27 years between 1976 and 2002, approximately half of all 12th graders had been exposed to cannabis in the United States. There is growing evidence that early and regular marijuana use is associated with later increases in depression, suicidal behavior, and psychotic illness and may bring forward the onset of schizophrenia. Most of the recent data reject the view that marijuana is used to self-medicate psychotic or depressive symptoms. Research on treatment is very limited. CONCLUSIONS: Research on the mental health effects of cannabis has increased dramatically. Although doubts still remain about the role of cannabis in the causation of juvenile psychiatric disorder, the weight of the evidence points in the direction of early and regular cannabis use having substantial negative effects on psychosocial functioning and psychopathology.

Adolescent↗

PubMed2006

Comparison of long-term outcomes in adolescents with anorexia nervosa treated with family therapy.

OBJECTIVE: To describe the relative effectiveness of a short versus long course of family-based therapy (FBT) for adolescent anorexia nervosa at long-term follow-up. METHOD: This study used clinical and structured interviews to assess psychological and psychosocial outcomes of adolescents (ages 12-18 years at baseline) who were previously treated in a randomized clinical trial using family therapy between 1999 and 2002. RESULTS: Eighty-three percent (71/86) of subjects participated in follow-up assessments of current psychological and psychosocial functioning. In addition, 49% (35) were interviewed using the Eating Disorder Examination. Mean length of follow-up was 3.96 years (range 2.3-6.0 years). There were no statistically significant differences between the two groups on any measure at long-term follow-up. As a whole, the group was doing well with 89% above 90% ideal body weight, 74% with Eating Disorder Examination scores within the normal range, and 91% of postmenarcheal females not on birth control had menstrual return. CONCLUSIONS: A short course of family therapy is as effective as a longer course at follow-up.

Adolescent↗

PubMed2006

Childhood adversity and psychosocial adjustment in old age.

OBJECTIVE: The objective of this study was to test the hypothesis that higher level of childhood adversity is associated with lower level of psychosocial adjustment in old age. METHOD: Participants are 253 older persons (mean age: 79.8, standard deviation: 2.1; 73.9% women) from the Rush Memory and Aging Project, a clinicopathologic study of common chronic conditions of old age. Childhood adversity was assessed with a 16-item measure based on portions of the Childhood Trauma Questionnaire and other inventories. Psychosocial adjustment was assessed with multiple measures of neuroticism (i.e., proneness to negative emotions) and social engagement. RESULTS: Based in part on a factor analysis, composite measures of total adversity, emotional neglect, parental intimidation, parental violence, family turmoil, and financial need were developed. In a series of linear regression models adjusted for age, sex, own education, and parental education, the composite measure of childhood adversity was associated with all facets of neuroticism and accounted for more than 13% of the variance in the composite neuroticism measure. Emotional neglect and parental intimidation had the strongest associations with neuroticism. Childhood adversity was not related to frequency of participation in social activities, but more adversity was associated with having a smaller network (accounting for 3% of the variance) and feeling more emotionally isolated (accounting for 7% of the variance). CONCLUSION: Childhood adversity is associated with less adaptive psychosocial functioning in old age.

Aged↗

PubMed2004

A 7-year experience of genetic males with severe phallic inadequacy assigned female.

PURPOSE: We examine the hypotheses underlying the clinical decision to assign female gender at birth in male neonates with severe phallic inadequacy. MATERIALS AND METHODS: A total of 18 genetic males with severe phallic inadequacy were assessed longitudinally for physical, social, psychological and sexual identity development. Diagnoses included cloacal (11) and classic (1) exstrophy, partial androgen resistance (3), mixed gonadal dysgenesis (2) and penile agenesis (1). Neonatal sex assignment was female in 15 and male in 3 patients. RESULTS: All patients demonstrated marked male typical behaviors and interests. Of the 15 female assigned patients 1 died, 1 refused to declare sexual identity or orientation, 1 converted to male before initial evaluation, 1 was reassigned male by the parents and 5 others declared male sexual identity. Thus, of 17 living patients 10 live as males and 6 as females. Of patients 17 years or older only those living as male lived independently. The 4 oldest patients living as male but only 1 patient living as female would discuss sexual orientation-all 5 declared orientation toward females, and 3 of these 4 males had girlfriends or were married. The sexually undeclared patient lived in a residential treatment center because of major behavioral difficulties since age 15. Only patients living as male had dated. CONCLUSIONS: This longitudinal study implies that males with severe phallic inadequacy reared male and those reared female but converting to male can have functional psychosocial developmental trajectories. Those reared female have a realistic likelihood of recognizing male sexual identity and converting to male. Those not converting to male appear to have less successful psychosocial developmental trajectories.

Adolescent↗

PubMed2005

Medical and surgical palliative care of patients with urological malignancies.

PURPOSE: Urological malignancies are relatively common and patients often live many years with disease. There are many effective medical and surgical palliative treatments, although few comprehensive guidelines have been published. We reviewed the various palliative treatments available for the 3 most common urological malignancies, namely prostate cancer, bladder cancer and renal cancer. MATERIALS AND METHODS: A literature search of the last 15 years was performed using MEDLINE/PubMed. In addition, relevant journals were targeted for specific information related to this review. Our clinical experience was combined with the current literature to create guidelines for palliative care. RESULTS: Several effective treatments are available for the palliative care of patients with prostate, bladder or renal cancer. Options in palliative care are varied with regard to invasiveness, morbidity, risks and benefits. The algorithms described provide a framework to a sequential approach to achieving palliation. Urologists are central to initiating care and referrals to improve outcomes in these patients. CONCLUSIONS: Palliative care includes disease directed treatment as well as functional, psychosocial and spiritual support. Disease directed therapy and palliative care should be provided simultaneously throughout illness. Improved quality of care and quality of life as well as physician satisfaction are frequent outcomes of this approach. Supportive care begins at initial diagnosis and it should be flexible to meet the changing needs of patients with cancer and their families.

Algorithms↗