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Social functioning in body dysmorphic disorder: assessment considerations.

Individuals with body dysmorphic disorder (BDD) have markedly poor social functioning; however, previous reports may underestimate impairment. Scoring on certain functioning measures such as the Social Adjustment Scale-Self Report (SAS-SR) potentially excludes more severely ill individuals from some domains, thereby possibly underestimating functional impairment. To explore this issue, 73 individuals with BDD who reported having no primary relationship (and were therefore excluded from scoring on the SAS-SR Primary Relationship domain) were compared to 58 individuals with BDD who had a primary relationship. Subjects without a primary relationship had significantly poorer global social adjustment on several measures. They also had poorer scores on the Global Assessment of Functioning Scale and greater severity of BDD and depressive symptoms at a trend level. These findings suggest that the SAS-SR may underestimate social impairment. This underestimation may pertain to other domains of functioning, other disorders, and certain other functioning and quality of life measures.

Adult↗

The hyperactive child at adolescence: cognitive, emotional, and social functioning.

In view of the paucity of detailed follow-up studies on hyperactive children, the performance of 15 adolescents diagnosed hyperactive 5 years previously was compared to that of a control group of equivalent age, sex, intelligence, and social class. Eleven cognitive tests measuring sustained attention, visual-motor and motor skills, abstraction, and reading ability, as well as three self-assessment tests examining self-esteem, activity level, social functioning, academic status, and career aspirations were administered. The hyperactives performed significantly worse than the controls on the sustained attention, visual-motor, and motor tasks, and on two of the four reading tests. They also gave themselves significantly lower ratings on some of the self-esteem and sociability items. It would appear that the hyperactives at adolescence still have attentional and stimulus-processing difficulties, which affect not only their academic performance but also their social functioning.

Achievement↗

Social function in schizophrenia and schizoaffective disorder: associations with personality, symptoms and neurocognition.

BACKGROUND: Research has indicated that stable individual differences in personality exist among persons with schizophrenia spectrum disorders predating illness onset that are linked to symptoms and self appraised quality of life. Less is known about how closely individual differences in personality are uniquely related to levels of social relationships, a domain of dysfunction in schizophrenia more often linked in the literature with symptoms and neurocognitive deficits. This study tested the hypothesis that trait levels of personality as defined using the five-factor model of personality would be linked to social function in schizophrenia. METHODS: A self-report measure of the five factor model of personality was gathered along with ratings of social function, symptoms and assessments of neurocognition for 65 participants with schizophrenia or schizoaffective disorder. RESULTS: Univariate correlations and stepwise multiple regression indicated that frequency of social interaction was predicted by higher levels of the trait of Agreeableness, fewer negative symptoms, better verbal memory and at the trend level, lesser Neuroticism (R2 =.42, p <.0001). In contrast, capacity for intimacy was predicted by fewer negative symptoms, higher levels of Agreeableness, Openness, and Conscientiousness and at the trend level, fewer positive symptoms (R2 =.67, p <.0001). CONCLUSIONS: Taken together, the findings of this study suggest that person-centered variables such as personality, may account for some of the broad differences seen in outcome in schizophrenia spectrum disorders, including social outcomes. One interpretation of the results of this study is that differences in personality combine with symptoms and neurocognitive deficits to affect how persons with schizophrenia are able to form and sustain social connections with others.

Adult↗

[Severity of alcohol dependence and social functioning of male patients with alcoholism. I. Functioning in the sharing of marital roles].

The relations between social functioning and severity of alcohol dependence of 40 male patients from Dependence Treatment Ward in Bydgoszcz were studied. Using the MAST, CAGE, and self clinical scale the cohort was divided into two groups: less and more severe dependent probands. The demographic and social data of patients from both groups did not differ significantly. Social functiong was evaluated by use the Scale of Social Roles taking into consideration the set of marital roles (with basic roles of sexual partner, friend, guardian, and family support). The disposition to perform the role, privileges, fulfilling the duties, activity, and harmonization of the role were estimated in each of the role mentioned above and in every patient. It was shown that subjects more dependent on alcohol are significantly less active in the role of sexual partner and in support of family, as well as are less effective in performing such roles and are more egoistic in the role of sexual partner than men less dependent on alcohol. No differences were found in other roles among studied groups. The revealed differences were discussed in the aspect of psychologica and interactive hanges in marital couple.

Adult↗

Electrodermal activity as a predictor of social functioning in female schizophrenics.

Twenty-nine female schizophrenics and 20 female controls were presented with a series of moderately intense tones in a standard orienting habituation paradigm while skin conductance was monitored. Premorbid adjustment and symptoms were also rated, and the schizophrenics were observed 2 years later. The total schizophrenic group was divided into a good-outcome group and a poor-outcome group. Good social functioning outcome required both self-supporting ability in the job market and at least a minimal social life. The poor-outcome group had a significantly higher skin-conductance level and frequency of spontaneous skin-conductance fluctuations than the control group, whereas the few patients with good outcome did not differ from controls. These results are contrary to previous findings with a group of schizophrenic men in which poor social functioning was associated with low electrodermal activity. This discrepancy is discussed in terms of sex differences in schizophrenic disorder.

Acoustic Stimulation↗

Defining fragility of the elderly severely mentally handicapped according to mortality risk, morbidity, motor handicaps and social functioning.

The main aim of this study was to find a cut-off point in the age-distribution at which the physical fragility of the severe mentally handicapped residents increases. The following criteria for age-related fragility were used: mortality risk, morbidity rates of chronic diseases, motor problems and social functioning. The age-specific mortality risks were computed by means of data of the National Case register in the period 1978-1983. The morbidity-rates, rates of motor handicaps and handicaps of social functioning were calculated from a random sample of 550 severe mentally handicapped in 100 institutions and sheltered homes. The results of this cross-sectional study showed a high prevalence of diseases and handicaps, and a high mortality-rate until the age of 30, mainly determined by pre- and perinatal birth defects. The most healthy residents were found according to our criteria in the 30-50 year age group. A significant increase in health problems of 'the elderly' were observed only after the age of about 50 years, as indicated by a high prevalence of diseases and sensory handicaps, mortality risk, motor problems and problems with basis personal skills. The linguistic skills of elderly persons were significantly better in comparison with the younger residents.

Activities of Daily Living↗

Experiencing undesired daily life events, instrumental functioning, social support and well-being of Israeli elderly women: comparison between caregivers/non-caregivers for adult children with mental retardation.

The purpose of the study was to examine the extent to which 160 mothers who care for an adult child with mental retardation differ in respect to undesired daily life events, instrumental functioning, social support and well-being from a comparably matched group of age peers. Findings indicated that caregivers for adult children with mental retardation reported more undesired daily life events in comparison to the matched group. However, no differences were found in respect to their instrumental functioning, social support and well-being. A detailed analysis showed significant variations in measures of undesired daily life events and social support.

Activities of Daily Living↗

Social functioning, psychopathology, and medication side effects in relation to substance use and abuse in schizophrenia.

OBJECTIVE: To identify correlates of self-reported substance use and problems associated with that use in people with schizophrenia. METHODS: A sample of 404 patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder and longitudinal assessments of substance use were examined. Three groups were formed according to consistency of substance use over time: No/Low Alcohol, Alcohol Only, and Drug Use (with or without alcohol use). Similar groups were formed regarding problems associated with alcohol use. Groups were compared on demographics, psychiatric history, psychopathology, medication side effects, and social functioning. RESULTS: Substance users were more likely to be young, male, and to have lower levels of education. Substance users generally had fewer negative symptoms, more social contacts, and better social-leisure functioning. However, substance users, especially drug users, also were rated as having more interpersonal and family problems, had an earlier age at first psychiatric hospitalization, and were more likely to have been recently hospitalized. Patients reporting problems with alcohol use reported more frequent alcohol and drug use, greater severity of akathisia, and problems in interpersonal, family, and self-efficacy domains. CONCLUSIONS: Many of the same variables that correlate with substance use disorder also correlated with moderate substance use in this sample of people with schizophrenia. Although moderate users of alcohol and drugs may have better social functioning in some areas, they also are likely to have substantial problems in interpersonal relationships, especially those involving family members.

Adolescent↗

Mental health, social functioning, and feelings of hatred and revenge of Kosovar Albanians one year after the war in Kosovo.

A cross-sectional cluster sample survey was conducted in June 2000 in Kosovo to assess the prevalence of mental health problems associated with traumatic experiences, feelings of hatred and revenge, and the level of social functioning among Kosovar Albanians approximately 1 year after the end of the war. Findings of the second cross-sectional survey were compared with those from our 1999 mental health survey in Kosovo. Included in the survey were 1399 Kosovar Albanians aged 15 years or older living in 593 randomly selected households across Kosovo. Twenty-five percent of respondents reported PTSD symptoms, compared with 17.1% in 1999. The MOS-20 social functioning score improved to 69.8 from 29.5 in 1999. In the 2000 survey 54% of men felt hatred toward the Serbs, compared with 88.7% in 1999.

Adolescent↗

Total gastrectomy: the influence of preserved duodenal transit and of pouch reconstruction on abdominal symptoms, nutrient assimilation, and medico-social functioning.

BACKGROUND/AIMS: The aim of this retrospective study was to establish whether patients with different reconstruction after total gastrectomy (duodenal bypass without pouch (subgroup Ia, n = 88); duodenal bypass with pouch (subgroup Ib, n = 27); continuous duodenal transit (subgroup II, n = 27)) differ concerning abdominal symptoms, nutrient assimilation, and medico-social functioning. METHODS: The 142 patients (49 females, 93 males; mean age 57.2 years, (95% confidence interval 55 to 59)) after potentially curative total gastrectomy for gastric malignancy 500 days earlier (mean: 95% confidence interval 334 to 666) were evaluated for abdominal symptoms, biochemical and haematological parameters, endoscopic findings, small intestinal bacterial overgrowth, oro-caecal transit time, objective signs of malassimilation, and the degree of medico-social functioning. RESULTS: There were no significant differences between the subgroups in any of the parameters examined. CONCLUSION: In this study, neither subjective nor objective patient data support preference for any single mode of the examined reconstructions after total gastrectomy. However, small patient numbers, unstandardised reconstruction procedures and a recruitment bias might influence these findings.

Analysis of Variance↗

Poor premorbid social functioning and theory of mind deficit in schizophrenia: evidence of reduced context processing?

Investigations have demonstrated deficits in theory of mind (ToM) ability in schizophrenia. Yet, the development of, and mechanisms associated with these deficits are not well understood. The present investigation examined the hypothesis that, among chronic schizophrenia patients, impaired ToM is associated with failures in context processing, greater disorganized symptoms, and poor premorbid functioning. Forty-two inpatients with schizophrenia spectrum disorders were assessed on tests of ToM, visual and linguistic context processing, executive functioning, and verbal IQ. Symptomatology and premorbid functioning were also assessed. Results revealed that more impaired ToM was associated with poorer performance on both visual and linguistic context processing measures and higher ratings of disorganization on the BRRS. ToM was also associated with poorer childhood social functioning and an earlier age of illness onset. ToM was not associated with verbal processing speed, verbal fluency, response inhibition, sequence learning, or estimated verbal IQ. A significant regression model including measures of childhood peer problems and visual and language context processing significantly predicted ToM performance and accounted for 43% of the variance. These findings suggest that, among chronic schizophrenia patients, deficits in ToM ability may be the result of context processing impairments. These impairments may be a factor in both poor social functioning during childhood and greater disorganized symptoms after illness onset.

Adult↗

[Association of depressive symptoms and social functioning in primary care service, Brazil].

OBJECTIVE: Depressive disorders represent a major public health problem due to their high prevalence and psychosocial impact. Depressed patients are assiduous users of primary care services, although their depression is very often misdiagnosed. The objective of the study is to evaluate the association between depressive symptoms and social functioning in individuals that seek primary care services in a Brazilian capital. METHODS: The study included 2,201 primary care users in the city of Porto Alegre, Brazil. The participants' physical and emotional health was assessed through an interview using a questionnaire including 2 general questions from the World Health Organization's Quality of Life instrument (WHOQOL-brief); other questions from the Medical Outcomes Study Short-Form 12 (SF-12), MHI 5 (MHI-5), Centers for Epidemiologic Studies-Depression (CES-D), and additional questions about work loss days and health care utilization. RESULTS: Of all individuals, 79.5% were women aged on average 40 years. The intensity of depressive symptoms (measured by CES-D) was 20.2 for women and 16.2 for men. All parameters studied had an inverse relationship with the intensity of depressive symptoms. CONCLUSIONS: This study reinforce the findings that depressive symptoms have a strong association with poor social functioning and quality of life and a higher utilization of health resources in primary care patients.

Adolescent↗

[Validity and reliability of the Duke-UNC-11 questionnaire of functional social support].

OBJECTIVE: The aim of this study is to analyse the validity and reliability of the functional social support questionnaire, Duke-UNC-11. DESIGN: Descriptive. Crossover study. SETTING: Urban health centre. PATIENTS: 656 patients were interviewed in their homes. 60 had the questionnaire repeated (30 self-filled and 30 using an interviewer) an average of 6 days later. MEASUREMENTS AND MAIN RESULTS: The intraclass correlation coefficients of the 11 items in the Duke-UNC-11 were above 0.50, for both self-filled and interviewer questionnaires; the ones on the scale were 0.92 and 0.80, respectively. The factorial analysis separated two sub-scales, confidential support (7 items) and affective support (4 items). Low social support was significantly associated to: being over 40, widowed or divorced, living alone, over-user, worse subjective health, greater chronic morbidity, mental health disorder and family dysfunction. The multiple linear regression equation managed to explain 30% of the variability of social support, in which family function (family APGAR) explained 23.5%, education 3.3%, perception of internal health control 2%, mental health 1.2% and perception of susceptibility to/seriousness of illness 0.3%. CONCLUSIONS: The questionnaire Duke-UNC-11 is valid and reliable.

Adult↗

Epilepsy in the elderly: incidence, social function, and disability.

The incidence of epilepsy in persons greater than or equal to 60 years was studied during a 5-year period in an urban area. The incidence of patients with definite epilepsy was 77 new cases per year per 100,000 citizens greater than 60 years of age, with a significant excess of male patients. Generalized and partial seizures each accounted for about half of the seizures, but the majority of patients experienced generalization at least once. Of 163 patients with onset of epilepsy during the study period, 152 could manage in their own home, but 97 of these required permanent home help. Marital status, dementia, and focal neurological signs, but not age, influenced patients' social function. A group of patients of the same age with established epilepsy before the study period managed as well or even better, indicating that epilepsy did not significantly influence social function. For both groups, too many patients as compared with the population at risk were economically inactive at the time of admission. Judging from patients' previous occupation, it seems as if patients predominantly came from the lower social classes, indicating that occupational risks may be of ethiological importance.

Activities of Daily Living↗

Karenni refugees living in Thai-Burmese border camps: traumatic experiences, mental health outcomes, and social functioning.

In June 2001, we assessed mental health problems among Karenni refugees residing in camps in Mae Hong Son, Thailand, to determine the prevalence of mental illness, identify risk factors, and develop a culturally appropriate intervention program. A systematic random sample was used with stratification for the three camps; 495 people aged 15 years or older from 317 households participated. We constructed a questionnaire that included demographic characteristics, culture-specific symptoms of mental illness, the Hopkins Symptoms Checklist-25, the Harvard Trauma Questionnaire, and selected questions from the SF-36 Health Survey. Mental health outcome scores indicated elevated levels of depression and anxiety symptoms; post-traumatic stress disorder (PTSD) scores were comparable to scores in other communities affected by war and persecution. Psychosocial risk factors for poorer mental health and social functioning outcomes were insufficient food, higher number of trauma events, previous mental illness, and landmine injuries. Modifications in refugee policy may improve social functioning, and innovative mental health and psychosocial programs need to be implemented, monitored, and evaluated for efficacy.

Adaptation, Psychological↗

Social functioning in chronic depression: effect of 6 weeks of antidepressant treatment.

Social functioning was assessed in 189 nonmelancholically depressed outpatients. Patients were then treated for 6 weeks in a double-blind trial of phenelzine, imipramine, or placebo and functioning was reassessed. Before treatment, younger, more severely depressed, more chronically depressed patients and those with a DSM-III diagnosis of major depression plus dysthymic disorder were more functionally impaired than patients without these characteristics. Chronically depressed patients who responded to treatment reported significantly improved functioning while nonresponders did not. These results suggest that for some chronically depressed patients, impaired functioning results at least partly from the Axis I mood disorder instead of being entirely attributable to Axis II character pathology.

Adult↗

Social functioning among girls with fragile X or Turner syndrome and their sisters.

Social behaviors among two genetically homogeneous groups--girls with fragile X (fraX) or Turner syndrome (TS)--were examined to address the role of family environment versus biological determinants of social dysfunction in girls with these disorders. Using a sibling pair design, girls with fraX or TS were compared with their own sisters on measures of IQ and social functioning. The 8 girls with fraX and the 9 girls with TS had lower FSIQ scores and higher ratings of social and attention problems relative to their own sisters. Girls with fraX also had higher ratings of withdrawn behaviors, relative to their own sisters. The unaffected sisters were not rated as demonstrating any difficulties in these areas, relative to controls. Correlations between problem ratings and FSIQ were not statistically significant. Although these preliminary findings do not indicate a lack of familial impact on social development in girls with either disorder, the results provide preliminary evidence that social dysfunction reported for girls with fraX or TS cannot be attributed solely, nor primarily, to global aspects of the family environment.

Adolescent↗

Relationship of depression with measures of social functioning in adult drug abusers.

The present study describes the relationship between depression and several measures of social functioning--including employment, criminal activity, incarceration, marital functioning, and alcohol and drug use--in a population of adult drug abusers. Our investigation extends past work in this area by specifically investigating the effects of depression (as opposed to simple substance use) on social and interpersonal functioning. Predictably, elevated levels of depression were associated with increased use of hard drugs and alcohol, greater levels of institutionalization, reduced attendance at work or school, and lower overall rates of marital satisfaction. Consistent with previous reports, level of marijuana use was not related to severity of depression. It appears that depressed substance abusers experience significantly more social, vocational, and interpersonal dysfunction than their nondepressed counterparts. It is proposed that the efficacy of existing treatment programs for adult drug abusers will be enhanced through the addition of strategies to assess and ameliorate depression.

Adolescent↗