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PubMed1996

The predictive value of P300-amplitudes in the course of schizophrenic disorders.

Auditory P300-amplitudes have been found to be correlated with the social functioning and with the impairment in daily life by negative symptoms in cross-sectional studies. In this prospective longitudinal study, the correlation of auditory P300-amplitudes registrated at the index examination was investigated with the clinical outcome after an average of 2.4 years. Based on previous studies, only schizophrenic patients who were in a stabilized residual state were included in the study. Reference-independent P300-parameters of the index examination were correlated with axis V of DSM-III-R (GAF), with the Brief Psychiatric Rating Scale (BPRS) and with the Scale for Assessment of Negative Symptoms (SANS) assessed at the follow-up examination. The correlation of index P300-amplitude with social functioning at follow-up was significant. No correlations of index P300 with the current symptomatology at follow-up, as expressed by BPRS and SANS was found, however. The results indicate a predictive value of the P300-amplitude on the clinical outcome in terms of social functioning of schizophrenic patients.

Acoustic Stimulation↗
PubMed1996

Predictors of functional outcome among adolescents and young adults with psychotic disorders.

Adolescents and young adults who experience the onset of a psychotic disorder often demonstrate major disruptions in occupational and social functioning. Yet, certain persons appear to be at a greater risk for impaired functioning after an episode of psychosis than others. This review of the psychiatric research literature on outcomes in psychotic disorders identifies several variables predictive of occupational and social functioning among young persons with both affective and nonaffective psychoses. Variables predictive of functional outcomes include diagnosis, symptom severity, duration of onset of symptoms, age of onset of symptoms, gender, stressful life events, premorbid functioning, and social supports. A model for conceptualizing the relationships of these variables to functioning is presented, and the implications for occupational therapy practice and research are discussed.

Adolescent↗
PubMedDate not supplied

Clinical significance of lifetime mood and panic-agoraphobic spectrum symptoms on quality of life of patients with rheumatoid arthritis.

BACKGROUND: Previous studies suggested that rheumatoid arthritis (RA) is associated with depressive and anxiety symptomatology. The well-being and functioning of patients with RA may be significantly influenced by subthreshold psychiatric comorbidity. Health-related quality of life (HRQoL) of patients with RA, compared with the Italian norms and patients with diabetes, was assessed by the influence of lifetime mood and panic-agoraphobic spectrum symptoms and demographic and clinical variables. METHODS: Ninety-two patients were consecutively recruited at the Department of Rheumatology at the University Hospital of Pisa, Italy. All patients met diagnostic criteria of RA according to the American College of Rheumatology. Health-related quality of life was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey questionnaire (MOS SF-36). Mood and panic-agoraphobic spectra were assessed by two different structured self-report instruments: the Mood Spectrum (MOODS-SR) and the Panic-Agoraphobic Spectrum (PAS-SR), respectively. RESULTS: Patients with RA were compared, as regards the MOS SF-36 scale scores, with the Italian normative population and patients with diabetes. Compared with the Italian population, patients with RA showed significantly lower MOS SF-36 scale scores, except for role emotional. Moreover, patients with RA scored significantly lower on the role physical, bodily pain, and social functioning scales compared with patients with diabetes and higher on role emotional and mental health. A significant worsening of all MOS SF-36 scale scores was related to higher scores of the depressive domains of MOODS-SR, except for social functioning and bodily pain. A statistically significant negative association was also found between PAS-SR total score and the MOS SF-36 scales physical functioning, vitality, role emotional, and mental health. There were no statistically significant correlations between MOS SF-36 scales and the manic MOODS spectrum. In the multivariate models, the negative correlations between depressive MOODS, role emotional, and mental health were confirmed and the severity of arthritis showed a significant impact on all MOS SF-36 areas with the exception for social functioning; moreover, manic MOODS was associated with better general health. CONCLUSIONS: The present report shows that lifetime depressive spectrum symptoms negatively affects HRQoL of patients with RA and subthreshold mania improves the perception of general health. Diagnosis and appropriate clinical management of depression, including subthreshold symptoms, might enhance HRQoL in these patients.

Adult↗
PubMed1990

Prosthetic use and functional and social outcome following major lower limb amputation.

A total of 175 consecutive below and above-knee amputees sent to the prosthetic workshop in Helsinki for prosthetic fitting from 32 hospitals were reviewed to determine their functional ambulation and social adaptation. The average age of the patients was 62.2 years at the time of the prosthetic fitting. The mortality was 11% (19) during the first postoperative year. One-year postoperative information was obtained for 141 of the surviving patients (90%) by personal contact. At the time of the review, 68% of the amputees (96 patients) who had been fitted with a prosthesis made extensive and regular use of it. Half of all the above-knee amputees and 79% of the below-knee amputees used their prosthesis throughout the day or over seven hours a day. A total of 72% of the above-knee amputees (33/46) and 85% of the below-knee amputees (67/79) had useful ambulation, at least indoors. Of the 141 patients contacted, 124 (88%) lived in their own homes. The remaining 16 patients (11%) lived in apartment houses for the aged or old people's homes. A total of 48 amputees (34%) needed a regular home help.

Adolescent↗
PubMed1993

[Mental development of 'meanings' related to scripts: 'dining' script as an example].

The purpose here is to investigate how the process of relating 'meanings' to scripts is influenced by the developmental changes of concepts about these activities, with an example of 'dining'. Based on previous studies that the concept of 'dining' develops from physiological function orientation to social function orientation, second, fourth, and sixth graders, and college students were asked to plan 'dining' with a physiological goal or a social one. The results are as follows. (1) Generated plans became more connected with goals developmentally in both social and physiological context. (2) Second graders who attached much importance to physiological function of 'dining' were apt to generate plans with physiological meanings even in social goal context.

Adolescent↗
PubMedDate not supplied

Creation of a model of independence for community-dwelling elders in the United States.

BACKGROUND: A goal of many public policies in support of older Americans is independence, but the meaning of independence in the context of community-dwelling elders is not clear. OBJECTIVE: To create a preliminary conceptual model of independence for older, community-dwelling Americans. METHODS: Exploratory factor analysis was used during secondary analysis of a federal dataset, the Second Supplement on Aging (N = 9,447). After preparation of the dataset, 51 variables were selected for possible submission to factor analysis. Initial item reduction resulted in 21 variables for factor structure development. RESULTS: Three factors for a preliminary conceptual model of independence were identified: physical function, social ability, and physical health. Physical function, explaining 29.5% of the variance, included variables related to elders' ability to function in everyday life, such as how well they function in their homes. Social ability variables included items related to social activities, education, driving, and leaving the house, and accounted for 8.6% of the variance. Physical health explained 6.1% of the variance and included variables related to visits to the doctor, prescription drug use, and number of days spent in bed during the past year. DISCUSSION: Findings suggest the importance of physical function for independence and the importance of a physical environment that supports various levels of physical function. Social ability plays a role in independence and may require adequate physical function, financial and material resources, and social support. Physical health may be a component of physical function or reflect access to healthcare. Future studies using primary data are indicated for further development of the concept of independence in the context of community-dwelling elders in the United States. A conceptual model of independence will guide nurses in their assessments of and interventions for older, community-dwelling adults and will help policymakers prioritize spending for programs that have independence as a goal.

Activities of Daily Living↗
PubMed2005

A trial of problem-solving by community mental health nurses for anxiety, depression and life difficulties among general practice patients. The CPN-GP study.

OBJECTIVES: To compare the effectiveness of community mental health nurse (CMHN) problem-solving and generic CMHN care, against usual general practitioner (GP) care in reducing symptoms, alleviating problems, and improving social functioning and quality of life for people living in the community with common mental disorders; and to undertake a cost comparison of each CMHN treatment compared with usual GP care. DESIGN: A pragmatic, randomised controlled trial with three arms: CMHN problem-solving, generic CMHN care and usual GP care. SETTING: General practices in two southern English counties were included in the study. CMHNs were employed by local NHS trusts providing community mental health services. PARTICIPANTS: Participants were GP patients aged 18--65 years with a new episode of anxiety, depression or reaction to life difficulties and had to score at least 3 points on the General Health Questionnaire-12 screening tool. Symptoms had to be present for a minimum of 4 weeks but no longer than 6 months. INTERVENTIONS: Patients were randomised to one of three groups: (1) CMHN problem-solving treatment, (2) generic CMHN treatment, or (3) usual GP care. All three groups of patients remained free to consult their GPs throughout the course of the study, and could be prescribed psychotropic drug treatments. MAIN OUTCOME MEASURES: Patients were assessed at baseline, and 8 weeks and 26 weeks after randomisation. The primary outcome measure was psychological symptoms measured on the Clinical Interview Schedule -- Revised. Other measures included social functioning, health-related quality of life, problem severity and satisfaction. The economic outcomes were evaluated with a cost--utility analysis. RESULTS: Twenty-four CMHNs were trained to provide problem-solving under supervision, and another 29 were referred patients for generic support. In total, 247 patients were randomised to the three arms of the study, referred by 98 GPs in 62 practices. All three groups of patients were greatly improved by the 8-week follow-up. No significant differences were found between the groups at 8 weeks or 26 weeks in symptoms, social functioning or quality of life. Greater satisfaction with treatment was found in the CMHN groups. CMHN care represented a significant additional health service cost and there were no savings in sickness absence. CONCLUSIONS: The study found that specialist mental health nurse support is no better than support from GPs for patients with anxiety, depression and reactions to life difficulties. The results suggest that healthcare providers could consider adopting policies of restricting referrals of unselected patients with common mental disorders to specialist CMHNs, although there may be other roles in primary care that CMHNs could play effectively. Further research should address the predictors of chronicity in common mental disorders and target extra treatment. More research is also needed into the effectiveness and cost-effectiveness of problem-solving treatment for other disorders, of facilitated self-help treatments for common mental disorders and of CMHN care for people with severe and enduring mental illnesses, as well as the prevention of mental disorders.

Adolescent↗
PubMed2005

Compulsory community and involuntary outpatient treatment for people with severe mental disorders.

BACKGROUND: There is controversy as to whether compulsory community treatment for people with severe mental illnesses reduces health service use, or improves clinical outcome and social functioning. Given the widespread use of such powers it is important to assess the effects of this type of legislation. OBJECTIVES: To examine the clinical and cost effectiveness of compulsory community treatment for people with severe mental illness. SEARCH STRATEGY: We undertook searches of the Cochrane Schizophrenia Group Register to 2003 and Science Citation Index. We obtained all references of identified studies and contacted authors of each included study. SELECTION CRITERIA: All relevant randomised controlled clinical trials of compulsory community treatment compared with standard care for people with severe mental illness. DATA COLLECTION AND ANALYSIS: We reliably selected and quality assessed studies and extracted data. For binary outcomes, we calculated a fixed effects risk ratio (RR), its 95% confidence interval (CI) and, where possible, the weighted number needed to treat/harm statistic (NNT/H). MAIN RESULTS: We identified two randomised clinical trials (total n=416) of court-ordered 'Outpatient Commitment' (OPC) from the USA. We found little evidence to indicate that compulsory community treatment was effective in any of the main outcome indices: health service use (2 RCTs, n=416, RR readmission to hospital by 11-12 months 0.98 CI 0.79 to 1.2), social functioning (2 RCTs, n=416, RR outcome 'arrested at least once by 11-12 months' 0.97 CI 0.62 to 1.52), mental state, quality of life (2 RCTs, n=416, RR homelessness 0.67 CI 0.39 to 1.15) or satisfaction with care (2 RCTs, n=416, RR perceived coercion 1.36 CI 0.97 to 1.89). However, risk of victimisation may decrease with OPC (1 RCT, n=264, RR 0.5 CI 0.31 to 0.8, NNT 6 CI 6 to 6.5). In terms of numbers needed to treat, it would take 85 OPC orders to prevent one readmission, 27 to prevent one episode of homelessness and 238 to prevent one arrest. AUTHORS' CONCLUSIONS: Based on current evidence, community treatment orders may not be an effective alternative to standard care. It appears that compulsory community treatment results in no significant difference in service use, social functioning or quality of life compared with standard care. There is currently no evidence of cost effectiveness. People receiving compulsory community treatment were, however, less likely to be victim of violent or non-violent crime. It is, nevertheless, difficult to conceive of another group in society that would be subject to measures that curtail the freedom of 85 people to avoid one admission to hospital or of 238 to avoid one arrest. We urgently require further, good quality randomised controlled studies to consolidate findings and establish whether it is the intensity of treatment in compulsory community treatment or its compulsory nature that affects outcome. Evaluation of a wide range of outcomes should be included if this type of legislation is introduced.

Ambulatory Care↗
PubMed2000

How does the short form 36 health questionnaire (SF-36) in rheumatoid arthritis (RA) relate to RA outcome measures and SF-36 population values? A cross-sectional study.

The aim of the study was to show that the SF-36 is a practical tool for use on outpatients with RA, to examine the relationship between the SF-36 and indices of outcome in RA, and to compare the results with population norms and other disease states. Eighty-six consecutive RA patients attending the Haywood Hospital in Stoke-on-Trent and starting or changing second-line therapy were enrolled. Disease outcome was assessed using the American College of Rheumatology core set and all subjects completed the SF-36 health questionnaire. The cohort had moderately active disease (median ESR 46) and appreciable disability (median HAQ 1.875). Impairment of health status was moderate to marked by the SF-36, with significant differences from population norms and chronic disease states such as low back pain. Good correlations were observed between HAQ and physical function (r>0.75, p<10(-6)) and HAQ and social function (r>0.61, p<10(-6)). In contrast, SF-36 scales for physical and emotional role showed no association with activity measures. We concluded that, SF-36 is a practical tool for use in patients with RA. HAQ is associated with its physical and social function scales. Other SF-36 scales, such as physical and emotional role, are not associated with activity core set measures; this suggests different information is involved. RA has a considerable impact on health status compared to other diseases.

Aged↗
PubMed2004

Social skills of children with neurofibromatosis type 1.

Children with neurofibromatosis type 1 (NF1) have difficulties in forming friendships and are often rejected by their peers. Factors that contribute to these negative social outcomes are poorly understood. This study investigated the social skills of children with NF1 and the influence of comorbid conditions, such as attention-deficit-hyperactivity disorder (ADHD) and specific learning dfficulties. We assessed and analyzed data from 79 children with NF1 (42 males, 37 females; mean age 11 years 6 months, SD 2 years 4 months) and 46 unaffected siblings (19 males, 27 females; mean age 12 years 1 month, SD 2 years 6 months; age range 8 to 16 years). Social skills were measured with the Social Skills Rating System. Children with NF1 had significantly poorer social outcomes than their unaffected siblings, and significantly poorer social skills in comparison with normative data. The presence of ADHD (in 39% of children with NF1) was the major risk factor for poor social functioning. Children with NF1 and ADHD had the poorest social skills and social outcomes when compared with children with NF1 only or children with NF1 and learning difficulties. These findings dispel the previous assumption that NF1 alone is associated with poor social functioning and has major implications for the development of effective interventions.

Adaptation, Psychological↗
PubMedDate not supplied

Evaluation of a social-skills training group intervention with children treated for brain tumors: a pilot study.

OBJECTIVE: To evaluate the effectiveness of a manual-based, social-skills training, group intervention to improve social skills and social functioning of children treated for brain tumors, and to assess the impact of cognitive functioning on the effectiveness of the intervention. METHODS: Three social-skills training group interventions, each comprised of 5 to 7 children ages 8 to 14 years, were conducted. A parent component was included. In total, 13 children and their parents and teachers completed standard measures prior to and 9 months after the intervention. Children participated in a neuropsychological test battery at baseline. RESULTS: Social skills and social functioning variables changed in the direction of improved functioning, with several scores showing significant improvement from baseline to the follow-up assessment. Small to medium effect sizes were documented. Higher verbal and nonverbal functioning were associated with greater improvement. CONCLUSIONS: Findings are suggestive of the potential effectiveness of social-skills training in groups for children with brain tumors. Multisite, randomized, controlled studies are recommended as the next step.

Adolescent↗
PubMed2003

Hoarding behavior in the elderly: a comparison between community-dwelling persons and nursing home residents.

OBJECTIVE: To determine correlates of hoarding behavior in frail elderly persons. METHODS: Information about nursing home residents (n = 408) and community-dwelling senior day-care participants (n = 177) was gathered through interviews with family and professional caregivers, medical chart review, and physician examinations, and included the following areas of assessment: hoarding behavior, demographic and health information, level of cognitive functioning, activities of daily living (ADL) performance, depressed affect, social functioning, manifestations of agitated behaviors, and previous stressful life experiences. RESULTS: We found that 15% of the nursing home residents and 25% of the community-dwelling senior day-care participants manifested hoarding behavior at a rate of several times a week or higher. For nursing home residents, hoarding behavior was significantly related to a larger appetite, taking fewer medications, higher social functioning, comparatively less ADL impairment, and manifestations of physically nonaggressive agitated behaviors. For senior day-care participants, hoarding behavior was significantly associated with being female, a larger appetite, comparatively less gait impairment, fewer medical diagnoses, more involvement in activities, a positive diagnosis of dementia, hallucinations, the delusion of infidelity, and manifestations of three syndromes of agitated behaviors. CONCLUSION: While hoarding behavior in our samples presents differently from compulsive hoarding described in the literature, we obtained robust findings that show that despite differences in living conditions, the elderly persons who manifested hoarding behavior were those with relatively fewer health and functional disabilities. In addition, those who exhibited hoarding behavior also manifested agitated behaviors. We suggest that future researchers develop alternative measures of hoarding behavior so as to further clarify the phenomenon of hoarding behavior in the elderly.

Activities of Daily Living↗
PubMed2001

Patient-assessed outcomes after excision of acoustic neuroma: postoperative symptoms and quality of life.

OBJECT: The aim of this study was to assess whether outcomes from excision of acoustic neuroma vary among patients and have a material impact on their quality of life (QOL). METHODS: A questionnaire concerning postoperative symptoms and the Short Form 36 (SF-36) QOL instrument were mailed to 97 consecutive patients who had undergone acoustic neuroma surgery via the translabyrinthine approach. The survey response rate was 78% and the symptomatology was consistent with other reports, supporting the representativeness of the sample. The respondents' QOL was rated significantly below published norms and their work capacity was reportedly reduced. Specifically, the following SF-36 dimensions were reduced: physical functioning and role-physical, together with vitality, general health, and social functioning. Greater numbers of postoperative symptoms and larger tumors were associated with a worse rating of physical functioning. More severe balance problems were associated with lower ratings of social functioning. The disparity between the patient's self-estimate and self-measurement and the clinician's assessment of the patient's facial functioning raises doubts about the validity of subjective reports and assessment. CONCLUSIONS: The present study supports the use of generic QOL measures to assess outcome and to draw comparisons between different populations.

Adolescent↗
PubMed2005

Arthrodesis of the knee after failed infected total knee arthroplasty.

Infection after total knee arthroplasty (TKA) can be a challenging and difficult problem to treat. In selected patients, knee arthrodesis is a well-recognized salvage procedure after infected TKA. The authors retrospectively reviewed their experience with this treatment option, presenting 20 patients (8 women, 12 men), performed between 1990 and 2002. The average age was 67 years (range: 47-81 years) and the mean number of previous surgical procedures was 6 (range: 4-11 procedures). There were multiple indications for knee arthrodesis, including extensive bone or soft tissue loss, poor bone stock, and recurring infections. One-stage fusion was done in 7 knees while, on the other 13, arthrodesis was performed as two-stage fusions. The average clinical follow-up was 4.5 years (range: 2-11 years). 18 of the 20 patients were interviewed and graded using the Visual Analogue Scale (VAS) for pain, the Short Form-36 Health Survey (SF-36), and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire that has knee-related quality of life items. According to the VAS, the mean intensity was 3.4 points. 6 (33%) of the patients had no difficulty with the knee and 9 (50%) of them had mild or moderate difficulty. The SF-36 scores were similar to those for normative data for patients after TKA, with only the social functioning, role emotional, and physical functioning scores being lower and the role physical and social functioning scores being higher. Three of 20 fusions failed, whereas two knees became non-infected non-unions. In one, the knee infection persisted and required above-knee amputation. The two-stage arthrodesis gave the most predictable rate of fusion. Persistent infection and extensive bone stock losses led to failure even under the best circumstances. In our opinion, arthrodesis of the knee is a satisfactory salvage procedure following a failed TKA, and can provide reliable expectation for a stable, painless extremity for high-functioning patients who are able to walk.

Aged↗
PubMed2001

[Sociodemographic predictors of therapeutic results in patients with chronic, non-malignant pain].

INTRODUCTION: Chronic pain is in its nature multidimensional and is most successfully treated by a multidisciplinary approach. Some patients do not benefit from treatment, and psychological and socio-economic factors may play a major role. The present study investigated the ability of sociodemographic variables to predict the short-term effect of multidisciplinary treatment in patients with chronic pain who where referred consecutively to a Danish multidisciplinary pain centre. METHOD: Pain scores (VAS) and health-related quality of life (HRQL) were assessed. On entry and three and six months later HRQL was evaluated by medical outcome short form (SF-36) and the psychological general well-being scale (PGWB). Sociodemographic variables were: age, gender, educational level, civil status employment status, and disability pension (DP) status. RESULTS: Of the sociodemographic variables evaluated, only the DP status seemed to be a significant outcome predictor. Patients applying for a DP do not improve. Patients receiving a DP and those who do not achieved moderate improvements, but these were significantly larger. The same pattern was seen for changes in psychological well-being and social functioning. The DP status predicted improvement in pain and social functioning. DISCUSSION: The present study indicates that the multidimensional problems experienced by patients applying for a DP are dominated by sociodemographic factors. Focus on the solution of these socio-economic problems is important, if patients with chronic pain are to benefit from multidisciplinary pain treatment.

Adult↗
PubMed1994

Social and functional impact of reduced posterior dental units in older adults.

The number of teeth needed to maintain adequate dental function in older adults is unknown. The purpose of this study was to examine the relationship between oral function and the number of opposing pairs of posterior teeth. We identified 338 subjects with complete anterior dentitions from an interview and examination survey of Ontario adults aged 50 and over; 261 had no partial denture and 77 had removable partial dentures (RPD). Oral function was measured using questions assessing chewing ability, mandibular function and socio-psychological impact. Subjects with no partial dentures were further allocated to five groups, based on their dental status: complete dental arch (n = 69); 5-7 functional units-pairs of opposing posterior teeth (n = 109); 3 or 4 functional units (n = 48) and 0-2 functional units (n = 35). Oral function problems increased with decreasing functional units being markedly more prevalent among the groups with 0-2 functional units. 34% of subjects in the 0-2 group reported one or more problems with chewing ability compared to 6-17% in the other groups (chi 2 P = 0.001 d.f. = 3). The 77 subjects who wore removable partial dentures, reported social and dental function at levels comparable to those with no dentures. From these results, there appears to be little socio-functional need to replace lost posterior teeth with a partial denture unit the person has fewer than, 3 posterior functional units. The low number of partial denture wearers limited our ability to detect a lasting benefit from RPD treatment.

Aged↗
PubMed1995

Vulnerability to psychosis in unipolar major depression: is premorbid functioning involved?

OBJECTIVE: This research examined whether deficits in premorbid functioning are associated with a vulnerability to psychosis in unipolar major depressive disorder. METHOD: A group of 92 inpatients with unipolar major depression were assessed for premorbid functioning and psychotic symptoms during an index hospitalization. They were prospectively assessed for psychotic symptoms 2.0 and 4.5 years after hospital discharge. RESULTS: The psychotic depressed patients had significantly poorer premorbid functioning--particularly, adolescent social functioning--than the nonpsychotic depressed patients. Longitudinal analyses indicated that poor premorbid social adaptation was significantly associated with the emergence of psychosis during the follow-up period in depressed patients who had not been psychotic as inpatients. CONCLUSIONS: Factors related to a vulnerability to psychosis among patients with major depression are present even years before the onset of overt psychotic symptoms. The data could support the view that impaired premorbid functioning is one manifestation of prepsychotic processes that constitute an underlying diathesis for psychotic episodes during the longitudinal course of unipolar major depression. These findings are consistent with other emerging findings pointing to early developmental deficits in patients who subsequently develop psychotic disorders.

Adaptation, Psychological↗