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PubMed2001

Relatives of patients with severe psychotic illness: factors that influence appraisal of caregiving and psychological distress.

BACKGROUND: Research shows considerable variability in the effect on relatives of patients' mental illness but the determinants of relatives' experience remain unclear. We investigated the influence of demographic, social and clinical characteristics on relatives' experience when conceptualised using a stress-appraisal-coping paradigm. METHODS: Our sample was drawn from relatives of patients recruited to the UK700 case management study (n = 154). Demographic, social and clinical data were collected from patients, and relatives completed the Experience of Caregiving Inventory and the General Health Questionnaire. We predicted that patients' symptomatology in particular would influence relatives' experience, and that relatives who appraised caregiving more negatively and less positively would experience greater psychological distress. RESULTS: Linear regression analyses revealed that relatives' appraisal was not predicted by patients' symptomatology. Instead, relatives appraised caregiving more negatively if the patient was unemployed or younger, and less positively if the patient had been ill for longer or had poorer social functioning. Little of the variance in appraisal was explained by these variables, however. Consistent with the stress-coping model, relatives' negative appraisal was a strong predictor of psychological distress and accounted for a substantial proportion of its variance. Positive appraisal did not predict psychological distress, however. None of the demographic, social or clinical characteristics tested had any significant effect on relatives' psychological distress once appraisal was adjusted for. There was an unexpected positive correlation between the two appraisal scales, with relatives who appraised caregiving more negatively also appraising it more positively. CONCLUSIONS: Our results support a stress-coping model of caregiving but further research is required to determine more influential predictors of relatives' appraisal. Our findings indicate that interventions aimed at patients' social functioning and relatives' negative appraisal of caregiving may assist in reducing relatives' psychological distress.

Adult↗
PubMed1982

Ego development in opiate addicts. An application of Loevinger's stage model.

This paper reports findings from a study of ego functioning in a sample of 97 opiate addicts applying for treatment and a demographically matched control group of 29 applicants at a job training program. Level of ego development was evaluated using the Loevinger Sentence Completion Test. In addition, in the addict sample, we assessed the correlation between level of ego development and other clinical features including present and past drug use, criminal history, psychological symptoms, and social functioning. The mean ego development scores for the opiate addicts and controls were not significantly different although both groups achieved scores that were, on the average, one full stage lower than those obtained in other studies of nonclinical adult populations. Ego development ratings indicated that around one third of both addict and control groups seemed to be relying on internalized standards for self-regulation. Within the addict group, those at lower levels of ego development reported more psychological symptomatology, poorer social functioning, and heavier drug use. Implications for treatment planning and rehabilitative efforts are discussed.

Adult↗
PubMed1995

Cost-effectiveness of clozapine treatment in therapy-refractory schizophrenia.

The costs and effects of clozapine treatment of refractory schizophrenic patients have been discussed recently. This study shows that 18 months of clozapine treatment results in an improvement of symptoms and social functioning in approximately 70% of treatment-refractory schizophrenic patients, compared with treatment with conventional neuroleptics during a similar period of time. Treatment with clozapine reduces the cost of inpatient care but places increased demands on active rehabilitation resources in outpatient care. This leads to increased total costs in a short-term perspective, but clozapine treatment is cost-saving for annual maintenance therapy. These costs must be weighed against the positive effects on psychotic symptoms and social functioning.

Adult↗
PubMed1998

Psychiatric, neuropsychological, and psychosocial features of DSM-IV subtypes of attention-deficit/hyperactivity disorder: results from a clinically referred sample.

OBJECTIVE: To assess the validity of the DSM-IV subtypes of attention-deficit/hyperactivity disorder (ADHD). METHOD: Using structured diagnostic interviews and psychometric measures of cognitive and social functioning, the authors assessed 413 children and adolescents consecutively referred to a pediatric psychopharmacology clinic since 1991. RESULTS: Marked psychiatric differences were found among DSM-IV subtypes of ADHD, but few differences were found in cognitive or psychosocial functioning. The greatest psychiatric differences were found between the combined-type subjects (who tended to show more impairment in multiple domains) and the other two subgroups. The inattentive patients, however, were more likely to have required extra help in school. The hyperactive-impulsive patients were not different from controls on rates of depression, Child Behavior Checklist measures of social functioning, or psychometric measures of intellectual functioning and academic achievement. CONCLUSIONS: The results suggest that, regarding clinical features, combined-type patients have a more severe disorder than the other DSM-IV subtypes.

Adolescent↗
PubMedDate not supplied

Comparison of Short Form-36 and Migraine Disability Assessment questionnaire in patients with migraine.

BACKGROUND: The Short Form-36 (SF-36) and Migraine Disability Assessment (MIDAS) questionnaires are two of the most commonly used tools to measure outcomes in people suffering from headaches. Nevertheless, little is known about their interrelationship in patients with headache. OBJECTIVES: The aim of this study was to investigate the interrelationship between SF-36 and MIDAS questionnaires in patients with migraine. METHODS: We enrolled 231 patients with migraine (male/female: 43/188, mean age 35.3+/-8.1) who visited our headache clinic. They completed the SF-36, MIDAS, and a headache intake form. RESULTS: The correlation coefficients between the MIDAS score and 8 domains of the SF-36 ranged from -0.30 for the mental health domain to -0.53 for the social functioning domain (P<0.01). Canonical correlation analysis showed that the overall overlap between the 2 instruments was moderately strong (canonical correlation coefficients r=0.707 and 0.572). The overall measured redundancies for MIDAS and SF-36 scales in this study were 35.4% and 11.5%, respectively. The stepwise linear regression model showed that the social functioning domain alone explained 27.9% of variance in the MIDAS scores. Bodily pain, physical functioning, and general health domains added an additional 11.4% of the explained variance in the regression model. CONCLUSION: Despite the fact that these two measures were considerably correlated, the MIDAS and SF-36 were found to measure different aspects of the impact of headache for the sample investigated. The MIDAS questionnaire does not cover the emotional domain; therefore, an accompanying psychological questionnaire might help assess the outcome for headache studies.

Adult↗
PubMed2006

[Cochlear implantation in deaf adults: effect on quality of life].

INTRODUCTION: Our aim was to assess the effect of cochlear implant (CI) surgery on the mental quality of life in totally deaf adults using a generic type of questionnaire. MATERIALS AND METHODS: The survey comprised 40 adult CI users who answered a standard and a retrospective version of the Short Form 36 questionnaire (SF-36). In the questionnaires, specific questions focused on four dimensions of the mental quality of life: vitality, social functioning, and emotional and mental health. RESULTS: Due to qualitative and quantitative deficiencies, the emotional scale was omitted. A statistically significant improvement in the quality of life (p<05) was demonstrated in the three remaining subscales between pre-implant and post-implant scores. The greatest improvement was observed in the social functioning subscale. Pre-implant mean scores on all three subscales of the SF-36 were markedly below the mean scores of the equivalent subscales of the Danish population, whereas the post-implant mean scores in two out of three cases were above the mean scores of the Danish population. DISCUSSION: CI was shown to have a statistically significant positive impact on the quality of life of adult deaf patients. This is in accordance with other published studies.

Adult↗
PubMed2006

[The impact of subclinical vertebral fractures on health-related quality of life in women with osteoporosis].

The aim of the study was to evaluate the impact of subclinical vertebral fractures on health-related quality of life in women with postmenopausal osteoporosis. A disease-specific instrument, Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO-41) questionnaire, developed to measure quality of life in patients with osteoporosis, was used. A total of 120 postmenopausal women who came for consultation were examined. Subclinical vertebral fractures were identified by standardized lateral radiographs. Patients were divided into three study groups according to bone mineral density and incident fracture status: group 1 (control group)--40 women without osteoporosis, group 2--40 women with osteoporosis, but without vertebral fracture, and group 3--40 women with subclinical osteoporotic vertebral fracture. The last group was divided into two subgroups: with one fracture and with multiple vertebral fractures. The mean total score of the QUALEFFO-41 for the control group was 34.12 (95% CI 30.27-37.96), for the group with osteoporosis, but without vertebral fracture--36.51 (95% CI 33.56-39.45), and for the group with non-clinical osteoporotic vertebral fracture--35.69 (95% CI 32.08-39.29). There were statistically significant differences in domains A (pain) and E (social function) between women with one non-clinical vertebral fracture and control group. Our results showed no statistically significant differences in health-related quality of life, assessed QUALEFFO-41, between women with subclinical vertebral fractures and control group. Women with one subclinical vertebral fracture showed statistically significant worse results in pain, social function, and general health perception domains. Significantly greater changes in body appearance were noted among women with multiple subclinical vertebral fractures.

Aged↗
PubMed1987

Prognostic scale for chronic schizophrenia.

Although prognostic scales are available for schizophrenia, these focus on acute or subacute populations where premorbid functioning and established chronicity are the best predictors of outcome. Their usefulness in chronic schizophrenia is limited. The authors describe a simple and reliable 5-item, 12-point prognostic scale for chronic schizophrenia independent of chronicity. It measures prognosis as the product of a dynamic interplay between the highest level of adaptive occupational and social functioning ever achieved by the individual and the "invasiveness" of the Axis I disorder as manifest by genetic loading (family history of schizophrenia), erosion of reality testing (psychotic assaultiveness), and preservation of affect in psychopathology (depressed mood). Among chronic schizophrenic patients in the Chestnut Lodge Followup Study (n = 163), the prognostic score (based on history and admission clinical picture) allowed strong probabilistic statements to be made about long-term outcome. Tables present the conditional probability or risk of specific outcomes in the domains of institutionalization, work functioning, social relations, and global outcome for patients at varying levels along the prognostic spectrum. Close examination of these predictor-outcome relationships suggests that prognosis in chronic schizophrenia may be thought of as the variability (as opposed to fixedness) remaining in the individual's future life course, and poor outcome can be predicted with greater sensitivity than good outcome.

Adaptation, Psychological↗
PubMed2003

Types of transference studied in group of schizophrenic patients.

In order to find out what within the patient-therapist relationship can influence outcome, transference- countratransference patterns have been studied in the framework of psychodynamic treatment setting. The sample consisted of 40 female schizophrenic patients. All patients were interviewed by SADS-L, and diagnosed according to DSM III R rules including the course of illness. Level of social functioning was assessed on SADS-L scale. The transference/countratransference pattern was assessed by independent observer on the basis of especially designed questionnaire in active phase of illness and in the remission phase. The study found out that some transference patterns are associated with certain phase of illness, course of illness and level of social functioning. Neurotic transference pattern was associated with course of illness-remission. We do not know to which extent it is, or is it at all, related with schizophrenic's premorbid functioning or to the schizophrenic disease itself.

Adult↗
PubMed2001

Outpatient mental health care, self-help groups, and patients' one-year treatment outcomes.

OBJECTIVE: To examine the association between the duration and amount of outpatient mental health care, participation in self-help groups, and patients' casemix-adjusted one-year outcomes. METHODS: A total of 2,376 patients with substance use disorders, 35% of whom also had psychiatric disorders, were assessed at entry to treatment and at a one-year follow-up. Information about the duration and amount of outpatient mental health care was obtained from a centralized health services utilization database. RESULTS: Patients who obtained regular outpatient mental health care over a longer interval and patients who attended more self-help group meetings had better one-year substance use and social functioning outcomes than did patients who were less involved in formal and informal care. The amount of outpatient mental health care did not independently predict one-year outcomes. CONCLUSIONS: The duration of outpatient mental health care and the level of self-help involvement are independently associated with less substance use and more positive social functioning. The provision of low intensity treatment for a longer time interval may be a cost-effective way to enhance substance abuse and psychiatric patients' long-term outcomes.

Adult↗
PubMed2005

A critical review of the health-related quality of life of children and adolescents after liver transplantation.

We critically examined research on health-related quality of life (HRQL) in children and adolescents after liver transplantation. The specific aims were to identify research studies on HRQL after liver transplantation, to critique the methodological quality of the studies, to estimate overall HRQL after transplant, and to make recommendations for future research. Databases searched included Medline, Cumulative Index to Nursing and the Allied Health Literature, PsycINFO, EMBASE, Allied and Complementary Medicine, Institute for Scientific Information Web of Science, and Applied Social Sciences Index and Abstracts. Searches also were made on related Web sites and proceedings of transplantation and associated conferences. Eligible studies involved children between birth and 18 years of age who received isolated orthotopic, auxiliary, or living related liver transplantation. HRQL was assessed through 2 or more of the domains of physical health, psychological functioning, social functioning, family functioning, or general well-being. Eligible studies were abstracted, assessed for methodological quality, and synthesized using the sign test to provide an indication of the effect of liver transplantation on each HRQL domain. The synthesis of findings suggested an improvement in HRQL in comparison with pretransplant status; there was a trend toward a worse HRQL in comparison with the healthy population and better than those with other chronic illnesses. In conclusion, liver transplantation in childhood has a negative impact on some aspects of HRQL. However, this finding is tentative because of the small number of studies and variable study quality found.

Adolescent↗
PubMed1996

Validation of the Short Form 36 (SF-36) health survey questionnaire among stroke patients.

BACKGROUND AND PURPOSE: Few studies have examined the utility of a new generic health status measure, the Short Form 36 health survey questionnaire (SF-36), in stroke patients. Our aim was to test the internal consistency and validity of the SF-36 in a cohort of long-term stroke survivors. METHODS: The Australian version of the SF-36 was tested in 90 consecutive 1-year stroke survivors (mean age, 72 years) identified from our hospital discharge data. The instrument was administered by personal interview. Validity was assessed by comparing patients' scores on the SF-36 with those obtained for the Barthel Index, the 28-item General Health Questionnaire, and the Adelaide Activities Profile, an instrument developed from the Frenchay Activities Index. RESULTS: The SF-36 was relatively quick and easy to use and had satisfactory internal consistency (Cronbach's alpha > 0.7). For all eight SF-36 health scales, the mean scores for patients dependent in self care and with mental ill health were significantly different from patients without these disabilities, but the strength of the differences varied in a predictable manner. However, the SF-36 social functioning scale did not provide a valid measure of everyday activities relevant to many elderly patients as measured by the Adelaide Activities Profile. CONCLUSIONS: The SF-36 avoids the "ceiling effect" of most disability scales and provides a valid measure of physical and mental health after stroke, but it does not appear to characterize well social functioning. Thus, the instrument may need to be supplemented by other measures for a comprehensive assessment of stroke outcome.

Adult↗
PubMed2004

[Symptom distresses and coping strategies in breast cancer women with mastectomy].

The purpose of this descriptive cross-sectional survey was to understand the correlation between symptom distresses and coping strategies in female victims of breast cancer with in two years of their undergoing a mastectomy. The instruments used in this study were the Physical Symptoms Scale, short form of Profile of Mood states (POMS-SF), Social Function Distress Questionnaire, Jalowiec Coping scale (JCS), and demographic data. The data were analyzed by descriptive statistic, t-test, one-way ANOVA, post Scheffe test and Pearson product-moment correlation. The essential results are summarized as follows. Degrees of biopsychosocial distresses varied from none to mild. Physical symptom distress, psychological distress, and social function distress were positively correlated. When patients were confronted with symptom distresses, they tended to adopt problem-focused coping strategies. The more problem-focused coping strategies, they used the less symptom distresses they experienced. The results of this study could be used to help to develop nursing interventions and efficient coping strategies. Patient may then be able to use the latter to solve symptom distresses and enhance their quality of life.

Adaptation, Psychological↗
PubMed2003

The association of pretreatment health-related quality of life with surgical complications for patients undergoing open surgical resection for colorectal cancer.

OBJECTIVE: The purpose of this study was to define the association between pretreatment health-related quality of life (HRQL) and surgical complications for patients with colorectal cancer. SUMMARY BACKGROUND DATA: For patients with colorectal cancer, surgical complications arise from an interaction between underlying medical comorbidity, colorectal cancer severity, and quality and type of treatment provided. Measurement of HRQL provides a summarization of well-being in the context of medical comorbidity and colorectal cancer severity. The summarization of these factors may be useful in prospective risk assessment of patients about to undergo surgery for colorectal cancer. METHODS: A single-institution, prospective, cohort study of patients with colorectal adenocarcinoma was performed from August 1, 1999, to March 31, 2002. Before treatment, all participants completed Medical Outcomes Survey SF-36 (SF-36); after the first year of the study, patients also completed the colorectal cancer module of the Functional Assessment of Cancer Therapy survey (FACT-C). Information was collected on demographics, treatment, tumor variables, and complications. RESULTS: Ninety-seven patients have undergone open resection of their colorectal cancer. All patients completed SF-36; 65 completed FACT-C. Thirty patients (31%) experienced complications, including 4 (4%) deaths. Age, race, albumin level, American Society of Anesthesia class, specialty surgical training, tumor location, and stage were not associated with complications in univariate analysis. Patients experiencing surgical complications had significantly lower HRQL scores on SF-36 Social Functioning, General Health Perception, and Mental Health Index scales as well as the Mental Health Component summary score. FACT-C Social/Family, Emotional, Functional Well-Being scores, and the Colorectal Cancer Concerns score were also significantly lower for patients sustaining complications. When these HRQL scales were examined in a multivariate model including albumin level, tumor location, and ASA class, SF-36 Social Functioning (Odds Ratio [OR] = 0.98; 95% Confidence Interval [CI] = 0.97-0.99) and FACT-C Colorectal Cancer Concerns (OR = 0.89; 95% CI = 0.79-0.99) scales retained a significant association with complications. CONCLUSIONS: Pretreatment HRQL scores as measured by several scales of SF-36 and FACT-C were significantly associated with complications. Future studies should concentrate on defining the predictive role of HRQL in determining surgical outcome for patients with colorectal cancer.

Adenocarcinoma↗
PubMed2006

What is familial about familial bipolar disorder? Resemblance among relatives across a broad spectrum of phenotypic characteristics.

CONTEXT: Current diagnostic criteria for bipolar affective disorder define a phenotype that is highly heritable, yet clinically variable. A more homogeneous definition might facilitate genetic and other studies, but the best approach is unclear. Familial features of bipolar disorder should help define more homogeneous subtypes, but there are few data indicating which clinical features of bipolar disorder are the most familial. OBJECTIVE: To study the familiality of phenotypic features in families ascertained through individuals with bipolar affective disorder. DESIGN: The study comprises 1246 individuals in 172 multiplex families ascertained for genetic linkage studies of bipolar disorder. The familiality of 40 diverse phenotypic features was studied using mixed-effects regression analysis. RESULTS: Substance abuse, alcoholism, psychosis, history of suicide attempt, and the level of social functioning were all strongly familial in this sample. Several other traits, including clinical subtype, earliest age at onset, and comorbid panic disorder, showed a suggestion of familiality that did not hold up to conservative correction for multiple testing. CONCLUSIONS: This is the largest and most comprehensive study to assess the familiality of phenotypic features in bipolar disorder. Our results suggest that comorbid conditions and social functioning should be considered along with other familial clinical features in formulating subtypes of bipolar disorder suitable for further studies. Familial variables may help reduce diagnostic heterogeneity in genetic and other biological studies.

Adult↗
PubMed1993

Familial versus sporadic ankylosing spondylitis. Two different diseases?

OBJECTIVE: To define potential differences and the possible contribution of susceptibility or severity genes in familial versus sporadic ankylosing spondylitis (AS). METHODS: Three hundred twenty patients with AS were studied: 160 who had first-degree relatives with AS (familial) and 160 age- and sex-matched controls who had no first-degree relative with the disease (sporadic). Disease expression in the two groups was evaluated using an index of physical, psychological, and social functioning (the Arthritis Impact Measurement Scales [AIMS]) and an assessment of spinal mobility. RESULTS: Familial disease was significantly milder than sporadic disease as assessed by all measures, e.g., spinal mobility score (mean 4.08 versus 4.65, P < 0.038), AIMS overall impact score (mean 2.63 versus 3.59, P = 0.002), AIMS physical activity score (4.19 versus 5.10 [P = 0.004]), AIMS social function score (4.02 versus 4.60, P = 0.023), and AIMS pain score (4.15 versus 5.33, P = 0.002). CONCLUSION: The greater prevalence of AS in at-risk families may be explained by the occurrence of more AS "susceptibility" genes in those families, whereas the more severe disease, seen in patients with sporadic AS, is conferred by the presence of more "severity" genes than "susceptibility" genes.

Adolescent↗
PubMed1992

A health-related quality of life instrument for patients evaluated for epilepsy surgery.

The goals of surgery in treating intractable epilepsy are to eliminate seizures and improve quality of life. This report describes the development of the Epilepsy Surgery Inventory (ESI)-55, a 55-item measure of health-related quality of life for epilepsy patients. The ESI-55 includes the following scales (number of items in parentheses): health perceptions (9), energy/fatigue (4), overall quality of life (2), social function (2), emotional well-being (5), cognitive function (5), physical function (10), pain (2), and three separate scales of role limitations due to emotional, physical, or memory problems (5 items each). Also included is one change in health item. The ESI-55 was completed by 89% of 224 adults who had undergone a protocol evaluation for epilepsy surgery since 1974. Alpha internal consistency reliability coefficients ranged from 0.76 to 0.88 except for social function (alpha = 0.68). Multitrait scaling analyses supported item discrimination across scales. Factor analysis confirmed previously identified mental and physical health factors, and yielded a third factor defined by cognitive function and role limitations scales. Construct validity was supported by correlations of the ESI-55 with a mood profile instrument. Analysis of ESI-55 scale scores by seizure classification showed that the 44 patients who were seizure-free following surgery scored higher than did 55 patients who continued to have seizures (P less than 0.05 for all comparisons); 43 patients having seizures without loss of consciousness scored in between. Results of this study indicate that the ESI-55 is reliable, valid, and sensitive to differences in seizure status.

Adult↗
PubMed2003

[Temporary working disability among younger patients with back pain and its interaction with severity of pain, functional capacity, social factors and personality styles].

The relationships between sick absenteeism and clinical measures were studied for a group of younger patients with chronic back pain (mean years of age for women and men were 41.7 and 42.2, respectively) who were sent to a rehabilitation programme. The duration of sick absenteeism during the last year as well as the momentary status of working ability were correlated with different clinical variables and personality styles. At the beginning of the rehabilitation program, the measure of functional capacity (FFbH-R, Kohlmann u. Raspe, 1996) showed the strongest correlation with temporary working disability (r = -.46) and duration of sick absenteeism during the last year (r = -.44). The severity of pain showed a lower but significant correlation with temporary working disability (r =.24) and duration of sick absenteeism (r =.25). In contrast, depression, vitality and age did not show significant correlations with temporary working disability at the beginning of the rehabilitation. In addition, some of the personality styles from the PSSI (Kuhl u. Kazén, 1997) showed significant correlations with temporary working disability and duration of sick absenteeism. When entering the variables into regression analyses, the measure of functional capacity was the most important predictor of sick absenteeism. Severity of pain, depression, vitality and age did not significantly add to the variance accounted for. In contrast, distinct personality styles from the PSSI significantly contributed to an additional proportion of variance in sick absenteeism and temporary working disability. At the end of the rehabilitation program, there were stable relationships between temporary working disability and functional capacity (r = -.45) as well as severity of pain (r =.39). In, correlations between temporary working disability and depression (r =.30) and vitality (r = -.19) were significant. This was due to the stronger improvement during therapy among patients who were able to work compared to patients who were not.

Absenteeism↗