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Autonomy of long-stay psychiatric inpatients
Wagner,Luciane Carniel; Fleck,Marcelo Pio de Almeida; Wagner,Mário; Dias,Míriam Thaís Guterres;
Revista de Saúde Pública , 2006, DOI: 10.1590/S0034-89102006000500021
Abstract: objective: to assess personal autonomy of long-stay psychiatric inpatients, to identify those patients who could be discharged and to evaluate the impact of sociodemographic variables, social functioning, and physical disabilities on their autonomy was also assessed. methods: a total of 584 long-stay individuals of a psychiatric hospital (96% of the hospital population) in southern brazil was assessed between july and august 2002. the following instruments, adapted to the brazilian reality, were used: independent living skills survey, social behavioral schedule, and questionnaire for assessing physical disability. results: patients showed severe impairment of their personal autonomy, especially concerning money management, work-related skills and leisure, food preparation, and use of transportation. autonomy deterioration was associated with length of stay (or=1.02), greater physical disability (or=1.54; p=0.01), and male gender (or=3.11; p<0.001). the risk estimate of autonomy deterioration was 23 times greater among those individuals with severe impairment of social functioning (95% ci: 10.67-49.24). conclusions: in-patients studied showed serious impairment of autonomy. while planning these patients' discharge their deficits should be taken into consideration. assessment of patients' ability to function and to be autonomous helps in identifying their needs for care and to evaluate their actual possibilities of social reinsertion.
Quality of life in patients with personality disorders seen at an ordinary psychiatric outpatient clinic
Kjersti Narud, Arnstein Mykletun, Alv A Dahl
BMC Psychiatry , 2005, DOI: 10.1186/1471-244x-5-10
Abstract: 72 patients with PDs at a POC filled in the MOS Short Form 36 (SF-36), and two established psychiatric self-rating measures. A national norm sample was compared on the SF-36. An independent psychiatrist diagnosed PDs and Axis-I disorders by structured interviews and rated the Global Assessment of Functioning (GAF). All measurements were repeated in the 39 PD patients that attended the 2 years follow-up examination.PD patients showed high co-morbidity with other PDs and Axis I mental disorders, and they scored significantly lower on all the SF-36 dimensions than age- and gender-adjusted norms. Adjustment for co-morbid Axis I disorders had some influence, however. The SF-36 mental health, vitality, and social functioning were significantly associated with the GAF and the self-rated psychiatric measures. Significant changes at follow-up were found in the psychiatric measures, but only on the mental health and role-physical of the SF-36.Patients with PDs seen for treatment at a POC have globally poor QoL. Both physical and mental dimensions of the SF-36 are correlated with established psychiatric measures in such patients, but significant changes in these measures are only partly associated with changes in the SF-36 dimensions.According to the DSM-IV [1] personality disorders (PDs) are characterized by enduringly deviating patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts. Such patterns lead to "clinically significant distress or impairment in social, occupational, or other important areas of functioning". The DSM-IV does not indicate how "clinically significant distress or impairment" (page 633) should be evaluated, however, and a recent study showed that various formulations of this criterion hardly increased diagnostic validity [2].Since the DSM-IV included the Global Assessment of Functioning Scale (GAF) as Axis V, it is reasonable to consider if the GAF should be us
Relationships among neurocognition, symptoms and functioning in patients with schizophrenia: a path-analytic approach for associations at baseline and following 24 weeks of antipsychotic drug therapy
Ilya A Lipkovich, Walter Deberdt, John G Csernansky, Bernard Sabbe, Richard SE Keefe, Sara Kollack-Walker
BMC Psychiatry , 2009, DOI: 10.1186/1471-244x-9-44
Abstract: Data were obtained from a clinical trial assessing the cognitive effects of selected antipsychotic drugs in patients with schizophrenia. Patients were randomly assigned to 24 weeks of treatment with olanzapine (n = 159), risperidone (n = 158), or haloperidol (n = 97). Psychosocial functioning was assessed with the Heinrichs-Carpenter Quality of Life Scale [QLS], cognition with a standard battery of neurocognitive tests; and psychiatric symptoms with the Positive and Negative Syndrome Scale [PANSS]. A path-analytic approach was used to evaluate the effects of changes in cognitive functioning on subdomains of quality of life, and to determine whether such effects were direct or mediated via changes in psychiatric symptoms.At baseline, processing speed affected functioning mainly indirectly via negative symptoms. Positive symptoms also affected functioning at baseline although independent of cognition. At 24 weeks, changes in processing speed affected changes in functioning both directly and indirectly via PANSS negative subscale scores. Positive symptoms no longer contributed to the path-analytic models. Although a consistent relationship was observed between processing speed and the 3 functional domains, variation existed as to whether the paths were direct and/or indirect. Working memory and verbal memory did not significantly contribute to any of the path-analytic models studied.Processing speed demonstrated direct and indirect effects via negative symptoms on three domains of functioning as measured by the QLS at baseline and following 24 weeks of antipsychotic treatment.Neurocognitive impairment has been found to be strongly correlated with deficits in psychosocial and occupational functioning in patients with schizophrenia [1,2]. These earlier reviews of the literature (including a meta-analysis) were focused on identifying specific neurocognitive deficits that restrict the functioning of schizophrenia patients, as opposed to the use of more global measures of n
Psychiatric and family functioning in children with leukemia and their parents
Goodarzi A
Tehran University Medical Journal , 1999,
Abstract: The present study reports data from a cross-sectional investigation of the psychiatric and psychosocial functioning of 55 children diagnosed with acute lymphocytic leukemia and their families at three points in time: diagnosis (newly diagnosed), 1 year postdiagnosis, and 1 year after the completion of chemotherapy (offtherapy). Results reveal minimal psychopathology in these children and their parents based on self-and informantreports and structured diagnostic interviews. These families appear to be functioning adequately and report more family cohesiveness and marital satisfaction after chemotherapy was completed. Coping strategies commonly used by children and their parents include problem solving, a positive outlook, and good communication. Implications for psychiatric consultation are presented.
The Impact of Individual Depressive Symptoms on Impairment of Psychosocial Functioning  [PDF]
Eiko I. Fried, Randolph M. Nesse
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0090311
Abstract: Previous studies have established that scores on Major Depressive Disorder scales are correlated with measures of impairment of psychosocial functioning. It remains unclear, however, whether individual depressive symptoms vary in their effect on impairment, and if so, what the magnitude of these differences might be. We analyzed data from 3,703 depressed outpatients in the first treatment stage of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Participants reported on the severity of 14 depressive symptoms, and stated to what degree their depression impaired psychosocial functioning (in general, and in the five domains work, home management, social activities, private activities, and close relationships). We tested whether symptoms differed in their associations with impairment, estimated unique shared variances of each symptom with impairment to assess the degree of difference, and examined whether symptoms had variable impacts across impairment domains. Our results show that symptoms varied substantially in their associations with impairment, and contributed to the total explained variance in a range from 0.7% (hypersomnia) to 20.9% (sad mood). Furthermore, symptoms had significantly different impacts on the five impairment domains. Overall, sad mood and concentration problems had the highest unique associations with impairment and were among the most debilitating symptoms in all five domains. Our findings are in line with a growing chorus of voices suggesting that symptom sum-scores obfuscate relevant differences between depressed patients and that substantial rewards will come from close attention to individual depression symptoms.
Disability claims on psychiatric grounds in the South African context: A review
MT Mokoka, ST Rataemane, M dos Santos
South African Journal of Psychiatry , 2012,
Abstract: We review the nature of disability claims on psychiatric grounds in the South African context, including factors contributing to disability claims, specific disorders usually leading to disability claims, impairment and disability, assessing the degree of impairment, guidelines in assessing psychiatric disability, ethical considerations, consequences of medical boarding, and rehabilitation. Psychiatrists should consider the potential benefits of supervised and mentored work rehabilitation programmes, graded return to work or an appropriate alternative position in consultation with employers.
Psychiatric Diagnoses in a Sample of Outpatient Psycho-Geriatric New Referrals with Suspected Mild Cognitive Impairment
Jeremia Heinik, Perla Werner and Gitit Kavé
The Open Geriatric Medicine Journal , 2008, DOI: 10.2174/1874827900801010010]
Abstract: Psychiatric symptoms/syndromes are frequent in Mild Cognitive Impairment (MCI). However, only a few studies reported full psychiatric diagnoses in MCI. We describe the nosology and prevalence of psychiatric diagnoses in a group of 102 consecutive patients evaluated for suspected MCI and finally re-classified into dementia, MCI and No Cognitive Impairment. Psychiatric diagnoses were frequent in MCI and the other groups as well, however they were qualitatively different in each group.
Associations between the Rorschach Ego Impairment Index and Measures on Intrapsychic and Interpersonal Functioning  [PDF]
Jaakko Stenius, Olavi Lindfors, Risto Antikainen, Jarl Wahlstr?m, Laura Sares-J?ske, Paul Knekt
Open Journal of Psychiatry (OJPsych) , 2018, DOI: 10.4236/ojpsych.2018.81001
Abstract: The Rorschach Ego Impairment Index-2 (EII-2) has shown considerable validity as a measure of personality disturbance. However, few studies have been conducted on the associations between the EII-2 and measures related to ego strength and interpersonal capacities in mood and anxiety disorder patients. This study examined the strength of associations between the EII-2 and its subcomponents with measures of psychological suitability for psychotherapy, personality functioning, and interpersonal problems. A total of 315 outpatients with mood or anxiety disorders were assessed with the Rorschach Comprehensive System (RCS), comprising the EII-2, the Suitability for Psychotherapy Scale (SPS), the Inventory of Interpersonal Problems (IIP-64), and the Quality of Object Relations Scale (QORS), as part of a pre-treatment evaluation. The relatively weak associations found in the study between the EII-2 and the other measures were mostly in the hypothesized direction and often modified by personality pathology. Of the EII-2 subcomponents, the Good Human Representation (GHR) variable was associated with the SPS. The subcomponent Critical Contents were associated with the IIP and the subcomponent WSum6 with the IIP and QORS. Further research is needed to clarify whether the EII-2 has incremental validity in predicting the treatment outcome and alliance in comparison to interview-based and self-report measures.
Neuropsychological and Socio-Occupational Functioning in Young Psychiatric Outpatients: A Longitudinal Investigation  [PDF]
Rico S. C. Lee, Daniel F. Hermens, M. Antoinette Redoblado-Hodge, Sharon L. Naismith, Melanie A. Porter, Manreena Kaur, Django White, Elizabeth M. Scott, Ian B. Hickie
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0058176
Abstract: Background Clinical symptoms and neuropsychological deficits are longitudinally associated with functional outcome in chronic psychiatric cohorts. The current study extended these findings to young and early-course psychiatric outpatients, with the aim of identifying cognitive markers that predict later socio-occupational functioning. Methods At baseline, 183 young psychiatric outpatients were assessed. Ninety-three returned for follow-up (M = 21.6 years old; SD = 4.5) with an average re-assessment interval of 21.6 months (SD = 7.0), and primary diagnoses of major depressive disorder (n = 34), bipolar disorder (n = 29), or psychosis (n = 30). The primary outcome measure was cross-validated with various other functional measures and structural equation modelling was used to map out the interrelationships between predictors and later functional outcome. Results Good socio-occupational functioning at follow-up was associated with better quality of life, less disability, current employment and being in a romantic relationship. The final structural equation model explained 47.5% of the variability in functional outcome at follow-up, with baseline neuropsychological functioning (a composite of memory, working memory and attentional switching) the best independent predictor of later functional outcome. Notably, depressive and negative symptoms were only associated with functioning cross-sectionally. Diagnosis at follow-up was not associated with functional outcome. Conclusions Neuropsychological functioning was the single best predictor of later socio-occupational outcome among young psychiatric outpatients. Therefore, framing psychiatric disorders along a neuropsychological continuum is likely to be more useful in predicting functional trajectory than traditional symptom-based classification systems. The current findings also have implications for early intervention utilising cognitive remediation approaches.
Evaluation of functional impairment in psoriasis  [cached]
Gaikwad Rohini,Deshpande Sharmishtha,Raje Swati,Dhamdhere D
Indian Journal of Dermatology, Venereology and Leprology , 2006,
Abstract: Background: Psoriasis is a chronic disease, the course of which is punctuated by exacerbations and remissions. The impact of a chronic, relapsing, and disfiguring disease such as psoriasis on occupational, social, and other areas of functioning is substantial and needs attention. Aim: The purpose of this study was to assess the level and nature of functional impairment in psoriasis. Methods: Forty-three consecutive patients attending the dermatology clinic of a rural hospital were studied for psychiatric comorbidity and the level of functioning, using a semistructured questionnaire. Results: Psoriasis affected social functioning of 48% patients, led to decreased work efficiency in 51.1%, and to subjective distress at work in 62.8% of patients. Stress in home environment and interpersonal relationships was reported by 69.8%. Social and occupational functioning worsened with increasing severity of psoriasis after 1-year duration of illness. Patients complaining of pruritis frequently had anxiety disorders. Psychiatric comorbidity was detected in 67.4% cases. Conclusion : Substantial proportion of patients suffered deterioration of functioning, especially with increasing duration of illness. Thus, timely attention by dermatologists is needed in order to limit the disability caused by psoriasis. To achieve this, liaison with psychiatrist would be crucial along with illness education and emotional support.
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