Improvements In Social Functioning Research Articles

Patient satisfaction with treatment outcomes after surgery and/or radiotherapy for spinal metastases

BackgroundPatient satisfaction is infrequently investigated despite its importance in assessing efficacy and patient comprehension. The purpose of this study was to investigate patient satisfaction with treatment outcomes after surgery and/or radiotherapy for spinal metastases and to evaluate how health‐related quality of life (HRQOL) is related to patient satisfaction.MethodsPatients with spinal metastases treated with surgery and/or radiotherapy were enrolled in a prospective, international, observational study. Demographic, histologic, treatment, and HRQOL data were collected. HRQOL was evaluated with the Numeric Rating Scale pain score, the 3‐level version of the EuroQol 5‐Dimension (EQ‐5D‐3L) instrument, and the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0). Patient satisfaction was derived from the SOSGOQ2.0 at 6, 12, and 26 weeks after treatment. Patients were classified as satisfied, neutral, or dissatisfied.ResultsTwelve weeks after treatment, 183 of the surgically treated patients (84%) were satisfied, and only 11 (5%) were dissatisfied; in contrast, 101 of the patients treated with radiotherapy alone (77%) were satisfied, and only 7 (5%) were dissatisfied. Significant improvements in pain, physical function, mental health, social function, leg function, and EQ‐5D were associated with satisfaction after surgery. Satisfaction after radiotherapy was associated with significant improvements in pain, mental health, and overall SOSGOQ2.0 scores. Dissatisfaction after treatment was associated with lower baseline values for leg strength and lower social functioning scores for surgically treated patients and with lower social functioning scores and being single for patients treated with radiotherapy.ConclusionsHigh levels of satisfaction with treatment outcomes are observed after surgery and/or radiotherapy for spinal metastases. Posttreatment satisfaction is associated with significant improvements in pain and different dimensions of HRQOL.

Occupational therapy interventions in mental health: a scoping review of recent evidence

Background/Aims Studies investigating the effect of occupational therapy in mental health are few. This scoping review aims to identify, present and assess studies that have investigated the effect of occupation- and activity-based/focused interventions performed by occupational therapists in mental health. Methods The scoping review involved searching six databases, covering articles from 2003 to 2018. ‘The Matrix Method’ was used to describe and synthesise the content of the included studies. The Oxford Level of Evidence was used to rank the evidence, and The Critical Appraisal Skills Programme was used to assess the quality of the study. Results A total of 21 original studies and 4 systematic reviews were included in this review. Interventions, approaches, programmes, training, and activities such as cooking, artwork, crafts, pottery, sports, calligraphy, horticulture, and music, organised individually or in groups, were investigated in the included studies. Individualised occupational therapy showed clinically significant improvements in social functioning and cognition, promising results were found on supported employment and education. Conclusions Few high-quality studies that have investigated the effect of occupation-and activity-based/focused interventions performed by occupational therapists in mental health were found. This scoping review highlights the importance of future high quality studies to support evidence-based practice within mental health occupational therapy.

Comparison and Clinical Implementation of Quality of Life Tools in Patients with Small Bowel Neuroendocrine Tumors Treated with Lu-DOTA-TATE PRRT

Aim: This study assesses if clinically developed quality of life (QoL) tools are as effective in small bowel neuroendocrine tumors (NETs) as NET-specific research questionnaires. Methods: QoL in patients with small bowel NETs treated with Lu-DOTA-TATE was assessed with The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, QLQ-GI.NET21 and Edmonton Symptom Assessment System Revised (ESAS-r) at baseline and after four treatments. Repeated measures ANOVA was performed. Results: Both EORTC and ESAS-r demonstrated maintained overall QoL. EORTC demonstrated statistically and clinically significant improvement in insomnia, diarrhea, gastrointestinal, endocrine symptoms and social function. ESAS-r demonstrated statistically and clinically significant improvement in overall total symptom distress score. Conclusion: ESAS-r is quick and easy to interpret. It is not as sensitive to individual symptoms but does track overall function. EORTC assessment is more complex, but better reflects QoL for NET specific symptoms.

General health, vitality, and social function after sinus surgery in chronic rhinosinusitis.

ObjectivesChronic rhinosinusitis (CRS) has an impact on health‐related quality of life (HRQOL). The objective of this study was to examine generic and disease‐specific HRQOL and symptoms in CRS patients with (CRSwNP) and without (CRSsNP) nasal polyps before and 6 months after sinus surgery, and to identify preoperative patient factors associated with HRQOL outcome in the two groups separately.MethodsThis prospective, observational study consisted of 220 CRSwNP and 196 CRSsNP patients. Generic and disease‐specific HRQOL were measured using the Short‐Form‐Health‐Survey (SF‐36) and Sino‐Nasal‐Outcome‐Test (SNOT‐20). Symptoms were assessed on a visual analog scale.ResultsPreoperatively, CRSwNP patients reported worse score in general health (SF‐36), rhinologic subset (SNOT‐20): nasal obstruction, nasal discharge, and altered sense of smell compared to CRSsNP patients, who reported worse score in physical role, bodily pain, ear/face subset, and facial pain. After surgery, generic and disease‐specific HRQOL and symptoms improved in both groups. CRSwNP patients had greater improvement in general health, vitality and social function, nasal obstruction, and altered sense of smell, compared to CRSsNP‐patients. In both groups, higher age, daily smoking, and having had sinus surgery previously were associated with less generic HRQOL improvement, in addition to female sex and allergy in CRSsNP patients.ConclusionThe greater improvement in general health, vitality, and social function after surgery may indicate a greater potential for generic HRQOL improvement in CRSwNP patients compared to CRSsNP patients. Female sex and allergy was associated with less improvement of generic HRQOL in the CRSsNP group, but not in the CRSwNP group.Level of evidence2c outcome research.

Effects of a Vocational Social-Skills Program on Psychosocial Functioning Among Young Adults With Autism

Abstract Date Presented 04/05/19 This study examined the effects of a group-delivered, vocational social skills intervention among young adults with high-functioning autism. Participants made statistically significant improvements in social function, self-efficacy, and psychological wellness. Results support this program as a Level III evidence-based intervention, and highlight the need for additional development, validation, and application of manualized, psychosocial interventions in OT. Primary Author and Speaker: Annemarie Connor Contributing Authors: Connie Sung, Alicia Strain, Songtian Zeng, Sarah Fabrizi

Impact of Positive Emotion Regulation Training on Negative Symptoms and Social Functioning in Schizophrenia: A Field Test.

Background: The poor efficacy of drug or psychological treatments on the primary negative symptoms of schizophrenia has led to the development of new interventions. The Positive Emotions Program for Schizophrenia (PEPS) is an emotion regulation strategy training that aims to intensify positive emotions and develop positive performance beliefs. A randomized controlled trial showed that PEPS is effective in reducing the composite score of the reduction of experience syndrome (anhedonia and apathy). The present study is designed to evaluate its feasibility in natural conditions to measure external validity of PEPS. Materials and Methods: Twenty-one participants recruited through the French national network of expert centers followed eight sessions of PEPS and were assessed pre- and posttest with the Scale for Assessment of Negative Symptoms (SANS) and the Personal and Social Performance (PSP). The scales of the SANS were divided into a composite score of the reduction of the ability to experience and a composite score of the reduction of expression. Results: All participants followed the 8 sessions of PEPS, and both composite scores were significantly and clinically improved at posttest. Social functioning assessed with the PSP was also improved. Conclusions: This field test shows that participation in PEPS is accompanied by a reduction of negative symptoms and an improvement of social functioning. Both negative syndromes, reduction of expression and reduction of experience, are improved. Participants are younger than those in previous studies, which may explain this unexpected result. However, this calls for a controlled study with younger participants.

When acute adversity improves psychological health: A social-contextual framework.

Human beings are routinely exposed to varying forms of acute adversity. Our responses take varying forms too, ranging from chronic distress to resilience. Although this pronounced variability is widely recognized, one possible outcome of acute adversity has been invariably, though understandably, ignored: an improvement in psychological and social functioning. In this analysis, I argue that, under some conditions, people can experience marked psychological improvement after acute adversity. I describe this response pattern as psychosocial gains from adversity (PGA) and define it as favorable and reliable change on an index of psychological functioning from before to after exposure to adversity. In the present article, first I distinguish PGA from traditional perspectives on growth after adversity on the basis of key conceptual differences. I then review empirical evidence for PGA as a replicable response pattern following different forms of adversity, including bereavement, military deployment, and mass trauma. I propose a multilevel theoretical model for PGA that focuses on automatic prosocial affiliative behaviors and group-level contextual factors that are conditioned by acute adversity. I describe moderators and boundary conditions at different levels of analysis that will enhance or detract from the likelihood of PGA. I conclude with the implications of PGA for theory and empirical research on postadversity outcomes and outline a research agenda to better understand it. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Effects Of Cooled Compression Exercise Technology On Health, Sleep, And Quality Of Life In Veterans.

Veterans are disproportionately affected by physical and emotional functional disorders compared to their civilian counterparts, a discrepancy that is deepened by delay to care within the Veterans Health Administration. Research has supported use of compression exercise in physically limited populations and demonstrated physiological responses at lower intensities (10-20% one repetition maximum vs 70% for hypertrophy in resistance exercise). Combination of low-pressure compression exercise and cooling has shown elevated growth hormone and testosterone and depressed nighttime cortisol, indicating this may be beneficial for addressing emotional and sleep dysfunctions. PURPOSE: To determine the safety and efficacy of an accessible cooled compression exercise system on markers of physical and emotional function in veterans. METHODS: 14 veterans completed 24 sessions in 12 weeks. Baseline and endpoint questionnaires validated for clinical significance were administered to determine sleep quality (Pittsburg Sleep Quality Index), quality of life (RAND Short Form 36), and respiratory dysfunction related to stress and anxiety (Nijmegen Questionnaire). RESULTS: Two-tailed T-tests were performed on the data. Sleep quality improved in 71% of subjects (9.15±6.87 vs 5.57±3.74, p = 0.0232), 57% improved quality of life (73.45±17.17 vs 84.46±9.27, p = 0.0316), and 71% decreased adverse respiratory symptoms (11.29±8.38 vs 7.86±6.26, p = 0.0594) compared to baseline. Increases were seen in all 8 sub-scores of quality of life, with statistically significant improvements in social functioning (75±28.17 vs 94.64 ±11.62, p = 0.0058), energy and fatigue (48.93±25.21 vs 65.63±19.26, p = 0.0426), emotional wellbeing (66±24.29 vs 85.14±14.16, p = 0.0054, and general health (72.14±15.78 vs 79.64±12.78, p = 0.0497). For sleep quality, those subjects with baseline scores defined as clinically disturbed sleep (n=8, 58%) all (100%) experienced sleep improvements (9.14±6.87 vs 5.57±3.74, p = 0.00301), with 25% resolving below clinical delineation. CONCLUSION: These findings suggest that the combination of cooling and compression exercise may be an effective intervention method to address symptoms in veterans and other individuals living with insomnia, post-traumatic stress, chronic fatigue, and depression.

Efficacy of Group-Based Organised Physical Activity Participation for Social Outcomes in Children with Autism Spectrum Disorder: A Systematic Review and Meta-analysis.

The aim of this novel review and meta-analysis was to clarify the effects of group-based organised physical activity (OPA) for social and communicative outcomes in children with Autism Spectrum Disorder (ASD). Searches yielded 4347 articles. Eleven were identified for review and seven for meta-analysis. Pooled statistical results revealed a non-significant effect for communication (k = 4; g = 0.13, CI [- 0.12, 0.38], p = .13) and a significant small-medium improvement in overall social functioning (k = 6; g = 0.45, CI [0.19, 0.72], p = .001). Despite acknowledged limitations, these findings are important in the context of a growing clinical and consumer-driven demand for research that determines the role of OPA as a non-medical and inclusive treatment for children with ASD.

Preclinical characterization of AMPA receptor potentiator TAK-137 as a therapeutic drug for schizophrenia.

The downregulation of the glutamate system may be involved in positive, negative, and cognitive symptoms of schizophrenia. Through enhanced glutamate signaling, the activation of the α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazole‐propionic acid (AMPA) receptor, an ionotropic glutamate receptor, could be a new therapeutic strategy for schizophrenia. TAK‐137 is a novel AMPA receptor potentiator with minimal agonistic activity; in this study, we used rodents and nonhuman primates to assess its potential as a drug for schizophrenia. At 10 mg kg−1 p.o., TAK‐137 partially inhibited methamphetamine‐induced hyperlocomotion in rats, and at 3, 10, and 30 mg kg−1 p.o., TAK‐137 partially inhibited MK‐801‐induced hyperlocomotion in mice, suggesting weak effects on the positive symptoms of schizophrenia. At 0.1 and 0.3 mg kg−1 p.o., TAK‐137 significantly ameliorated MK‐801‐induced deficits in the social interaction of rats, demonstrating potential improvement of impaired social functioning, which is a negative symptom of schizophrenia. The effects of TAK‐137 were evaluated on multiple cognitive domains—attention, working memory, and cognitive flexibility. TAK‐137 enhanced attention in the five‐choice serial reaction time task in rats at 0.2 mg kg−1 p.o., and improved working memory both in rats and monkeys: 0.2 and 0.6 mg kg−1 p.o. ameliorated MK‐801‐induced deficits in the radial arm maze test in rats, and 0.1 mg kg−1 p.o. improved the performance of ketamine‐treated monkeys in the delayed matching‐to‐sample task. At 0.1 and 1 mg kg−1 p.o., TAK‐137 improved the cognitive flexibility of subchronic phencyclidine‐treated rats in the reversal learning test. Thus, TAK‐137‐type AMPA receptor potentiators with low intrinsic activity may offer new therapies for schizophrenia.

A meta regression analysis of quality of life correlates in adults with ASD

BackgroundIn this meta-regression analysis, we investigated Pearson’s r correlations between Quality of Life (QoL) and several putative correlates, including (a) age, (b) intellectual quotient (IQ), (c) autism severity, and (d) social functioning (SF). MethodRobust variance estimation was used to synthesize the effect sizes from published and unpublished studies/datasets. One hundred sixty five effect sizes (extracted from 17 studies/datasets) comprising a total of 1721 participants with ASD (mean age = 35.64 years; mean percent male = 62.24%) were retrieved. ResultsSummary effect sizes derived from unconditional meta-regressions for the association between QoL and age, IQ, and autism severity were close to zero and statistically insignificant. In contrast, the summary effect size for the association between QoL and social functioning was statistically significant and moderately sized. ConclusionOf the correlates we examined, only social functioning appears to bear significant summary-level associations with QoL. Improvements in social functioning may enhance QoL in adults with ASD. Alternatively, interventions aimed at neurotypical populations that promote ASD acceptance may lead to increased QoL that is not dependent on social functioning. Factors other than normative adult outcomes that may influence adult QoL should be explored.

Long term effects of early childhood traumatic brain injury on narrative discourse gist and psychosocial functioning

Purpose: To examine the long-term consequences of early childhood traumatic brain injury (TBI), approximately 6.8 years post-injury, on cognitive communication competency within a complex interplay of individual, contextual, and psychosocial factors. Additionally, we were interested in looking at the association of communication competence with social competence and overall functioning.Methods: 64 children with orthopedic injury, 40 children with moderate traumatic brain injury, and 14 children with severe traumatic brain injury who were between 3 years and 6 years 11 months at injury completed a narrative discourse task and clinical measures in a single visit at a longer term follow up in early adolescence, an average of 6.8 years post injury. Analyses of covariance were conducted to compare groups on the discourse task, and hierarchical linear regressions were conducted to examine the association of discourse measures with clinical measures of cognitive and psychosocial functioning.Results: Children with severe traumatic brain injury performed worse than children with moderate traumatic brain injury and orthopedic injury on all discourse indices and clinical measures. Injury severity, pragmatic skills, and socioeconomic status were associated with discourse gist. Discourse gist was the most sensitive measure of communication competence, and it was significantly associated with psychosocial outcomes independent of group.Conclusion: Children who sustain a severe traumatic brain injury in early childhood are at risk for long-term cognitive communication impairments that may be related to a complex interplay of injury, individual, and social factors.Implications for rehabilitationThe assessment and treatment of cognitive communication impairments after traumatic brain injury are complex and require consideration of individual, contextual, and psychosocial factors.Discourse, in general, and gist reasoning specifically, is a sensitive measure for detecting cognitive communication competence several years after pediatric traumatic brain injury.Treatments to address gist reasoning deficits may support improvements in global and social functioning.

Building Skills, Confidence, and Wellness: Psychosocial Effects of Soft Skills Training for Young Adults with Autism.

Recognizing that social functioning and mental health are linked to social participation and employment outcomes, this pilot study examined the preliminary outcomes of an eight-session, work-related social skills training program designed for young adults with high-functioning autism (HFASD). Results indicate statistically significant improvements in social cognition, social function, and social confidence. Furthermore, participants (n = 26) reported statistically significant reductions in anxiety, and a trend toward lessening depressive symptoms. These results suggest that: (1) social skills training is suitable for individuals with HFASD and clinically-significant levels of anxiety and/or depression, and (2) bolstered social functioning may have broader, cyclical impacts on social confidence, psychological wellness, and social and vocational participation in this population.

Social functioning outcomes among individuals with substance use disorders receiving internet-delivered community reinforcement approach

Background: The community reinforcement approach (CRA) is an evidence-based practice for the treatment of substance use disorders and achieving and maintaining abstinence, but few studies have systematically explored the effect of CRA on secondary, yet also important outcomes, such as social functioning. Objectives: The purpose of this study was to examine whether an internet-based version of the CRA plus contingency management is associated with improved social functioning of individuals seeking substance use disorder treatment in a multi-site clinical effectiveness trial. Methods: Social functioning was measured using the 54-item Social Adjustment Scale assessing role performance in six domains (work, social and leisure activities, extended family relationships, marital relationship, parenting, and immediate family). Generalized linear mixed models tested the effects of treatment, time, sex, baseline abstinence, baseline social functioning and baseline psychological distress on overall social functioning and across social functioning subscales at the end of the 12-week treatment phase and 3 and 6 months post treatment. Results: Results showed no significant association between treatment and total social functioning score or any subscale scores. Being male was significantly associated with better social functioning overall at the end of treatment (p = .024). Higher levels of psychological distress at baseline predicted significantly worse social functioning at the end of treatment overall (p = .037). Conclusions: The addition of an internet-based version of the CRA was not associated with greater improvements in social functioning compared to standard outpatient care after 12 weeks of treatment. Implications for internet-delivered CRA are discussed.

Successful treatment of clozapine-nonresponsive refractory hallucinations and delusions with pimavanserin, a serotonin 5HT-2A receptor inverse agonist

BackgroundClozapine was the widely accepted gold standard treatment for treatment resistant psychotic symptoms. Clozapine has efficacy of about 50% and some responding patients have to discontinue it due to serious adverse effects. The search for novel agents to use for clozapine-non-responders continues. One such possible agent is the non-dopaminergic antipsychotic pimavanserin, an inverse agonist of serotonin 5-HT2A receptors which was recently approved for the hallucinations and delusions of Parkinson's Disease Psychosis. We report here the successful results of using pimavanserin in patients with refractory hallucinations and delusions who failed to respond to clozapine. We also report similar results in refractory psychosis patients who did not receive clozapine. MethodsWe present ten cases of patients with schizophrenia and schizoaffective disorder with refractory hallucinations and delusions who received a trial of pimavanserin when clozapine or multiple antipsychotics failed. Six of ten patients had not responded to a clozapine trial. The subjects' ages ranged between 21 and 77 years and were followed up for several months. ResultsAll 10 patients with refractory hallucinations and delusions showed marked response to pimavanserin 34 mg/day within 4–8 weeks, with continuation of the response for several months of follow-up. Improvements in negative symptoms and social functioning were also observed in several patients. DiscussionThis series of 10 cases of patients with refractory psychosis who responded to pimavanserin is an important new finding that has never been reported before. Controlled studies comparing clozapine and pimavanserin in refractory schizophrenia are warranted to confirm these clinical observations.

The 10-year functional outcome of schizophrenia in Butajira, Ethiopia

BackgroundLong-term functional schizophrenia outcomes are not well characterized in low-income environments because of the rarity of prospective studies. ObjectivesTo assess and describe long-term schizophrenia's functional outcomes and potential outcome predictors. MethodsFollowing a baseline assessment, 316 people with schizophrenia were studied for 10 years, on average. Of the total, 79 were incident cases: cases with onset of the illness occurring two years or less from entry into the study. SF-36 scores of physical and social functioning were used to assess functional outcomes. Linear mixed models were employed to evaluate the association of functioning with potential predictors. ResultsSocial and physical functioning scores regarding the cohort were lower than the population's norm for most of the follow-up period. Incident cases had better function than prevalent cases. Fifteen percent of incident and 30% of prevalent cases had reduced social functioning for at least six years. Declining symptom severity during the follow-up period was significantly associated with improvement in social functioning. When baseline functioning was controlled for, the long-term trend in functionality was not associated with demographic or illness characteristics (age and speed of onset, duration of illness and neuroleptic use at entry, substance use, and medication adherence). ConclusionLong-term physical and social functioning of the population with schizophrenia were significantly lower than the population norm. A significant proportion of the cohort had lower functioning for the long-term. Functioning was not associated with demographic or illness characteristics of the study population.

Impact of Selective Quality of Life Analysis in Patients with Local Hyperhidrosis after Sympathicus Clipping

Hyperhidrosis (HH) is associated with physical and psychological restrictions. The treatment includes both conservative and surgical methods and aims to permanently improve the quality of life (QoL) of those affected. Endoscopic sympathetic blockade (ESB) is an established surgical therapeutic method and is considered effective when conservative treatment options fail. The aim of our study was to comprehensively analyse the QoL alteration and patient satisfaction after ESB and to identify the corresponding influencing factors. From July 2008 to April 2016, 105 patients were operated for treatment-refractory HH. In all cases, an ESB was performed according to the HH form and the STS expert consensus (STS: Society of Thoracic Surgeons). QoL and hyperhidrosis status were selectively analysed pre- and postoperatively and evaluated using detailed questionnaires (a self-developed questionnaire, SF36, DLQI, Hyperhidrosis LQ (HidroQoL)). Statistical processing was performed with SPSS Statistics version 21.0.0.2 for Windows (Armonk, NY: IBM Corp.). Descriptive statistical analysis and nonparametric tests were used. 105 patients who underwent bilateral ESB between July 2008 and April 2016 were evaluated: 73 women (69.5%) and 31 men (29.5%) with median age of 26 years (range: 16 - 64 years). Of the 105 patients who underwent bilateral ESB, 12 patients had focal Hyperhidrosis palmar and axillar (12.4%), 20 had Hyperhidrosis palmo-plantar (19.0%), 47 had Hyperhidrosis palmoplantar and axillar (44.8%), 11 had Hyperhidrosis axillar (10.5%), and 14 had Hyperhidrosis facial (13.3%). HydroQoL scores showed improvement in all forms of HH. All patient groups demonstrated improvement in DLQI, while the LQ analysis of SF36 showed an improvement in social functioning and mental well-being in all forms of HH other than HA. 86.7% of patients (n = 91) were satisfied with their postoperative outcome. Compensatory sweating (CS) was observed in 76.2% of cases (n = 80), without a clear LQ impact. No significant correlation between CS and the hyperhidrosis form was found. ESB is associated with a long-time improvement in social functioning, psychological well-being, and high patient satisfaction. The onset of CS has no clear correlation to QoL and patient satisfaction.

Social and functional outcomes with two doses of aripiprazole lauroxil vs placebo in patients with schizophrenia: a post-hoc analysis of a 12-week phase 3 efficacy study

To assess the effect of the long-acting antipsychotic aripiprazole lauroxil (AL) on social and functional outcomes compared with placebo in patients with acute schizophrenia, a post-hoc analysis was conducted. Patients with acute schizophrenia were enrolled in a 12-week, double-blind, placebo-controlled efficacy trial, and randomized 1:1:1 to receive AL 441 mg, AL 882 mg, or placebo every 4 weeks. Changes in social functioning using the 6- and 4-item Positive and Negative Syndrome Scale (PANSS) Prosocial subscales were evaluated. The Personal and Social Performance (PSP) total score evaluated patients’ global improvement. Changes from baseline were analyzed using mixed-effect models repeat measurements. PANSS Prosocial subscale scores and PSP total score improved significantly with AL vs. placebo, without any dose-related difference in magnitude of response. Significant mean ± SE improvements in 6-item PANSS Prosocial scores from baseline to Day 85 were observed for both individual active treatment groups (e.g., AL 441 mg and AL 882 mg groups) vs. placebo. There were significant changes in PSP total score from baseline to Day 85 for both AL doses vs. placebo. This post-hoc analysis demonstrated a significant improvement in social functioning with AL vs. placebo, as assessed by the PANSS Prosocial subscale and PSP total score.

Interdisciplinary Pain Management Improves Pain and Function in Pediatric Patients with Chronic Pain Associated with Joint Hypermobility Syndrome.

The relation between chronic musculoskeletal pain and joint hypermobility in a small percentage of the pediatric population is well described. However, literature discussing the treatment of chronic pain associated with joint hypermobility in pediatrics is limited. The present study examines the impact of interdisciplinary treatment on chronic pain in pediatrics with joint hypermobility syndrome. To determine if pediatric patients with chronic pain related to joint hypermobility can be effectively treated with an intensive, interdisciplinary pain management program, as measured by changes in pain, psychosocial and physical functioning, as well as parental coping. Retrospective cohort study. Urban academic tertiary intensive outpatient interdisciplinary pain management clinic. The study involved 30 patients who met the criteria for a diagnosis of joint hypermobility and chronic pain and completed an interdisciplinary pain management program. All patients were treated in an intensive pediatric interdisciplinary pain management program for a duration of 6 to 8 weeks. The program provided physical therapy, occupational therapy, psychological counseling, and weekly pediatric rehabilitation medicine follow-up. Outcome measures included numeric rating scale pain scores, the Bath Adolescent Pain Questionnaire, and the Bath Adolescent Pain-Parent Impact Questionnaire. Changes from pre- to post-treatment were analyzed using paired-samples t tests. Patients endorsed pre- to post-treatment improvements in pain, depression, general anxiety, pain-related anxiety, social functioning, and physical functioning (P < .05). The patients' parents showed significant improvements in depression, anxiety, catastrophic thinking, self-blame and helplessness, leisure functioning, and parental behavior (P < .05). The present findings suggest that an intensive interdisciplinary rehabilitation pain management program yields short-term improvements in pain, emotional and physical function, and daily activity in a pediatric population diagnosed with joint hypermobility. Parents also experienced benefits from the program. A larger prospective study with longer-term follow-up is needed. III.

The Efficacy of Vortioxetine on Anhedonia in Patients With Major Depressive Disorder.

Background: Anhedonia is a common, persistent, and disabling phenomenon in treated adults with Major Depressive Disorder (MDD). Hitherto, relatively few antidepressant agents have been evaluated with respect to their effect on anhedonia in MDD.Methods: This is a post-hoc analysis of a primary study that sought to evaluate the sensitivity to change of the THINC-integrated tool (THINC-it) in MDD (ClinicalTrials.gov Identifier: NCT03053362). Adults meeting DSM-5 criteria for MDD with at least moderate depressive symptom severity [i.e., Montgomery Åsberg Depression Rating Scale (MADRS) total score ≥20] were eligible. Subjects were recruited between October 2017 and August 2018 in Toronto, Ontario at the Brain and Cognition Discovery Foundation. All subjects received open-label vortioxetine (10–20 mg/day, flexibly-dosed) for 8 weeks. Herein, the primary outcome of interest was the change from baseline to endpoint in the Snaith-Hamilton Pleasure Scale (SHAPS) total score, as well as the MADRS anhedonia factor. The mediational effects of improvements in anhedonia on general function and quality of life, as measured by the Sheehan Disability Scale (SDS) and the 5-Item World Health Organization Well-Being Index (WHO-5), were secondarily assessed.Results: A total of 100 subjects with MDD were enrolled in the primary study and began treatment with vortioxetine. Vortioxetine significantly improved anhedonia as evidenced by significant baseline to endpoint improvements in SHAPS and MADRS anhedonia factor scores (p < 0.0001). Improvements in the SHAPS and the MADRS anhedonia factor correlated with improvements in general function (i.e., SDS) and quality of life (i.e., WHO-5) (p < 0.0001). Notably, improvements in anhedonia were found to mediate the association between improvements in overall depressive symptom severity (i.e., MADRS total score) and social functioning (i.e., social life component of the SDS) (p = 0.026).Conclusion: The unmet need in depression is to improve patient functioning and other patient-reported outcomes (e.g., quality of life). Antidepressant interventions capable of attenuating anhedonia as well as cognitive dysfunction in MDD may help in this regard, as improvement in these domains have been associated with improvement in psychosocial function and quality of life.