Psychosocial Outcomes In Patients Research Articles

A randomized trial of energy‐restricted high‐protein versus high‐carbohydrate, low‐fat diet in morbid obesity

Conflicting evidence exists as to weight loss produced by diets with different carbohydrate/protein ratio. The aim was to compare the long-term effects of high-protein vs. high-carbohydrate diet (HPD, HCD), combined with cognitive behavior therapy (CBT). In a randomized trial, 88 obese participants (mean age, 46.7; mean BMI, 45.6 kg m(-2) ) were enrolled in a 3-week inpatient and 48-week outpatient treatment, with continuous CBT during the study period. All subjects consumed a restricted diet (1,200 kcal day(-1) for women, 1,500 for men; 20% energy from fat, <10% saturated fat). HPD derived 34% energy from proteins, 46% from carbohydrates; HCD 17% from proteins, 64% from carbohydrates. The primary outcome was 1-year percent weight loss. Secondary outcomes were attrition rates and changes in cardiovascular risk factors and psychological profile. Attrition rates were similar between groups (25.6%). In the intention-to-treat analysis, weight loss averaged 15.0% in HPD and 13.3% in HCD at 1 year, without any difference throughout the study period. Both diets produced a similar improvement in secondary outcomes. The relative carbohydrate and protein content of the diet, when combined with intensive CBT, does not significantly affect attrition rate, weight loss and psychosocial outcome in patients with severe obesity.

Cognitive, functional, and psychosocial outcome after severe traumatic brain injury: A cross-sectional study at a tertiary care trauma center

Traumatic brain injury (TBI) constitutes a significant public health problem. To assess cognitive, functional, and psychosocial outcome in patients with severe TBI (STBI). A total of 77 survivors of STBI treated at our center were prospectively assessed in the outpatient department 1 year after the injury. These patients were assessed for cognitive, functional, and psychosocial outcome using cognitive outcome tests, dysfunctional analysis questionnaire, and personality trait inventory, respectively. Cognitive and functional outcome was graded as average and above average recovery (good recovery) or below average recovery (poor recovery). Psychosocial outcome was assessed as average recovery (good recovery) or mild impairment and severe impairment (poor to very poor recovery). Statistical analysis was done using Chi-square and Fisher's exact tests. The ability to learn new things was most affected aspect of cognitive function and only 1% of patients had good recovery in this domain. However, 44% had good outcome for simple memory. A total of 61% showed good recovery in several aspects of functional status. At the end of 1 year, 62.5% patients still remained unemployed. 45.4% patients had good recovery, while 37% had severe impairment for various personality traits and 40% of patients had impaired emotional stability, while 57% patients showed impaired recovery in depressive tendency. In this study 61% patients with STBI had good recovery in functional outcome and 45.4% in psychosocial outcome at 1 year follow-up. However, improvement in cognitive outcome was not so optimistic with the ability to learn new things being most affected.

The role of daytime sleepiness in psychosocial outcomes after treatment for obstructive sleep apnea.

We investigated the role of daytime sleepiness and sleep quality in psychosocial outcomes of patients with obstructive sleep apnea (OSA) treated with continuous positive airway pressure (CPAP). Thirty-seven individuals with moderate to severe OSA and compliant with CPAP treatment for at least 3 months were compared to 27 age- and education-matched healthy controls. The OSA group and the control group were studied with overnight polysomnography (PSG) and compared on measures of daytime sleepiness (Epworth Sleepiness Scale), sleep quality (Pittsburg Sleep Quality Index), mood (Beck Depression Inventory, Profile of Mood States), and functional outcomes (Functional Outcomes of Sleep Questionnaire). After CPAP treatment, the OSA group improved on sleep quality and sleepiness. As a group, they did not differ from controls on sleep architecture after CPAP. The OSA group also showed significant improvements in functional outcomes and was comparable to controls on mood and functional outcomes. Persistent difficulties included lowered activity level and residual sleepiness in some individuals. Sleepiness was found to be a significant predictor of mood and affective states, while both sleepiness and sleep quality predicted functional outcomes. These results highlight the importance of assessment and intervention targeting psychosocial functioning and sleepiness in individuals with OSA after treatment.

Effects of exercise on psychosocial outcomes in patients undergoing hematopoietic stem cell transplantation

SummaryHematopoietic stem cell transplantation (HSCT) is an intense treatment to cure patients from leukemia or lymphoma. Prior, during, and after the transplantation procedure patients experience considerable physical, psychological and psychosocial distress. In light of the increasing number of successfully treated patients the need is growing for evidence-based adjuvant therapy options, which reduce treatment-related side effects and enhance the rehabilitation process. Due to its multidimensional effectiveness physical exercise might be a suitable intervention to counteract with HSCT-related side-effects. Twenty-nine publications could be detected within a systematic literature search. The studies suggest that exercise training is an important therapeutic approach in the supportive care for HSCT patients. Significant benefits from the exercise interventions have been reported for physical performance and psychosocial parameter like quality of life (QoL), fatigue status and distress. Several other benefits, such as a more rapid immune recovery or alleviation of therapy-related side effects have been reported in some studies. Future studies should address existing methodological problems, identify further effect levels of physical exercise therapy and integrate a long-term perspective for the participants in the context of HSCT.

Effects of exercise on psychosocial outcomes in patients undergoing hematopoietic stem cell transplantation

SummaryHematopoietic stem cell transplantation (HSCT) is an intense treatment to cure patients from leukemia or lymphoma. Prior, during, and after the transplantation procedure patients experience considerable physical, psychological and psychosocial distress. In light of the increasing number of successfully treated patients the need is growing for evidence-based adjuvant therapy options, which reduce treatment-related side effects and enhance the rehabilitation process. Due to its multidimensional effectiveness physical exercise might be a suitable intervention to counteract with HSCT-related side-effects.Twenty-nine publications could be detected within a systematic literature search. The studies suggest that exercise training is an important therapeutic approach in the supportive care for HSCT patients. Significant benefits from the exercise interventions have been reported for physical performance and psychosocial parameter like quality of life (QoL), fatigue status and distress. Several other benefits, such as a more rapid immune recovery or alleviation of therapy- related side effects have been reported in some studies. Future studies should address existing methodological problems, identify further effect levels of physical exercise therapy and integrate a long-term perspective for the participants in the context of HSCT.

Psychosocial outcome in patients at clinical high risk of psychosis: a prospective follow-up

In patients at clinical high risk (CHR) of psychosis, transition to psychosis has been the focus of recent studies. Their broader outcome has received less attention. We studied psychosocial state and outcome in CHR patients. In the European Prediction of Psychosis Study, 244 young help-seeking CHR patients were assessed with the Strauss and Carpenter Prognostic Scale (SCPS) at baseline, and 149 (61.1%) of them were assessed for the second time at the 18-month follow-up. The followed patients were classified into poor and good outcome groups. Female gender, ever-married/cohabitating relationship, and good working/studying situation were associated with good baseline SCPS scores. During follow-up, patients' SCPS scores improved significantly. Good follow-up SCPS scores were predicted by higher level of education, good working/studying status at baseline, and white ethnicity. One-third of the followed CHR patients had poor global outcome. Poor working/studying situation and lower level of education were associated with poor global outcome. Transition to psychosis was associated with baseline, but not with follow-up SCPS scores or with global outcome. The majority of CHR patients experience good short-term recovery, but one-third have poor psychosocial outcome. Good working situation is the major indicator of good outcome, while low level of education and non-white ethnicity seem to be associated with poor outcome. Transition to psychosis has little effect on psychosocial outcome in CHR patients. In treating CHR patients, clinicians should focus their attention on a broader outcome, and not only on preventing transition to psychosis.

A Population-Based Study of Breast Cancer-Specific Survival Following Mastectomy and Immediate or Early-Delayed Breast Reconstruction

Immediate breast reconstruction allows for improved patient psychosocial outcomes after mastectomy. We used the Surveillance, Epidemiology, and End Results (SEER) database to study the breast cancer-specific survival of patients treated with immediate or early-delayed breast reconstruction after mastectomy. Population-level de-identified data was abstracted from the SEER database. All female patients treated with mastectomy for a diagnosis of ductal and/or lobular breast cancer between 1998 and 2002 were included. Breast cancer-specific survival was reported as hazard ratios using multivariate analysis to control for patient demographic and oncologic covariates. Demographic covariates included age, race, marital status, income, education, and county metropolitan status; oncologic covariates included tumor stage, histology, grade, lymph node status, hormone receptor status, receipt of radiation therapy, and unilateral or bilateral mastectomy. A total of 52,249 patients were included in the study. Patients treated with mastectomy and reconstruction had a significantly lower hazard of death (HR 0.73, p < 0.0001) compared with patients treated with mastectomy only. Black patients had a significantly increased hazard of death (HR 1.42, p < 0.0001) compared with white patients. Receipt of radiotherapy did not significantly associate with hazard of death (HR 1.03, p = 0.3494). Additionally, bilateral mastectomy did not significantly associate with hazard of death (HR 0.98, p = 0.763). Our analysis shows that patients who undergo breast reconstruction after mastectomy have a higher breast cancer-specific survival than those undergoing mastectomy alone, when controlling for demographic and oncologic covariates. Further research is required to understand the nature of this relationship.

Theory of mind and its relevance in schizophrenia

Social cognitive impairments are considered to be core features of schizophrenia and have been hypothesized to play a mediator role between basic neurocognition and patients' outcomes. In this context, theory of mind (ToM) abilities are of special relevance, and deficits in this area may represent trait markers of schizophrenia. In this review, studies published since September 2010 have been summarized with a particular focus on the relationships between ToM and psychopathology, neurocognition, and psychosocial outcomes in patients with schizophrenia, as well as on ToM abilities in high-risk individuals. In addition, recent neuroimaging data as well as treatment interventions have been described. The reviewed literature strengthens the hypothesis that ToM deficits have the potential to be valid markers for schizophrenia.

Exercise rehabilitation for cancer related fatigue: home or gym based?

BackgroundAs people live longer the number living with and beyond cancer is increasing. Due to the after effects of disease and treatments many individuals who survive cancer do not enjoy...

The Psycho-Social Rehabilitation of Patients with Alcohol-Related Brain Damage in the Community†

To describe the clinical presentation, course and psycho-social outcome of patients with alcohol-related brain damage (ARBD) referred from acute general hospital inpatient settings to a newly commissioned community team. A follow-up study of a consecutive series of 41 patients subjected to a developing, phased rehabilitation programme in community settings. Patients were followed for an average of 25 months. Thirty-two patients were either abstinent or categorized as 'controlled drinkers' and were placed in appropriate community settings. Acute hospital admissions were reduced by 85%. The various domains of a neuropsychiatric assessment tool, the health of the nation outcome scale-acquired brain damage, improved with the exception of concomitant mental illness and self-directed harmful behaviour. A community team with experience in working with younger people with cognitive impairment can provide a service for people with ARBD. Such a service is not dependent on pre-designated specialist institutions but relies on person-centred care planning, close follow-up and collaborative work with a variety of community agencies. A structured rehabilitation programme provides a framework for intervention.

Late-Onset Bipolar Disorder and Cognitive Impairment: A Case Report

Back to table of contents Previous article Next article LettersFull AccessLate-Onset Bipolar Disorder and Cognitive Impairment: A Case ReportEmel Kurt, M.D., Gjergji Sinani, M.D., and Volkan Topcuoglu, Emel KurtSearch for more papers by this author, M.D., Gjergji SinaniSearch for more papers by this author, M.D., and Volkan TopcuogluSearch for more papers by this author, Assoc. Prof.Published Online:1 Oct 2012https://doi.org/10.1176/appi.neuropsych.11100267AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: New-onset mania in elderly persons is more than twofold more likely to have comorbid neurological disorders such as silent cerebral infarcts, tumors, neurosyphilis, and frontotemporal dementia (FTD) than in younger patients.1 The literature reveals the extent and course of cognitive deficits among patients with bipolar disorder (BD).2 The case reported here arose from clinical observations of an elderly adult patient with psychotic BD.Case Report“Mr. G” was born in 1950, is retired, married, and the father of a child. He and his family have described several hypomanic episodes each spring since 1996, with irritability, anger, and increase in the amount of speech, excessive, running thoughts, grandiosity and feeling fearless. Sodium valproate + valproic acid 1,000 mg/day was initiated in one of such episodes. Also, they have described depressive episodes occurring each winter since 1996. However, in 2003, Mr. G started to suffer from auditory and visual hallucinations. Meanwhile, the patient started to have sensory aphasia and difficulty in executive functions such as ordering, planning, and abstracting. The family informed us that the hypomanic and depressive episodes have disappeared since 2005. In his laboratory assessment, serum folate, vitamin B12, and thyroid hormone levels were in normal ranges, and HIV and syphilis markers were negative. Cranial MRI showed cerebellar and cerebral atrophy; PET scan revealed significant hypometabolism in bilateral parietotemporal regions. Neuropsychological assessment showed inability to maintain attention, frontal-type deterioration in verbal memory, impairment in visual-spatial configuration, language and speech apraxia, and difficulty in making and repeating sentences was noted. According to these findings frontotemporal-type dementia was diagnosed, and rivastigmine 16 mg/day was added by titration.DiscussionAt the beginning, we diagnosed the present case as bipolar affective disorder because of the episodic course of depressive and manic symptoms. However, the addition of some core features of FTD,1 such as hallucinations, behavioral disturbances, sensory aphasia, apathy, indifference, and impairment in executive functions in a nonepisodic manner, have led us to diagnose the case as FTD. In a recent meta-analysis, psychotic BD patients were found to be associated with poorer cognitive performance, including verbal memory, executive function tests of planning/reasoning, and processing speed, than BD patients without a psychotic history.3 This case presentation might be remarkably important according to the recent discussion of relationship between BD and cognition in the literature.Dept. of Psychiatry University of Marmara Istanbul, TurkeyCorrespondence: Dr. Sinani; e-mail: [email protected]comReferences1 Woolley JD, Wilson MR, Hung E, et al.: Frontotemporal dementia and mania. Am J Psychiatry 2007; 164:1811–1816Crossref, Medline, Google Scholar2 Burdick KE, Goldberg JF, Harrow M: Neurocognitive dysfunction and psychosocial outcome in patients with bipolar I disorder at 15-year follow-up. Acta Psychiatr Scand 2010; 122:499–506Crossref, Medline, Google Scholar3 Bora E, Yücel M, Pantelis C: Neurocognitive markers of psychosis in bipolar disorder: a meta-analytic study. J Affect Disord 2010; 127:1–9Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 24Issue 4 Fall 2012Pages E32-E32 Metrics PDF download History Published online 1 October 2012 Published in print 1 October 2012

Psychosocial functioning of patients after endoscopic thoracic sympathectomy

Endoscopic thoracic sympathectomy is considered the treatment modality of choice for patients with disabling hyperhidrosis. However, the psychosocial impact of the intervention has not been systematically studied in American samples before and after sympathectomy. It is expected that the reduction of symptoms is associated with improved psychosocial functioning and quality of life. The aim of this study was to examine psychosocial functioning in patients with hyperhidrosis undergoing thoracic sympathectomy. Patients with hyperhidrosis undergoing evaluation for sympathectomy were recruited from Shands Hospital at the University of Florida. Fifty-one patients completed individual psychological assessment batteries prior to undergoing sympathectomy and at 1-month follow-up, measuring the constructs of health-related quality of life, anxiety, and depression. Repeated-measures analyses of variance revealed that 1 month after sympathectomy, patients reported significant improvements across the domains of physical quality of life (p=0.01), mental quality of life (p=0.005), trait anxiety (p<0.001), and depression (p=0.007). Sympathectomy resulted in increases in health-related quality of life, and decreases in anxiety and depression within 1 month post procedure. Results suggest that sympathectomy exists as an effective treatment choice for both medical and psychosocial outcomes in patients with hyperhidrosis.

Neurocognitive dysfunction and psychosocial outcome in patients with bipolar I disorder at 15‐year follow‐up

Despite increasing interest in cognitive dysfunction in bipolar disorder, little is known about its impact on functional outcome relative to affective symptoms. A total of 33 bipolar I subjects were evaluated at index hospitalization and prospectively followed up 15 years later. Affective symptoms, cognition, global functioning, work, and social adjustment were assessed at follow-up and analyzed by linear regression. Global functional impairment was significantly associated with poor performance on a cognitive measure of processing speed (WAIS Digit Symbol). Digit symbol performance also was the sole significant predictor of social functioning. Neither symptom severity nor course of illness features significantly contributed to global and social functioning. In contrast, verbal learning deficits, recent depression, and lifetime hospitalizations all were independently associated with work disability. Processing speed is robustly associated with social and global functioning in bipolar disorder. Poor work functioning is significantly related to subsyndromal depression, course of illness, and verbal learning deficits. Cognitive and mood symptoms warrant consideration as independent determinants of functioning in patients with bipolar disorder many years after an index manic episode.

Psychosocial outcomes in patients with recurrent major depressive disorder during 2 years of maintenance treatment with venlafaxine extended release

Background Psychosocial outcomes from the Prevention of Recurrent Episodes of Depression with Venlafaxine ER for Two Years (PREVENT) study were evaluated. Methods Adult outpatients with recurrent major depressive disorder (MDD) and response or remission following 6-month continuation treatment with venlafaxine extended release (ER) were randomized to receive venlafaxine ER or placebo for 1 year. Patients without recurrence on venlafaxine ER during year 1 were randomized to venlafaxine ER or placebo for year 2. Psychosocial functioning was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire—Short Form (Q-LES-Q), Life Enjoyment Scale—Short Version (LES-S), Social Adjustment Scale—Self-Report (SAS-SR) total and individual factors, Short Form Health Survey (SF-36) (vitality, social functioning, and role function-emotional items), and Longitudinal Interval Follow-up Evaluation (LIFE). Results At year 1 end, better overall psychosocial functioning was seen among patients randomly assigned to venlafaxine ER ( n = 129) vs placebo ( n = 129), with significant differences at end point on SF-36 role function-emotional, Q-LES-Q, and SAS-SR total, and work, house work, social/leisure, and extended-family factor scores ( p ≤ 0.05). At year 2 end, significant differences favored venlafaxine ER ( n = 43) vs placebo ( n = 40) on SF-36 vitality and role function-emotional, Q-LES-Q, LES-S, LIFE, and SAS-SR total, social/leisure, and extended-family factor scores ( p ≤ 0.05). Limitations Patients with chronic MDD or treatment resistance were excluded and long-term specialist care was a financial incentive for treatment compliance. Discontinuation-related adverse events may have compromised the integrity of the treatment blind. Conclusions For patients with recurrent MDD, 2 years' maintenance therapy with venlafaxine ER may improve psychosocial functioning vs placebo.

Psychosocial Considerations for Children and Young Adolescents with Implantable Cardioverter Defibrillators: An Update

The extension of the life-saving benefits of the implantable cardioverter-defibrillator (ICD) to prevent sudden cardiac arrest in children and young adults represents a key clinical development. The psychosocial adjustment in young ICD patients has not been as well-studied as in adults and remains an area of needed research. The current paper reviews the quantitative research regarding ICD patient psychosocial outcomes in the adult and pediatric literature, and highlights existing intervention research on adult ICD patients and its implications for young ICD patients. Literature review indicates that anxiety may be the most problematic psychosocial reaction for young ICD patients, similar to adult patients. Since young ICD patients appear to be more likely to experience shocks than adults; shock-related anxiety is suspected to be particularly common. Interventions in adults have shown a reduction in anxiety but no pediatric intervention studies are currently available in the literature. Additional research and clinical attention is warranted to further assist young ICD patients to achieve desirable quality of life outcomes.

Evaluation of an outpatient, peer group intervention for people with acquired brain injury based on the ICF ‘Environment’ dimension

Purpose. This study aimed to evaluate the effectiveness of an intervention based on the ICF ‘Environment’ dimension for enhancing the well-being and psychosocial outcomes of patients with acquired brain injury in an outpatient (day hospital) setting.Method. A mixed methodology cohort study comparing an intervention group with an historical non-intervention group using pre- and post-intervention and follow-up measures. The 6-week group intervention involved participants and their significant others. Pre- and post-intervention data from the intervention group and the non-intervention group were compared using 2 × 2 analyses of variance for five standardised outcome measures. Semi-structured interviews with intervention participants and significant others were used to provide qualitative feedback.Results. A significant group by time interaction was found for level of community integration on the Sydney Psychosocial Reintegration Scale and depression scores on the Hospital Anxiety and Depression Scale, with greater improvements for the intervention group compared with the non-intervention group. No other significant differences between groups were found. Gains in community integration were maintained by the intervention group at 1-month follow-up. Qualitative feedback from participants indicated the value of: sharing experiences, the group content, goal setting, comparing with others and the group processes.Conclusions. The Environment-focused intervention was useful in improving patient outcomes in terms of better self-reported community integration.

Risk of depression, anxiety, and somatization one month after diagnosis in children with standard risk ALL on COG AALL0331

10052 Background: Symptoms of depression, anxiety and somatization are found in internalizing 2 disorders; characterized by intense fears concerning one’s social world and physical outcomes. Children with Acute Lymphoblastic Leukemia (ALL) experience stressors and receive medications that may increase symptoms of internalizing disorder, but rarely receive psychological intervention during leukemia therapy. Past studies have been limited by lack of prospective data and representative samples. Methods: In the current study of psychosocial outcomes in patients enrolled on AALL0331 for standard risk ALL at 38 Children’s Oncology Group sites, the child’s caregiver completed the Behavior Assessment System for Children, Second Edition (BASC-II). All evaluations were done one month after diagnosis. There were 95 participants (88% of those eligible) with a mean age of 4.9 years, 46% female and 58% Caucasian, 20% Hispanic, 5 % African American and 11% other. Consistent with BASC-II validation studies, patients with T-scores over 84% of the normative population were categorized as having internalizing symptoms in the at risk/clinical range. The proportion of study patients with clinically significant scores was then compared to the expected 16% in the normative population. Results: Overall, 39% of the sample demonstrated at risk/clinical internalizing symptoms (p<.00001) including; anxiety (27%, p=.006), depression (24%, p=.03) and somatization (41%, p=.0001). Females were more likely (34%) than males (21%) to experience anxiety. Children younger than 6 years at diagnosis had higher risk of anxiety (32%), depression (27%) and somatization (35%) than older children (18%, 18% and 29%, respectively). Children with annual family incomes of less than forty thousand dollars had higher rates of anxiety (35% vs. 20%, p=.007) and depression (31% vs. 11%; p=.02) than those with higher incomes. Conclusion: Children with ALL, one month after diagnosis, endorsed internalizing symptoms at twice the expected proportion in the general population. These symptoms can potentially affect a patient’s well being, medical compliance and the trajectory of their treatment, suggesting that more rigorous psychological treatment and assessment are warranted. No significant financial relationships to disclose.

PSYCHOSOCIAL STATUS BEFORE AND AFTER TEMPORAL LOBE EPILEPSY SURGERY

The purpose of this prospective work was to evaluate the relationship between seizure outcome and psychosocial status in patients who underwent temporal lobe epilepsy surgery for medically intractable seizure. The Liverpool Psychosocial Battery, which includes physical, social, and psychological domains, was completed by 63 patients with temporal lobe epilepsy before surgery, as well as 6 months and 2 years after surgery. The differences regarding the Liverpool Psychosocial Battery domains were compared between seizure-free and nonseizure-free patients at 6 months and 2 years after surgery. Serial follow-up results were also compared with the baseline. On all measures, patients showed significantly better scores after surgery compared with the baseline (P < 0.05). Although seizure-free patients showed improved "psychosocial" outcome over those who continued to have seizures, the differences did not reach a significant level on social and psychological domains. Surgery has significantly positive effects on psychosocial outcome in patients with temporal lobe epilepsy. However, positive psychosocial changes are not limited to those patients who became seizure free after surgery.

Neurocognitive Impairment and Dementia in Mood Disorders

Neurocognitive Impairment and Dementia in Mood Disorders

76 Quality-of-life and psychosocial outcomes in patients with MPS disorders who have undergone hematopoietic stem cell transplant

76 Quality-of-life and psychosocial outcomes in patients with MPS disorders who have undergone hematopoietic stem cell transplant