Psychosocial Outcomes In Patients Research Articles

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

Medical and psychosocial outcome of patients with occupational contact dermatitis in Israel

Although the medical, financial and prognostic factors of occupational contact dermatitis (OCD) have been addressed, studies on the social outcome of OCD are sparse. To define the medical and psychosocial outcome of patients with OCD. Workers with OCD were interviewed by telephone using a questionnaire that included questions about the occupation, dermatological disease, sick leave, present working status and disability claims, and questions related to the subjective perceptions of OCD in all areas of psychosocial functioning and quality of life. Seventy workers (64.3% males and 35.7% females) were interviewed. Forty per cent had stopped working and one-third had taken sick leave because of OCD. Forty-seven (67.1%) were currently working while 23 (32.8%) were unemployed. Disability compensation was claimed by only 41.4% and was received by 24.3%. Eight workers (11.4%) had persistent postoccupational dermatitis (PPOD). Loss of employment affected the occupational area of the workers' lives (100%), and also interpersonal relationships (45.7%), relationships within the family (18.6%), daily functioning (45.7%) and mental health (24.3%). Considerable working time is lost because of unemployment or sick leave due to OCD. Only a small proportion of eligible patients with OCD apply for disability compensation and an even smaller proportion receive it. Our study demonstrates the significance of OCD to the psychosocial aspects of workers' lives and emphasizes that the assessment of OCD outcome should relate not only to the medical but also to the psychosocial aspect of the disease.

Physical and Psychosocial Outcome in Morbidly Obese Patients <I>with</I> and <I>without</I> Bariatric Surgery: a 4½-Year Follow-up

Morbidly obese patients show high somatic and psychiatric co-morbidity. Bariatric surgery is accepted as the obesity treatment with the greatest long-term success. There is growing evidence that follow-up studies should address somatic as well as psychosocial conditions of patients undergoing bariatric surgery and non-operatively treated patients. This study investigates the physical and psychosocial outcomes of patients with and without bariatric surgery. A sample of 131 morbidly obese patients applying for bariatric surgery underwent somatic and psychological assessment (T0). A first follow-up study (T1) was conducted 2 years after T0 in 119 patients. The present second follow-up (T2) was carried out 4 1/2 years after T0 and 3.2 years after potential bariatric surgery. Psychological/psychosocial measures were collected in the 93 patients, 63 of whom were treated surgically, via the Psychosocial Stress and Symptom Questionnaire (PSSQ) and a telephone interview covering BMI, employability, medication, doctor consultations, eating behavior, and physical/psychological well-being. Patients with and without bariatric surgery showed a BMI reduction, which was significantly greater in those who underwent surgery (P<.001). The average percentage of excess weight loss (%EWL) between T0 and T2 was 11.5% in patients with no bariatric surgery, 36.0% in patients with laparoscopic gastric banding, and 52.8% in patients with laparoscopic gastric bypass (%EWL between T0 and T2 in patients of all groups significant, P<.001). Patients with and without surgical treatment showed significant improvement with regard to depressive symptoms and binge-eating behavior. Three-quarters of the surgically-treated and two-thirds of the non-treated patients rated their physical, psychological, and psychosocial well-being as "good" at T2. After 3 to 4 years, all of the patients have adapted well to their weight and body appearance, regardless of whether they have undergone surgery. Weight loss is, however, greater for operated patients, which strongly decreases the risk of developing obesity-related co-morbidities.

Intersex Conditions in Children and Adolescents: Surgical, Ethical, and Legal Considerations

Introduction Approximately one in 2000 children globally is born with an intersex condition. There is unfortunately a relative paucity of data on the choices and the surgical and psychosocial outcomes in patients who undergo genital surgery for intersex conditions and ambiguous genitalia, especially in developing countries. Specialists in these and other countries, where patient follow-up is generally poor, are faced with the daunting task of offering the appropriate medical and surgical management, in the absence of guidelines or recommendations. Surgical considerations A surgical procedure in these patients sometimes involves clitoral recession, reduction, vaginoplasty, and gonadectomy. The best surgical outcome is likely to be achieved with a multidisciplinary surgical team; however, the choice of surgery and appropriate timing remains controversial. Some authors have suggested delaying surgery until the child becomes competent to make his/her own decisions. Legal/Ethical Considerations All procedures should conform to an ethical code of practice and be in the interest of the child. Exhaustive counseling of all parties and informed consent is of paramount importance, as is adherence to laws that protect the rights of the child as outlined in respective constitutions. Recommendations Recommendations in this article, which have been put together from the combined input of three departments, are broad-based. They emphasize the need for extensive counseling, informed consent, adherence to ethical and legal norms, a multidisciplinary input and a shift away from a paternalistic approach.

Improving quality of life beyond seizure control

ABSTRACT More than 50 years ago, Lennox and Markham urged physicians who treated patients with epilepsy to “match modern drug and surgical therapy with practical sociopsychological therapy” and to be “concerned not only with turbulent brain waves but with disturbed emotions”. Indeed, while seizure frequency and severity correlate with quality of life and psychosocial outcomes for patients with drug‐resistant epilepsy, numerous other epilepsy‐related factors may also be significant determinants. These factors include medical and psychiatric co‐morbidities, side effects of therapy, stigma, parental anxiety, employment status, seizure worry, self‐esteem and self‐mastery. Importantly, these epilepsy‐related factors may be amenable to educational or therapeutic interventions, which if successful may benefit patients even without a concomitant reduction in seizure frequency or severity. Therefore, while further research is needed, physicians and other health care providers should comprehensively attend to these factors and refer patients with treatment‐resistant seizures, when appropriate, for further evaluation and treatment to improve their quality of life beyond seizure control.

Cancer patients' satisfaction with communication, information and quality of care in a UK region

Effective patient-professional communication can be of crucial importance to long-term psycho-social outcomes in patients with cancer. This study identifies patient satisfaction with regard to various aspects of communication and perceived quality of care. A well-validated questionnaire was administered to 435 cancer patients throughout Northern Ireland during a 3-month period. Northern Ireland can be regarded as a typical UK region in terms of cancer service configuration. The cohort consisted of patients with breast, colorectal, lung, prostate, gynaecological and gastric cancers. There was a 78% response rate. Satisfaction scores were individually calculated for various aspects of care, particularly diagnosis, treatment, follow-up and overall care. Non-parametric analysis examined the interaction between satisfaction scores and primary tumour site, age and gender. While overall satisfaction scores were relatively high, there was considerable variation. Of particular note was the interaction between perceived satisfaction and quality of care, communication, tumour site and age. Key findings are that there are a number of issues with regard to information and communication which can be clearly improved within Northern Ireland cancer services. The paper concludes that patient-professional communication should be tailored to meet individual need.

The effects of second-generation antipsychotics on cognitive functioning and psychosocial outcome in schizophrenia.

Neuropsychological deficits seem to be a major predictor of psychosocial outcome in patients with schizophrenia. Second-generation antipsychotics have shown greater promise in treating neuropsychological deficits than conventional antipsychotic drugs. This article summarizes the effect of newer antipsychotics on cognitive functioning and the implications for functional outcome. In this context it also addresses several methodological and conceptional issues that limited the comparison of these studies.

Psychosocial outcomes in patients with schizophrenia: quality of life and reintegration

The increasing interest in the quality of life and reintegration of schizophrenic patients is a major conceptual shift in therapeutic outcome criteria. At the beginning of neuroleptic or antipsychotic treatment, symptom reduction was the most relevant outcome parameter for a long time. With the development of atypical antipsychotic agents, more ambitious success criteria, including the patient's perspective, are now considered. The effects on positive psychotic symptoms do not differ markedly between typical and atypical antipsychotic agents, but the lack of motor symptoms, the improvement of negative, affective and cognitive symptoms, and particularly the greater chance of improving subjective well-being, quality of life and reintegration are the major advantages of atypical agents, obvious especially during long-term treatment. The assessment of quality of life as well as of social reintegration are new approaches to differentiate therapeutic effects and to consider more the patient's perspective. There is strong evidence in numerous trials that in comparison with typical neuroleptics, atypical agents improve quality of life significantly. With regard to reintegration, because of the more difficult methodology, there is less evidence of the advantages of atypical agents. This review describes the development of quality of life and reintegration research in schizophrenic patients, and summarizes the methodological problems and the clinical trials.

A review of psychosocial outcome in patients with bipolar disorder.

The aim of this paper is to review outcome in patients with bipolar disorder as assessed by interepisode level of functioning, as until recently this dimension of outcome has been relatively under-emphasized. Studies that examined psychosocial outcome in bipolar disorder were reviewed on the basis of rating measurements employed, length of follow-up, number of subjects followed and degree of impairment reported. Studies were included only if results from patients with bipolar and unipolar disorder were reported in such a way that the groups could be distinguished. When studies of psychosocial outcome in bipolar disorder are examined in aggregate, it appears that 30-60% of individuals with this disorder fail to regain full functioning in occupational and social domains. This review highlights the fact that inter-episode functional recovery is incomplete in some patients, suggesting that comprehensive rehabilitative assessment and intervention may be essential to reduce the morbidity associated with this disorder.

Psychosocial outcomes for patients and carers after aneurysmal subarachnoid haemorrhage

As part of a 'clinical governance' initiative, a patient/carer led study was designed to determine the psychosocial outcome of a consecutive cohort of 137 aneurysmal sub-arachnoid haemorrhage (ASAH) patients of whom 45% had experienced a severe haemorrhage. Most patients were middle class (51%), female (63%), aged under 54 years (53%) and 30% had school-age children. Information booklets did not meet the need for case-specific answers and communication problems were identified despite the high rating of in-patient treatment. Substantial problems occurred after discharge because of a hiatus in care and support by community-based services. Carers carried major psychosocial burdens, fifty-one per cent reporting that their work was negatively affected, and after a year, employment cost to carers was 182,000 and 590,000 for patients. 11% of patients lost their jobs as a direct consequence of the ASAH. A cost-feasible solution to improve the communication-support problems was identified by these 'consumers'.

Coronary Artery Bypass Grafting: Long-Term Psychological and Social Outcomes

Long-term psychosocial outcomes were examined in 132 patients 7 to 22 years M = 9.4 years after coronary artery bypass grafting. The control group comprised 145 medically treated patients with coronary heart disease of 7 to 22 year duration M = 9.2 . Significantly more medically than surgically treated patients were scored in the clinically significant range for anxiety, and for depression on the hospital anxiety and depression scale. Significantly more medically than surgically treated patients reported a definite, considerable, or very severe impairment of family relationships, social activities, leisure activities, home management, and work on the social functioning scale. Work status did not significantly differ between surgical and medical patients. This study shows previously unreported long-term favorable psychosocial outcomes in patients who underwent coronary artery bypass grafting.

Well-being of haemophilia patients: a model for direct and indirect effects of medical parameters on the physical and psychosocial functioning

This study outlines the development and evaluation of a structural equation model for establishing the consequences of haemophilia. The hereditary disorder is characterized by a high tendency to haemorrhages, with recurrent bleeding into the joints causing irreversible joint damage. The model is, in general, an attempt to answer the following questions: what is the effect of haemophilia on the well-being (i.e. satisfaction, health, somatic complaints and self-esteem) of patients and what is the additional or mediating role of other individual characteristics in this pathway? Disease severity, joint impairment and disability are defined as antecedents of well-being and the mediating roles of appraisal (i.e. the personal evaluation of the disease), health beliefs (i.e. locus of control), psychological characteristics (i.e. anxiety, anger, depression and optimism) and social support are investigated. Psychological variables turned out to be the strongest determinants of well-being and partly mediated the detrimental effect of disability on well-being. The role of appraisal remained somewhat unclear, as no significant relationship was established between this personal evaluation of haemophilia and well-being. Nevertheless, appraisal very well reflected the level of disability. An internal locus of control and favourable psychological characteristics appeared to reduce the perceived seriousness of haemophilia. No evidence was found for social support to act as a mediator between disability and well-being. The perception of support did show moderately strong associations with psychological characteristics (i.e. anxiety and depression) and satisfaction ratings. The study merits further research on quantifying the relationships between clinical parameters and psychosocial outcomes in patients with a chronic disease.

Effects of Pulmonary Rehabilitation on Physiologic and Psychosocial Outcomes in Patients With Chronic Obstructive Pulmonary Disease

Objective: To compare the effects of comprehensive pulmonary rehabilitation with those of education alone on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary dis...

Effects of Pulmonary Rehabilitation on Physiologic and Psychosocial Outcomes in Patients with Chronic Obstructive Pulmonary Disease

To compare the effects of comprehensive pulmonary rehabilitation with those of education alone on physiologic and psychosocial outcomes in patients with chronic obstructive pulmonary disease. Randomized clinical trial. University medical center. 119 outpatients with chronic obstructive pulmonary disease that was stable while patients received a standard medical regimen. Patients were randomly assigned to either an 8-week comprehensive pulmonary rehabilitation program or to an 8-week education program. Pulmonary rehabilitation consisted of twelve 4-hour sessions that included education, physical and respiratory care instruction, psychosocial support, and supervised exercise training. Monthly reinforcement sessions were held for 1 year. The education group attended four 2-hour sessions that included video-tapes, lectures, and discussions but not individual instruction or exercise training. Pulmonary function, maximum exercise tolerance and endurance, gas exchange, symptoms of perceived breathlessness and muscle fatigue with exercise, shortness of breath, self-efficacy for walking, depression, general quality of well-being, and hospitalizations associated with pulmonary diseases. Patients were followed for 6 years. Compared with education alone, comprehensive pulmonary rehabilitation produced a significantly greater increase in maximal exercise tolerance (+1.5 metabolic equivalents [METS] compared with +0.6 METS [P < 0.001]; maximal oxygen uptake, +0.11 L/min compared with +0.03 L/min [P = 0.06]), exercise endurance (+10.5 minutes compared with +1.3 minutes [P < 0.001]), symptoms of perceived breathlessness (score of -1.5 compared with +0.2 [P < 0.001]) and muscle fatigue (score of -1.4 compared with -0.2 [P < 0.01]), shortness of breath (score of -7.0 compared with +0.6 [P < 0.01]), and self-efficacy for walking (score of +1.4 compared with +0.1 [P < 0.05]). There were slight but nonsignificant differences in survival (67% compared with 56% [P = 0.32]) and duration of hospital stay (-2.4 days/patient per year compared with +1.3 days/patient per year [P = 0.20]). Measures of lung function, depression, and general quality of life did not differ between groups. Differences tended to diminish after 1 year of follow-up. Comprehensive pulmonary rehabilitation significantly improved exercise performance and symptoms for patients with moderate to severe chronic obstructive pulmonary disease. Benefits were partially maintained for at least 1 year and tended to diminish after that time.

Course and outcome in bipolar affective disorder: a longitudinal follow- up study

A number of recent studies have questioned whether, despite modern treatment, the natural course of bipolar illness today still involves multiple relapses and impaired psychosocial functioning. This prospective follow-up study examined longitudinal outcome in a large group of inpatients with affective disorders. Fifty-one bipolar manic patients and 49 unipolar depressed patients were interviewed three times: 1) during hospitalization, 2) approximately 2 years after discharge, and 3) approximately 4.5 years after discharge. Subjects were treated under routine conditions and assessed for global adjustment, rehospitalization, and work and social functioning. Only 41% of the bipolar group had a good overall outcome by the time of the 4.5-year follow-up. The bipolar patients had more severe work impairment than the unipolar group. More than one-half of the bipolar patients were rehospitalized at least once during the 4.5-year follow-up period. Outcome for both diagnostic groups improved significantly over time. Many contemporary bipolar patients demonstrate gradual improvement in the first several years after hospitalization. However, a subgroup approaching 60% still experience poor posthospital adjustment in one or more areas of functioning.

Comorbidity in psychosis at first hospitalization.

The authors sought to determine the prevalence and effects of medical and psychiatric comorbidity on initial outcome in a group of patients experiencing a first episode of psychosis. Patients with a first episode of psychosis who were consecutively admitted to a hospital (N = 102) were examined for the presence of psychiatric and medical disorders. Patients were given psychiatric diagnoses with the use of the Structured Clinical Interview for DSM-III-R and were rated weekly on symptom rating scales. Outcome variables at discharge were final symptom rating scale scores, length of hospitalization, and recovery on the basis of operationalized criteria. Comorbid diagnoses were present in 52.0% (N = 53) of the patients, and 37.7% (N = 20) had multiple comorbid diagnoses. The most common comorbid diagnosis was substance abuse. Patients with affected psychoses were significantly more likely than those with nonaffective psychoses to have a comorbid substance abuse diagnosis. Patients with psychiatric comorbidity had poorer initial outcomes, while those with medical comorbidity had fewer symptoms at discharge. Comorbidity is common and may be a useful predictor of the outcome of a first episode of psychosis.

Psychosocial outcome in patients with moderate to severe head injury: 2-year follow-up.

Psychosocial outcome and recovery of a group of 31 consecutive adult patients with moderate to severe head injuries were prospectively investigated over a 2-year period. A friend control group was used for comparison purposes. We conclude that moderate and severe head injuries have a significant long-term impact on psychosocial functioning. More specifically, although there is an increase over time in the number of subjects who resume former levels of activity, many moderate to severely head-injured people remain unable to work, support themselves financially, live independently and participate in pre-injury leisure activities at least up to 2 years post-injury. Initially, self-perceived limitations in everyday functioning are widespread, with physical functioning being of primary concern. Over time, there is improvement in both physical and psychosocial areas. However, in spite of improvement, difficulties in psychosocial functioning become dominant later due to greater improvement in the physical area. This study gives no evidence of general increase in emotional distress with increasing time since injury.

Psychosocial outcome of patients with amygdalohippocampectomy

We examined the quality of life of 90 patients who underwent the microsurgical procedure of selective amygdalohippocampectomy (AHE) for treatment of medically intractable complex partial seizures. The variables—psychosocial adjustment, personal career, and family support—were analyzed. These variables were then correlated with the postoperative seizure outcome, the preoperative duration of seizures, and the amount of tissue resected during surgery. A significant positive correlation was found between seizure outcome and psychosocial outcome. However, there was no significant correlation between seizure outcome and personal career outcome, although the trend was seen that a better personal career is associated with a better seizure outcome. The better the functional outcome was, the shorter the preoperative duration of seizure illness. Regarding the resected amount of tissue, it was observed that the postoperative psychosocial outcome was better in patients who had a more radical removal of the parahippocampal gyrus, irrespective of the total amount of tissue resected. We conclude that complete postoperative seizure control is the most important single variable predicting psychosocial outcome.

Quality of life in chronic dialysis patients: Factors unrelated to dialysis modality

The quality of life (medical, psychological, and social adaptation) of 66 chronic dialysis patients was studied crosssectionally. The participants had similar levels of medical, psychological, and social adaptation to those found in previous studies of chronic dialysis patients. Medical, psychological, and social adaptation are independent dimensions that are only weakly intercorrelated. When categorized by specific individual or treatment characteristics, men and those over age 51 had poorer medical and psychological adaptation than did women and younger dialysis patients. Duration of dialysis was not related to quality of life. Vocationally active as compared to vocationally inactive subjects had generally superior medical, psychological, and social adaptation. Male sex, age over 51, and vocational inactivity are all associated with poorer dialysis patient adaptation. The development of profiles of groups of dialysis patients at increased risk for poor adaptation may help in targetting scarce psychosocial intervention resources. Studies of the psychosocial efficacy of differing treatment modalities need to consider non-treatment-related factors that may effect patient psychosocial outcomes.

Predictors of interepisode symptoms and relapse in affective disorder patients treated with lithium carbonate

For 98 affective disorder patients receiving lithium prophylaxis for a mean of 45 months, number of interepisode symptoms correlated with relapse rate. Response to prophylaxis appeared highly determined by prelithium frequency of episodes and duration of lithium treatment.