Range Of Impaired Functioning Tool Research Articles

A randomised controlled trial of a mitochondrial therapeutic target for bipolar depression: mitochondrial agents, N-acetylcysteine, and placebo

BackgroundA phasic dysregulation of mitochondrial bioenergetics may operate in bipolar disorder, increased in mania and decreased in depression. We aimed to examine efficacy of two add-on treatments in bipolar depression: N-acetylcysteine (NAC) and NAC with a combination of nutraceutical agents that may increase mitochondrial biogenesis.MethodsA three-arm 16-week, double-blind, randomised, placebo-controlled trial, adjunctive to usual treatment, was conducted. Participants (n = 181) with bipolar disorder and current depressive symptoms were randomised to 2000 mg/day NAC (n = 59), 2000 mg/day NAC with the combination nutraceutical treatment (CT, n = 61), or placebo (n = 61). The primary outcome was change in Montgomery-Åsberg Depression Rating Scale (MADRS) total score from baseline to week 16. Young Mania Rating Scale, Clinical Global Impression (CGI)-Improvement and CGI-Severity scales, Patient Global Impression scale, Social and Occupational Functioning Assessment Scale (SOFAS), Longitudinal Interval Follow-Up Evaluation - Range of Impaired Functioning Tool (LIFE-RIFT), and Quality of Life Enjoyment, and Satisfaction Questionnaire Short Form (Q-LES-Q-SF) were secondary outcomes.ResultsOne hundred forty-eight participants had post-randomisation data and were analysed (NAC = 52, CT = 47, Placebo = 49). No between-group differences were found for the rate of change between baseline and 16 weeks on any of the clinical and functioning variables. Improvements in MADRS, BDRS, SOFAS, and LIFE-RIFT scores from baseline to the week 20 post-discontinuation visit were significantly greater in the CT group compared to those in the placebo. At week 20, the CGI-I was significantly lower in the CT group versus placebo. Gastrointestinal symptoms were significantly greater in the NAC than in the placebo group.ConclusionsThese overall negative results, with no significant differences between groups detected at the primary outcome but some positive secondary signals, suggest either delayed benefit of the combination or an improvement of symptoms on withdrawal which warrants further exploration regarding the composition, mechanisms, and application of mitochondrial agents in illnesses characterised by mitochondrial dysfunction.Trial registrationANZCTR (ACTRN12612000830897).

Adjunctive minocycline treatment for major depressive disorder: A proof of concept trial.

Conventional antidepressant treatments result in symptom remission in 30% of those treated for major depressive disorder, raising the need for effective adjunctive therapies. Inflammation has an established role in the pathophysiology of major depressive disorder, and minocycline has been shown to modify the immune-inflammatory processes and also reduce oxidative stress and promote neuronal growth. This double-blind, randomised, placebo-controlled trial examined adjunctive minocycline (200 mg/day, in addition to treatment as usual) for major depressive disorder. This double-blind, randomised, placebo-controlled trial investigated 200 mg/day adjunctive minocycline (in addition to treatment as usual) for major depressive disorder. A total of 71 adults with major depressive disorder ( Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition) were randomised to this 12-week trial. Outcome measures included the Montgomery-Asberg Depression Rating Scale (primary outcome), Clinical Global Impression-Improvement and Clinical Global Impression-Severity, Hamilton Anxiety Rating Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, Social and Occupational Functioning Scale and the Range of Impaired Functioning Tool. The study was registered on the Australian and New Zealand Clinical Trials Register: www.anzctr.org.au , #ACTRN12612000283875. Based on mixed-methods repeated measures analysis of variance at week 12, there was no significant difference in Montgomery-Asberg Depression Rating Scale scores between groups. However, there were significant differences, favouring the minocycline group at week 12 for Clinical Global Impression-Improvement score - effect size (95% confidence interval) = -0.62 [-1.8, -0.3], p = 0.02; Quality of Life Enjoyment and Satisfaction Questionnaire score - effect size (confidence interval) = -0.12 [0.0, 0.2], p < 0.001; and Social and Occupational Functioning Scale and the Range of Impaired Functioning Tool score - 0.79 [-4.5, -1.4], p < 0.001. These effects remained at follow-up (week 16), and Patient Global Impression also became significant, effect size (confidence interval) = 0.57 [-1.7, -0.4], p = 0.017. While the primary outcome was not significant, the improvements in other comprehensive clinical measures suggest that minocycline may be a useful adjunct to improve global experience, functioning and quality of life in people with major depressive disorder. Further studies are warranted to confirm the potential of this accessible agent to optimise treatment outcomes.

DSM-IV post-traumatic stress disorder among World Trade Center responders 11-13 years after the disaster of 11 September 2001 (9/11).

Post-traumatic symptomatology is one of the signature effects of the pernicious exposures endured by responders to the World Trade Center (WTC) disaster of 11 September 2001 (9/11), but the long-term extent of diagnosed Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) post-traumatic stress disorder (PTSD) and its impact on quality of life are unknown. This study examines the extent of DSM-IV PTSD 11-13 years after the disaster in WTC responders, its symptom profiles and trajectories, and associations of active, remitted and partial PTSD with exposures, physical health and psychosocial well-being. Master's-level psychologists administered sections of the Structured Clinical Interview for DSM-IV and the Range of Impaired Functioning Tool to 3231 responders monitored at the Stony Brook University World Trade Center Health Program. The PTSD Checklist (PCL) and current medical symptoms were obtained at each visit. In all, 9.7% had current, 7.9% remitted, and 5.9% partial WTC-PTSD. Among those with active PTSD, avoidance and hyperarousal symptoms were most commonly, and flashbacks least commonly, reported. Trajectories of symptom severity across monitoring visits showed a modestly increasing slope for active and decelerating slope for remitted PTSD. WTC exposures, especially death and human remains, were strongly associated with PTSD. After adjusting for exposure and critical risk factors, including hazardous drinking and co-morbid depression, PTSD was strongly associated with health and well-being, especially dissatisfaction with life. This is the first study to demonstrate the extent and correlates of long-term DSM-IV PTSD among responders. Although most proved resilient, there remains a sizable subgroup in need of continued treatment in the second decade after 9/11.

Protocol and rationale-the efficacy of minocycline as an adjunctive treatment for major depressive disorder: a double blind, randomised, placebo controlled trial.

While current pharmacotherapies are efficacious, there remain a clear shortfall between symptom remission and functional recovery. With the explosion in our understanding of the biology of these disorders, the time is ripe for the investigation of novel therapies. Recently depression is conceptualized as an immune-inflammatory and nitro-oxidative stress related disorder. Minocycline is a tetracycline antibiotic that has anti-inflammatory, pro-oxidant, glutamatergic, neurotrophic and neuroprotective properties that make it a viable target to explore as a new therapy. This double blind, randomised, placebo controlled adjunctive trial will investigate the benefits of 200 mg/day of minocycline treatment, in addition to any usual treatment, as an adjunctive treatment for moderate-severe major depressive disorder. Sixty adults are being randomised to 12 weeks of treatment (with a 4 week follow-up post-discontinuation). The primary outcome measure for the study is mean change on the Montgomery-Asberg Depression Rating Scale (MADRS), with secondary outcomes including the Social and Occupational Functioning Assessment Scale (SOFAS), Clinical Global Impressions (CGI), Hamilton Rating Scale for Anxiety (HAM-A), Patient Global Impression (PGI), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and Range of Impaired Functioning Tool (LIFE-RIFT). Biomarker analyses will also be conducted at baseline and week 12. The study has the potential to provide new treatment targets, both by showing efficacy with a new class of 'antidepressant' but also through the analysis of biomarkers that may further inform our understanding of the pathophysiology of unipolar depression.

Psychosocial Functioning in Depressive Patients: A Comparative Study between Major Depressive Disorder and Bipolar Affective Disorder.

Introduction. Major depressive disorder (MDD) and bipolar affective disorder (BAD) are among the leading causes of disability. These are often associated with widespread impairments in all domains of functioning including relational, occupational, and social. The main aim of the study was to examine and compare nature and extent of psychosocial impairment of patients with MDD and BAD during depressive phase. Methodology. 96 patients (48 in MDD group and 48 in BAD group) were included in the study. Patients were recruited in depressive phase (moderate to severe depression). Patients having age outside 18–45 years, psychotic symptoms, mental retardation, and current comorbid medical or axis-1 psychiatric disorder were excluded. Psychosocial functioning was assessed using Range of Impaired Functioning Tool (LIFE-RIFT). Results. Domains of work, interpersonal relationship, life satisfaction, and recreation were all affected in both groups, but the groups showed significant difference in global psychosocial functioning score only (P = 0.031) with BAD group showing more severe impairment. Conclusion. Bipolar depression causes higher global psychosocial impairment than unipolar depression.

COMPLICATED GRIEF SYMPTOMS IN ANXIETY DISORDERS: PREVALENCE AND ASSOCIATED IMPAIRMENT

Previous research has identified high rates of comorbid anxiety disorders among individuals presenting with primary CG. In the present study, we examined the prevalence of comorbid CG in bereaved primary anxiety disorder (AD) patients compared to bereaved healthy controls. We also examined the impairment associated with comorbid CG in AD. Participants were 242 bereaved adults (mean (SD) age = 41.5 (13.1), 44.2% women) with a primary AD diagnosis, including generalized anxiety disorder (GAD; n = 57), panic disorder (PD; n = 49), posttraumatic stress disorder (PTSD; n = 29), and generalized social anxiety disorder (GSAD; n = 107), as well as 155 bereaved healthy controls with no current DSM-IV Axis I diagnosis (mean (SD) age = 43.0 (13.6), 51.0% women). CG symptoms were measured using the 19-item inventory of complicated grief (ICG), with threshold CG defined as an ICG score of ≥30. Quality of life and functional impairment were assessed with the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Range of Impaired Functioning Tool (LIFE-RIFT), respectively. Participants with primary ADs had significantly higher rates of threshold CG symptoms than bereaved controls (12.0% vs. 0.65%; Fisher's Exact P < 0.001). Rates of threshold CG were significantly elevated for each AD when compared to bereaved controls. After adjustment for age, sex, education, and comorbid major depressive disorder, threshold CG was associated with lower quality of life (β = -0.140, P = 0.023) and greater impairment (β = 0.141, P = 0.035) among individuals with AD. Our findings suggest that threshold CG is of clinical relevance in bereaved individuals with a primary anxiety disorder. Screening for CG in patients with ADs may be warranted.

Change in psychosocial functioning and depressive symptoms during acute-phase cognitive therapy for depression

Major depressive disorder (MDD) is highly prevalent, is recurrent, and impairs people's work, relationships and leisure. Acute-phase treatments improve psychosocial impairment associated with MDD, but how these improvements occur is unclear. In this study, we tested the hypotheses that reductions in depressive symptoms exceed, precede and predict improvements in psychosocial functioning. Patients with recurrent MDD (n=523; 68% women, 81% Caucasian, mean age 42 years) received acute-phase cognitive therapy (CT). We measured functioning and symptom severity with the Social Adjustment Scale - Self-Report (SAS-SR), Range of Impaired Functioning Tool (RIFT), Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HAMD) and Inventory for Depressive Symptomatology - Self-Report (IDS-SR). We tested cross-lagged correlations between functioning and symptoms measured at baseline and the beginning, middle and end of acute-phase CT. Pre- to post-treatment improvement in psychosocial functioning and depressive symptoms was large and intercorrelated. Depressive symptoms improved more and sooner than did psychosocial functioning. However, among four assessments across the course of treatment, improvements in functioning more strongly predicted later improvement in symptoms than vice versa. Improvements in psychosocial functioning and depressive symptoms correlate substantially during acute-phase CT, and improvements in functioning may play a role in subsequent symptom reduction during acute-phase CT.

Predictors of early adulthood quality of life in children with obsessive-compulsive disorder.

The goal of this study was to determine childhood clinical predictors of quality of life (QoL) in early adulthood in children with obsessive-compulsive disorder (OCD). A longitudinal cohort study was conducted with 36 (out of 62 eligible) children with OCD, interviewed once at childhood baseline (mean age 12.1±2.1, range 8.0-15.8), and again in early adulthood after an average follow-up interval of 9years. QoL was measured in adulthood with the longitudinal interval follow-up evaluation range of impaired functioning tool (LIFE-RIFT). Forty-two percent of children experienced a remission of OCD symptoms by early adulthood. OCD appeared to most strongly impair the interpersonal relationships and work domains of QoL. QoL and severity of OCD and anxiety symptoms were significantly associated in early adulthood. Primary hoarding symptoms in childhood predicted poor QoL in adulthood. Increased symptoms in the forbidden thoughts dimension in both childhood and adulthood were associated with improved adulthood QoL. Children for whom OCD symptoms remitted by adulthood showed no evidence of residual impairment in QoL, whereas children whose OCD symptoms failed to remit by adulthood showed at most mild impairment in QoL. Hoarding symptoms in childhood appear to portend not only the persistence of OCD symptoms but also poorer QoL in early adulthood.

Occupational functioning and impairment in adults with body dysmorphic disorder

Objective Body dysmorphic disorder (BDD) is relatively common and appears to be associated with marked impairment in psychosocial functioning. Previous reports, however, did not investigate occupational functioning in detail, assess impairment specifically in occupational functioning using standardized measures in a nontreatment seeking sample, or examine correlates of occupational impairment. Methods Occupational functioning and other clinical variables were assessed in 141 adults with BDD. Measures included the Range of Impaired Functioning Tool and other reliable and valid self-report and interviewer-administered measures. Results Fewer than half of subjects were working full-time, and 22.7% were receiving disability pay. Thirty-nine percent of the sample reported not working in the past month because of psychopathology. Of those subjects who worked in the past month, 79.7% reported impairment in work functioning because of psychopathology. Adults with BDD who were not working because of psychopathology were comparable to subjects who were working in most demographic variables, delusionality of BDD beliefs, and duration of BDD. However, compared to subjects who worked in the past month, those not currently working because of psychopathology had more severe BDD and more chronic BDD. They also were more likely to be male, had less education, and had more severe depressive symptoms, a higher rate of certain comorbid disorders, poorer current social functioning and quality of life, a higher rate of lifetime suicidality, and were more likely to have been psychiatrically hospitalized. Conclusions A high proportion of individuals with BDD were unable to work because of psychopathology; most who worked reported impairment in occupational functioning. Certain clinical variables, including more severe and chronic BDD, were associated with not working.

Deterioration in psychosocial functioning predicts relapse/recurrence after cognitive therapy for depression

BackgroundAssociations between major depressive disorder (MDD) and psychosocial functioning are incompletely understood across time and during continuation phase cognitive therapy (C-CT). We examined the validity of the Range of Impaired Functioning Tool (RIFT; [Leon, A.C., Solomon, D.A., Mueller, T.I., Turvey, C.L., Endicott, J., Keller, M.B., 1999. The Range of Impaired Functioning Tool (LIFE-RIFT): A brief measure of functional impairment. Psychol. Med. 29, 869–878.]) as a measure of psychosocial functioning and its relations to depressive symptoms in C-CT and assessment-only control conditions. MethodsOutpatients with recurrent MDD who responded to acute-phase cognitive therapy (A-CT) were randomized to 8 months of C-CT (n=41) or assessment-only (n=43) and followed 16 additional months [Jarrett, R.B., Kraft, D., Doyle, J., Foster, B.M., Eaves, G.G., Silver, P.C., 2001. Preventing recurrent depression using cognitive therapy with and without a continuation phase: A randomized clinical trial. Arch. Gen. Psychiatry 58, 381–388.]. Interviewers rated depressive symptoms and psychosocial functioning monthly. Patients completed additional self-reports. ResultsThe RIFT converged appropriately with other measures of psychosocial functioning, depressive symptoms, cognitive content, and personality. About half (55%) of patients were psychosocially “well” (RIFT≤8) during the first month post-A-CT. C-CT improved psychosocial functioning only transiently compared to the assessment control. Examined prospectively, depressive symptom level did not predict monthly changes in psychosocial functioning significantly, whereas psychosocial dysfunction level predicted monthly changes in depressive symptoms and relapse/recurrence. LimitationsFindings may not generalize to other patient populations, treatments, and assessment methods. The cross-lagged correlational data structure allows only tentative conclusions about the causal effect of psychosocial functioning on depressive symptoms. ConclusionsThe RIFT is a valid measure of psychosocial functioning among responders to A-CT for depression. After such response, deteriorations in psychosocial functioning may signal imminent major depressive relapse/recurrence and provide targets for change during treatments focused on relapse/recurrence prevention.

Functional impairment in body dysmorphic disorder: A prospective, follow-up study

Cross-sectional/retrospective studies indicate that individuals with body dysmorphic disorder (BDD) have markedly impaired psychosocial functioning. However, no study has prospectively examined functioning in BDD. In this study, which is to our knowledge the first prospective study of the course of BDD, psychosocial functioning was assessed at baseline and over 1–3 years (mean = 2.7 ± 0.9 years) of follow-up with the Global Assessment of Functioning scale (GAF), Social and Occupational Functioning Scale (SOFAS), and LIFE-RIFT (Range of Impaired Functioning Tool). Psychosocial functioning was poor during the follow-up period. Functioning remained stably poor over time on the SOFAS and LIFE-RIFT, although there was a trend for a gradual and slight improvement on the GAF over time. The cumulative probability of attaining functional remission on the GAF (score > 70 for at least 2 consecutive months) during the follow-up period was only 5.7%. On the SOFAS, the cumulative probability of attaining functional remission (score > 70 for at least 2 consecutive months) was 10.6%. BDD severity significantly predicted functioning on the GAF ( p = 0.0012), SOFAS ( p = 0.0017), and LIFE-RIFT ( p = 0.0015). A trend for a time-by-BDD severity interaction was found on the GAF ( p = 0.033) but not the SOFAS or LIFE-RIFT. More delusional BDD symptoms also predicted poorer functioning on all measures, although this finding was no longer significant when controlling for BDD severity. Functioning was not predicted, however, by age, gender, BDD duration, or a personality disorder. In conclusion, psychosocial functioning was poor over time, and few subjects attained functional remission. Greater BDD severity predicted poorer functioning.

Impact of obsessive-compulsive disorder on quality of life

Background Although obsessive-compulsive disorder (OCD) has been found to be the 10th leading cause of disability of all medical conditions in the industrialized world, comparatively little is known about psychosocial functioning and quality of life (QOL) in OCD, particularly with regard to their relationship with symptom severity. Method Quality of life and psychosocial function of 197 adults were assessed as part of a larger intake interview for a 5-year prospective study of OCD course. Two self-report measures (the Quality of Life Enjoyment and the Medical Outcomes Survey 36-Item Short-Form Health Survey) and 2 clinician-rated measures (the Range of Impaired Functioning Tool and the Social and Occupational Functioning Assessment Scale), each with established reliability and validity, were administered. Symptom severity was assessed with the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Results Quality of life was significantly impaired compared with published community norms with large effect sizes found for all domains assessed. The correlations ( r) between all QOL measures and the YBOCS total score were significant, ranging from 0.40 to 0.77. Correlations between the YBOCS obsessions subscore and QOL measures were higher than those found between the YBOCS compulsions subscore and QOL. Insight as measured by the Brown Assessment of Beliefs Scale was significantly correlated with 5 of the 7 measures, although more modestly than the YBOCS correlations ( r = 0.22 to 0.37). Subjects with a YBOCS score of 20 or higher had significant decline in QOL compared with those subjects with YBOCS scores lower than 20. Severity of obsessions and depressive symptoms, as well as marital status, were significant predictors of impairment in QOL. Conclusions These findings indicate that all aspects of QOL are markedly affected in individuals with OCD and are associated with OCD severity (particularly obsessional severity) and depression severity. Exploratory results suggest that QOL and psychosocial functioning begins to be more significantly affected at YBOCS scores higher than 20. This score might be considered as a threshold criterion for OCD for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Psychosocial functioning and quality of life in body dysmorphic disorder

Psychosocial functioning and quality of life in body dysmorphic disorder (BDD) have received only limited investigation. We examined these domains in 176 subjects with current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), BDD using reliable measures, several of which have not been used previously in BDD studies. Scores were compared to published norms. On the Medical Outcomes Study 36-Item Short-Form Health Survey, mental health–related quality of life scores for BDD subjects were approximately 1.8 SD units poorer than US population norms and 0.4 SD units poorer than norms for depression. On the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form, BDD subjects had a mean converted score of 49.9% ± 16.4%, which was 2.1 SD units poorer than the normative community sample score of 78.1% ± 13.7%. On the Social Adjustment Scale—Self-Report, BDD subjects had a mean Overall Adjustment total score of 2.37 ± 0.52, which was 2.4 SD units poorer than the published norm of 1.59 ± 0.33. Scores on the Range of Impaired Functioning Tool reflected functional impairment in all domains. More severe BDD symptoms were significantly associated with poorer functioning and quality of life on all measures. On all but one measure, functioning and quality of life for subjects who were not currently receiving mental health treatment did not significantly differ from those who were receiving treatment. These findings indicate that individuals with BDD, regardless of treatment status, have markedly poor functioning and quality of life. In addition, they suggest that treatment should aim at improving functioning and quality of life in addition to relieving symptoms.

Substance Use Disorders in Individuals With Body Dysmorphic Disorder

Little is known about substance use disorders (SUDs) in individuals with body dysmorphic disorder (BDD). Although studies have examined SUD comorbidity in BDD, no previous studies have examined clinical correlates of SUD comorbidity. We examined rates and clinical correlates of comorbid SUDs in 176 consecutive subjects with DSM-IV BDD (71% female; mean +/- SD age = 32.5 +/- 12.3 years). Comorbidity data were obtained with the Structured Clinical Interview for DSM-IV. BDD severity was assessed with the Yale-Brown Obsessive Compulsive Scale Modified for BDD, and delusionality (insight) was assessed with the Brown Assessment of Beliefs Scale. Quality of life and social/occupational functioning were examined using the Social Adjustment Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, Medical Outcomes Study 36-Item Short-Form Health Survey, and Range of Impaired Functioning Tool. All variables were compared in BDD subjects with and without lifetime and current SUDs. Data were collected from January 2001 to June 2003. 48.9% of BDD subjects (N = 86) had a lifetime SUD, 29.5% had lifetime substance abuse, and 35.8% had lifetime substance dependence (most commonly, alcohol dependence [29.0%]). 17% (N = 30) had current substance abuse or dependence (9.1% reported current substance abuse, and 9.7% reported current dependence). 68% of subjects with a lifetime SUD reported that BDD contributed to their SUD. There were far more similarities than differences between subjects with a comorbid SUD and those without an SUD, although those with a lifetime SUD had a significantly higher rate of suicide attempts (p = .004). These preliminary results suggest that SUDs are very common in individuals with BDD. Subjects with and without a comorbid SUD were similar in most domains that were examined.

Care satisfaction, hope, and life functioning among adults with bipolar disorder: data from the first 1000 participants in the Systematic Treatment Enhancement Program

Objective The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is designed to evaluate the longitudinal outcome of patients with bipolar disorder. The STEP-BD disease-management model is built on evidence-based practices and a collaborative care approach designed to maximize specific and nonspecific treatment mechanisms. This prospective study examined the longitudinal relationships between patients' satisfaction with care, levels of hope, and life functioning in the first 1000 patients to enter STEP-BD. Methods The study used scores from the Care Satisfaction Questionnaire, Beck Hopelessness Scale, Range of Impaired Functioning Tool, Young Mania Rating Scale, and Montgomery-Åsberg Depression Rating Scale at 5 time points during a 1-year interval. Analyses tested mediational pathways between care satisfaction, hope, and life functioning, depression, and mania using mixed-effects (random and fixed) regression models. Results Increases in care satisfaction were associated with decreased hopelessness ( P < .01) but not related to symptoms of depression or mania. Similarly, decreased hopelessness was associated with better life functioning ( P < .01) but not related to symptoms of depression or mania. Depression was independently associated with poorer life functioning ( P < .0001). Conclusions This study provided support for the hypothesized mediational pathway between care satisfaction, hopelessness, and life functioning. Findings suggest that providing care that maximizes patient hope may be important. By so doing, patients might overcome the learned helplessness/hopelessness that often accompanies a cyclical illness and build a realistic illness-management strategy.

Relationships among psychosocial functioning, diagnostic comorbidity, and the recurrence of generalized anxiety disorder, panic disorder, and major depression

The present study examined the relationships among impaired psychosocial functioning, comorbidity, and the cumulative probability of future recurrence of anxiety disorders and major depression in recovered patients. Participants were part of the Harvard/Brown Anxiety Disorders Research Program (HARP), a naturalistic, prospective, longitudinal study of anxiety disorders in psychiatric outpatients. Using proportional hazards regressions, worsening psychosocial impairment in general and in specific areas was significantly associated with an increased risk of panic disorder, generalized anxiety disorder, and major depression recurring, even after controlling for diagnostic comorbidity. These results are consistent with and extend similar findings for patients with major depression [Leon, A., Solomon, D. A., Mueller, T. I., Endicott, J., Posternak, M., Judd, L. L., et al. (1999). The range of Impaired Functioning Tool (LIFE-RIFT): a brief measure of functional impairment. Psychological Medicine, 29, 869–878; Leon, A., Solomon, D. A., Mueller, T. I., Endicott, J., Posternak, M., Judd, L. L., et al. (2000). A brief assessment of psychosocial functioning of subjects with bipolar I disorder: The LIFE-RIFT. The Journal of Nervous and Mental Disease, 188, 805–812], and suggest that increased psychosocial impairment may be a risk factor for relapse.

A brief assessment of psychosocial functioning of subjects with bipolar I disorder: the LIFE-RIFT. Longitudinal Interval Follow-up Evaluation-Range Impaired Functioning Tool.

Those afflicted with bipolar disorder often suffer from substantial functional impairment both when in episode and when in remission. This study examined the psychometric properties of a brief assessment of psychosocial functioning, the Range of Impaired Functioning Tool (LIFE-RIFT), among subjects with bipolar I disorder. The study sample consisted of 163 subjects who presented with bipolar I disorder at intake into the NIMH Collaborative Depression Study (CDS). All LIFE-RIFT items come from the Longitudinal Interval Follow-up Evaluation (LIFE). Follow-up data that were used to examine the reliability and validity of the scale come from assessments of psychosocial functioning that were conducted 6, 12, 18, and 24 months after intake into the CDS. The results of factor analyses indicate that the scale items are measures of one construct, psychosocial functioning. The interrater agreement on the scale score was very good with an intraclass correlation coefficient was 0.94. The internal consistency reliability among the scale items was uniformly satisfactory over the four assessment periods, with coefficient alpha ranging from 0.78 to 0.84. Mixed-effect regression analyses showed that during mood episodes subjects were significantly more impaired than those in recovery. In conclusion, the psychometric properties of the LIFE-RIFT were examined in subjects with bipolar I disorder. The analyses from this longitudinal, observational study provide empirical support for the reliability and validity of the scale. The LIFE-RIFT provides a brief, inexpensive alternative to scales currently used to assess psychosocial functioning and can be easily added to semistructured assessments that are used in clinical and treatment outcome studies.

The Range of Impaired Functioning Tool (LIFE-RIFT): a brief measure of functional impairment.

The literature documents that functional impairment is associated with affective disorders. Nevertheless, the choice among thorough, yet brief, well-validated assessments of functional impairment is limited. The objective of this study was to evaluate the psychometric properties of a brief scale of functional impairment, the Range of Impaired Functioning Tool (LIFE-RIFT). The study sample included subjects who presented with major depressive disorder at intake into the NIMH Collaborative Depression Study (CDS). The LIFE-RIFT is composed of items that are included in the Longitudinal Interval Follow-up Evaluation (LIFE). The reliability and validity were examined using data from LIFE-RIFT assessments conducted at four points in time: 6, 12, 18 and 24 months after intake into the CDS. Cross-sectional one factor models accounted for the covariance structure among the four scale items. A longitudinal factor model, with an invariant factor structure over time, also fitted the data well and indicated that the scale items are measures of one construct, namely functional impairment. The internal consistency reliability of the scale was supported with alpha coefficients ranging from 0.81 to 0.83. The inter-rater reliability intraclass correlation coefficient (ICC) was 0.94. Mixed-effect linear regression models showed that those in episode were significantly more impaired than those in recovery. Furthermore, in analyses of predictive validity, impairment was positively associated with subsequent recurrence and negatively associated with subsequent recovery. This psychometric evaluation provides empirical support for the reliability and validity of the LIFE-RIFT, a brief measure of functional impairment.

Obsessive compulsive disorder: update in treatment possibilities

Although obsessive-compulsive disorder (OCD) has been found to be the 10th leading cause of disability of all medical conditions in the industrialized world, comparatively little is known about psychosocial functioning and quality of life (QOL) in OCD, particularly with regard to their relationship with symptom severity.Quality of life and psychosocial function of 197 adults were assessed as part of a larger intake interview for a 5-year prospective study of OCD course. Two self-report measures (the Quality of Life Enjoyment and the Medical Outcomes Survey 36-Item Short-Form Health Survey) and 2 clinician-rated measures (the Range of Impaired Functioning Tool and the Social and Occupational Functioning Assessment Scale), each with established reliability and validity, were administered. Symptom severity was assessed with the Yale-Brown Obsessive-Compulsive Scale (YBOCS).Quality of life was significantly impaired compared with published community norms with large effect sizes found for all domains assessed. The correlations (r) between all QOL measures and the YBOCS total score were significant, ranging from 0.40 to 0.77. Correlations between the YBOCS obsessions subscore and QOL measures were higher than those found between the YBOCS compulsions subscore and QOL. Insight as measured by the Brown Assessment of Beliefs Scale was significantly correlated with 5 of the 7 measures, although more modestly than the YBOCS correlations (r = 0.22 to 0.37). Subjects with a YBOCS score of 20 or higher had significant decline in QOL compared with those subjects with YBOCS scores lower than 20. Severity of obsessions and depressive symptoms, as well as marital status, were significant predictors of impairment in QOL.These findings indicate that all aspects of QOL are markedly affected in individuals with OCD and are associated with OCD severity (particularly obsessional severity) and depression severity. Exploratory results suggest that QOL and psychosocial functioning begins to be more significantly affected at YBOCS scores higher than 20. This score might be considered as a threshold criterion for OCD for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.