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Chronic pain and functional impairment associated with temporomandibular joint (TMJ) disorders (TMD) considerably reduce oral health-related quality of life (OHRQoL). In the present study we have assessed the influence of prolotherapy in patients with TMD by the subjective measurement of QoL using the Oral Health Impact Profile-14 (OHIP-14). Twenty-five patients diagnosed with TMD (mean (range) age 38 (18 - 70) years) were included. They had all undergone dextrose prolotherapy to the TMJ at regular time intervals (four times at intervals of two weeks) using the method suggested by Hemwall-Hackett. They were asked to answer the OHIP-14 questionnaire before and two years after prolotherapy. Seven domains of OHRQoL were rated on a 5-point Likert scale from 0 (never) to 4 (very often). Domain scores and total OHIP-14 scores were compared using inferential statistics (chi squared and Wilcoxon signed rank tests). Prolotherapy was effective over time, as all the domains' mean scores decreased considerably after treatment. The total mean score before prolotherapy was 21.20, which was extensively reduced to 13.08 after prolotherapy (p=0.001). There was statistically significant improvement in all domains, including functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap (p≤0.005 in all cases). We concluded that prolotherapy has a promising role in the improvement of OHRQoL of patients with TMD, and its beneficial effects persist at least two years after treatment.

OBJECTIVE The aim of this study was to compare the effectiveness of two types of treatment (counselling programme versus counselling programme plus jaw exercises) to improve the quality of life of patients with disc displacement with reduction (DDWR). MATERIALS AND METHODS Patients were divided into two groups. The test group received guidelines for temporomandibular disorders (TMD) plus jaw exercises for DDWR, and the control group received only guidelines for TMD. The total number of investigated patients was 70, thus 35 per group. The oral health-related quality of life was assessed by the OHIP-14 questionnaire. Both groups were evaluated at the baseline and 30 days post-treatment. RESULTS In the counselling group, there was statistically significant decrease in pain (P = .015) and social disability (P = .046) subscales. In the counselling plus jaw exercise group, there was statistically significant decrease in all subscales (P

INTRODUCTION This paper analyses the correlations between scores on scales assessing impairment, psychological distress, disability, and quality of life in patients with peripheral facial palsy (PFP). MATERIAL AND METHODS We conducted a retrospective cross-sectional study including 30 patients in whom PFP had not resolved completely. We used tools for assessing impairment (Sunnybrook Facial Grading System [FGS]), psychological distress (Hospital Anxiety and Depression Scale [HADS]), disability (Facial Disability Index [FDI]), and quality of life (Facial Clinimetric Evaluation [FaCE] scale). RESULTS We found no correlations between FGS and HADS scores, or between FGS and FDI social function scores. However, we did find a correlation between FGS and FDI physical function scores (r=0.54; P

Aim: This prospective controlled clinical study aimed to evaluate the effect of botulinum toxin Type A (BTX-A) on pain control and quality of life (QoL) in patients with chronic myofascial pain. Materials & methods: Patients with chronic myofascial pain were randomly divided into two groups (n = 20): counseling and self-care and Michigan-type occlusal splint (MOS) (CG-control group) or BTX-A injection (BTX-AG). The pain was evaluated with visual analogue scale and QoL with the oral health impact profile-14 (OHIP-14) questionnaire. Results: In both groups, the pain was reduced, and QoL improved after 30 days. The results of social disability and handicap were better for patients treated with counseling and self-care and MOS. Conclusion: Minimally invasive strategies and BTX-A application improved QoL and alleviated myofascial pain.

X‐linked hypophosphataemia (XLH) and osteogenesis imperfecta (OI) are rare congenital disorders characterised by skeletal dysplasia. The two disorders may include dental anomalies potentially affecting individual well‐being. The aims of study were (a) to assess the oral health‐related quality of life (OHRQoL) in Danish adults with XLH or OI, and (b) to compare the results of the groups. A cross‐sectional study including 35 adults with XLH, 56 adults with OI type I and 17 adults with OI types III‐IV was conducted. The OHRQoL was assessed by the 49‐item version of the questionnaire Oral Health Impact Profile (OHIP). Summed domain scores (seven) were compared between XLH and OI groups. Prevalence of severe impact on OHRQoL (scores 3‐4) was compared between groups. The median scores in XLH group exceeded the medians in OI (P

Hearing impairment is a common chronic condition in middle-aged and elderly adults. The number of individuals with hearing impairment is expected to rise because of the longer life expectancies and trends in the population growth. Acquired hearing impairment in adulthood is not just a disorder of the sense of hearing. It is primarily a social disability because its handicapping effect is experienced in interaction with other people. This paper aims to explore how the repair of problems in hearing is initiated by hearing-impaired individuals with acquired mild to severe hearing impairment. By using the method of conversation analysis (CA), this paper examines the occurrence of other-initiations of repair (OIR) and how it is typically resolved in actual mundane interaction. In addition, this paper reveals the challenges and the impact of hearing impairment as the state of hearing deteriorates. This article argues that the frequency of OIR in mild hearing impairment does not differ from normally hearing individuals. However, in a more severe grade of hearing impairment, the OIR sequences are longer, more frequent, multimodal and may require more vigilance from the normally-hearing conversation partner. Implications for counselling are suggested.

Pain is one of the most common reasons that patients access the health care system and if not managed appropriately can lead to a multitude of adverse consequences. Pain presents as a barrier for both the patient and the physician. For the patient, it is a major source of physical disability, emotional distress, functional limitation and social disability. For the physician it is challenging from a clinical assessment standpoint and finding an appropriate management strategy. There is a high prevalence of hospitalized medical patients with psychiatric and behavioral health disorders (Pezzia et al., BMC Health Serv Res 18(1):336, 2018). Assessment and treatment of pain is particularly complex for patients with mental health issues, but it is encountered so often as mental illnesses and pain frequently co-occur (Dewar, J Psychosoc Nurs 45(7):8–9, 2007; Gatchel, Am Psychol 59(8):795–805, 2004). Therefore, a comprehensive, multimodal treatment plan, individualized to each patient is required and increases the opportunities for successful treatment. In this chapter, we review prevalence of pain in hospitalized patients with psychiatric illness.

Objectives Dental implant treatment (DIT) improves peoples’ oral health-related quality of life (OHQoL). Assessment of longitudinal changes in OHRQoL may be undermined by response shift (RS). RS is the process by which quality of life changes, independent of health status as a result recalibration, reprioritization or reconceptualization. Thus, this study aimed to describe RS in the OHRQoL and perceived oral health of individuals receiving DIT and to compare the then-test, a self-anchored scale and the classification and regression trees (CRT) approaches for assessing RS. Methods OHRQoL was assessed in 100 patients receiving DIT using the OHIP-Edent (n = 100) and a self-anchored scale (n = 45) before placement of the final restoration and 3 to 6 months after treatment was completed. The OHIP-Edent was also used as a retrospective assessment at follow-up. CRT examined changes in the OHIP-Edent total score as a dependent variable with global changes in oral health and each OHIP-Edent subscale score as independent variables. Results OHRQoL and perceived oral health improved after treatment. The OHIP-Edent score decreased from 36.4 at baseline to 12.7 after treatment. On average, participants recalibrated their internal standard downwards (− 4.0 OHIP-Edent points). CRT detected downwards recalibration in 5% of participants and upwards in 15%. Reprioritization was observed in the social disability and psychological discomfort aspects of OHRQoL. Conclusions RS affects longitudinal assessments of OHRQoL in DIT, reducing the apparent magnitude of change. The then-test and CRT are valid and complementary methods to assess RS.

Objectives: the aims of this study were the development of a novel questionnaire to assess the impact of prosthetic treatments on oral health-related quality of life (OHRQoL) and the performance of a prospective pilot study. Background: the currently preferred OHRQoL measurement tool is the oral health impact profile-49 (OHIP-49), a self-report questionnaire which mainly focuses on general effects related to oral health. Materials and methods: A total of 24 adult participants (9 females and 15 males) were recruited and asked to complete the novel questionnaire twice: once before the prosthetic treatment began and 4&ndash, 6 weeks post-treatment. The assessment of the change in OHRQoL was based on the differences in participants&rsquo, answers before and after treatment. Data were analyzed using ANOVA with a repeated-measures method and t-tests. The reliability of the questionnaire was tested using Cronbach&rsquo, s alpha and intraclass coefficient (ICC). Results: The questionnaire was found to be reliable (&alpha, &ge, 0.6), with &ldquo, social disability&rdquo, having the highest score (&alpha, = 0.868). All domains showed an improvement (&alpha, &lt, 0.005) in OHRQoL scores after treatment. Conclusions: the novel questionnaire tested in this study was found to be reliable and convenient to use, and demonstrated that prosthetic treatments have a significant positive effect on OHRQoL post-treatment scores.

Objectives Knowledge about self-rated disability over time in psychotic disorders is limited. How self-rated disability relates to clinician-rated global functioning, self-rated life satisfaction and symptomatology was investigated across the first year of treatment in early psychosis. Methods Participants with first treated episode of psychosis (n = 115) were investigated at baseline and 1-year follow-up. Self-rated Disability was measured with World Health Organization- Disability Assessment Schedule 2.0. Clinician-rated global functioning, self-rated life satisfaction, and symptomatology were measured with appropriate scales. Results Average self-rated disability in first-treated episode of psychosis was high, corresponding with the 10% highest in a general population sample. However, 37% were not disabled at a clinically significant level after one year. Self-rated disability was highest in the two social domains (Getting along with people and Participation in society), but improved significantly from baseline to 1-year. At 1-year follow-up self-rated disability had significant weak to medium correlations with clinician-rated global functioning and positive symptoms, and mainly medium to strong correlations with life satisfaction and depressive symptoms. Yet only baseline depression significantly predicted disability after one year. Conclusion Self-rated disability in first treated episode of psychosis is high, but improves across the first year, indicating signs of early recovery. Moreover, self-rated disability is related, but distinct from clinician-rated global functioning and self-rated life satisfaction, suggesting that self-rated disability should also be assessed in order to more fully describe outcomes in first episode psychosis. The findings highlight the need for specialised treatment of depression and social disability in early psychosis.

Chronic cerebral ischemia is a common problem especially among the elderly. It gradually leads to social disability and invalidisation of those patients. One of the possible pathogenic mechanisms of this condition is the endothelial dysfunction. Thus, the attempt to repair the latter is one of the treatment goals. It is assumed that actovegin improves tissue microcirculation by expanding precapillary zone – the main marker of the metabolic activity in the microvascular endothelium. Actovegin activates anaerobic metabolism and oxygenation in endotheliocytes. Patients, treated by actovegin, showed improvement of cognitive functions and psycho-emotional state. Due to the absence of proteins, the drug has good tolerance and low toxicity.

Objective Estimate predictive associations of marital status with social dysfunction in schizophrenia patients. Methods 817 schizophrenia patients lived in the community of Dongguan, Guangdong province, China, were investigated with the Social Disability Screening Schedule (SDSS) during a three-month period (1.2010–3.2010). The demographic data were harvested. The χ2 test, t test, and fisher's exact were used for comparisons between groups, as appropriate. Multinomial logistic regression (MLR) was used to analyze the predictive associations of demographic variables to the grading of social dysfunctions. Results The study group consisted of male and female patients aged 16–59 years, 407 females, and 410 males with the mean age (40.7 ± 9.5) years. Analysis of the data revealed significant differences in course of disease and marital status among patients (with and without dysfunction). The married patient made a significant difference with divorced/widowed patient in mildly–moderately social dysfunction. There was a significant difference in married and never-married patient with mildly and profoundly social dysfunction. Significant differences were noticed in the self care and occupational roles of the married patient with that of the never-married. Conclusion This study confirmed that bad marital status is associated with higher odds of social dysfunction among patients with schizophrenia living in the community. These effects should be included in considerations of public health investments in preventing and treating mental disorders.

Anorectal malformations are an important group of congenital anomalies that vary widely in their anatomical characteristics and complexity. Understanding the long-term functional outcomes after modern treatments, and how these compare to the general population, are essential for ensuring that patients receive optimal, evidence-based care. With increasing appreciation of the wider impact of the illness on patients and their families, minimizing social disability from fecal incontinence and enabling normal social integration from the outset are key management concerns. This review summarizes the current knowledge on the functional outcomes by type of malformation, reflecting on the literature, and our institutional experience over a follow-up period of nearly 30 years. (C) 2017 Elsevier Inc. All rights reserved.

SUMMARYIntroduction.Cognitive dysfunction is one of the main comorbidities of epilepsy which co-exists with seizures and contributes to the adverse impact of the disease on employment, education and interpersonal relationships. A fundamental question regarding cognitive dysfunction in epilepsy goes as follows: in comparison to seizures, what role does cognitive dysfunction play in causing social disability? The purpose of this review was to evaluate our understanding of the role cognitive impairment plays in social disability in persons with epilepsy (PWE). We systematically searched the medical literature and identified studies which assessed the impact of seizures and cognitive function on some aspect of social disability in PWE.Results and Discussion.We identified 12 studies which adequately measured all variables in non-surgical cohorts, and 9 studies of cohorts following epilepsy surgery. We found evidence from non-surgical and from surgical series that cognitive variables strongly correlate with levels of social disability.Conclusions.We conclude that efforts to better understand the origins of cognitive dysfunction in epilepsy and subsequently at developing treatment modalities will be needed in order to reduce the degree of social disability caused by the condition.

Objective: This study aimed to evaluate oral health-related quality of life (OHRQOL) changes following third molar surgery, and investigate demographic and clinical variables’ effect on (OHRQOL) in the first postoperative week. Methods: 45 subjects had surgical removal of lower third molar/s by one surgeonat Jordan University hospital from March 2011 to November 2011, following a standardized protocol. Patients’ demographics and clinical data were recorded. (OHRQOL) was evaluated before surgery using the Oral Health Impact Profile (OHIP)-14. On postoperative days (PD) 1, 3, 5 and 7, patients completed the (OHIP)-14 & the condition-specific (HRQOL) instrument. Results: A significant deterioration in OHRQOL was seen on (PD)1(P=0.000), and (PD)3 (P=0.000), except for psychological discomfort and disability domains. On (PD)5, no difference was found, however, females had significantly lower OHRQOL levels than males on (OHIP)-14 (P=0.008) and the domains: physical (P=0.048), psychological (P=0.016) and social disability(P=0.018). Conclusions: Third molar surgery was associated with deterioration in patients’ OHRQOL on the first three postoperative days. Females had a slower recovery, with no effect of other factors on patients’ recovery pattern.

Foram estudados os transtornos psiquiátricos em ações previdenciárias contra o INSS em uma vara federal de São José dos Campos no período de um ano a fim de conhecer as patologias de maior prevalência e o perfil profissional de quem busca a justiça para auxílio previdenciário e aposentadoria. Um perfil sociológico bem definido se sobressaiu na pesquisa, sugerindo que transtornos afetivos em homens adultos com fracos elos psicossociais é causa frequente de incapacidade labora Le social.

Objetivo. Analizar las demandas de atención de los tras­tornos mentales graves (TMG) y factores asociados con la utilización de servicios en México. Material y métodos. Se llevó a cabo un estudio analítico transversal en dos fases: la primera con una base de datos nacional de servicios disponibles y su utilización; la segunda, una muestra de regis­tros médicos de un hospital psiquiátrico. Resultados. La esquizofrenia es el TMG más prevalente; más de 50% de hos­pitalizados fueron hombres, con edad promedio 37 años. La utilización de servicios estuvo asociada con la edad (β=1.062; p=.000), ingreso familiar (β=1.000, p=.000) y no tener ocupa­ción (β=3.407; p=.000). La población con esquizofrenia tiene cuatro veces más la probabilidad de requerir estar exenta de pago (β=4.158; p=.000). Conclusiones. La población con TMG es más vulnerable por la discapacidad funcional y social asociada; requiere de intervenciones específicas de salud acompañadas de una política de protección financiera adaptada a sus necesidades de atención.

Background. In connection with the challenges of modernity, PTSD is a serious problem of general and especially military psychiatry. The diagnosis of "PTSD" is, in the first place, etiologically determined, but both "developmental and clinical assessment of this condition" have such "non-medical" factors as social and family-associated ones. Method. The research material is modern publications devoted to the study of socio-psychological, family and social factors that play a role in shaping PTSD and influence the use of this diagnosis when inspecting. The research method is bibliographic-analytical. Results. According to North American authors, the number of firefighters who received disabilities due to PTSD increased from 1999 to 2004 by 79.5%, while the disability due to other diseases among them grew by only 12 2%. Social disability policy encourages military personnel to receive psychiatric diagnoses, primarily PTSD. In society, the diagnosis of PTSD is often used to justify criminal behavior. Another problem lies in the fact that another part of the military personnel, on the contrary, hide the symptoms of PTSD, fearing the everyday stigmatization of the “mentally ill” and undermining their careers. In addition to societal factors affecting the use of the PTSD diagnosis, important non-medical factors are family aspects of military personnel. The development of PTSD and its transition to the prolonged form are negatively affected by the absence of military personnel at home for more than six months, the impossibility of remote communication with loved ones during the hostilities, the absence of a family, and family-like, ironically, the presence of children in the family. Conclusion. Due to the influence of socially-associated factors, there are certain parts of military personnel involved in the hostilities, one of which is prone to simulating or aggravating the symptoms of PTSD, and the second, on the contrary, is prone to dissimulation of post-stress psychopathological symptoms. Among family factors that should be considered as opportunistic, special attention should be paid to the lack of the possibility of remote communication with relatives during stay in the combat zone, the absence of military personnel at home for more than six months, and the presence of military personnel in their families. To improve the quality of diagnostic and rehabilitation work, it is necessary to conduct a scientifically grounded adaptation of modern foreign psychological tests aimed at diagnosing PTSD and developing specific domestic techniques as soon as possible.

Ninety-nine neurotic patients from a controlled trial of CPN v. psychiatric out-patient aftercare were followed up seven years later. Of the 92 survivors, 76 were successfully interviewed. Few differences were found between the groups. Chronic mild symptoms and moderate social disability persisted, and tended to worsen a little. Treatment patterns persisted for one to two years beyond the original study; the CPN group had more CPN contacts, fewer psychiatric out-patient contacts and less psychiatric care. Thereafter, more out-patients were discharged from psychiatric care and care patterns for the two groups became similar. Out-patients attended more non-psychiatric out-patient clinics than the CPN group, but it is possible that this reflected pre-existing differences. About a third of patients remained in contact with the psychiatric service during follow-up.

There is growing interest in measuring social disability as a core element of autism spectrum disorders in medication trials. We conducted a secondary analysis on the Aberrant Behavior Checklist Social Withdrawal subscale using data from two federally-funded, multi-site, randomized trials with risperidone. Study 1 included 52 subjects assigned to placebo and 49 subjects to risperidone under double-blind conditions. Study 2 included 49 subjects assigned to risperidone only and 75 subjects assigned to risperidone plus parent training. After 8 weeks of treatment, all active treatments were superior to placebo (effect sizes ranging from 0.42 to 0.65). The findings suggest that the Social Withdrawal subscale may be a useful measure of social disability in acute treatment trials.

Epilepsy is a complex disorder that is commonly associated with additional brain dysfunction, social isolation and vocational difficulty. Each of these factors may contribute to the increased prevalence of psychiatric illness in epilepsy, but emerging evidence is providing a more complete and clearer elucidation of the problem. Clinical investigations have consistently demonstrated that depression has a large impact on subjective health status. In patients with recurrent seizures, depression appears to have a stronger association with quality of life than does seizure rate. In fact, depression is second only to medication toxicity as the clinical factor that explains the greatest variance in quality of life. Only a small number of studies have investigated the plausible neurobiological mechanisms of depression in epilepsy, but preliminary data suggest that underlying brain dysfunction may be a more important predictor than vocational or social disability. Furthermore, specific aspects of hippocampal dysfunction may be a causal factor in the genesis and maintenance of depression in temporal-lobe epilepsy. Current treatment recommendations for depression in epilepsy are similar to those for otherwise neurologically normal depressed patients, emphasizing the role of serotonin reuptake inhibitors, but certain antidepressants should be used with caution. Ongoing studies are attempting to define optimal treatment strategies and more definitive data, to guide clinical management, are expected to become available in the near future.

Introduction/Background Hypermetric tremor, from cerebellar origin, directly relate to iterative hypermetria by delayed antagonist correction at each movement, is a frequent neurological disorder, which can cause significant functional and social disability. Nowadays, the clinical evaluation of tremors relies mainly on subjective rating tools. The purpose of the study was to develop quantitative markers of hypermetric tremor of the upper limb to help clinicians with diagnosis, follow-up and assessment of treatment effects. Material and method We prospectively analyzed data from two volumetric tests (30 seconds and 5 table-to-mouth tests), a device for evaluating rapid alternating pronosupination movements “the Hand Tapper” (large/small movements ratios) and spiralography (number of spikes per turn and symmetry coefficient). We compared these parameters in three populations: 18 patients (age: 63 ± 16 years) with upper limb cerebellar tremor, 15 patients with Parkinson's disease with predominant tremor (67 ± 7 years) and 18 healthy subjects (age: 63 ± 15 years). Results At the volumetric tests, the height of remaining water is measured in the polystyrene cup (90 mm height) after each test. For the 30 seconds posture test (H30): cerebellar = 41.2 ± 8.5 mm, parkinson = 82.9 ± 4.5 mm, healthy subjects = 90.0 ± 0.0 mm, (P cerebellar vs parkinson = 2 × 10−5) and for the 5 table-to-mouth back and forth movements test (HX5): cerebellar = 27.3 ± 7.6 mm, parkinson = 88.7 ± 0.3 mm, healthy subjects = 89.9 ± 0.1 mm (P cerebellar vs parkinson = 10−11). At the “Hand Tapper”, the large/small pronosupination movements ratios (L/S) were: cerebellar = 65.0 ± 4.6%, parkinson = 50.2 ± 2.2%, healthy subjects = 47.9 ± 3.0% (P cerebellar vs parkinson = 0.01). At the spiralography, the number of spikes per turn were: cerebellar = 10.7 ± 1.7; parkinson 6.1 ± 1.3; healthy subjects = 2.0 ± 0.3 (P cerebellar vs parkinson = 0.03). Conclusion The height of remaining water on volumetric tests, L/S ratios with Hand Tapper, and the number of spicules on spiralography seem to be representative markers of cerebellar hypermetry, compared to “parkinsonism”. Explorations of diagnostic performances of these parameters and correlations with the severity of the tremor will be the subject of a future analysis.

Summary Objective To determine if any characteristics exist in baseline data collected from chiropractic patients attending a private chiropractic practice that might predict success with chiropractic treatment. Design Prospective cohort study. Subjects Seven hundred and eighty-eight patients with low back pain (LBP) eligible for chiropractic treatment attending a private chiropractic clinic. Methods Baseline Bournemouth Questionnaire (BQ) scores were collected together with patient gender and duration of symptoms. Outcomes were BQ scores and Patient Global Impression of Change (PGIC) scores at 4 and 12 weeks. Patients were categorised as ‘better’ if they chose the top two items of the scale. Odds ratios (OR) were calculated to detect potential predictors of outcome. Results Baseline BQ scores were higher in acute patients with females tending to score higher particularly in depression. Around 74% of patients get better at 4 weeks with a statistically and clinically significant drop of 27 points on the BQ. Further improvement was minimal up to 12 weeks. Having low back pain for less than 4 weeks reduced the risk of poor recovery at 4 and 12 weeks [OR 0.56 (95% CI 0.36–0.88) and 0.41 (95% CI 0.26–0.67)]. In this group low depression scores were also associated with better outcomes in male patients [OR 0.1 (95% CI 0.01–0.55)] while low social disability scores were associated with better outcomes in females [OR 0.1 (95% CI 0.01–0.94)]. Conclusion Different subgroups of LBP patients that are likely to succeed with chiropractic intervention can be identified using routinely collected data in a chiropractic practice. Duration of symptoms, found here as a predictor, is in agreement with other larger studies although some predictors are unique to this practice population. Further research is needed exploring the possible differences between patients with different duration of other conditions and the potential influence of gender.

Bipolar disorder is a recurring, often chronic, illness characterised by periods of mania and depression with variable inter-episode recovery. For the majority of patients it is the depressive component of this illness that contributes to most of the associated morbidity, social disability and mortality. Research and clinical experience suggest that acute treatment and prevention of depressive episodes is by far the most challenging aspect of the care of patients with the disorder. This review examines the contribution of depression to the course and outcome of bipolar disorder as well as diagnostic difficulties that often complicate treatment and may lead to inappropriate medication. Key studies that form the evidence base of treatment recommendation for bipolar depression are presented and areas of therapeutic uncertainty are highlighted.

Background: The percentages of patients with acute low back pain (LBP) that go on to a chronic state varies between studies from 2% to 34%. In some of these cases low back pain leads to great costs. Aims: To evaluate the evidence for prognostic factors for return to work among workers sick listed with acute LBP. Methods: Systematic literature search with a quality assessment of studies, assessment of levels of evidence for all factors, and pooling of effect sizes. Results: Inclusion of studies in the review was restricted to inception cohort studies of workers with LBP on sick leave for less than six weeks, with the outcome measured in absolute terms, relative terms, survival curve, or duration of sick leave. Of the studies, 18 publications (14 cohorts) fulfilled all inclusion criteria. One low quality study, four moderate quality studies, and nine high quality studies were identified; 79 prognostic factors were studied and grouped in eight categories for which the evidence was assessed. Conclusions: Specific LBP, higher disability levels, older age, female gender, more social dysfunction and more social isolation, heavier work, and receiving higher compensation were identified as predictors for a longer duration of sick leave. A history of LBP, job satisfaction, educational level, marital status, number of dependants, smoking, working more than 8 hour shifts, occupation, and size of industry or company do not influence duration of sick leave due to LBP. Many different constructs were measured to identify psychosocial predictors of long term sick leave, which made it impossible to determine the role of these factors.

SummaryObjective– Many different factors, both related to the individual and illness (“intrinsic” factors) and to the environment (“extrinsic” factors), contribute in different ways to the development of disability. Basing on data of literature, this review focuses the main “intrinsic” factors predicting disability in schizophrenia.Method– A systematic search on Mediline of all papers published during the period 1965-2001 was performed, using “schizophrenia”, “outcome”, “psychosocial outcome”, “social disability” and “social adjustment” as key words. Only papers reporting specifically data about predictive factors and psychosocial outcome variables were considered; prospective follow-up studies were considered, but retrospective and cross-sectional studies were also taken into account when data deriving from prospective studies were inconsistent.Results– Male sex predicts a higher disability among demographic factors; lower social and occupational adjustment are premorbid personality factors associated with higher disability; among factors related to illness, younger age at onset of illess, “nuclear”, “non paranoid” and in particular “deficit” forms of schizophrenia seem to predict more disability. The latter seems to be predicted also by higher levels of negative symptoms and neuropsychological deficits ; the role of depressive symptoms seems to be less supported by follow-up data; a continuous course of the illness predicts more disability, although some evidences show a progressive reduction of disability, at least in the long term.Conclusions– Disability shows a largely autonomous course respect to symptoms and has to be considered an independent parameter of outcome. Few intrinsic factors show a predictive role also in the long term.

Depression is one of the most prevalent disorders in the general population, causing personal and social disability and impairment. Major studies assessing the diagnosis and management of depression have shown that it is often underdiagnosed and undertreated. A pan-European study aimed at assessing the extent and consequences of depression in six different countries is reported in this article. Different types of depressive profiles are analyzed and their respective management has been compared. The importance of improving diagnosis and treatment of depression is underlined. Appropriate management of depression depends on the recognition of depressive symptoms by patients, their possibility of seeking care, and the ability of the primary care physician to recognize the disorder and prescribe the appropriate medicines. Improvement in all of these fields is necessary.

IntroductionStuttering constitutes for children a psychological and social disability, in which the environmental context plays an important role in the installation, stabilization and aggravation or attenuation.ObjectiveOur study aims to describe the socio-familial characteristics of children with stuttering.Patients and methodsThis is a descriptive and analytical-retrospective study carried out on 80 children with stuttering and had been followed-up in the child psychiatry department of UMC Hédi Chaker Sfax (Tunisia) for more than 3 years (January 2012 to 31 December 2013).ResultsIn our study, the prevalence of stuttering in child psychiatry consultation department of Sfax is 4%. Most of the patients were either the youngest (36.25% of cases) or seniors (35% of cases).Personal history of speech disorder had been reported in 8 children (10% of cases). Family history of speech disorder was reported in 33.75% of cases. These disorders had been kind of stuttering in 60.66% of cases, speech delay in 18.52% of cases and sound speech disorder in 7.41% of cases.The parent–child relationship is marked by a parental rigidity in 18.6% of cases. The existence of triggering factor was noted in 37.5% of cases: traumatic situation (30% of cases), the birth of a younger sibling (22% case).ConclusionThe emergence and evolution of stuttering depend on predisposing, precipitating and chronicisants factors. Identifying these factors and adopting a favorable parental attitude contribute to the fight against stuttering in children and, at least, avoid aggravation and chronicity of this disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

In the WHO study on Psychological Problems in General Health Care (WHO-PPGHC), a random sample of 5438 patients from 15 international centres were investigated to study prevalence and type of mental disorders by use of standardized methods. Using the General Health Questionnaire, 9.7% of the practice attenders admitted that they have or recently had suicidal ideations. In a logistic regression analysis, predictors of suicidal ideation were hopelessness, presence of an ICD-10 diagnosis, social disability in terms of occupational role functioning and daily routine, and lack of social adaptation in terms of lower age and being less educated. The predictors are discussed in an explanatory model of suicidal ideation in general healthcare. Implications for patient care in general healthcare are discussed.

Objective. The aim of this open-label 8-week study was to assess the effectiveness of quetiapine on aggressive behaviour and social dysfunctions in patients suffering from a cluster B personality disorder (DSM-IV). Methods. The visits were performed at baseline and at days 14, 28 and 56. After a standard titration schedule, the patients received a dose augmented or reduced dose, within a range from 50 to 400 mg/day during the visits, depending on efficacy and tolerance. Assessment of efficacy was based on the French version of the Social Disability and Aggression Scale SDAS (SDAS-21). Response was defined as a decrease of ≥50% reduction of the total scores compared to baseline. Tolerability was assessed with the CGI, UKU, EPS-scales. Results and conclusion. Eight of the 12 patients included received 200 mg/day quetiapine after titration (all patients: 50-400 mg/day). At week 8, five out of 12 patients were responders based on the SDAS-21 scores for the average expression of the symptoms, and six out of 12 on the basis of SDAS-21 scores for the peak expression. There was a significant correlation between weight change and total SDAS variation (Kendall's τb= -0.644; p=0.02). These findings should be reexamined in further studies.

Fetal alcohol spectrum disorders, characterized by emotional, behavioral, cognitive and/or social disability, is an important condition to those providing mental health treatment worldwide. With no safe level of alcohol consumption found during pregnancy, symptoms at the severe end of the spectrum c

The population characteristics of people with severe and enduring mental health problems living in 'high support' Health and Local Authority (LA) residential facilities were compared in this survey of social functioning and psychiatric symptomatology. The survey was intended to assist in local service planning, particularly in the targeting of relatively high cost provision. A cross-sectional survey of all 62 residents of the three Local Authority hostels was conducted and compared to an earlier survey of 76 residents living in seven NHS residential facilities. Residents of NHS facilities were found to have poorer social functioning than LA residents; had more physical health problems; had higher levels of behaviour problems and risk behaviours which were both rated as more serious in terms of their effect on community tenure. The survey's findings were consistent with the results of other surveys of the characteristics of people considered 'hard to place' in the community as a result of mental health pro...

Background Oral lichen planus (OLP) can seriously affect the quality of life of patients because it has a strong impact on social relations, psychological status and daily activities. Objective To study the quality of life using the Oral Health Impact Profile (OHIP-49) (validated Spanish version) in patients with OLP. Patients and methods A total of 74 patients with a minimum age of 18 years who had lichen planus were recruited into the study, along with 74 ‘healthy’ subjects matched by sex and age who acted as control. Both groups completed the OHIP-49. Results Higher scores were obtained on the OHIP-49 index in patients with OLP for all the subgroups and for the overall total than in the control group. Furthermore, there were statistically significant differences in the items concerning psychological discomfort, social disability and handicap in patients with OLP. Conclusions The study shows that the quality of life in patients with OLP is reduced and that patient-centred measures should be considered in the management of patients with OLP.

INTRODUCTION: Acne represents a common problem which is capable of producing clinical and psychological scarring. The following paper reviews the psychological problems and clinical scarring that might arise from acne, summarises the recognised psychological questionnaires that might help in the assessment of any psychosocial disability and examines the need for early therapy. CONCLUSIONS: Treating acne early on in the disease's course appears to reduce the clinical scars that may ensue. Effective therapy for acne may also reduce psychological and social disability. (J Dermatol Treat (2000) 11:3–6)

The purpose of this paper was to examine and present attention deficit hyperactivity disorder (ADHD) as a social disability. The overall outcomes from the literature indicate how children with ADHD and social disability display similar behavior patterns (e.g., conduct disorders, attention problems, and difficulties in family functioning). Other difficulties found with ADHD children were low self-esteem, bad reputations among peers, conflicts in friendships, problems in social skills, and difficulty in overcoming self-centeredness in social skills. Early identification of social disability, however, may result in provision of preventative services, such as suggested parent and mentor methods, and maximization of the chances for positive experiences in school, extracurricular activities, and the neighborhood. These services are recommended, and success depends on effort and consistent implementation of procedures.

The frequency and type of psychological problems of outpatients in general healthcare settings, the recognition and management of those problems by physicians, and the course of the problems were investigated using a two-stage sampling design method. The subjects were outpatients visiting the department of internal medicine of two general hospitals in Nagasaki prefecture. For the first-stage investigation, the General Health Questionnaire 12-item version (GHQ-12) was used. A second-stage investigation was then conducted, which used many instruments containing the Composite International Diagnostic Interview (CIDI) and Groningen Social Disability Scale (GSDS). As a result, 1555 patients participated in the first-stage, 483 were selected and 336 (69.5%) participated in the second-stage investigation. No significant differences were seen in age or sex between the GHQ score groups among the 1555 subjects of the core sample. The background factors of the two hospital samples differed significantly in the distribution of age, sex and physical diseases. There were some differences in the participation between men and women in age and GHQ score. It was then suggested that variances should be considered in such an epidemiological study.

BackgroundCommunity care for people with psychosis can be provided via several different service models. The study compared two models: standard community treatment with high patient:staff ratios, and intensive community treatment in which there was more of an emphasis on community involvement and lower patient:staff ratios.MethodAll people fulfilling diagnostic criteria for psychosis and living in two defined geographical areas in south London were identified. These people were provided with either an intensive or standard service depending on their address. Their social behaviour and symptoms were measured at the beginning of the study and after two years.ResultsThere is little evidence of any effects of the two service models on levels of symptoms. However, the standard service did seem to be advantageous in reducing social disability for those with medium or low levels of disability.ConclusionsThe effect of intensive community services was the opposite to that predicted. Despite improvements in outcomes (e.g. hospital admission), there were no advantages for this type of service in the measures of disability or symptoms. In fact, the standard service was effective in reducing disability, whereas in the intensive service there was no change.

Oral malodor is a significant social disability which usually has a local cause, particularly arising from the oral flora. Malodor may arise from the lingual or periodontal flora, gram-negative anaerobes being the main organisms capable of releasing sulphur compounds from the putrefaction of debris and other material. Volatile sulphur compounds, cadaverine and other substances appear responsible for much of the malodor. Systemic disease may underlie some cases of oral malodor. The objective assessment of malodor is still best performed by the human sense of smell (organoleptic method) but more quantifiable measures are being developed.

This study examines educational/occupational outcome and social functioning of adolescents treated for psychosis (mean onset age 16.1 yrs +/- 1.3). In a sample of 157 subjects, 26 patients with schizoaffective episodes (defined as any episode meeting ICD-9 criteria for schizoaffective psychosis, occurring at any time during the course of illness) were compared to 101 patients with schizophrenia, and to 30 affective disordered patients, all without schizoaffective episodes. Follow-up information (mean interval 7.3 yrs +/- 4.3) was obtained on 130 subjects. The three groups did not differ concerning sex, duration of first inpatient treatment, symptoms and social competence at discharge, nor at follow-up. At the time of outcome subjects with schizoaffective episodes showed greater similarities to schizophrenic than to severe affective disorder. Educational and occupational impairment was found in 72% of the schizoaffective group (schizophrenic group 79%, affective group 40%), obvious or more severe social disability in 86% of the schizoaffective group (schizophrenic 79%, affective 40%). Disabilities regarding performance of specific social roles and specific downward educational and occupational drifts were found to be more marked in schizoaffective than in affective disorder. Implications for further research and clinical practice are discussed.

Society has asked physicians to serve as gatekeepers for certain social welfare benefits through the determination of disability. The medical determination of disability rests on the distinction between medical impairment and social disability. This distinction cannot be established rationally in chronic low back pain patients. Determination of disability therefore rests covertly on nonscientific factors. Attribution of low back pain disability to an underlying disease often magnifies disability. Medical education and compensation programs both need a better understanding of the social origins of disability, if the rising tide of disability due to low back pain is to be stemmed.

Objective: To assess the extent to which ceasing the use of cannabis or other substances reduces the symptoms and social disability associated with psychotic illness. Methods: The electronic databases CINAHL, EMBASE, MEDLINE and PsycINFO were searched for peer-reviewed publications in English that report data about the characteristics of current and former substance-using patients diagnosed with psychotic illnesses. The searches yielded 328 articles, of which 23 studies met the inclusion criteria. Four key outcome variables; positive symptoms, negative symptoms, ratings of depression and global function, and five other measures of outcome that were reported in five or more studies were examined using meta-analysis. Results: Current substance-using patients were significantly younger than former substance-using patients (standardised mean difference (SMD) = −0.38), but did not differ in age at onset of psychosis, sex, level of education or marital status. Current substance users had higher scores on rating scales of positive symptoms (SMD = 0.29) and depression (SMD = 0.36), and lower scores on global function (SMD = −0.26) when compared with former substance users. There was a significant improvement in the ratings of positive symptoms, mood and global function among patients who stopped using substances during the first episode of psychosis, while improvements in the symptoms of patients with a more established psychotic illness did not reach statistical significance. Conclusion: The results suggest that substance use contributes to both the symptoms and the burden of disability experienced by patients with psychosis. Patients in the early stages of psychotic illness should be informed about the benefits of giving up substances earlier, rather than later in the illness. Psychiatric services should regard the treatment of substance use as an integral part of the treatment of psychotic disorders.

A national survey of psychiatric morbidity was carried out to estimate the prevalence of psychiatric morbidity among adults aged 16–64 in Great Britain, the nature and extent of associated social disability, the nature and extent of comorbidity, use of services, and to investigate recent precipitating factors of illness and their association with different lifestyles. Ten thousand adults living in private households were asked the revised Clinical Interview Schedule (CIS-R). Attempts were also made to estimate the prevalence of psychosis, drug, and alcohol dependence. The sample was designed to be nationally representative and interviewing procedures aimed at maximising response and producing high quality data.

BackgroundThis paper examined the hypothesis that males with first-episode psychosis (FEP) experience lower pre-morbid adjustment, greater social disability and more self-perceived needs at illness onset than females (by controlling for duration of untreated psychosis, diagnosis, age and symptoms at onset). Results disconfirming this hypothesis were thought to suggest the potentially mediating role of social context in determining the impact of symptoms and disability on the everyday lives of male patients in the early phase of psychosis.MethodA large epidemiologically representative cohort of FEP patients (n=517) was assessed within the Psychosis Incident Cohort Outcome Study (PICOS) framework – a multi-site research project examining incident cases of psychosis in Italy's Veneto region.ResultsDespite poorer pre-morbid functioning and higher social disability at illness onset, males reported fewer unmet needs in the functioning domain than females did. An analysis of help provided by informal caregivers showed that males received more help from their families than females did. This finding led us to disconfirm the second part of the hypothesis and suggest that the impact of poorer social performance and unmet needs on everyday life observed in male patients might be hampered by higher tolerance and more support within the family context.ConclusionsThese findings shed new light on rarely investigated sociocultural and contextual factors that may account for the observed discrepancy between social disability and needs for care in FEP patients. They also point to a need for further research on gender differences, with the ultimate aim of delivering gender-sensitive effective mental health care.

Although it has often been reported that premorbid social deficits are associated with clinical outcome in schizophrenia, the association between clinical outcome and social disabilities during admission for a first psychosis is still unclear. We examined whether a detailed assessment of social disability (assessed using the Groninger Social Disabilities Schedule-II) in the month before admission for a first psychotic episode contributed to the prediction of disease outcome in terms of psychopathology in 82 patients with schizophrenia. After controlling for the Positive and Negative Syndrome Scale sum score at baseline, none of the social disability domains significantly predicted the number of relapses or the severity of clinical symptoms at a 5-year follow-up. Our results suggest that poor social functioning at admission does not necessarily predict poor disease outcome. Following Di Michele and Bolino (Psychopathology 37:98-104, 2004), we hypothesize that, to reliably predict the course of schizophrenia, it may be necessary to assess social functioning during clinical stabilization.

SummaryObjective - assessment of the burden perceived by a sample of key-relatives of schizophrenic patients. Design - Observational study of key-relatives of patients with a PSE-CATEGO diagnosis of active paranoid schizophrenia. Assessment of possible correlations between the family burden, the patients' symptoms and disabilities, as well as the relatives attitude of overinvolvement and criticism. Setting - Inpatient and outpatient psychiatric units of the Department of Psychiatry of the First Medical School, University of Naples. Subjects - 25 patients, with a diagnosis of active paranoid schizophrenia, according to ICD-9 diagnostic criteria, minimun illness history 1 year, at least one previous admission, living with at least one adult relative. Main outcome measures - Standardized assessment of patients clinical status and social disability and of relatives clinical status attitude and perceived burden. Results - The burden, both objective and subjective, was found to be present to a marked or very marked degree in more than 50% of the inteviewed relatives. A marked effect of the patients illness was observed especially on relatives social contacts and leisure activities. Also the attitudes of criticism and overinvolvement were detected in the great majority of the relatives. 52% of the relatives, when assessed by the PSE-9, received a psychiatric diagnosis. The objective burden was found to be associated with some «negative» symptoms and deficits of social functioning in the patients. Finally, significant correlations were observed between the objective and subjective dimensions of the burden and the relatives attitudes of hypercriticism toward the patients. Conclusions - The present study seems to be relevant both from the epidemiological point of view and for psychiatric care planning.

Multiple chemical sensitivity (MCS) is a chronic nonallergic, multisymptom disorder triggered by common environmental chemicals in concentrations considered nontoxic for most individuals. The condition may lead to loss of occupation and social isolation, and no effective treatment has been reported. Electroconvulsive therapy (ECT) is a safe and effective treatment of severe depression and medical conditions such as chronic pain disorders.We report a case of a 45-year-old man with a 5-year history of MCS who had to quit his job to live a solitary life without his wife and children because of the condition. The patient had no history of psychiatric illness and no signs of clinical depression at treatment start. Over a 3-week period, he underwent a course of 8 ECTs, giving a remarkable effect on symptom severity and social functional level. After a partial symptom relapse, maintenance treatment was started with 1 ECT every second week. No memory impairment or other complications of ECT were reported at the 4-month follow-up.In this case, a substantial, positive effect on symptom severity and social disability related to MCS was obtained by an initial ECT course and maintenance treatment. Electroconvulsive therapy should be considered an option in severe and socially disabling MCS, but more studies are needed to evaluate if ECT can be recommended as a treatment in MCS.