Search

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 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.

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.

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.

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.

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...

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 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.

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.

BACKGROUND: Traumatic physical injury can result in many disabling sequelae including physical and mental health problems and impaired social functioning. OBJECTIVES: To assess the effectiveness of psychosocial interventions in the prevention of physical, mental and social disability following traumatic physical injury. SEARCH STRATEGY: The search was not restricted by date, language or publication status. We searched the following electronic databases; Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO (Ovid SP), Controlled Trials metaRegister (www.controlled-trials.com), AMED (Allied & Complementary Medicine), ISI Web of Science: Social Sciences Citation Index (SSCI), PubMed. We also screened the reference lists of all selected papers and contacted authors of relevant studies. The latest search for trials was in February 2008. SELECTION CRITERIA: Randomised controlled trials that consider one or more defined psychosocial interventions for the prevention of physical disability, mental health problems or reduced social functioning as a result of traumatic physical injury. We excluded studies that included patients with traumatic brain injury (TBI). DATA COLLECTION AND ANALYSIS: Two authors independently screened the titles and abstracts of search results, reviewed the full text of potentially relevant studies, independently assessed the risk of bias and extracted data. MAIN RESULTS: We included five studies, involving 756 participants. Three studies assessed the effect of brief psychological therapies, one assessed the impact of a self-help booklet, and one the effect of collaborative care. The disparate nature of the trials covering different patient populations, interventions and outcomes meant that it was not possible to pool data meaningfully across studies. There was no evidence of a protective effect of brief psychological therapy or educational booklets on preventing disability. There was evidence from one trial of a reduction in both post-traumatic stress disorder (PTSD) and depressive symptoms one month after injury in those who received a collaborative care intervention combined with a brief psycho-educational intervention, however this was not retained at follow up. Overall mental health status was the only disability outcome affected by any intervention. In three trials the psychosocial intervention had a detrimental effect on the mental health status of patients. AUTHORS' CONCLUSIONS: This review provides no convincing evidence of the effectiveness of psychosocial interventions for the prevention of disability following traumatic physical injury. Taken together, our findings cannot be considered as supporting the provision of psychosocial interventions to prevent aspects of disability arising from physical injury. However, these conclusions are based on a small number of disparate trials with small to moderate sample sizes and are therefore necessarily cautious. More research, using larger sample sizes, and similar interventions and patient populations to enable pooling of results, is needed before these findings can be confirmed.

Contains fulltext : 80353.pdf (Publisher’s version ) (Closed access) It is hypothesised that autism symptoms are present in Attention-Deficit/Hyperactivity Disorder (ADHD), are familial and index subtypes of ADHD. Autism symptoms were compared in 821 ADHD probands, 1050 siblings and 149 controls. Shared familiality of autism symptoms and ADHD was calculated using DeFries-Fulker analysis. Autism symptoms were higher in probands than siblings or controls, and higher in male siblings than male controls. Autism symptoms were familial, partly shared with familiality of ADHD in males. Latent class analysis using SCQ-score yielded five classes; Class 1(31%) had few autism symptoms and low comorbidity; Classes 2-4 were intermediate; Class 5(7%) had high autism symptoms and comorbidity. Thus autism symptoms in ADHD represent a familial trait associated with increased neurodevelopmental and oppositional/conduct disorders.

The aims of this study were to identify and trace all schizophrenic patients discharged from in-patient and day-patient psychiatric services in Harrow between 1 January 1975 and 1 January 1985, to examine the patients in terms of their mental state, cognitive functioning, extrapyramidal function and social disability, and to relate their current status in those terms to demographic, historical and treatment variables. The data collection was conducted between 1 February 1987 and 1 January 1990. The project was devised against the background of developing community care policies for psychiatric patients. In the UK, policies of closure of the mental hospitals have been advocated for a considerable time (Tooth & Brooke, 1961). In the US the plan of closing the mental hospitals and replacing in-patient care with care in the community was partially adopted (Scharfstein, 1978; Fink & Weinstein, 1979; Winslow, 1979). In Italy it was carried out in a much more complete way, at least in some areas (Jones & Poletti, 1985, 1986), but problems appear to have arisen in both of these countries (Donovan, 1982; Papeschi, 1985).

Objective: To establish a model that estimates a preference-based measure (valuation) of social participation for children between 8 and 18 years of age from the Handicap Scale for Children (HSC), a validated questionnaire for children with a chronic illness. Methods: Vignettes of the HSC classification system were valued by a representative sample of 249 persons aged 18 years onwards. Linear and nominal scale (mixed-effects) models were used to analyze the valuations of the vignettes. Results: We established a model that performed better than a model that simply sums up the levels of each dimension. Conclusion: We obtained a measure that can be used for assessing need, for quality assurance and for evaluating interventions on a group level aiming to increase social participation in children with chronic illnesses. © 2008 Expert Reviews Ltd.

Introduction Meeting patients’ needs is of great importance for ensuring quality of life and reducing social disability in severe mental disorders, such as schizophrenia. However, the degree of agreement between patients and their therapists in the assessment of needs warrants further investigation, regarding that high patient-therapist agreement is associated with improved outcomes. Objectives Current symptomatology might differentially affect the self-report and clinician-rated appraisal of schizophrenia patients’ needs. Aims To examine the potential impact of current symptoms on patients’ and therapists’ assessment of patients’ needs. Methods Fifty-three schizophrenia patient–staff pairs were interviewed using the Greek research version of the Camberwell Assessment of Need (CAN-R). Patients’ symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS). Results The degree of agreement between staff and patients in the assessment of needs was high. Significant correlations were found between the total number of needs and all the dimensions of PANSS (positive, negative, general psychopathology) in the staff group but not in the patient group. In both groups, the total number of unmet needs was significantly correlated with the general psychopathology and the total PANSS scores. Conclusions The constancy of the therapeutic context might contribute to a high rate of agreement between patients and staff about needs of the latter. The severity of symptoms may influence clinicians’ assessment of schizophrenia patients’ needs. Nevertheless, according to both patients’ and therapists’ assessments symptom severity is associated with greater number of unmet needs.

Objectives: The purpose of this study was to determine whether subjects suffering from anorexia nervosa (AN) or bulimia nervosa (BN) would demonstrate more severe social disability than a control group; and whether social disability could be best explained as a function of the eating disorder itself or as a function of comorbid anxiety or depressive disorders. Method: Subjects were166 AN subjects, 105 BN subjects and 271 control subjects matched for age, sex and socio-economic status. Prevalence of anxiety or depressive disorders was assessed (through the Mini International Neuropsychiatric Interview), and social functioning was measured (through the Groningen scale). Results: The majority of AN and BN subjects demonstrated social disability in the “social role” (leisure time, time spent with friends) and the “occupational role” (work or educational activities). A regression analysis was employed to uncover predictive factors of social disability. Eating disorders (AN and BN), anxiety disorders and depression accounted for a large portion of social disability. Discussion: Anxiety and depressive disorders appear to play an important role in the type of social disability demonstrated in eating disorder patients. Therapeutic implications are discussed.

Background: Identifying need for treatment due to mental problems is necessary for rational health care planning. The aim of this study was to study reports of psychiatric symptoms, social disability and low wellbeing as indicators of meetable need of care. Methods: An extensive questionnaire was sent out to a representative adult population in Stockholm, Sweden. Psychiatric symptom scales, social disabilities due to psychological distress and wellbeing were included. Of the 10,442 persons that answered 1093 were interviewed by psychiatrists. Meetable need of care was assessed and psychiatric diagnoses were made according to DSM-IV. Results: Reports of psychiatric symptoms, social disabilities and low wellbeing were all associated with being female, younger, single, manual work and unemployed. Somatic disorders, a lower degree of social network and more negative life events were also associated. Of the interviewees persons with low well-being had the highest risk for being regarded as having meetable need of care. Additionally they were more likely to fulfil the criteria for a psychiatric disorder accordingtoDSM-IV. Conclusion: Persons with low wellbeing had a higher risk of having meetable need of care than persons with psychiatric symptoms and/or social disabilities had.

SummaryAims — To investigate in persons with mental disorders 1) the patterns of clinical course and their frequencies, 2) the impact of clinical course on two social dimensions of outcome, such as disability and quality of life. Methods — Study conducted with a longitudinal design in the “real world” of community mental health services. Clinical course was retrospectively assessed by using an instrument developed by our group, taking into account previous literature in this area; disability and quality of life were measured, respectively, with the WHO—Disability Assessment Schedule and the Lancashire Quality of Life Profile. Results — In patients with non affective psychosis, continuous and episodic course showed the same tendency to occur, whereas in subjects with affective disorders (either psychotic or neurotic) episodic course was more frequent. Continuous course was associated with higher levels of disability and lower quality of life in psychotic patients, while a poorer quality of life in some areas was associated with episodic course in patients with non psychotic disorders. Conclusions — The impact of clinical course on social disability and quality of life is different depending upon the specific diagnostic category. This suggests that specific and individualised interventions should be provided in order to prevent the negative impact of clinical course on life conditions of persons with mental disorders.Declaration of Interestthe study has been supported by a Grant from MURST 60% to Prof. Mirella Ruggeri and Fondi 1% per la Ricerca Sanitaria Finalizzata 2001 Ministry of Health, to Professor M. Tansella.

While controlled trials with SRIs have demonstrated a selective efficacy in obsessive–compulsive disorder (OCD), up to 40–60% of patients do not have a satisfactory outcome. Non-response to treatment in OCD is associated with serious social disability. There are a large number of non-responsive patients, and they are difficult to cluster due to ambiguities in the diagnostic criteria, possibility of subtypes, and a high rate of comorbidity. Moreover, the findings of current studies of so-called ‘non-responsive’ cases are currently non-generalizable because of the lack of an operational definition of non-response. The result has been that a cumulative body of data on a reasonably homogeneous sample of non-responders has not been developed. The aims of this paper are to clarify some of the obstacles in defining stages of response and levels of non-response and, through a comprehensive analysis, to propose a systematic nosology for this rather common condition. Better characterization of which patients respond and do not respond to various treatments will enable more accurate clustering of patients, and help facilitate multi-site data collection for future research trials.

Introduction: We present the results of a 42 year long-term follow-up of 44 patients (19 males, 25 females) with childhood-onset schizophrenia (COS, age at onset: 7–14 years) who could be traced for a second follow-up examination 27 years after the first follow-up. Method: Data from interviews, clinical records, premorbid and social disability assessments were evaluated for statistical analyses. The symptomatology observed during the whole course of illness was rediagnosed by DSM-IV criteria. Results: The paranoid, catatonic, and schizoaffectives subtypes appeared most frequently. There have been no gender differences in age of first psychiatric symptoms (AFS), AFPS, and age of first hospitalization. Kaplan-Meier’s survival-analysis carried out for AFPS with sex as the grouping factor revealed that the cumulative prevalence appears to be earlier in females (between 7 and 15 years) than in males (between 10 and 18 years). Of the 44 patients 50% had a continuing severe course. Patients with onset before 12 years of age were characterized by a chronic/insidious onset, marked premorbid abnormalities, and by a poorer remission. Premorbid features of social withdrawal and reluctance indicated a risk for social disability within the later course. Conclusion: COS, as a rare but severe variant of schizophrenia, frequently develops from premorbid social maladaptation to an insidious onset but is subsequently followed by a transition to a course and outcome not distinguishable from that of adult-onset schizophrenia.

BackgroundThe aim of this study was to determine the effect of physical morbidity on the outcome of patients with psychiatric disorder, and to compare the effects of non-medically and medically explained symptoms.MethodOne hundred and fifty psychiatric cases were recruited using a two-stage design from 1620 consecutive patients attending their GP. Subjects were assessed at the time of screening, and one year subsequently, using the Composite International Diagnostic Instrument adapted for use in primary care (CIDI - PHC) and the Groningen Social Disability Schedule (GSDS). Assessments of psychiatric morbidity were also obtained from GPs.ResultsMedically explained somatic symptoms were strongly related to psychological outcome one year later. Whereas just over a half of patients with no medically explained symptoms had recovered from a psychiatric disorder, the percentage recovery fell to 41% in those with 1 −4 medically explained symptoms, and only 21% in patients with five or more medically explained symptoms.ConclusionsPhysical ill-health has been shown to make an independent contribution to psychological outcome. The specific needs of these patients should receive greater attention.

Pain has been viewed as an important concomitant of late-life illness that can threaten the quality of life of older adults. In considering linkages between chronic physical illness and psychological distress in late life, the associations between reporting of pain and indices of depression have been extensively studied (Parmelee, 1994; Romano & Turner, 1985). Nevertheless, the role of pain in mediating the effects of ill health on functioning and psychological well-being has seldom been considered in a more comprehensive framework. Such a framework could organize our understanding of the biopsychosocial and ecological context of pain and consider its sequelae for both social and psychological well-being (Kahana & Kahana, 1996).

The Prognostic Scale by Strauss and Carpenter (1974) is thoroughly analysed and its predictive value is compared with other predictors, such as symptomatology, premorbid adjustment and social disability. A sample of 138 first-hospitalized schizophrenic patients serve as database. The total days of stationary treatment, the number of rehospitalizations, a complex criterion regarding the course of illness and the extent of social impairment were selected as outcome criteria. The period of time allowing for predictions was 36 months after index episode. A factor analysis yields results indicating that the Prognostic Scale can be divided into two subscales, namely the “social functioning in the previous twelve months” and the “extent of handicap by psychiatric symptoms”. With respect to prognostic aspects it is the first subscale which proves to be especially valuable.

It is thought that this distressing condition may be much under-diagnosed due to a variety of factors such as the varying severity of the disease, time of onset and social disability caused. Research has put the occurrence of the condition as high as between one in 2000 and one in 3000 for boys and between one in 5000 and one in 10 000 for girls. Boys would appear to be around three times as likely to be affected as girls.

BackgroundThis randomised controlled study tested whether adding imagined to live exposure plus ritual prevention would enhance gains in obsessive-compulsive disorder (OCD).MethodOut-patients with OCD were randomly allocated to either have nine sessions of daily live self-exposure and ritual prevention to external cues alone (Ex) (n = 23) or to have, in addition to Ex, daily self-exposure to the imagined internal cues of the consequences of not ritualising (group Exi) (n = 23). All patients had the same sessional exposure time of 1 h 30 min (Exi 1 h live, 30 min imagined; Ex 1 h 30 min live), and had to practise either Exi or Ex daily for the same duration and to keep diaries of that self-exposure homework throughout treatment. Patients were followed up to week 32. Outcome measures were YBOCS for rituals and obsessions, compulsion checklist, target rituals and obsession, general anxiety, depression (Beck, Hamilton), work and social disability, clinical global impression (CGI).ResultsAt weeks 4, 9, 20 and 32 the two groups improved similarly with no significant difference between them, neither for washers nor for checkers. Imagined exposure was more difficult to do than live exposure and there were more drop-outs.ConclusionsDaily imagined exposure to internal cues did not enhance exposure to external cues. Perhaps longer imagined exposure would have been more enhancing.

The lifetime prevalence of schizophrenia is about 1%, but the associated social disability and cost are disproportionately large. According to the World Health Organization, schizophrenia is among the leading causes of disability worldwide. Representative measures have estimated the annual cost of schizophrenia in England to be £2.6bn and in Canada to be $C2.35bn (£1.06bn).1–3 A growing body of evidence suggests that the early stages of schizophrenia are critical in forming and predicting the course and outcome of the disorder.4 Accordingly, clinical and research interest is now focused on the early stages of the illness because early detection and treatment may result in a better prognosis and functional outcome. The first episode of schizophrenia typically occurs in the late teenage years or the early 20s.5 However, the illness can remain undetected for about 2–3 years …