Cognitive functioning in schizophrenia: implications for psychiatric rehabilitation.
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Research in psychopathology and the cognitive neurosciences suggests new applications in psychiatric rehabilitation. Analysis of performance deficits on laboratory tasks can contribute to treatment planning, individual and family counseling, and staff consultation, much like it does in cases of brain injury and other types of central nervous system neuropathology. Recognition of the nature of cognitive impairments in schizophrenia can inform design of psychosocial techniques such as social and living skills training. Cognitive impairments are increasingly seen as potential targets for pharmacological and psychosocial treatment and rehabilitation. In this article, three key issues for application of cognitive technology in psychiatric rehabilitation of schizophrenia and related disorders are formulated as straightforward, clinically relevant questions: (1) What is the prognostic significance of cognitive impairment in acute psychosis? (2) Can cognitive functioning improve in the chronic, residual course? (3) How does cognitive improvement benefit other aspects of recovery and rehabilitation? These questions are addressed through review of previous findings and new multivariate analyses of cognitive functioning in the acute, post-acute, and chronic residual phases of schizophrenia. (+info)
Should schizophrenia be treated as a neurocognitive disorder?
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The search is on for meaningful psychopharmacological and cognitive/behavioral interventions for neurocognitive deficits in schizophrenia. Findings in this area are emerging rapidly, and in the absence of integrating frameworks, they are destined to emerge chaotically. Clear guidelines for testing neurocognitive interventions and interpreting results are critical at this early stage. In this article, we present three models of increasing complexity that attempt to elucidate the role of neurocognitive deficits in schizophrenia in relation to treatment and outcome. Through discussion of the models, we will consider methodological issues and interpretive challenges facing this line of investigation, including direct versus indirect neurocognitive effects of antipsychotic medications, selection of particular neurocognitive constructs for intervention, the importance of construct validity in interpreting cognitive/behavioral studies, and the expected durability of treatment effects. With a growing confidence that some neurocognitive deficits in schizophrenia can be modified, questions that seemed irrelevant only a few years ago are now fundamental. The field will need to reconsider what constitutes a successful intervention, what the relevant outcomes are, and how to define treatment efficacy. (+info)
Decision support for patient preference-based care planning: effects on nursing care and patient outcomes.
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OBJECTIVE: While preference elicitation techniques have been effective in helping patients make decisions consistent with their preferences, little is known about whether information about patient preferences affects clinicians in clinical decision making and improves patient outcomes. The purpose of this study was to evaluate a decision support system for eliciting elderly patients' preferences for self-care capability and providing this information to nurses in clinical practice-specifically, its effect on nurses' care priorities and the patient outcomes of preference achievement and patient satisfaction. DESIGN: Three-group quasi-experimental design with one experimental and two control groups (N = 151). In the experimental group computer-processed information about individual patient's preferences was placed in patients' charts to be used for care planning. RESULTS: Information about patient preferences changed nurses' care priorities to be more consistent with patient preferences and improved patients' preference achievement and physical functioning. Further, higher consistency between patient preferences and nurses' care priorities was associated with higher preference achievement, and higher preference achievement with greater patient satisfaction. CONCLUSION: This study demonstrated that decision support for eliciting patient preferences and including them in nursing care planning is an effective and feasible strategy for improving nursing care and patient outcomes. (+info)
The prevalence of stroke and associated disability.
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BACKGROUND: There are limited data available on the prevalence of stroke in the United Kingdom. Such data are important for the assessment of the health needs of the population. This study aimed to determine the prevalence of stroke and the prevalence of associated dependence in a district of northern England. METHODS: This was a two-stage point prevalence study. A valid screening questionnaire was used to identify stroke survivors from an age- and sex-stratified sample of the population aged 45 years and over in a family health services authority district. This was followed by assessment of stroke patients with scales of disability and handicap. RESULTS: The overall prevalence of stroke was found to be 17.5/1000 (95 per cent confidence interval (CI) 17.0, 18.0). The prevalence of stroke-associated dependence was 11.7/1000 (95 per cent CI 11.3, 12.1). Self-reported comorbidity was most commonly due to circulatory and musculoskeletal disorders. CONCLUSIONS: The prevalence of stroke in this district is considerably higher than current guidelines and previous results suggest. Nevertheless, the result from this study combined with that from a previous study in another district in the United Kingdom should allow those interested in epidemiologically based health needs assessment to make reasonable estimates of the burden of stroke in their area. (+info)
Analysis of factors that characterize health impairment in patients with chronic respiratory failure. Quality of Life in Chronic Respiratory Failure Group.
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This study was designed to identify a core set of items that may characterize impaired health in chronic respiratory failure (CRF) since none of the questionnaires commonly used to measure impaired health in patients with CRF were developed for use in such patients. Questionnaire items, identified from several sources, were administered to 92 patients with stable severe chronic hypoxia or hypercapnia, together with physiological measures of disease severity, the Sickness Impact Profile (SIP) and the St George's Respiratory Questionnaire (SGRQ). Of the 152 items identified, only 28 correlated with patients' perceptions of overall health and were also independent of age, sex, disease or type of treatment and did not show floor or ceiling effects. Principal components analysis identified three specific factors: "daily activities", "cognitive function", and "invalidity". The total score for the whole 28-item set correlated with other measures of disease activity, including SGRQ (r = 0.86) and SIP (r = 0.70), but not spirometry. The interquartile range of the 28-item set was wider than that of the SGRQ or the SIP. This study characterized two areas of health impairment in chronic respiratory failure that had not previously been identified: effects of impaired cognitive function on daily life, and a sense of invalidity. The measurements properties of this 28-item set suggest that it may be a more discriminative instrument for patients with chronic respiratory failure than existing questionnaires. (+info)
Population based study of social and productive activities as predictors of survival among elderly Americans.
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OBJECTIVES: To examine any association between social, productive, and physical activity and 13 year survival in older people. DESIGN: Prospective cohort study with annual mortality follow up. Activity and other measures were assessed by structured interviews at baseline in the participants' homes. Proportional hazards models were used to model survival from time of initial interview. SETTING: City of New Haven, Connecticut, United States. PARTICIPANTS: 2761 men and women from a random population sample of 2812 people aged 65 and older. MAIN OUTCOME MEASURE: Mortality from all causes during 13 years of follow up. RESULTS: All three types of activity were independently associated with survival after age, sex, race/ethnicity, marital status, income, body mass index, smoking, functional disability, and history of cancer, diabetes, stroke, and myocardial infarction were controlled for. CONCLUSIONS: Social and productive activities that involve little or no enhancement of fitness lower the risk of all cause mortality as much as fitness activities do. This suggests that in addition to increased cardiopulmonary fitness, activity may confer survival benefits through psychosocial pathways. Social and productive activities that require less physical exertion may complement exercise programmes and may constitute alternative interventions for frail elderly people. (+info)
First year after head and neck cancer: quality of life.
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PURPOSE: Treatment regimens for head and neck cancer patients profoundly affect several quality-of-life domains. Rehabilitative needs have been identified through cross-sectional analyses; however, few studies have prospectively assessed quality of life, included assessment of psychosocial variables, and identified predictors of long-term follow-up. PARTICIPANTS AND METHODS: The present study addresses these limitations through a prospective assessment of 105 patients with a newly diagnosed first primary squamous cell carcinoma of the oral cavity, pharynx, or larynx. Participants were enrolled onto a larger randomized controlled trial comparing a provider-delivered smoking cessation intervention with a usual-care-advice control condition. Participants completed a battery of self-report measures after diagnosis and before treatment and additional quality-of-life instruments at 1 and 12 months after initial smoking cessation advice. RESULTS: Participants displayed improvements at 12 months in functional status (P = .006) and in the areas of eating, diet, and speech; however, the latter three represent areas of continued dysfunction, and the changes were not statistically significant. Despite these improvements, patients reported a decline in certain quality-of-life domains, including marital (P = .002) and sexual functioning (P = .017), as well as an increase in alcohol use (P < .001). Predictors of quality of life at 12 months included treatment type, the Vigor subscale of the Profile of Mood States instrument, and quality-of-life scores obtained 1 month after initial smoking cessation advice. CONCLUSION: Results reinforce the need for rehabilitation management through the integration of psychologic and behavioral interventions in medical follow-up. (+info)
Declining physical abilities with age: a cross-sectional study of older twins and centenarians in Denmark.
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OBJECTIVE: To evaluate whether physical disability reaches a plateau in the oldest age groups. DESIGN: Cross-sectional survey. PARTICIPANTS: A total of 3351 individuals, which included all those living in Denmark who celebrated their 100th anniversary during the period from 1 April 1995 to 31 May 1996 (276 subjects) and all Danish twins aged 75-94 registered in the Danish Twin Register (3075 subjects). MAIN OUTCOME MEASURES: The ability to perform selected items of basic activities of daily living independently. RESULTS: The prevalence of independence in each of six selected activities of daily living was significantly lower in both men and women centenarians compared with octo- and septuagenarians. The sex difference in independence in all six selected activities of daily living was larger for each advancing age group, with women being most disabled (P < 0.001). In centenarians 20% of women and 44% of men were able to perform all selected activities of daily living independently. CONCLUSION: Compared with individuals aged 75-79 years, physical abilities of men and women gradually diminished in age groups 80-84, 85-90 and 90-94, with the lowest levels among 100-year-olds. Although women have lower mortality, they are more disabled than men, and this difference is more marked with advancing age. (+info)