Psychosocial functioning

Important outcome indicators to evaluate postintoxication and/or postwithdrawal treatment of substance abuse and dependence can be divided into three major groups decreased consumption of substances, decreased problems associated with substance use, and increased psychosocial functioning. Although it is less commonly employed, a quality-of-life scale can help determine how substance abuse/dependence treatment has affected your patients lives. If you are involved in the cost-justification of services, a cost-benefit analysis could also become important, although this is more often used at the administrative level,... 

Schizophrenia is a chronic heterogeneous syndrome of disorganized and bizarre thoughts, delusions, hallucinations, inappropriate affect, cognitive deficits, and impaired psychosocial functioning. 

The goals of treatment include the following alleviation of target symptoms, avoidance of side effects, improvement in psychosocial functioning and productivity, compliance with the prescribed regimen, and involvement of the patient in treatment planning. 

Puig-Antich, J., Kaufman, J., Ryan, N.D., Williamson, D.E., Dahl, R.E., Lukens, E., Todak, G., Amhrosini, P., Rabinovich, H., and Nelson, B. (1993) The psychosocial functioning and family environment of depressed adolescents. J Am Acad Child Adolesc Psychiatry 32 244—253. 

Puig-Antich, J., Lukens, E., Davies, M., Goetz, D., Brennan-Quattrock, J., and Todak, G. (1985) Psychosocial functioning in prepubertal depressive disorders. II. Interpersonal relationships after sustained recovery from the affective episode. Arch Gen Psychiatry 42 511-517. 

In a recent study, Elannery-Schroeder and Kendall (2000) compared group and individual CBT to a WLC in 37 children (ages 8-14 years) with GAD, SAD, and/ or SoP. Treatment outcome was evaluated using diagnostic interviews and child, parent, and teacher reports of anxiety and other measures of psychosocial functioning at post-treatment and 3-month follow-up. At post-treatment, significantly more children in the indi-... 

Pearlstein TB, Halbreich U, Batzar ED, et al Psychosocial functioning in women with premenstrual dysphoric disorder before and after treatment with sertraline or placebo. J Clin Psychiatry 61 101-109, 2000... 

Clinical trials have found that patients with dysthymia without a concurrent major depressive episode had a higher response rate to treatment with either a selective serotonin reuptake inhibitor (SSRI) or a tricyclic antidepressant than to placebo. These patients also experienced improvement in psychosocial functioning ( 18). 

Depressive disorders can also cause substantial morbidity. Injury or illness occurs secondary to suicide attempts, accidents, substance abuse, malnutrition, or irrational behavior resulting from psychosis. Failure to seek medical attention for intercurrent medical disorders may occur because of apathy, feelings of guilt, or low self-esteem. Finally, impaired concentration and attention, a lack of energy, or anhedonia can all substantially impair psychosocial functioning (e.g., failure to advance in one s career or in school job loss social isolation dysfunctional home life, including divorce). 

Early reports found clozapine to benefit some affectively disordered patients (e.g., bipolar, schizoaffective) who had previously been treatment-refractory, but improved rapidly and significantly on this agent ( 108, 109, 278). Further, many patients were able to sustain their early gains in psychosocial functioning over a 3-5-year period. The low incidence of EPS and TD also increased interest in potentially new indications for these agents. 

La Greca, A. M., Swales, T., Klemp, S., Madigan, S., and Skyler, J. (1995a). Adolescents with diabetes Gender differences in psychosocial functioning and glycemic control. Child Health Care 24, 61-78. 

The conversion from ultra high risk (UHR) of SZ to overt illness is of considerable interest and JH MRS can play a role in the understanding of this process, and hopefully, finding interventions to prevent the development of SZ or to attenuate the symptoms before they have led to full-blown illness and impaired psychosocial function. One study (Wood et al., 2003) assessed the left medial temporal and left DLPFC... 

Although the course of the illness is variable, the long-term prognosis for many schizophrenic patients is poor. The disease is marked by intermittent acute psychotic episodes and impaired psychosocial functioning between acute episodes, with most of the deterioration in psychosocial functioning occurring within 5 years after the first psychotic episode. By late life, the patient may appear burned out, that is, the patient ceases to have acute psychotic episodes, but residual symptoms, as previously described, persist. However, functional skills may actually improve compared with earlier in the patient s life. In a subpopulation of patients, probably 5% to 15%, psychotic symptoms are nearly continuous, and response to typical antipsy-chotics is poor. ... 

A certain minority of patients fail to benefit from antipsychotic therapy, and their psychosocial functioning may actually worsen. Unfortunately, no accepted method is available to identify these people before treatment. ... 

Hollander E, Stein DJ, Kwon JH, et al. Psychosocial function and economic costs of obsessive-compulsive disorder. CNS Spectr 1997 2 16-25. 

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