Neuropsychological support to relatives of patients with severe traumatic brain injury in the sub-acute phase

Many studies have reported emotional distress in relatives of patients with brain injury, but few studies have investigated neuropsychological interventions for relatives. The present study assessed the amount of neuropsychological support as well as the actual number of sessions with a neuropsychologist during rehabilitation in a sub-acute unit. The study also examined whether the amount of support was related to the condition of the patient or the relative at admission. The sample consisted of 26 patients and their closest relative, and measures included demographic variables as well as characteristics related to the patient: Glasgow Coma Scale, Injury Severity Score, Early Functional Abilities, Functional Independence Measure, Rancho Los Amigos; and to the relative: symptoms of anxiety and depression (SCL-90-R), quality of life (SF-36) and amount and number of sessions of neuropsychological support. On average, the relatives received about 18 units of 15 minutes and had six sessions with a neuropsychologist during hospitalisation. A total of 38% participated in group sessions. Relatives' symptoms of anxiety at admission were associated with the number of sessions as well as the amount of support, indicating that relatives with more symptoms of anxiety received more support during the hospitalisation.     

A longitudinal study of family functioning after TBI and relatives' emotional status

The objectives of the study were to examine family functioning and relatives' emotional state after traumatic brain injury (TBI), and to test a model of the relationship between neurobehavioural status, family functioning and relatives' emotional status at two and five years post-injury. The relatives of 98 adult individuals who had sustained severe TBI were followed up 2 and 5 years post-injury and completed the Family Assessment Device, the Hospital Anxiety and Depression Scale, and rated the neurobehavioural status (cognitive, behavioural, emotional, social) of their injured relative, using the Structured Outcomes Questionnaire. A structural equation model, based on existing research, was developed and tested on 66 of the participants. The level of family functioning and the rates of clinically relevant levels of anxiety and depression did not change over time (p?>?.05). The starting path model was revised. The final model had an excellent fit, χ²(16)?=?15.20, p?=?.51; CFI?=?1.00, RMSEA?<?.001, p for test of close fit?=?.66. In this model, poor family functioning and symptoms of anxiety and depression in the relatives were predicted by behavioural and mood changes in the injured individual. The relationship between family functioning and relatives' mood was reciprocal. The findings suggest the need for timely investigation and institution of interventions. Support is needed both for individual family members in dealing with their emotional distress as well as for the family as a whole, with the aim of maximising quality of life for those with TBI and their relatives.     

Stettegrupper for skizofrene patienters forældre

Contact between psychiatrists and the patient's family have become of current importance after Julian P. Leff and others of his contemporaries have proved that psychosocial interventions in the environment of the patient can have a positive influence on the course of schizophrenia. This article recounts what we have learned from inviting the relatives of schizophrenic patients to attend group meetings, the purposes of which were 1) to create better contact with the ward and 2) to get relatives to talk about mutual problems. Until then the parents' experience with the psychiatric services had been most unsatisfactory. The dominant theme in the current meetings was the feeling of relief at finding fellow sufferers. Information about schizophrenia and discussions about expedient patterns of behaviour when in the company of schizophrenic patients were two equally important subjects. The parents showed their approval by very regular attendance of the meetings but stated at the final evaluation that they would like further information and behaviour training. The professional received a first-hand impression of the burden the schizophrenic families have felt obliged to carry and the lack of professional support they have experienced. We believe that the supervision, the education, and the behaviour training of the family can be improved with the current decentralisation of psychiatric services.     

Lægemiddelinteraktion: Hæmmende virkning af neuroleptica på tricycliske antidepressivas metabolisering

In connection with the changes in psychiatry, the situation of the relatives is seldom considered. The great importance of the relatives for the patients in psychiatric care is shown in this study, in which relatives of both committed patients and voluntarily admitted patients' have been interviewed. The mental patients need for care, even committed care, was confirmed by the relatives. The relatives' own situation was greatly influenced by the mental patient. By supporting the patient, the relatives had to give up normal activities of their own. On the other hand, they were seldom asked to take part in the treatment planning of psychiatry, and they did not experience being accepted as an important resource to the mental patient. The research clearly points out the importance of giving support to the relatives and of being actively implicated and accepted as important resources in the treatment of the patients.     

创伤性颅脑损伤患者一级亲属的社会支持状况

目的 了解创伤性颅脑损伤患者一级亲属的社会支持状况,为提供有效的社会资源提供参考.方法 采用社会支持量表调查300名颅脑损伤患者一级亲属的社会支持状况.结果 本组一级亲属的社会支持总分显著高于常模(P<0.01);影响一级亲属社会支持状况的因素有:获取信息、居住地点、精神病性因子、医疗费用来源、职业状态、患者住院天数、自身舒适需求、支持需求和一级亲属的年龄.结论 创伤性颅脑损伤患者一级亲属的社会支持整体水平较高,医护人员应该指导一级亲属充分利用社会资源,以提高对创伤事件的应对能力.     

Characterizing behavioral and cognitive dysexecutive changes in progressive supranuclear palsy.

Frontal lobe dysfunction is a prominent feature of many neurological disorders. Early diagnosis may be enhanced by establishing a profile of cognitive, behavioral, and emotional change. Traditional psychometric assessment focuses on cognitive dysfunction and fails to identify behavioral changes, particularly those associated with orbitofrontal dysfunction. We examined progressive supranuclear palsy (PSP), a prototypical subcortical dementia with frontal features, using commonly available neuropsychological measures and a modification of the Katz Adjustment Scale-Relatives (KAS-R), an instrument first developed to assess dysexecutive changes in head-injured patients. Executive tests identified deficits in reasoning, planning, set shifting, verbal fluency, information processing speed, and response initiation. On the KAS-R, changes in apathy, social withdrawal, and independence were observed, with little change in belligerence, social irresponsibility, uncooperativeness, obstreperousness, anxiety, and depression. The results show the potential utility of this instrument in characterizing behavioral and emotional changes associated with frontal lobe dysfunction in neurodegenerative disease.     

On the consequences of DNA profile mismatches for close relatives of an excluded suspect

If the DNA profiles of a crime stain and the reference sample from the suspect do not match, the suspect is excluded as the donor of the crime stain. However, in some situations the DNA evidence can suggest that a close relative of the suspect might match the stain, in particular when the reference sample from the suspect and the crime stain share rare alleles. This finding can be important for the authorities. The forensic scientist has to decide whether or not to notify the authorities in these circumstances. To the best of our knowledge there is not yet an objective rule for making this decision. We propose such a decision rule for brothers of the suspect, investigate its performance and address some ethical, legal, and practical aspects. Our calculations can be simply adjusted for other relatives of the suspect. Received: 8 December 1997 / Received in revised form: 16 July 1998     

Increased antibody response to microbial antigens in patients with Crohn's disease and their unaffected first-degree relatives

Background

Antibodies directed towards bacterial antigens are considered as serological markers of Crohn's disease. Their role in disease pathogenesis is still under investigation.

Aim

Assess the serologic response towards microbial antigens in Crohn's disease patients, their unaffected first-degree relatives and healthy controls.

Methods

This retrospective study included 60 Crohn's disease patients, 86 unaffected first-degree relatives and 100 healthy controls. Their sera were tested for anti-chitobioside, anti-laminaribioside, anti-mannobioside, anti-Saccharomyces cerevisiae and anti-outer membrane porin C of Escherichia coli.

Results

The prevalence of anti-chitobioside and anti-laminaribioside was higher in Crohn's disease patients and their first-degree relatives than in healthy controls (51.67%, 61.63% and 8%, respectively, for anti-chitobioside and 76.17%, 88.37% and 23.00% for anti-laminaribioside; p < 0.0001).The cumulative semiquantitative immune response against all the tested antibodies was higher in unaffected relatives than in healthy controls (p < 0.001).The quantitative analysis revealed that serum levels of anti-chitobioside, anti-laminaribioside and anti-mannobioside were similar in first-degree relatives and Crohn's disease patients and higher than healthy controls (p < 0.001).

Conclusions

Both qualitative and quantitative analysis revealed that unaffected first-degree relatives have increased antibody response to microbial antigens. This impaired immunological response towards enteric microorganisms may result from a genetic predisposition.     

对新生儿家属实施系统健康宣教的效果研究分析

目的研究分析对新生儿家属进行系统健康宣教的措施和效果,为其应用和研究提供有效的依据。方法选取2013年6月—2014年6月在该院住院治疗的200例新生儿,随机分为两组,每组100例。对照组,接受常规健康宣教,观察组,接受系统健康宣教,比较两组新生儿的健康教育达标情况,并评估其护理满意度。结果观察组新生儿家属的健康教育达标率为92%、护理满意度为98%明显优于对照组的78%和86%（P〈0.05）。结论加强新生儿家属的系统健康宣教可有效提高其照顾新生儿的能力,对于促进新生儿健康,减轻痛苦具有重要意义,值得临床推广应用。