The Dynamics of Quality of Life in ALS Patients and Caregivers

Background  Quality of life (QOL) in people with amyotrophic lateral sclerosis (ALS) and their caregivers may depend on disease progression, premorbid characteristics (e.g., personality or demographics), or idiosyncratic effects (e.g., life events unrelated to the disease). Furthermore, effects may differ for patients and caregivers; physical decline may impact the caregiver more than the patient. Purpose  The present study examined QOL in ALS patients and their caregivers over the course of the illness. Methods  Longitudinal data from ALS patients (N = 55) and caregivers (N = 53) yielded estimates of the sources of and changes over time in total QOL as well as individual domains (psychological existential, physical, and social) as measured by the McGill Quality of Life Questionnaire. Results  For both patients and caregivers, about half of QOL variance emerged from stable individual differences. Passage of time did not affect QOL in patients, but total QOL and particularly QOL related to physical symptoms declined over time in caregivers. Gender was mostly unrelated to QOL in patients and caregivers, but younger caregivers had lower QOL across a number of domains. Conclusions  Low QOL among ALS patients is likely due to pre-existing individual differences, whereas both individual differences such as demographics (e.g., age) and disease progression are likely to affect QOL among caregivers.     

The Relationship Between Eating Pathology and Perceived Family Functioning in Eating Disorder Patients in a Day Treatment Program

This study examines the perceived levels of family functioning and their relationships with eating pathology across three eating disorder diagnostic groups. Charts of 65 day treatment female patients, ranging in age from 12 to 27 years, were studied by diagnosis and assessed using the FACES-II and EDI-2. Using multiple regression analyses, it was determined that perceived family functioning yielded significant predictions for various EDI-2 subscales within both Anorexia Nervosa and Eating Disorder Not Otherwise Specified diagnoses. Significant correlations were found between FACESII and the EDI-2 for all three diagnostic groups. Using ANOVA analyses and Bonferroni comparisons, significant differences among diagnoses on the EDI-2 subscales were obtained when studying patients within different family types as defined by FACES-II. These data support previous findings that suggest that as family functioning is perceived to be more dysfunctional the severity level of eating pathology increases.     

Object Images of Eating Disorder Patients

Abstract: The authors investigated images held by eating disorder patients toward selected stimulus words using the semantic differential method. The concept "object image" was introduced here to designate the images which any person has about the mother, the father, etc. A comparison was made between 22 eating disorder patients with concurrent borderline personality disorder, 20 patients without borderline pathology, and 48 controls. The eating disorder patients were found to have a "weaker" image of "motherliness" and "womanliness" compared to the control group. Another characteristic of eating disorder patients was their unfavorable image of children. The authors also studied the images held by fathers and mothers. In the families with borderline patients, the discrepancies between what we term "object images" held by fathers, mothers, and daughters were conspicuous. The importance of a tripartite (daughter-mother-father) relationship in the psychopathology of eating disorder is discussed.     

Health-Related Quality of Life in Pediatric Patients with Syndromic Autism and their Caregivers

Journal of Autism and Developmental Disorders - Children with autism have a significantly lower quality of life compared with their neurotypical peers. While multiple studies have quantified the...     

The Relationship between Impulsivity and Quality of Life in Euthymic Patients with Bipolar Disorder

Objective

Bipolar disorder (BD) is characterized by elevated impulsivity, even during periods of remission. Many recovered BD patients have functional impairments, which can lead to poor quality of life (QoL). The aim of this study was to investigate the association between impulsivity and QoL in euthymic BD patients.

Methods

A total of 56 remitted or recovered patients with type I or II BD, diagnosed based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, were recruited. Psychiatrists administered the Clinical Global Impression (CGI) for BD and the Global Assessment of Functioning (GAF) scales and then interviewed the subjects to assess clinical variables. Patients completed the Barratt Impulsiveness Scale (BIS-11) and the World Health Organization Quality of Life Assessment Instrument-Brief Form (WHOQoL-BREF). Pearson correlations, univariate regression analyses, and multiple linear regression analyses were performed.

Results

The BIS-11 total score was significantly correlated with the WHOQoL-BREF total score (r=-0.55, p<0.01) and with the WHOQoL-BREF subscales. After controlling for GAF score and other clinical variables, the BIS-11 total score (β=-0.43, p=0.001) was independently associated with overall QoL. Additionally, the BIS-11 total score was particularly strongly associated with the physical, psychological, and social domains of the multi-dimensional QoL scale.

Conclusion

Our results suggest that high impulsivity is related to low QoL in euthymic BD patients. Further studies are needed to examine whether interventions for high impulsivity effectively improve QoL in patients with BD.     

Frequently Asked Medical Questions About Eating Disorder Patients

Abstract

Of the entire gamut of psychological disorders treated by clinicians, eating disorders are the ones most frequently punctuated by concomitant medical complications. Many of these are not serious, but a distinct number of these complications have serious ramifications. Herein, we discuss some of the most frequently encountered medical issues during the treatment of bulimics and anorectics.     

Frequently Asked Medical Questions About Eating Disorder Patients

Of the entire gamut of psychological disorders treated by clinicians, eating disorders are the ones most frequently punctuated by concomitant medical complications. Many of these are not serious, but a distinct number of these complications have serious ramifications. Herein, we discuss some of the most frequently encountered medical issues during the treatment of bulimics and anorectics.     

Factors Influencing Quality of Life in Stroke Patients: Focus on Eating Habits

Background: Adherence to healthy lifestyle factors has been shown to improve outcomes after stroke. This study aimed to identify lifestyle factors about eating habits that may affect the quality of life (QOL) in elderly stroke patients. Methods: Fifty elderly patients with a first-ever stroke were enrolled. QOL was assessed by the Stroke and Aphasia QOL Scale-39-J. Lifestyle factors about eating habits were collected using questionnaires (Questions 1-17) for the intake of salt, calcium, magnesium, potassium, taurine, fiber, and protein, and the frequency of breakfast. Results: QOL of physical, communication, and psychosocial subdomains was better in the low (healthy) tertile of poststroke eating habits (Questions 1-17) compared with the high tertile of post-troke eating habits (Questions 1-17). This relationship appeared in eating habits except for salt intake but not in eating habits of salt intake and directly measured salt intake. Compared with prestroke eating habits score, poststroke eating habits score was decreased (improved) in 36 patients concerning eating habits of salt intake, but only in 12 patients concerning eating habits except for salt intake (P < .05 by chi-square test). Poststroke eating habits of calcium and magnesium were associated with better psychosocial QOL and better physical or energy QOL, respectively. Conclusions: Poststroke eating habits of calcium and magnesium were associated with QOL in elderly patients with a first-ever stroke. Since eating habits except for salt intake was poorly improved after stroke, intensive interventions regarding eating habits might be important.     

Family Quality of Life of South African Families Raising Children with Autism Spectrum Disorder

This article describes the family quality of life among families who are raising a young child with autism spectrum disorder. Survey research was conducted with 180 families of children with autism spectrum disorder who were receiving disability-related services in the Gauteng province of South Africa. The principle measure used was the Beach Center Family Quality of Life Scale to assess five subdomains: family interaction, parenting, emotional well-being, material/physical well-being, and disability-related support. Results indicated that families felt the most satisfied with disability-related support and the least satisfied with the family’s emotional well-being. Family income, family type, and the severity level of autism were significantly associated with how satisfied families felt about their quality of life.     

The Use of Psychotropic Medications in Eating Disorder Patients with Personality Disorders

The use of psychotropic medications in eating disorder patients with personality disorders (PDs) is a complex topic. In this overview, we do not focus on individual studies, but rather on the philosophical issues and broader management principles of medications in this comorbid population. We review a general construct of personality and PD development, the theories that underlie how medications might work in PDs, and the target-symptom approach to treatment. We also discuss the essential elements of the prescribing context, an approach to psychotropic medication selection in the borderline personality population, and general caveats for medication use in those with eating disorders. Despite available data, significantly more research is needed in this area.     

The Use of Psychotropic Medications in Eating Disorder Patients with Personality Disorders

The use of psychotropic medications in eating disorder patients with personality disorders (PDs) is a complex topic. In this overview, we do not focus on individual studies, but rather on the philosophical issues and broader management principles of medications in this comorbid population. We review a general construct of personality and PD development, the theories that underlie how medications might work in PDs, and the target-symptom approach to treatment. We also discuss the essential elements of the prescribing context, an approach to psychotropic medication selection in the borderline personality population, and general caveats for medication use in those with eating disorders. Despite available data, significantly more research is needed in this area.     

The Economics of Eating Disorder Treatment

Illness–associated costs are a major concern in eating disorders (ED). Economic aspects of (ED) have been an area receiving research attention. In the last three years a number of studies have been completed, including studies examining national costs of ED; third party payer costs for ED treatment; societal costs of ED; and cost effectiveness analysis of specific treatments. Additionally, some work has been done to model costs associated with ED prevention efforts. A number of further cost effectiveness analyses are planned. This area will be a fertile one for continued study.     

Diverging Eating Psychopathology in Transgendered Eating Disorder Patients: A Report of Two Cases

This report documents two transgendered biological males who met criteria for an eating disorder, who interchangeably reported periods of endorsing masculine and feminine gender identities, allowing an exploration of how their preferred gender orientation impacted their eating disorder psychopathology. This report suggests that the divergence of body image psychopathology amongst men may be impacted by gender role orientation, which is consistent with a developing body of research.     

Medical Presentations of Covert Sexual Abuse in Eating Disorder Patients

Abstract

A subpopulation of patients with eating disorders have also experienced sexual abuse. Medical symptoms in that subpopulation can, at times, represent an embellishment of true organic pathology or a physical way of remembering past trauma (“body memories”). Organic disease must be ruled out by the use of specific and appropriate tests. A thorough history and a detailed physical examination are imperative so that the patient is not subjected to unnecessary, expensive, and/or often invasive tests, which may only worsen or complicate the patient's condition. Medical personnel and therapists alike should be vigilant to the connection between unusual physical symptoms and a history of sexual abuse in patients with eating disorders.     

Neuropsychological Characteristics of Patients in a Hospital-Based Eating Disorder Program

The existence of cognitive deficits associated with eating disorders has been debated for some time. The present study investigated cognitive impairments in a large sample of patients with anorexia nervosa from an inpatient treatment program. Fifty-nine women with anorexia nervosa were given a battery of neuropsychological tests assessing multiple cognitive domains. Over half of the patients had mild cognitive impairments in two or more neuropsychological tasks and approximately one-third failed two or more tasks. Depression level and body mass were not associated with cognitive impairment. Whether effective restoration of weight and resolution of core psychopathology contribute to reversal of cognitive deficits requires further research.     

Medical Presentations of Covert Sexual Abuse in Eating Disorder Patients

A subpopulation of patients with eating disorders have also experienced sexual abuse. Medical symptoms in that subpopulation can, at times, represent an embellishment of true organic pathology or a physical way of remembering past trauma (“body memories”). Organic disease must be ruled out by the use of specific and appropriate tests. A thorough history and a detailed physical examination are imperative so that the patient is not subjected to unnecessary, expensive, and/or often invasive tests, which may only worsen or complicate the patient's condition. Medical personnel and therapists alike should be vigilant to the connection between unusual physical symptoms and a history of sexual abuse in patients with eating disorders.     

Emotional Eating and Eating Disorder Psychopathology

The study examined to what extent emotional eating, restrained eating, and bulimic tendencies are found together in naturally occurring groups, and whether these groups differ in terms of the psychological characteristics relevant to eating disorders. One hundred twenty-seven normal-weight women filled in The Dutch Eating Behavior Questionnaire, The Eating Attitudes Test, The Eating Disorder Inventory, and five measures of psychological well-being. Cluster analysis revealed three dieter subgroups (Normal Dieters, Emotional Dieters, and Bulimic Dieters) and one nondieter group. The results showed that only some restrained eaters were emotional eaters and that only some emotional eaters had bulimic tendencies. In addition, emotional and bulimic dieters differed from nondieters more strikingly in terms of eating disorder psychopathology and low psychological well-being than normal dieters did. The results suggest that emotional eating is not responsible for overeating only but may, in concert with chronic dieting, also relate to the general psychopathology found to underlie eating disorders.