Behaviour problems and relationships with family and peers during adolescence

This study examines the relationship between (a) characteristics of adolescents' social networks, personal resources, and environmental risks; and (b) adolescents' behaviour problems. A socio-ecological perspective was used to determine whether social support and perceived conflict operate as risk or protective factors. Three samples of adolescents were studied: 63 adolescents in residential care; 29 in day treatment; and 63 who had had no contact with professional care. Interrelations were explored by means of structural equation modelling. Social support in family and peer group may operate as a risk factor or a protective factor depending on other risk factors in these subsystems. Perceived conflict is related to behaviour problems, although the influence differs depending on environmental risk factors and the type of behaviour problems.     

Symptom severity,amount of treatment,and 1-year outcomes among dual diagnosis patients

This study reports on associations among symptom severity, amount of treatment, and 1-year outcomes in a national sample of 8,622 dual diagnosis patients, who were classified at treatment entry into low-, moderate-, and high-severity groups. Patients with more severe symptoms at intake had poorer 1-year outcomes. Higher severity patients did not receive adequate doses of care: Compared with low-severity patients, they had a shorter duration of care, although a longer duration was associated with improved outcomes; they also were less likely to receive outpatient substance abuse treatment, although more intensive treatment was associated with better drug outcomes. High-severity patients improved more on drug and legal outcomes, but less on psychiatric and family/social outcomes, than low-severity patients did when treatment was of longer duration or higher intensity. Dual diagnosis patients with highly severe symptoms would likely benefit from a longer episode of care that includes substance abuse and psychiatric outpatient treatment.     

Correlations between some features of social networks and treatment outcome in patients with schizophrenia three years after initial hospitalization

There were studied correlations between some features of social networks of 56 DSM-III schizophrenic patients and "specific aims of treatment": insight, satisfaction of the treatment, compliance, motivation for the treatment and "outcome of treatment" in psychopathological and social level three years from the first admission. There were used Fallow-up Chart, Bizoń's Social Support Questionnaire, BPRS-LA scale and Social Assessment Scale (SAS). There were obtained statistically significant results concerning correlations between the type of support (concentrated, dispersed, and mixed) and the size of the extra-familiar network and the "specific aims" of treatment. This means that patients who have a mixed type of social support and a extended extra-familiar social network obtain better specific treatment aims as: motivation for treatment, co-operation in treatment, insight and a subjective satisfaction of treatment. There exists also significant correlation between some features of social network such as the range of network, the amount and localisation of support and the size of the extra-familiar network and the psychopathology level. The patients who get little support and those whose whole support is localised in family have higher level of negative symptoms measured with BPRS sub-scale. Patients of little range of the social network, including extra-familiar network show more positive symptoms three years after the first hospitalisation. There were found no correlations between the social network features and profession.     

Remission in prognosis of functional outcome: a new dimension in the treatment of patients with psychotic disorders

INTRODUCTION: The aim of the present study was to investigate whether or not the new concept of remission in the treatment of schizophrenia is of importance for functional outcome. The hypothesis was that patients having attained remission would function at a higher level and have a lower care requirement than those who had not attained remission. MATERIALS AND METHODS: Remission is defined through the application of the Positive and Negative Syndrome Scale (PANSS) instrument whereby none of the eight chosen items, representing core symptoms, should be found to present a value exceeding 3 points. The utility of attaining the severity criteria for remission, or not, was examined with regard to activity of daily living (ADL) ability, establishment of social functioning and social network, and amount of health care and community support that the patient consumed. Two hundred and forty-three patients were examined, of whom 93 patients (38%) had attained remission and 150 patients (62%) had not. The present patient population, consisting of 50% of all available patients with schizophrenia spectrum disorder within a homogeneous catchment area in NU Health Care, western Sweden, meeting the right diagnostic criteria, were in their habitual condition and were unaffected by any other functionally debilitating disorder, in particular dementia. As a control patients diagnoses were used as the independent variable to exclude that they better explain outcome than remission. RESULTS: It was found that patients that attainted the specified remission criteria showed a significantly superior outcome in all assessed areas with regard to activity of daily life, social functioning in society and consumption of health care. Remission patients functioned more effectively in social contexts in association with superior education, more often had occupations, possessed more established social networks and were more likely to be found living under family-like conditions. They exhibited a lower need for support in order to fulfill their everyday activities. Also, patients in remission required markedly less health care resources, both in the form of psychiatric treatment and community habitation support. In contrast diagnoses only made difference in 4 of 14 outcome parameters. DISCUSSION: The results suggest that the concept of remission has important implications for the treatment of patients with chronic psychosis. One possible conclusion is that if more patients attain remission, the patient's and society's burden resulting from the illness will decrease.     

Social networks, social support and the type of depressive illness

We hypothesised that there would be greater deficiencies in the quality and quantity of close personal relationship and social support in "neurotic" than in "endogenous" depressives, and that the relation between support and recovery would be stronger in the former. One hundred and thirty men and women who contacted hospital psychiatric services with depression were interviewed, and 119 (92%) reinterviewed after approximately 4 months. The association between the type of depression and deficiencies in social relationship was not impressive. However, differences were apparent in the prognostic implications of social relationship. For "neurotic" depressives, about half the social support variables assessed were significantly related to outcome, whereas the only significant predictor for "endogenous" cases was the presence of a close confidant. The results argue for further research on social support in clinical samples of acute depression.     

Relationships among mental health status, social context, and demographic characteristics in Taiwanese aboriginal adolescents: a structural equation model

The purposes of this study were to examine the relationships among mental health status, demographic characteristics, and social contexts, including family conflict and support, connectedness to school, and affiliation with peers who exhibit delinquent behavior and who use substances, among Taiwanese aboriginal adolescents. A total of 251 aboriginal junior high school students in an isolated mountainous area of southern Taiwan were recruited, and the relationships among mental health status, demographic characteristics, and social contexts among them were examined using a structural equation model (SEM). The SEM revealed that family conflict and support had direct influences on mental health status and connectedness to school. Family conflict had a direct relationship with affiliation with peers who use substances, and family conflict and support were both indirectly linked with affiliation with peers who exhibit delinquent behavior and who used substances; these were mediated by a poor mental health status. Female and older age were directly linked with a poor mental health status and were indirectly linked with a greater number of peers who exhibit delinquent behavior and who use substances via the poor mental health status. Disruptive parenting was directly linked with affiliation with peers who use substances. The authors suggest that those who devise strategies to improve aboriginal adolescents' mental health and discourage substance use should take these relationships among mental health, demographic characteristics, and social contexts into account.     

Attention deficit hyperactivity disorder and treatment outcome in opioid abusers entering treatment.

Symptoms of DSM-IV attention-deficit hyperactivity disorder (ADHD) were determined in patients entering methadone maintenance treatment. The relationship of ADHD to psychiatric and substance abuse comorbidity, attention testing, and treatment outcome was analyzed; 19% of patients had a history of ADHD, and 88% of these had current symptoms. Continuous Performance Testing indicated poorer attention in patients with ADHD. The only substance use disorder more common in the ADHD group was clonidine. There was significantly more current axis I, dysthymic disorder, anxiety disorder (including social phobia), and antisocial personality disorder in the ADHD patients. There was no difference between groups at the 1-year follow-up for illicit drug use, treatment retention, or treatment performance. The ADHD diagnosis did not convey significant prognostic implications for methadone maintenance treatment. A strong psychiatric assessment and treatment focus in the treatment program may help to explain the good treatment outcome.     

Course of schizoaffective psychosis: a retrospective study

This study investigated the clinical course and outcome of 72 patients diagnosed as suffering from schizoaffective psychosis according to ICD-9 criteria who also satisfied RDC criteria for schizoaffective disorder. The results show a clear relationship between patients' overall functioning and premorbid personality: a better premorbid social adjustment indicates a better current state. Those who met DSM-III criteria for schizophrenic or schizophreniform disorder had an earlier age of onset and a higher frequency of relapse, followed by schizoaffective and affective patients. Patients who presented interepisodic psychotic symptoms differed from those who did not in that they showed more recurrences, an earlier age of onset and a premorbid personality with poorer social adjustment. The age of onset of the disease was significantly earlier in patients who had hyperthymic episodes. Schizoaffective disorders therefore are a heterogeneous group as regards premorbid personality, DSM-III diagnosis, and the presence or absence of interepisodic psychotic symptoms and hyperthymic episodes.     

Results of surgical treatment in patients with bitemporal epileptiform abnormalities

Fifty-three of 57 patients who had evidence of bitemporal epileptiform abnormalities and who required investigation with stereotactic depth electroencephalography (SDEEG) recordings to determine the site of origin of seizures underwent surgical resection for the treatment of their epilepsy. A minimum of 2 years' follow-up was available in 48 patients who underwent a temporal lobe resection. In this group, 19 patients (40%) were greatly improved, and of these 14 (29%) became seizure free and 5 (10%) had no more than 3 seizures each year. Another 22 patients (46%) showed a worthwhile reduction in seizure frequency of at least 50%. Seven patients (15%) were not significantly improved. An etiological factor of early convulsions before age 3 (usually febrile) was associated with a better outcome. Both the lack of a strong predominance for SDEEG-recorded seizures to arise in the resected temporal lobe and the presence of residual epileptiform abnormalities in the postexcision electrocorticogram were correlated with poorer results.     

Social Support Resources and Post-Acute Recovery for Older Adults with Major Depression

This study assessed the relationships between older patients’ social support resources and depressive symptoms and psychosocial functioning at 6 months following a psychiatric hospital discharge. The data used in this study were extracted from a prospective study titled “Service Use of Depressed Elders after Acute Care” (National Institute of Mental Health-56208). This sample included 148 older patients who participated in the initial and the 6-month follow-up assessment. Ordinary Least Squares regression (OLS) was used to examine important social support resources in relation to older patients’ depressive symptoms and psychosocial functioning. A vast majority of patients were embedded in a social support network that consisted of acquaintances and confidants. Patients’ depressive symptoms were related to availability of a confidant and the extent to which they spent time with others. However, patients’ psychosocial functioning was not related to social support resources assessed in this study.     

Psychosocial outcome in schizophrenia and psychotherapeutic orientation

The purpose was to compare the psychosocial outcome in two groups of schizophrenic patients who were treated by different methods but were in other respects unselected, and to consider factors predictive of the outcome. The first sample, consisting of a total of 100 patients, had received hospital and outpatient care, here called traditional; only 12 of them had received sustained psychotherapy. Of the second sample, comprising 75 patients, 66 were treated in a psychotherapeutic community and 25 also received sustained psychotherapy. All patients were interviewed by the author on an average of 8 years after the first hospitalization. The patients treated in the psychotherapeutic community had remained longer under hospital care, particularly at first, and at the end of follow-up their functional capacity was lower, but they were more satisfied with the treatment received compared with the patients treated traditionally. The samples did not differ in terms of clinical status. The severity of the schizophrenic disorder, including diagnostic category, and a tendency toward grandiose thinking emerged as the most important factors predictive of psychosocial outcome. Premorbid psychosocial development and social support were also relevant to the outcome. After taking the predictor variables into account, extensive hospital care was still associated with a poor outcome. This may in part explain why, despite the greater amount of psychotherapy provided, the functional capacity of the patients who received psychotherapeutic community treatment had poorer outcome than those treated traditionally.     

Suicidality in older African Americans: findings from the EPOCH study.

The authors examined the current frequency of suicidality and associated characteristics in a sample of 835 African-American older adult residents of six urban public housing developments who consented to participate in an intervention trial of mobile outreach. The frequency of passive and active suicidal ideation was 2.5% and 1.4%, respectively. Characteristics of individuals with both active and passive suicidality included elevated anxiety, social dysfunction, somatic symptoms, low social support, lack of a confidant, and low religiosity. Characteristics of those with passive, but not active, ideation also included older age, lower levels of education, elevated depressive symptoms, poorer cognitive functioning, and having recently discussed emotional problems with a healthcare provider. The characteristics of those reporting active, but not passive, ideation included having a history of mental health treatment and reporting no instrumental support. Multivariate analyses indicated that depression and religiosity were uniquely associated with passive suicidal ideation, and life satisfaction and religiosity were uniquely associated with active suicidal ideation. The authors discuss implications of these findings and offer suggestions for research and clinical practice.     

Psychopathology as a predictor of treatment outcome in alcoholics

We performed a one-year follow-up study of 266 alcoholics who had received extensive psychiatric assessment, including diagnosis with the National Institute of Mental Health Diagnostic Interview Schedule and DSM-III criteria, during their index treatment episode. The aims were to evaluate the relationship between additional DSM-III diagnoses in alcoholics and outcome at follow-up, assess the relative prognostic power of different ways of measuring psychopathology by comparing categorical DSM-III diagnoses and a global symptom severity measure, and assess whether ratings of psychopathology add to the prognostic power of an alcohol-dependence measure. While coexistent psychiatric diagnoses generally predicted poorer treatment outcome, there were significant interactions in the relationship between diagnoses and treatment outcome for men and women. For men, having an additional diagnosis of major depression, antisocial personality, or drug abuse was associated with poorer outcome. For women, having major depression was associated with a better outcome in drinking-related measures, while antisocial personality and drug abuse were associated with poorer prognosis. The value of determining psychiatric diagnosis was supported by covariance analyses that suggested that prognostic significance of specific disorders was not accounted for by general psychopathology or general dependence dimensions.     

Psychosocial factors and depressive symptoms

The relationship of four psychosocial factors (family history of psychiatric illness, early loss of a nurturing relationship, stressful life events, and low social support) to depressive symptoms was investigated in university students using a cross-sectional design. A depressed group (N = 160), selected from a consecutive sample of students diagnosed depressed and attending a university psychiatric service, was contrasted with a nondepressed group (N = 206) randomly selected from the general university population within three strata (sex, academic level, and month of the year) to match the clinic group. Depression was measured by the Beck Depression Inventory. It was found that family history of psychiatric illness, stressful life events, and lack of a confidant all had a significant, independent direct effect on the occurrence of depressive symptoms, but early loss was not associated. An interaction effect among the psychosocial factors was not demonstrated.     

Social factors and the outcome of dementia

Previous studies have linked reduced survival in dementia with male sex, older age, longer duration of illness and increased severity of cognitive impairment. However, little is known about the potential influence of social factors (such as life events and social support) on the outcome of dementia. Sixty recently admitted patients with dementia (27 in-patients and 33 day patients) were given detailed psychiatric and social assessments. These included information on life events and social supports. At follow-up, 3 years later, data were collected on outcome. The hypotheses were that adverse life events and lack of social support would be associated with reduced survival. Nearly half the patients (48%) died during the follow-up period. The experience of life events before the first assessment was not associated with outcome. However, receiving meals on wheels (p=0.01) was associated with reduced survival, while attending a day centre (p=0.06) and having support from relatives (p=0.06) were associated with increased survival. Higher dependency (p=0.004) and poorer physical health (p=0.07) were associated with reduced survival. These results suggest that factors related to social support are associated with the outcome of dementia. In particular, receiving meals on wheels or home help may be a marker of a lack of social support, which influences outcome. Further studies are required to examine these associations in more detail.     

Evaluation of home care treatment for schizophrenic patients

Twenty-seven patients diagnosed as schizophrenics suffering their first episode of illness and who had not received any prior medical treatment for the present illness, have been treated in their own homes. The treatment was carried out by a visiting nurse, trained in follow-up assessment and counselling. The outcome of this group was compared with a similar group of 27 patients who underwent initial mental hospital admission and subsequent outpatient follow-up. Both groups were followed up for 6 months. The results reveal that the home treatment through a visiting nurse gives a better clinical outcome, better social functioning of the patient and greatly reduces the burden on the patients' families. This treatment modality is also more economical.     

The relationship of demographic, clinical, and outcome variables to neuroleptic treatment requirements

A retrospective study of 61 acute schizophrenic patients examined whether any demographic, clinical, and outcome characteristics distinguished patients who improved with placebo or low dosages of antipsychotics (PLD patients) from patients who required high conventional dosages of antipsychotics (HCD patients). Patients in the PLD group (n = 30) and HCD group (n = 31) were similar in overall level of psychopathology at admission. Prominent excitement and certain somatic and auditory hallucinations were significantly more frequent in the HCD patients. PLD patients were more likely to be female, were hospitalized more rapidly after the onset of psychosis, and were more often first admissions. Although paranoid symptoms and premorbid schizoid personality did not differentiate the two groups, nonschizoid patients who were nonparanoid tended to be in the PLD group while nonschizoid patients who were paranoid tended to be in the HCD group. PLD patients were less psychotic at discharge, remained out of the hospital for longer periods, and had fewer rehospitalizations. These results confirm other reports of better outcome for patients successfully treated without medication. PLD patients were also functioning better as family members 1 year after discharge. Further research is indicated to improve the prediction of which acute psychotic patients will respond without medication or to low dose neuroleptic treatment and to determine if these predictions are generalizable to other treatment settings.     

Social support,residual adversity and depressive outcome

Summary Investigators of the relationship between life stress and illness onset have been criticised for paying too little attention to factors which may protect individuals from the adverse consequences of stress. A major factor neglected in this regard has been social support. The present study investigates the relationship between social support, residual adversity and symptom severity in patients seven months after onset of a depressive illness. The results, whilst possibly lacking causal significance, suggested that the presence of social support conferred partial immunity against the recurrence of symptoms in individuals suffering a high level of residual adversity. Confiding relationships with reciprocity between confidant and patient concerning their personal affairs had the greatest protective qualities.The work was supported by the Science Research Council, the Mental Health Research Fund (Scottish Division) and the Medical Research Council     

Social support as a predictor of response to group therapy for complicated grief

This study investigated the effect of perceived social support on the outcome of group therapy for patients who experienced complicated grief following a variety of death losses. One hundred and seven psychiatric outpatients, who received either interpretive or supportive group therapy, rated their perceptions of social support from three sources (family, friends, and a special person) prior to treatment onset. For patients in both forms of therapy, perceived social support from friends was directly associated with favorable treatment outcome. In contrast, perceived social support from family was inversely related to outcome for patients in both forms of therapy. Perceived social support from a special person was directly related to favorable improvement in grief symptomatology for patients in interpretive therapy, but unrelated for those in supportive therapy. The results highlight the importance of assessing the level of support patients perceive from their social networks. The findings also suggest that the effect of perceived social support may also depend on the source of the support. Possible explanations and clinical implications of these findings are discussed.     

Stress, social support, and symptoms of depression in spouses of the medically ill

This study investigated the level and frequency of depressive symptoms in spouses of dialysis patients, as a function of a) severity of patient disease, b) level of stress experienced by the spouse, and c) perception of support from the ill partner. The subjects were forty patients who had begun dialysis in the last year and their spouses. Measures of depression, impact on family, perceived social support, and disease severity were applied. Significant depressive symptoms were reported by 20 percent of spouses. Symptom severity was not correlated with age, sex, or occupation of the spouses, nor with level of depression or functional impairment of the dialysis patients. The amount of social support received from the ill partner accounted for 37 percent of the variance in spouse depression, while social and financial stressors reported by the spouse explained 13 percent of the variance in spouse symptoms. These findings suggest that depressive symptoms in spouses of dialysis patients are associated with the social and economic consequences of the illness for the family but even more so with the amount of perceived support from the patient. The determinants of this perceived support need further exploration.