The relationship between social support and psychiatric symptomatology in medical students

This study investigated the relationship between social support and psychiatric symptom-atology among 82 first-year medical students at the University of Texas Medical School at Houston. A questionnaire was administered at several points during the medical school year. This questionnaire included the Hopkins Symptom Checklist and a measure of social support adapted for this study. It was hypothesized that social support and psychiatric symptomatology would be negatively correlated, i.e., that students who described themselves as experiencing more social support would be less symptomatic. The data supported this hypothesis at the beginning of the school year. However, by midyear, social support and symptomatology were positively correlated with each other. These findings, in conjunction with a few isolated studies in the social support literature, led the authors to conclude that in certain settings such as medical school, social ties may present competing demands on an individual's time and energy which have potentially detrimental as well as beneficial effects on mental health. In addition, the findings suggested that the relationship of social support to psychiatric symptomatology may change over time, that there are gender differences in the relationship, and that there may be an interaction between demographic factors, such as gender and marital status, and social support.     

The relationship of social network deficits with deficits in social functioning in long-term psychiatric disorders

Summary It has been suggested that deficits or impairments in social functioning may explain the depleted support networks of the mentally ill. With this in mind, 145 long-term users of day care psychiatric facilities, 57% of whom had a life-time diagnosis of schizophrenia, were examined to determine whether deficits in social and survival skills explained deficits in their social networks. Compared with patients with acute depression, long-term patients had smaller social networks. There was a very small but statistically significant association between observer ratings of deficits in social functioning (daily social and living skills) and self-reported family social networks size. Behavioural problems were also associated with smaller family networks. Among the long-term patients, duration of service contact and type of disorder (affective vs nonaffective psychosis) were not related to network size. These preliminary findings are discussed.     

The relationship between psychiatric symptomatology and motivation of challenging behaviour: a preliminary study

In addition to explaining challenging behaviour by way of behaviour analytic, functional analyses, challenging behaviour is increasingly explained by way of psychiatric symptomatology. According to some researchers, the two approaches complement each other, as psychiatric symptomatology may form a motivational basis for the individual's response to more immediate environmental challenges, like deprivation and aversive conditions. The most common example may be that depressive mood may render task demands aversive. Consequently, the person may show escape-motivated challenging behaviour in the presence of demands. The question becomes whether, or to what extent, relationships between psychiatric symptomatologies and particular functions of challenging behaviour exist. In the present, preliminary study, PAS-ADD checklist, a psychiatric screening instrument, and motivation assessment scale (MAS) were employed in order to investigate this issue. The results show that symptomatologies are largely unrelated to particular behavioural functions. Practical implications are discussed.     

A closer look at the relationship between the subdomains of social functioning,social cognition and symptomatology in clinically stable patients with schizophrenia

Impairments in social functioning commonly seen in schizophrenia are thought to be mediated by deficits in the domains of social cognition. Some previous research has explored how social cognitive skills and psychotic symptoms are associated with social functioning, however these associations are still under debate. The main aim of this study was to investigate the relationship between different domains of social cognition and psychotic symptomatology, and also to look at the relationships with individual subdomains of social functioning within a clinically stable schizophrenia population. 45 outpatients were recruited and symptoms were assessed with the PANSS, and measures of emotion processing, affective and cognitive theory of mind (ToM), mental state reasoning attributional biases, and social functioning were taken. A correlational analysis was performed with the data. Following this, a regression analysis was used to reveal which domains of social cognition best predicted psychotic symptoms. In this stable group of patients, our results support the suggestion of a likely distinction between affective and cognitive components of ToM. The study also demonstrated that ToM and mental state reasoning were the best predictors of psychotic symptoms. Here we reveal that cognitive ToM had the most widespread relationship with social functioning, across multiple subdomains, while only some specific subdomains of social functioning correlated with other domains of social cognition and symptomatology. Further to this, positive symptoms were associated with much fewer subdomains of social functioning than negative and general symptoms. These findings imply that different aspects of social functioning may be served by different domains of social cognition and symptomatology.     

The relationship between social networks and occupational and self-care functioning in people with psychosis

BACKGROUND: Relatively few studies have examined relationships between the social networks of people with psychotic disorder and other aspects of their functioning. The aim of this paper is to describe the social networks of people with psychosis and to investigate relationships between social networks and personal and occupational functioning, taking account of illness course. METHODS: A two-phase epidemiological survey of persons with psychosis was conducted in four predominantly urban areas of Australia. A census and screen for psychosis was followed by a semi-structured interview of a stratified random sample of participants to assess their functioning. Data relating to functioning and social networks from 908 individuals (most with a diagnosis of schizophrenia) were analysed using structural equation modelling (SEM). RESULTS: The majority of people with psychosis (67 %) had a network comprising of family and friends, 15 % were defined as having a family-dominated network, 11 % a friends-dominated network and 7 % of participants were defined as socially isolated (no family or friends). Participants who had friends and family in their network (12 %) or who had a family-dominated network (7 %) were more likely to be in full-time employment compared with those with a friends-dominated network (4 %) or those who were socially isolated (5 %). Dysfunction in self-care was more frequently reported among socially isolated people (50 %) and those with family-dominated networks (47 %) than among those with friends-dominated networks (35 %) and those who had friends and family in their social network (23 %). SEM revealed a strong association between social integration and functioning (r = 0.71), even after controlling for illness course. Social integration was defined as having contact with family and/or friends and functioning was defined as having employment and no difficulties in self-care. Male gender was associated with poorer self-care, and female gender was slightly, but significantly, associated with a greater likelihood of having friends. CONCLUSION: There is a strong relationship between social networks and functioning after taking account of course of illness. That is, the presence of family and friends is generally associated with better self-care and employment. Interventions that are targeted at improving social relationships are likely to have a positive impact on self-care and occupational functioning (and vice versa).     

Cognitive functioning and psychiatric symptomatology in patients with chronic hepatitis C.

Hepatitis C virus (HCV) infection is a major public-health-care problem, with over 170 million infected worldwide. Patients with chronic HCV infection often complain of various cognitive problems as well as symptoms of depression, anxiety, and fatigue. Relatively little is known, however, about the specific cognitive deficits that are common among HCV patients, and the influence of psychiatric symptomatology on cognitive functioning. In the current study of 21 chronically infected HCV patients, we assessed subjective cognitive dysfunction, depression, anxiety, and fatigue and compared these symptom areas to cognitive tests assessing visuoconstruction, learning, memory, visual attention, psychomotor speed, and mental flexibility. Results revealed that cognitive impairment ranged from 9% of patients on a visuoconstruction task to 38% of patients on a measure of complex attention, visual scanning and tracking, and psychomotor speed, and greater HCV disease severity as indicated by liver fibrosis was associated with greater cognitive dysfunction. Objective cognitive impairment was not related to subjective cognitive complaints or psychiatric symptomatology. These findings suggest that a significant portion of patients with chronic HCV experience cognitive difficulties that may interfere with activities of daily living and quality of life. Future research using cognitive measures with HCV-infected patients may assist researchers in identifying if there is a direct effect of HCV infection on the brain and which patients may be more likely to progress to cirrhosis and hepatic encephalopathy.     

The relationship between alexithymia and perinatal depressive symptomatology

OBJECTIVE: The purpose of this study was to examine the relationship between alexithymia and perinatal depressive symptoms and the stability of the alexithymia construct in a sample of low-income, predominantly Latina women during pregnancy and the early postpartum period. METHODS: Seventy-seven pregnant women completed self-report questionnaires and were classified as "high risk" or "low risk" for developing a major depressive episode based on a history of depression and/or current high depressive symptom scores. Measures included the Toronto Alexithymia Scale, the Center for Epidemiological Studies Depression Scale, and the Maternal Mood Screener, and were completed during pregnancy and at postpartum month 2. RESULTS: Alexithymia was positively associated with depressive symptoms during pregnancy and early postpartum. Women at high risk for depression had significantly higher alexithymia levels than low-risk women during pregnancy but not during postpartum. Alexithymia and depressive symptoms were independently and strongly correlated across the ante- and postpartum periods. Hierarchical regression analyses indicate that alexithymia scores at postpartum were predicted by alexithymia scores during pregnancy, above and beyond the variance explained by the depressive symptom scores during pregnancy and postpartum. CONCLUSION: Alexithymia is positively correlated with depressive symptoms during the perinatal period and is a stable phenomenon.     

Relationship between symptomatology and social disability

Summary The relationship between symptomatology and social functioning was investigated. Data were derived from a Dutch cohort of 82 patients with a first life-time episode of non-affective, functional psychosis, who participated in the WHO Collaborative Study on the Assessment and Reduction of Psychiatric Disability. Correlations between scores on two unidimensional, hierarchical rating scales in the 3 years after onset of illness were examined and a comparison was made between course of symptomatology and social disability. The relationship was found to be rather weak, a conclusion that is somewhat in variance with earlier studies. It is conjectured that this may partly be explained by the fact that different study methods were used.     

The association between severity of intellectual disability and psychiatric symptomatology

Background Mental illness is more prevalent in people with intellectual disabilities (ID) than in the normal population. The association between mental illness and severity of ID is also of importance in the understanding and treatment of maladaptive and challenging behaviours. The aim of this study was to investigate the association between severity of ID and prevalence of mental illness. Methods Using The Mini PAS‐ADD, an instrument designed to identify psychiatric symptoms in people with ID, informants were interviewed about the presence of symptoms in 96 participants with moderate, severe and profound ID, and asked about the use of psychotropic medication. Results Mental illness, particularly anxiety, depression and psychosis, was far more prevalent in participants with moderate ID than in people with severe and profound ID. The use of psychotropic medication was not significantly different between the groups. Conclusions The prevalence of psychiatric illness decreases with severity of ID. The usefulness of psychiatric illness models, in explaining maladaptive and challenging behaviours, also decreases with severity of ID. Drug treatment may become more complicated, and behavioural and environmental interventions may become relatively more important, as severity of ID increases.     

The relationship between patient characteristics and psychiatric day care outcomes in schizophrenic patients

Aim:  A retrospective study was conducted to assess the relationship between patient characteristics and psychiatric day care outcomes in 430 Japanese schizophrenic patients.
Methods:  The patients were divided into psychiatric day care completers and non-completers. Patients who could not be included in these groups were categorized as unclassifiable. The completers were subdivided into four outcome groups: (i) patients who obtained a part-time job, (ii) patients who began working at community workshops for mentally disabled persons, (iii) patients who obtained a full-time job or returned to their former positions, and (iv) patients who entered or returned to school. The non-completers were subdivided into two outcome groups: (i) patients who discontinued psychiatric day care because of worsened schizophrenia, and (ii) patients who were rehospitalized because of worsened schizophrenia. Age, sex, age of onset of schizophrenia, number and duration of previous psychiatric hospitalizations, number of persons living with the patient, educational background, previous employment type, marital status, chlorpromazine-equivalent doses of antipsychotic drugs used, and psychiatric day care outcomes were compared among the outcome groups with logistic regression analysis using the outcomes as target variables.
Results:  A later onset of schizophrenia and fewer previous psychiatric hospitalizations were significantly related with better outcomes. A higher educational background was related with the outcomes without statistical significance.
Conclusions:  Our results suggest that the assessment of the relationship between patient characteristics and psychiatric day care outcomes is essential to enhance therapeutic effectiveness of psychiatric day care by beginning appropriate communication, support, and programs for individual patients at the initiation of the care.     

A comparison of three scales for assessing social functioning in primary care

OBJECTIVE: Assessment of functional status is increasingly important in clinical trials and outcome research. Although several scales for assessing functioning are widely used, they vary in coverage, and direct comparisons among them are rare. Comparative information is useful in guiding selection of appropriate scales for research applications. METHOD: Results from three scales that measure functioning-the Medical Outcomes Study 36-item Short-Form Health Survey, the Social Adjustment Scale Self-Report, and the Social Adaptation Self-Evaluation Scale-were compared in a consecutively selected sample of 211 patients coming to primary care. Patients also received psychiatric assessments. RESULTS: All three scales were acceptable to patients, showed few significant correlations with demographic variables, and were able to differentiate psychiatrically ill and well patients. Correlations among scales, even among scale items that assessed similar domains of functioning, were modest. CONCLUSIONS: Although all three scales are presumed to assess functional status, their item content and coverage differ. Selection of a scale requires a review of the scale items and consideration of research priorities and the characteristics of the study group. If functional status is a critical outcome measure, use of more than one scale may be necessary.     

The primary care physician and psychiatric services

This article describes the relationship of self-assessed psychiatric skill among primary care physicians to their role in treating mental disorders. Physicians rated diagnostic skills more favorably than therapeutic skills. Factor analysis was used to identify three dimensions of physician skill: confidence in treatment of major disorders; confidence in treatment of anxiety; and diagnostic confidence. These variables were found to be associated with the reported number of patients with specific mental disorders managed by the physician.     

The relationship between executive functioning and dissociation

Although dissociation by definition affects cognition, few studies have used neuropsychological measures to examine dissociative phenomena. This study compared 33 high and 32 low dissociators based on the Dissociative Experiences Scale, on self-report and neuropsychological measures of executive function, including the Dysexecutive Questionnaire, Iowa Gambling Task, Operation Span task, and Wisconsin Card Sorting Test-64. High dissociators endorsed significantly more executive difficulties than did low dissociators, but these difficulties were not related to their performance on neuropsychological measures. Results suggest that dissociative individuals' perceptions of executive impairments may be divorced from objective deficits, revealing an important process underlying the clinical manifestations of dissociation.     

The relation between self-concept and social functioning in adolescence

A model of the relation between self-concept and internalizing and externalizing problem behaviours in adolescence, with the self-concept influencing problem behaviours (S-->IE), was assessed using a sample of 277 Swedish adolescents. The model was tested in a path analysis with data from Youth Self Report (YSR) and Structural Analysis of Social Behaviour (SASB) questionnaires. Consistent with the model, a positive self-concept was found to be the most important factor for adjustment and for protection against common problem behaviour. A negative self-concept combined with female gender were risk factors for internalized problems. Self-control had only a direct effect on externalizing behaviour for boys. Adolescents of 15, 16 years of age had a stronger relationship between a negative self-concept and externalizing problem behaviour than younger and older adolescents. Internalizing problem behaviours such as anxiety and depression predicted aggressive and delinquent behaviour. These findings highlight the importance of promoting of a positive self-concept in every adolescent in various psychosocial contexts.     

The association between social anxiety and social functioning in first episode psychosis

The purpose of the study was to examine the relationship between social anxiety and social functioning in first episode psychosis, and to determine whether those with psychosis have any maladaptive or irrational beliefs regarding social situations. A sample of 60 first episode patients (41 males, 19 females) participated in the study. The presence of social phobia was determined using the Structured Clinical Interview for DSM-IV (SCID-I). Measures included The Social Phobia and Anxiety Inventory (SPAI), the Social Functioning Scale (SFS), the Quality of Life Scale (QLS) and the Social Interaction Self-Statement Test. Thirty-two percent of the sample met SCID-I criteria for social phobia and approximately 60% of participants were experiencing elevated levels of social anxiety according to the SPAI (M=69.57, S.D.=27.42). Results were that negative symptoms and negative self-statements, but not social anxiety, were significant predictors of social functioning. This has implications for addressing these negative cognitions in early psychosis.     

精神分裂症患者认知功能与社会功能的相关性

目的探讨精神分裂症恢复期患者认知功能对社会功能的影响。方法对80例精神分裂症恢复期患者采用瑞文标准测验（CRT）、韦氏成人智力量表（WAIS）、威斯康星卡片测验（WCST）,分别与社会功能缺陷量表（SDSS）进行多重线性回归分析。结果经逐步回归分析显示,WCST中变量（正确反应数、持续错误数、分类数）、WAIS中言语量表分、CRT中瑞文总分进入回归方程,拟合的回归方程均有统计学意义。其中瑞文总分、言语量表分与SDSS呈线性负相关关系,持续错误数与SDSS呈线性正相关关系;比较WCST、CRT、WAIS与SDSS的相关性,回归模型的拟合最好的为WCST。结论精神分裂症患者的认知功能与社会功能有显著相关性,正确的评测及改善认知功能对提高患者的社会功能有重要意义,WCST提供了一个有效预测精神分裂症患者社会功能的重要方法。     

The burden of psychiatric disorder in primary care

In this paper, with the aid of several approaches to evaluating the burden of psychiatric disorder in primary care, it is demonstrated that they impose a considerable burden. Moreover, in addition to the traditional view that neurosis is responsible for this burden, evidence is provided to demonstrate that psychotic disorders are imposing an increasing amount of it. Implications of this burden are discussed in the light of the new general practice contracts, community care legislation, the purchaser/provider concept, the general trends in community care philosophy and demographic shifts. Some issues involving service planning and reseach are also discussed.     

Patterns of self-harm behavior among women with borderline personality symptomatology: psychiatric versus primary care samples

The current study investigated differences in self-harm behavior among individuals with borderline personality symptomatology from two different clinical settings. Participants were women, between the ages of 18 and 45, from an outpatient mental health setting or a primary care setting. Each participant completed the Self-Harm Inventory (SHI) and the borderline personality scale of the Personality Diagnostic Questionnaire-Revised (PDQ-R). Using a predetermined cut-off for substantial borderline personality symptomatology on the SHI, group comparisons with chi(2) analyses indicated that "overdosed" and "hit self" were significantly more common in the mental health subsample whereas "abused laxatives" was significantly more common in the primary care subsample. Using a predetermined cut-off for borderline personality on the PDQ-R, chi-square analyses indicated that "overdosed" and "hit self" remained significantly more common in the mental health subsample. Despite these differences, there was remarkable similarity of symptoms between groups. The implications of these findings are discussed.     

Relationships between social functioning and quality of life in a population of Dutch adult psychiatric outpatients

BACKGROUND: The relationship between social functioning and QOL in psychiatric patients has not been explicitly investigated before. AIMS: To investigate the relationship between social functioning and QOL in a population of psychiatric outpatients (N = 410) with a broad spectrum of psychiatric disorders. METHOD: Social functioning was assessed with the Groningen Social Behavior Questionnaire-100 (GSBQ-100) and the Global Assessment of Functioning (GAF) scale. QOL was measured with the WHO Quality of Life Assessment Instrument (WHOQOL-100). RESULTS: The study population experienced a wide range of problems concerning all aspects of social functioning. The numbers of problems were significantly higher compared with healthy controls and (partly) also compared with a norm group of psychiatric outpatients. Almost all scales of the GSBQ-100 were negatively correlated with all QOL aspects, whereas the GAF score correlated positively with all QOL aspects. In general, participants with problems on aspects of social functioning had lower QOL scores than those without such problems, even after a correction for the presence of psychopathology according to DSM-IV classification. CONCLUSION: In addition to the presence of psychopathology, social functioning is significantly related to QOL. Therefore, it should be considered more systematically in psychiatric assessment, treatment and program evaluation.