Occult ectopic ACTH secretion due to recurrent lung carcinoid: long-term control of hypercortisolism by continuous subcutaneous infusion of octreotide

OBJECTIVES: Patients with chronic fatigue syndrome complain of physical and mental fatigue that is worsened by exertion. It was predicted that the cognitive and motor responses to vigorous exercise in patients with chronic fatigue syndrome would differ from those in depressed and healthy controls. METHODS: Ten patients with chronic fatigue syndrome, 10 with depressive illness, and 10 healthy controls completed cognitive and muscle strength testing before and after a treadmill exercise test. Measures of cardiovascular functioning and perceived effort, fatigue, and mood were taken during each stage of testing. RESULTS: Depressed patients performed worst on cognitive tests at baseline. During the treadmill test, patients with chronic fatigue syndrome had higher ratings of perceived effort and fatigue than both control groups, whereas patients with depression reported lower mood. After exertion, patients with chronic fatigue syndrome showed a greater decrease than healthy controls on everyday tests of focused (p=0.02) and sustained (p=0.001) attention, as well as greater deterioration than depressed patients on the focused attention task (p=0.03). No between group differences were found in cardiovascular or symptom measures taken during the cognitive testing. CONCLUSIONS: Patients with chronic fatigue syndrome show a specific sensitivity to the effects of exertion on effortful cognitive functioning. This occurs despite subjective and objective evidence of effort allocation in chronic fatigue syndrome, suggesting that patients have reduced working memory capacity, or a greater demand to monitor cognitive processes, or both. Further insight into the pathophysiology of the core complaints in chronic fatigue syndrome is likely to be realised by studying the effects of exercise on other aspects of everyday functioning.     

Cognitive predictors of medical decision-making capacity in traumatic brain injury.

Objective: To identify cognitive predictors of medical decision-making capacity (MDC) in participants with moderate to severe traumatic brain injury (TBI). Participants: At baseline, participants were 34 adults with TBI and 20 healthy adults. At 6-month follow-up, participants were 24 adults with TBI and 20 healthy adults. Main Outcome Measures: Participants were administered the Capacity to Consent to Treatment Instrument (CCTI) and neuropsychological test measures. Multivariate cognitive predictor models were developed for CCTI consent abilities/standards (S) of understanding (S5); reasoning (S4); and appreciation (S3). Results: At baseline, short-term verbal memory and semantic fluency predicted TBI group performance on understanding (S5); short-term verbal memory and attention predicted performance on reasoning (S4); and working memory predicted performance on appreciation (S3). At 6 month follow-up, executive function, verbal processing speed, and working memory predicted TBI performance on understanding (S5); working memory and short-term memory predicted reasoning (S4); and basic executive functioning predicted appreciation (S3). Conclusions: Multiple cognitive functions are associated with acute impairment and partial recovery of MDC in patients with TBI. Short-term verbal memory predicted consent capacity of TBI participants at the time of acute inpatient hospitalization, while executive functioning and working memory predicted improved capacity at six-month follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of pulmonary rehabilitation on self-efficacy, quality of life, and exercise tolerance.

Objective: The objective of the present study was to investigate changes in psychological, physiological, and behavioral-performance variables as a function of pulmonary exercise rehabilitation. Study Design and Participants: Forty patients diagnosed with chronic obstructive pulmonary disease (COPD) were recruited for participation in a 12-week outpatient pulmonary rehabilitation program. Measures: Measures included 6-min walking distance (exercise tolerance), 6-min walking distance self-efficacy, overall quality of life, dyspnea, fatigue, and emotional function. Results: Results revealed significant improvements over the course of the program in each of these measures, regardless of disease severity. In addition, improvements in exercise tolerance were significantly associated with increases in self-efficacy, which, in turn, were significantly related to improved quality of life. Conclusions: The results support the tenets of social-cognitive theory and suggest that participation in an outpatient pulmonary rehabilitation program can provide both physiological and psychological benefits for individuals with COPD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A review of neuropsychological differences between paranoid and nonparanoid schizophrenia patients

This review examines the literature on neuropsychological differences between paranoid and nonparanoid schizophrenia subjects. Thirty-two studies related to intellectual functioning, attention, memory, language, visual-spatial, and motor functions are discussed. Subjects with paranoid schizophrenia did not demonstrate higher intellectual functioning than those with nonparanoid schizophrenia, and both groups performed similarly on tests of verbal ability and visual-spatial functions. Several studies suggest that the paranoid subtype is associated with higher performance on tests of executive functions, attention, memory, and motor skills. However, the findings are inconsistent. Methodological issues in the literature are examined, including varying degrees of participants' chronicity and severity of illness among studies, criteria for diagnostic group membership, medication effects, reliability and validity of the neuropsychological measures, and statistical power.     

Schematic knowledge influences on memory for scene information in young and older adults.

Two experiments were conducted to examine the hypothesis that aging is associated with an increase in schema-related influences on memory performance. In both studies, groups of young and older adults studied organized and unorganized visual scenes containing objects that varied in their likelihood of occurrence. Measures of attention allocation and memory for both objects and their relative locations were obtained. Consistent with expectations, attention allocation during study was disrupted more by lack of scene organization in the older adults. In addition, relatively systematic age differences were also obtained for retention, with greater schematic effects observed in the memory performance of older adults than in that of young adults. The results are discussed relative to current views of aging and cognitive change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support, knowledge of infant development, and maternal confidence among adolescent and adult mothers

The action of phospholipase A2 (PLA2) and related inflammatory mediators on the formation of hypoxic pulmonary arterial hypertension was studied. 30 Sprague-Dawley rats were equally divided into three groups at random: normal control group, hypoxic group and the group pretreated with dexamethasone plus hypoxia. The pulmonary arterial pressure (PAP) was measured by inserting a microcatheter into the pulmonary artery. After 30 min of hypoxia, the activity of PLA2, platelet activating factor (PAF), prostaglandin E2 (PGE2) and thromboxane B2 (TXB2) were measured in blood and lung tissue, and it was found that the mean pulmonary arterial pressure (mPAP), the PLA2 activity, PGE2, TXB2 and PAF in blood and lung tissue were significantly increased; but pretreatment with dexamethasone relieved the changes mentioned above. In hypoxia, a positive correlations was found between the PLA2 activity and mPAP, PAF, PGE2, TXB2 respectively; positive correlations were also found between PAF, PGE2, TXB2 and mPAP. In conclusion, PLA2 induced the release of inflammation mediators, which may play roles in the formation of the acute hypoxic pulmonary arterial hypertension.     

Intimate partner violence and preschoolers' explicit memory functioning.

This research examines whether parents' intimate partner physical violence (IPV) relates to their preschoolers' explicit memory functioning, whether children's symptoms of hyperarousal mediate this relation, and whether mothers' positive parenting moderates this relation. Participants were 69 mothers and their 4- or 5-year-old child (34 girls). Mothers completed measures of IPV, children's hyperarousal symptoms, parent-child aggression, and positive parenting. Measures of explicit memory functioning were administered to preschoolers. As expected, IPV correlated negatively with preschoolers' performance on explicit memory tasks, even after controlling for parent-child aggression and demographic variables related to preschoolers' memory functioning. Preschoolers' hyperarousal symptoms did not mediate the relation between IPV and explicit memory functioning, but mothers' positive parenting moderated this relation. Specifically, the negative relation between IPV and preschoolers' performance on 2 of the 3 explicit memory tasks was weaker when mothers engaged in higher levels of positive parenting. These findings extend research on IPV and children's adjustment difficulties to explicit memory functioning in preschoolers and suggest that mothers can ameliorate the influence of IPV on preschoolers' memory functioning via their parenting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pyridoxalated hemoglobin polyoxyethylene conjugate does not restore hypoxic pulmonary vasoconstriction in ovine sepsis

OBJECTIVES: Hypoxic pulmonary vasoconstriction, a protective mechanism, minimizes perfusion of underventilated lung areas to reduce ventilation-perfusion mismatching. We studied the effects of sepsis on hypoxic pulmonary vasoconstriction and attempted to determine whether hypoxic pulmonary vasoconstriction is influenced by pyridoxalated hemoglobin polyoxyethylene conjugate, a nitric oxide scavenger. DESIGN: Prospective, randomized, controlled experimental study with repeated measures. SETTING: Investigational intensive care unit at a university medical center. SUBJECTS: Nineteen female merino sheep, divided into three groups: group 1, controls (n = 5); group 2, sheep with sepsis (n = 6); and group 3, septic sheep treated with pyridoxalated hemoglobin polyoxyethylene conjugate (n = 8). INTERVENTIONS: All sheep were instrumented for chronic study. An ultrasonic flow probe was placed around the left pulmonary artery. After a 5-day recovery, a tracheostomy was performed and a double-lumen endotracheal tube was placed. Animals in groups 2 and 3 received a 48-hr infusion of live Pseudomonas aeruginosa (6 x 10(4) colony-forming units/kg/hr). After 24 hrs, sheep in group 3 received pyridoxalated hemoglobin polyoxyethylene conjugate (20 mg/kg/hr) for 16 hrs; sheep in groups 1 and 2 received only the vehicle. Hypoxic pulmonary vasoconstriction was repeatedly tested by unilateral hypoxia of the left lung with 100% nitrogen. Hypoxic pulmonary vasoconstriction was assessed as the change in left pulmonary blood flow. MEASUREMENTS AND MAIN RESULTS: In the animals in group 1, left pulmonary blood flow decreased by 62 +/- 8 (SEM)% during left lung hypoxia and remained stable during repeated hypoxic challenges throughout the study period. After 24 hrs of sepsis, left pulmonary blood flow decreased from 56 +/- 10% to 26 +/- 2% (group 2) and from 50 +/- 8% to 23 +/- 6% (group 3). In the sheep in group 2, there was no adaptation over time. Pulmonary shunt fraction increased. Pyridoxalated hemoglobin polyoxyethylene conjugate had no effect on hypoxic pulmonary vasoconstriction or pulmonary shunt. The animals receiving the bacterial infusion developed a hyperdynamic circulatory state with hypotension, decreased systemic vascular resistance, and increased cardiac output. Pyridoxalated hemoglobin polyoxyethylene conjugate increased mean arterial pressure and systemic vascular resistance but did not influence cardiac index. Pulmonary arterial pressure was increased during sepsis and increased even further after pyridoxalated hemoglobin polyoxyethylene conjugate administration. Oxygenation and oxygen delivery and uptake were not affected by pyridoxalated hemoglobin polyoxyethylene conjugate. CONCLUSIONS: Hypoxic pulmonary vasoconstriction is blunted during sepsis and there is no adaptation over time. It is not influenced by pyridoxalated hemoglobin polyoxyethylene conjugate. Pyridoxalated hemoglobin polyoxyethylene conjugate reversed hypotension and, with the exception of an increase in pulmonary arterial pressure, had no adverse effects on hemodynamics or oxygenation.     

Patterns of neuropsychological ability in brain-disordered versus normal children.

Examined the pattern of higher level vs lower level deficits in 25 brain-impaired children (aged 9–14 yrs) compared with 25 normal children (aged 9–24 yrs). It was hypothesized that measures of higher level abilities, such as abstract reasoning, would show greater differences between the groups than would measures of lower level abilities. Higher level functions measured included general neuropsychological functioning and verbal/academic skills; lower level functions measured included sensory and motor skills. Tests were selected from the Halstead-Reitan Neuropsychological Test Battery for Children, the Wechsler-Bellevue Intelligence Scale, the Wechsler Intelligence Scale for Children (WISC), and the Wide Range Achievement Test. Results show that the brain-impaired group was significantly poorer in each area of ability except sensory measures. Measures of motor functioning and general neuropsychological abilities best discriminated the brain-damaged group from the controls. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multidisciplinary treatment of chronic pulmonary insufficiency. 4. The influence of intrathoracic pressure variations on increases in pulmonary vascular pressure during exercise in patients with chronic obstructive pulmonary disease

In the present era of direct monitoring of pressure in patients with chronic obstructive pulmonary disease (COPD), an appreciation of all factors that may influence the observed pulmonary vascular pressures is essential. Our study examines the impact of respiratory variations in intrathoracic pressure on the recorded pulmonary vascular pressures in 28 patients with COPD. Althouth pulmonary hypertension was present in only nine subjects at rest, all had an abnormal increase in the mean pulmonary arterial pressure during supine exercise. In 15 subjects, this abnormal response was, in part, related to an increase in pulmonary arterial wedge pressure to 15 mm Hg or more. The increase in pulmonary arterial wedge pressure was directly related to the amplitude of the peak-to-peak respiratory variation of such wedge pressure. This variation correlated with the specific airway resistance but was not related to the arterial oxygen pressure or pulmonary vascular resistance. These findings indicate the important influence of exaggerated respiratory effort on the measurement of pulmonary arterial wedge pressure and mean pulmonary arterial pressure in patients with chronic obstructive pulmonary disease.     

Construct validity of WAIS—R factors: Neuropsychological test correlates in adults referred for evaluation of possible head injury.

A 3-factor solution of the Wechsler Adult Intelligence Scale—Revised (WAIS—R; Wechsler, 1981) in 260 adults with suspected head injury suggested relatively good construct validity for the factors, based on correlations with neuropsychological tests purported to measure similar abilities. The Verbal Comprehension factor was related to verbal ability, verbal memory, and executive functioning. The Perceptual Organization factor, although measuring primarily visual–spatial perception and visual constructional ability, was related to visual–spatial memory, visual attention, and executive functioning. The Freedom From Distractibility factor was correlated with two attention measures and was not associated with memory measures. Its association with executive functioning was inconsistent. The findings are discussed in terms of the multidimensional nature of neuropsychological tests and WAIS—R factors. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Longitudinal deficits to attention, executive, and working memory in subtypes of mild cognitive impairment.

Objective: Mild cognitive impairment (MCI) has emerged as a classification for a prodromal phase of cognitive decline that may precede the emergence of Alzheimer's disease (AD). Recent research suggests that attention, executive, and working memory deficits may appear much earlier in the progression of AD than traditionally conceptualized, and may be more consistently associated with the later development of AD than memory processing deficits. The present study longitudinally tracked attention, executive and working memory functions in subtypes of MCI. Method: In a longitudinal study, 52 amnestic MCI (a-MCI), 29 nonamnestic MCI (na-MCI), and 25 age- and education-matched controls undertook neuropsychological assessment of visual and verbal memory, attentional processing, executive functioning, working memory capacity, and semantic language at 10 month intervals. Results: Analysis by repeated measures ANOVA indicate that the a-MCI and na-MCI groups displayed a decline in simple sustained attention (ηp2 = .054) with a significant decline on a task of divided attention (ηp2 = .053) being evident in the a-MCI group. Stable deficits were found on other measures of attention, working memory and executive function in the a-MCI and na-MCI groups. The a-MCI group displayed stable impairments to visual and verbal memory. Conclusions: The results indicate that a-MCI and na-MCI display a stable pattern of deficits to attention, working memory, and executive function. The decline in simple sustained attention in a-MCI and n-MCI groups and to divided attention in a-MCI may be early indicators of possible transition to dementia from MCI. However, further research is required to determine this. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Immune function and neuropsychological performance in HIV-1-infected homosexual men

This study explores the relationship of immune dysfunction to the neuropsychological performance of individuals infected with HIV-1. Fifty-five HIV-positive homosexual men and 37 negative homosexual controls were evaluated using neuropsychological measures, physical exams, and measures of immune functioning. There were no significant differences favoring HIV-negative subjects over HIV-positive subjects. HIV-positive subjects, in fact, performed slightly better on attention and memory procedures. The HIV-positive subjects were then stratified according to the Centers for Disease Control symptom groupings (Group II, asymptomatic, n = 19; Group III, lymphadenopathy, n = 17; and Group IVA or C-2, symptomatic, non-AIDS, (n = 19). There were no significant neuropsychological differences among the three CDC groups. The HIV-positive subjects were also stratified on two measures of immune functioning: absolute CD4 counts (< 200, 201-400, > 400) and beta 2-microglobulin (beta 2M) (> or = 5.0, 3.0-5.0, < 3.0). Individuals with greater immune compromise, as measured by beta 2M, were more impaired on measures of attention and memory and had greater overall neuropsychological impairment (p < 0.05). Furthermore, 57% of the subjects who were abnormal on beta 2M were also impaired on measures of attention and memory, whereas only 14% of those with normal beta 2M were impaired on these same measures (p < 0.05). These results suggest that HIV-positive asymptomatics without evidence of immune compromise do not appear to be at greater risk of cognitive impairment than HIV-negative controls. However, for those HIV-positive individuals who are immune-compromised (even while asymptomatic), there is increased risk of neuropsychological impairment. These results also suggest that knowledge of serostatus and the use of the CDC classification system alone are insufficient in exploring the development of neuropsychiatric changes in HIV-1 infection.     

Subanesthetic concentrations of isoflurane suppress learning as defined by the category-example task

It has been shown that chronic oral steroid therapy (ST) does not induce respiratory muscle dysfunction in normal and asthmatic subjects. As corticosteroids are sometimes chronically used in the treatment of the patients with chronic obstructive pulmonary disease (COPD), the aim of our study was to verify whether ST could cause respiratory muscle impairment and, since ST also affects the central nervous system, whether ST could influence the ventilatory pattern. We retrospectively studied 12 COPD patients (group A), on long-term therapy (for at least 4 consecutive months, range 4-18 months) with an oral steroid, deflazacort, 15 mg.d-1. The subjects were strictly matched, with regard to age, sex, height, weight, forced expiratory volume in one second (FEV1), residual volume (RV), arterial oxygen tension (PaCO2), arterial carbon dioxide tension (PaCO2) and pH, with 12 COPD patients (Group B) who had never taken oral steroids. To assess respiratory muscle strength, we measured maximal inspiratory (MIP) and expiratory (MEP) pressures, while mouth occlusion pressure (P0.1) was employed to assess neuromuscular drive; ventilatory pattern and airway impedence were also evaluated. Effectiveness of ST was confirmed by the plasmatic levels of endogenous cortisol. No significant differences were observed between the two groups with regard to MIP (A 72.2 +/- 9.7 vs B: 70 +/- 7.2 cmH2O) and MEP (A 91.6 +/- 10.5 vs B 94.4 +/- 7.6 cmH2O) whilst P0.1 was significantly higher in group A (2.6 +/- 0.3 cmH2O) than in group B (1.8 +/- 0.1 cmH2O). No significant differences were found among all the ventilatory parameters, but the impedence was significantly higher in group A.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cognitive outcome in children and adolescents following severe traumatic brain injury: influence of psychosocial, psychiatric, and injury-related variables

Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than psychiatric or psychosocial factors as correlates of cognitive outcomes. We addressed this concern by recruiting a consecutive series (N = 24) of children age 5 through 14 years who suffered a severe TBI, a matched group who sustained a mild TBI, and a second matched group who sustained an orthopedic injury. Standardized intellectual, memory, psychiatric, family functioning, family psychiatric history, neurological, and neuroimaging assessments were conducted at an average of 2 years following injury. Severe TBI, when compared to mild TBI and orthopedic injury, was associated with significant decrements in intellectual and memory function. A principal components analysis of independent variables that showed significant (p < .05) bivariate correlations with the outcome measures yielded a neuropsychiatric factor encompassing severity of TBI indices and postinjury psychiatric disorders and a psychosocial disadvantage factor. Both factors were independently and significantly related to intellectual and memory function outcome. Postinjury psychiatric disorders added significantly to severity indices and family functioning and family psychiatric history added significantly to socioeconomic status in explaining several specific cognitive outcomes. These results may help to define subgroups of children who will require more intensive services following their injuries.     

Effect of 764-3 and ligustrazine on collagen content of extrapulmonary arteries during chronic hypoxia

OBJECTIVE: Effect of two antifibrotic Chinese drugs, 764-3 and ligustrazine, on collagen content in chronic hypoxic pulmonary hypertensive extrapulmonary arterial wall were examined. METHODS: Since collagen contains more than 10% hydroxyproline by weight and in other proteins there are almost no hydroxyproline, collagen content was expressed as micrograms of hydroxyproline. Hydroxyproline was determined by calorimetric method after oxidized by chloramine T. RESULTS: Both 764-3 and ligustrazine significantly inhibited the increase of pulmonary arterial pressure and elevation of hydroxyproline content in extrapulmonary arterial wall during chronic hypoxia. CONCLUSIONS: 764-3 and ligustrazine may be two hopeful therapeutic drugs for chronic hypoxic pulmonary hypertension.     

The role of overt attention in emotion-modulated memory.

The presence of emotional stimuli results in a central/peripheral tradeoff effect in memory: memory for central details is enhanced at the cost of peripheral items. It has been assumed that emotion-modulated differences in memory are the result of differences in attention, but this has not been tested directly. The present experiment used eye movement monitoring as an index of overt attention allocation and mediation analysis to determine whether differences in attention were related to subsequent memory. Participants viewed negative and neutral scenes surrounded by three neutral objects and were then given a recognition memory test. The results revealed evidence in support of a central/peripheral tradeoff in both attention and memory. However, contrary with previous assumptions, whereas attention partially mediated emotion-enhanced memory for central pictures, it did not explain the entire relationship. Further, although centrally presented emotional stimuli led to decreased number of eye fixations toward the periphery, these differences in viewing did not contribute to emotion-impaired memory for specific details pertaining to the periphery. These findings suggest that the differential influence of negative emotion on central versus peripheral memory may result from other cognitive influences in addition to overt visual attention or on postencoding processes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Memory functioning in children and adolescents with autism.

Objective: Memory functioning in children and adolescents ages 5–19 with autism (n = 50) and typically developing controls (n = 36) was assessed using a clinical assessment battery, the Test of Memory and Learning (TOMAL). Method: Participant groups were statistically comparable in age, nonverbal IQ, handedness, and head circumference, and were administered the TOMAL. Results: Test performance on the TOMAL demonstrated broad differences in memory functioning in the autism group, across multiple task formats, including verbal and nonverbal, immediate and delayed, attention and concentration, sequential recall, free recall, associative recall, and multiple-trial learning memory. All index and nearly all subtest differences remained significant even after comparing a subset of the autism group (n = 36) and controls that were matched for verbal IQ (p > .05). However, retention of previously remembered information after a delay was similar in autism and controls. Conclusions: These findings indicate that performance on measures of episodic memory is broadly reduced in autism, and support the conclusion that information encoding and organization, possibly due to inefficient cognitive processing strategies, rather than storage and retrieval, are the primary factors that limit memory performance in autism. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychological and cognitive outcomes of a randomized trial of exercise among patients with chronic obstructive pulmonary disease.

Exercise rehabilitation is recommended increasingly for patients with chronic obstructive pulmonary disease (COPD). This study examined the effect of exercise and education on 79 older adults (M age?=?66.6 ± 6.5 years; 53% female) with COPD, randomly assigned to 10 weeks of (a) exercise, education, and stress management (EXESM; n?=?29); (b) education and stress management (ESM; n?=?25); or (c) waiting list (WL; n?=?25). EXESM included 37 sessions of exercise, 16 educational lectures, and 10 weekly stress management classes. ESM included only the 16 lectures and 10 stress management classes. Before and after the intervention, assessments were conducted of physiological functioning (pulmonary function, exercise endurance), psychological well-being (depression, anxiety, quality of life), and cognitive functioning (attention, motor speed, mental efficiency, verbal processing). Repeated measures multivariate analysis of variance indicated that EXESM participants experienced changes not observed among ESM and WL participants, including improved endurance, reduced anxiety, and improved cognitive performance (verbal fluency). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Influence of symptoms, lung function, mood, and social support on level of functioning of patients with COPD

To explain how symptoms, lung function, mood, and social support affect level of functioning, patients (N = 143) with chronic obstructive pulmonary disease (COPD) completed measures assessing their symptoms (Bronchitis-Emphysema Symptom Checklist), mood (Profile of Mood States), social support (Personal Resource Questionnaire), and functioning (Sickness Impact Profile). Those who were receiving oxygen therapy (n = 52) had significantly lower FEV1 scores and experienced significantly poorer functioning than those who were not receiving oxygen therapy (n = 91). Results of path analyses indicated that symptoms and mood directly, and social support indirectly, influenced the functioning of those who were not receiving oxygen. For those who were receiving oxygen, only symptoms directly, and FEV1 indirectly, influenced their functioning. These models need to be confirmed using other samples of patients with COPD.