Cognitive deficits, psychopathology, and psychosocial functioning in bipolar mood disorder

BACKGROUND: The nutrition management of patients with malabsorption syndromes due to acquired immunodeficiency syndrome (AIDS) is problematic. The aim of this study was to compare the effects of total parenteral nutrition (TPN) and an oral, semielemental diet (SED) on body weight, body composition, quality of life, survival, and medical costs in AIDS patients with malabsorption. METHODS: This was a prospective, randomized, open-label study performed in outpatients. Twenty-three AIDS subjects (TPN group, 12; SED group, 11) with cryptosporidiosis, microsporidiosis, or malabsorption of unknown cause were randomized and followed. Subjects were prescribed equivalent amounts of formulas of similar composition for 3 months. Monthly estimations of caloric intake, body weight, body composition by bioimpedance analysis, and quality of life were recorded. Nutritional variables were analyzed by repeated-measures analysis of covariance, with the baseline measure as the covariate. Nutrition-related medical costs, survival, and indices of absorptive and immune function were compared, RESULTS: Subjects had lost an average of 1.5 and 1.0 kg body wt/mo for TPN and SED during the 6 months before study entry (p < not significant). The TPN group consumed more total calories than the SED group (p < .05). Weight change during therapy was significantly different from pretreatment in both groups (p < .01 for TPN, p = .023 for SED). The TPN group gained more weight than the SED group (p = .057) and significantly more fat (p = .02), but the changes in body cell mass were similar in the two groups. Changes in weight and body composition correlated with caloric intake but not the mode of feeding. The SED group scored significantly better than the TPN group on a physical functioning subscale of quality of life (p < .01). Survival was similar in the two groups. TPN therapy cost almost four times more than SED. Peripheral blood CD4+ lymphocyte numbers were unaffected by either therapy. Intestinal function was not affected by either therapy. CONCLUSIONS: An oral SED may reverse weight loss and wasting in AIDS patients with malabsorption.     

Current issues relating to psychosocial job strain and cardiovascular disease research.

[Correction Notice: An erratum for this article was reported in Vol 3(4) of Journal of Occupational Health Psychology (see record 2008-09594-001). On p. 12, in the caption to Figure 2, the copyright statement is missing. The caption should have read "The environment, the worker, and illness: Dynamic associations linking environmental strain and learning to evolution of personality. From Healthy Work: Stress, Productivity, and the Reconstruction of Working Life (p. 99), by R. A. Karasek and T. Theorell, 1990, New York: Basic Books. Copyright 1990 by Basic Books. Used with permission."] Examines recent reviews of cardiovascular (CV) job strain (JS) research by P. L. Schnall and P. A. Landsbergis (1994) and T. S. Kristensen (see record 1995-39109-001), which conclude that JS as defined by the demand–control model (the combination of contributions of low job decision latitudes and high psychological job demands) is confirmed as a risk factor for CV mortality in a large majority of studies. Lack of social support at work appears to increase this risk. Several still-unresolved issues are discussed in light of recent research. Methodological issues related to the use of occupational & career aggregate estimates, use of standard scales for job analysis, and recall bias in issues of self-reporting are examined. Confounding factors and differential strengths of associations by subgroups in JS–CV disease analyses with respect to social class, gender, and working hours are addressed. A review of results of monitoring JS–blood pressure associations and associated methodological issues is provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Domestic violence: legal, practice, and educational issues

Domestic violence is a recognized and growing public health concern in the United States. Health care professionals have a duty to improve the identification of victims of domestic violence, intervene effectively, and advocate for better education to break the cycle of abuse.     

Electrodiagnosis in neuromuscular disease

This article provides a general approach to the electrodiagnostic evaluation of the patient with neuromuscular disease. The electrodiagnostic findings in patients with various forms of peripheral neuropathy, motor neuron disease, neuromuscular junction disorders, and myopathy are presented. The pediatric electrodiagnostic evaluation is also discussed.     

Cognitive and educational outcome of very-low-birthweight children in early adolescence

A cohort of 138 very-low-birthweight (VLBW) 12-year-old children and matched control children were assessed on objective cognitive and educational measures. School performance was rated by teachers and by the children themselves. VLBW children were shown to have lower IQ scores, and poorer scores on all objective educational measures compared with control children. Controlling for IQ differences, mathematics and reading-comprehension scores remained significantly lower for VLBW children. Teachers rated VLBW children lower in all curriculum areas. Significantly more VLBW children were found to be 'failing' in one or more subject and an increased proportion compared with the control children had received remedial education. The VLBW group showed no evidence of 'catch up' between 6 and 12 years of age. Multiple regression analyses were used to identify predictors of cognitive and educational outcome. The duration of mechanical ventilation in the neonatal period was inversely related to outcome. Full-Scale IQ at 6 years, motor-skills score at 6 years, and head circumference at 12 years all predicted outcome at 12 years, as did maternal education, family income and size. Individually, many VLBW children perform satisfactorily, but as a group VLBW children appear to be at a long-term disadvantage to peers in the areas of cognitive and educational performance.     

Noninvasive ventilation in neuromuscular disease

The treatment of respiratory failure in patients who have NMD continues to be an evolving process. Negative-pressure ventilation, once prominent in the 1940s and 1950s, gave way to intermittent positive-pressure ventilation with tracheostomy or endotracheal tubes in the 1960s. Now there is a resurgence of noninvasive ventilation, brought about by innovative modes of positive pressure delivered through nasal and facial masks. Although frequently relegated to second-line choices, negative-pressure devices still offer a practical treatment alternative as patient preference still plays a role in selecting a proper mode of ventilation. Studies have shown that noninvasive ventilation can prevent or reverse respiratory failure and improve quality of life and longevity. Despite the seemingly widespread acceptance of noninvasive ventilation in the treatment of respiratory failure, physicians still appear reluctant to use ventilatory assistance in the neuromuscular arena. In 1985, a survey found that respiratory support systems were utilized routinely in only 33% of the 132 responding Muscular Dystrophy Association (MDA) clinics. Bach recently surveyed 273 MDA clinic directors and co-directors from 167 clinics, to evaluate their current use of mechanical ventilation. Ventilatory assistance was recommended and used electively in only 43 (26%) of the 167 clinics. Furthermore, it was the policy in 68 of the clinics to discourage the use of mechanical ventilation. Even more importantly, only 2 physicians who discouraged the use of mechanical ventilation were familiar with the newest noninvasive methods of ventilatory support. Sadly, although our methodologies in the treatment of respiratory failure continue to improve, physician practice has lagged behind. Physicians who treat patients who have NMD need to become cognizant of these new techniques and incorporate them into their present therapeutic armamentarium.     

Behavioral and psychosocial factors in AIDS: Methodological and substantive issues.

Examines disease transmission and vulnerability factors concerning acquired immune deficiency syndrome (AIDS) in the gay male population, with emphasis on germ-theory and overload-theory etiologic models. It is argued that the dominance of the germ-theory model has led to research that ignores or inadequately addresses lifestyle factors that may have direct consequences for immunologic functioning. An interactive model, which postulates that exposure to an AIDS agent will lead to clinically significant symptomatology only under conditions of host vulnerability, is proposed. Techniques for assessing the impact of AIDS on the gay male community and health policy implications are discussed. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive remediation in traumatic brain injury: update and issues

Cognitive Remediation (CR) is a relatively new treatment technique for alleviating residual cognitive deficits following traumatic brain injury. This is a promising yet still changing technique. The future of CR as a rational and systematic endeavor requires the incorporation of important new ideas that have been emerging in allied fields. For example, the emerging field of instructional psychology has contributed relevant concepts such as scaffolding, metacognition, and generalization. It is furthermore argued that the issues of awareness, self-concept, and self-efficacy are vital to the process of CR intervention, and an integrative (holistic) approach to the remedial endeavor is thus indicated.     

Contemporary psychosocial issues in cystic fibrosis: treatment adherence and quality of life

This review focuses on the two major psychosocial areas currently topical in cystic fibrosis research: treatment adherence and quality of life. First, the paper discusses the importance of evaluating adherence to treatments and medical advice, its measurement, predictors of adherence and non-adherence and whether the data should be used to inform clinical practice and policy decisions. Second, the purpose of evaluating quality of life in cystic fibrosis and an overview of the data are discussed. Both areas have suffered from problems with terminology and definition, inappropriate methodologies and hence difficulties with data interpretation. Future directions for research are advocated.     

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.     

Pregnancy after breast cancer: from psychosocial issues through conception

Women face numerous issues if they either contemplate childbearing or become pregnant after the diagnosis of breast cancer. Based on a search of the English medical literature from 1966 to 1997, we make the following conclusions regarding pregnancy after breast cancer: (1) Sexual function is not affected by the decision to treat breast cancer by breast conservation vs mastectomy. (2) Infertility after breast cancer treatment is directly proportional to patient age and the use and dose of alkylating agents. There is no conclusive information on the effects of duration, dose intensity, schedule, or route of administration of chemotherapy on subsequent fertility. (3) There appears to be no increase in birth defects in children whose parents were exposed to chemotherapy earlier in life. (4) Milk production of the irradiated breast is likely to be limited. Also, breastfeeding appears to decrease the risk of breast cancer. (5) With respect to monitoring pregnant women for breast cancer recurrence, in general the recommendations made by the American Society of Clinical Oncology (ASCO) regarding monitoring in nonpregnant women should be followed. (6) Pregnancy does not increase the risk of recurrent breast cancer. (7) Adjuvant tamoxifen (Nolvadex) therapy has adverse effects on pregnancy in vivo and in laboratory animals. No reports exist on the effects of tamoxifen on human pregnancy.     

Cognitive, educational, and behavioural outcomes at 7 to 8 years in a national very low birthweight cohort

AIMS: To examine cognitive, behavioural, and educational outcomes in middle childhood among a birth cohort of very low birthweight children. METHODS: Two hundred and ninety eight survivors from a national birth cohort of 413 New Zealand very low birthweight (VLBW) children born in 1986 were assessed at 7 to 8 years of age on measures of behaviour, cognitive ability, school performance and the need for special education. These outcomes were compared with the same measures in a general population sample of over 1000 children studied at a similar age. RESULTS: The VLBW children had significantly higher rates of problems and poorer levels of functioning across all outcome measures than the general child sample. These differences persisted even after control for variability in social, family, and other characteristics of the two samples and for the degree of sensorineural disability. There was evidence of a gradient of risk with birthweight, with extremely low birthweight children having generally higher rates of problems and difficulties than other VLBW children after covariate control. CONCLUSIONS: The findings are consistent with a growing body of research evidence which suggests that premature and VLBW infants are at increased risk of longer term morbidity and functional impairment in middle childhood.     

Electromyography of the diaphragm in neuromuscular disease

We compared the diaphragmatic electromyographic (EMG) recordings from 32 patients with known neuromuscular disease and respiratory symptoms (23 neuropathies, 9 myopathies) to recordings from 23 normal subjects. Turns analysis of 219-ms sections, or epochs, of the EMG demonstrated a significant overlap between diagnostic groups, although some epochs from neuromuscular patients were significantly different from normal. Empirical rules were derived to infer neuropathic and myopathic involvement of the diaphragmatic EMG.     

The role of exercise in neuromuscular disease

Persons with hereditary neuromuscular diseases generally lead a sedentary lifestyle, placing them at risk for diseases associated with inactivity and causing weakness, which compounds their primary disease. Although research is lacking in this area, evidence to date suggests that this population may benefit from both strengthening and aerobic fitness training programs. Overwork weakness has not been demonstrated in controlled trials of exercise, but clinicians need to be prudent in their recommendations, encouraging alternating periods of physical activity with scheduled rest. Future investigations should focus on the primary symptom of fatigue, and quantify changes in the ability to work and participate in physical activities as outcome measures of an exercise program.     

Management of cardiac complications in neuromuscular disease

Cardiovascular complications are common and varied in neuromuscular diseases. Knowledge of the complications specific to each disease is essential for appropriate screening for cardiovascular disease. Appropriate treatment of complications varies between neuromuscular diseases and draws primarily on experience from patients without neuromuscular disease. This article details the known cardiovascular complications and treatments for some of the major neuromuscular diseases.     

Political and psychosocial issues in psychotherapy for spouse abusers: Implications for treatment.

Considers and evaluates political and psychosocial factors that impact the delivery of psychotherapy for male spouse abusers in light of the perceived clinical need for such services. Objections to providing psychotherapy for spouse abusers are viewed as emanating primarily from conflicting philosophical definitions of the problem. A proposed model of spouse abuse seeks to integrate findings from the literature and experience to reduce the conflict between diverse philosophical positions. The model identifies 3 areas in which intervention can decrease the likelihood of spouse abuse: social attitudes in the larger environment, the man's individual characteristics and attitudes, and the nature of the interactions between the man and his spouse. Guidelines presented attempt to maximize psychotherapy effectiveness and reconcile political and psychosocial issues. It is suggested that the assailant is solely responsible for the physical violence. Although social attitudes, environmental events, and individual characteristics all interact to increase the probability of wife battering, intervention with the assailant is considered critical. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Battered women and AIDS: Assessment and treatment from a psychosocial–educational perspective.

HIV has reached pandemic proportions. First, it ravaged the underdeveloped countries of Africa, spreading to the developing countries in Asia and then to the Western World. In the industrialized nations, HIV was initially viewed as a disease of gay White males (A. Lea, 1994). As the disease spread, it became evident that HIV can impact all people. Eventually, epidemiologists recognized the high rate of incidence among women. This article discusses the biological, psychological, and sociological challenges of assessing and treating battered women with HIV/AIDS. In particular, battered women are at high risk because they are often reluctant to reveal the abuse and are vulnerable to sexual assault. Thus, for proper identification and treatment purposes, it is imperative that health care workers have a clear understanding of issues facing battered women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research of psychosocial issues of children with craniofacial anomalies: progress and challenges

Benign intracranial hypertension and communicating hydrocephalus are uncommon but important disorders that affect cerebrospinal fluid dynamics. They have clinical similarities but their management is usually different. The factors determining which of the two disorders will develop include brain compliance, the state of the cranial sutures, the nature of the insult and its magnitude. I propose that the time course of the pathological events leading to presentation may be a further factor to consider in the pathogenesis and management of these disorders.     

"Current issues relating to psychosocial job strain and cardiovascular disease research": Correction to Theorell and Karasek (1996).

Reports an error in "Current issues relating to psychosocial job strain and cardiovascular disease research" by T?res Theorell and Robert A. Karasek (Journal of Occupational Health Psychology, 1996[Jan], Vol 1[1], 9-26). On p. 12, in the caption to Figure 2, the copyright statement is missing. The caption should have read "The environment, the worker, and illness: Dynamic associations linking environmental strain and learning to evolution of personality. From Healthy Work: Stress, Productivity, and the Reconstruction of Working Life (p. 99), by R. A. Karasek and T. Theorell, 1990, New York: Basic Books. Copyright 1990 by Basic Books. Used with permission." (The following abstract of the original article appeared in record 1996-04477-002.) Examines recent reviews of cardiovascular (CV) job strain (JS) research by P. L. Schnall and P. A. Landsbergis (1994) and T. S. Kristensen (see record 1995-39109-001), which conclude that JS as defined by the demand-control model (the combination of contributions of low job decision latitudes and high psychological job demands) is confirmed as a risk factor for CV mortality in a large majority of studies. Lack of social support at work appears to increase this risk. Several still-unresolved issues are discussed in light of recent research. Methodological issues related to the use of occupational & career aggregate estimates, use of standard scales for job analysis, and recall bias in issues of self-reporting are examined. Confounding factors and differential strengths of associations by subgroups in JS-CV disease analyses with respect to social class, gender, and working hours are addressed. A review of results of monitoring JS-blood pressure associations and associated methodological issues is provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)