RESUMEN
This prospective study in 119 patients with cardiovascular diseases aimed to examine whether (a) illness representations mediate the relation of general maladaptive health beliefs to patients' coping behaviours and (b) these relations are moderated by the patients' perception of the amount of information provided by their physicians. Personal control and illness coherence mediated the relation of maladaptive health beliefs to coping behaviour. The amount of the provided information buffered the negative relation of maladaptive health beliefs to illness representations and coping. Thus, the detrimental effect of general maladaptive health beliefs may be counterbalanced by the amount of information provided by physicians.
Asunto(s)
Adaptación Psicológica , Enfermedades Cardiovasculares/psicología , Comunicación en Salud/métodos , Conocimientos, Actitudes y Práctica en Salud , Médicos , Autocontrol/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
OBJECTIVE: The aim of this study was to examine (a) whether illness representations mediate the relation of the amount of information provided by physicians to patients' adaptation to illness; (b) whether patient-physician agreement on the information provided impacts the aforementioned relationship. The study focused on information that, according to the Common Sense Self-Regulation Model, is essential for adaptation to illness. METHODS: The sample consisted of 93 patients undergoing chemotherapy and their physicians. Indirect (mediation) effects and conditional (moderated) indirect effects were examined using bootstrapping. RESULTS: The more illness and treatment-related information was provided by physicians, the more positive illness representations (specifically, illness consequences, emotional representations, and personal control) were reported by patients. In turn, these illness representations were related to better physical functioning and better adjustment to cancer. The degree of the patient-physician agreement on the information provided did not affect this relationship. CONCLUSIONS: What seems to be more crucial for patients' adaptation to cancer during treatment is the amount of information provided by physicians rather than their agreement with patients on the information provided. Also, there is a need to thoroughly examine the pathways through which information provision impacts adaptation to illness.
Asunto(s)
Adaptación Psicológica , Difusión de la Información , Neoplasias/psicología , Neoplasias/terapia , Relaciones Médico-Paciente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , MédicosRESUMEN
BACKGROUND: Bipolar disorder (BD) is associated with brain structural and cognitive abnormalities. There is a paucity of evidence regarding the evolution of these deficits over time. This study examined the relationship between age and brain morphology and cognition in patients with BD type I. METHODS: Brain structural magnetic resonance imaging data were acquired using a 1.5T scanner from 71 BD patients and 82 age- and gender-matched controls and analysed using Statistical Parametric Mapping. In addition, participants were evaluated using the Wechsler Adult Intelligence Scale, Revised; the Wechsler Memory Scale, third edition; the Hayling Sentence Completion Task, a measure of response inhibition; and the Wisconsin Card Sorting Test, which reflects rule discovery and perseveration. RESULTS: We found a significant effect of age but not of diagnosis and no age-by-diagnosis interaction in global gray and white matter and cerebrospinal fluid volumes. There was no differential effect of age on the two diagnostic groups with respect to cognitive task performance. CONCLUSIONS: Our findings do not support differential age-related changes in brain structure and cognition in patients with bipolar disorder compared to healthy individuals. Cross-sectional studies are, however, limited and longitudinal data will be required to further explore this issue.
Asunto(s)
Trastorno Bipolar/complicaciones , Trastorno Bipolar/patología , Encéfalo/patología , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/patología , Adulto , Factores de Edad , Anciano , Mapeo Encefálico , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Escalas de Valoración Psiquiátrica , Adulto JovenRESUMEN
Generalized cognitive deficits have been consistently reported in adolescents with early onset schizophrenia (EOS; defined as onset before the age of 17 years). The impact on cognition of potential interactions between disease pathology and brain maturation remains unclear. We therefore compared cognitive function between 20 EOS patients and 20 healthy controls matched on age, gender, and parental socioeconomic status at 2 time points, when aged 15.58 (2.27) and after a mean interval of 4 +/- 1.08 years when aged 19.46 (2.21) years. Repeated measures analyses revealed no differences between patients and controls in the degree of change over this time period in general intellectual function and planning ability as measured by the Tower of London. There was deterioration in the verbal memory and attentional control index scores from the Wechsler Memory Scale-Revised but relative improvement in Part A of the Trail Making Test. Patients' level of symptomatology as well as the type and dose of medication were comparable at both time points. We conclude that most aspects of cognitive function remain relatively stable in EOS patients during adolescence; there is evidence for deterioration in immediate verbal memory and attention while speed of information processing may show improvement.
Asunto(s)
Trastornos del Conocimiento/epidemiología , Esquizofrenia/epidemiología , Adolescente , Edad de Inicio , Trastornos del Conocimiento/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Procesos Mentales , Pruebas Neuropsicológicas , Corteza Prefrontal/fisiopatología , Esquizofrenia/fisiopatología , Índice de Severidad de la Enfermedad , Prueba de Secuencia Alfanumérica , Conducta VerbalRESUMEN
OBJECTIVE: To examine the contribution of premorbid function, duration of untreated psychosis (DUP), age of onset, severity of symptoms at presentation, and number of subsequent hospitalisations to the outcome of early onset schizophrenia (EOS; onset before 17th birthday). METHOD: Twenty-three EOS patients (mean age at onset 15.16 +/- 1.39 years) were re-assessed after a mean interval of 4 +/- 1.08 years. At baseline and follow-up clinical diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Axis I Disorders and symptoms were assessed with the Positive and Negative Syndrome Scale. Premorbid function, as measured with the Premorbid Adjustment Scale, age of onset and DUP were assessed at baseline only. Outcome was evaluated using the Social Adaptation Self-Evaluation Scale (SASS) and the Global Assessment of Functioning (GAF) Scale. RESULTS: Mean DUP was 2.95 +/- 3.59 months and mean total PAS score was 6.65 +/- 3.02. They had an average of 2.09 +/- 1.44 hospitalisations and their mean SASS and GAF scores were 37.27 +/- 6.5 and 54.19 +/- 18.99, respectively. Poor childhood premorbid function and the severity of negative symptoms at baseline were correlated with worse SASS and GAF scores. No other significant associations were found. CONCLUSIONS: Poor childhood function is the most significant predictor of outcome in EOS.
Asunto(s)
Adaptación Psicológica , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Ajuste Social , Adolescente , Adulto , Edad de Inicio , Niño , Conducta Infantil/psicología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Readmisión del Paciente/estadística & datos numéricos , Pronóstico , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Psicología del Adolescente , Psicología Infantil , Índice de Severidad de la Enfermedad , Distribución por Sexo , Factores de TiempoRESUMEN
BACKGROUND: Cognitive abnormalities are increasingly recognized as a feature of bipolar I disorder (BDI,) but there is limited information regarding the pattern and severity of cognitive impairment during remission and its relationship with clinical variables. METHODS: Forty-four remitted BDI patients recruited from a representative treatment sample and an equal number of matched healthy volunteers underwent comprehensive clinical and cognitive assessments. Cognitive evaluation covered the domains of IQ, memory, and executive function. The profile of cognitive deficits in patients was examined, and the correlation of executive function with clinical features and treatment variables was explored. RESULTS: Remitted BDI patients were impaired in tests of executive function compared with healthy participants. Within the patient group, current antipsychotic treatment predicted worse performance across all executive function tests, whereas duration of illness predicted loss of inhibitory control. Residual mood symptoms, regardless of polarity, had a negative impact primarily on measures of attentional interference. CONCLUSIONS: These results suggest that impaired executive function might be an important feature of BDI. Antipsychotic treatment, duration of illness, and level of symptoms are the most significant contributors to the observed impairment.
Asunto(s)
Trastorno Bipolar/psicología , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/psicología , Adolescente , Adulto , Antipsicóticos/uso terapéutico , Atención/fisiología , Trastorno Bipolar/tratamiento farmacológico , Femenino , Humanos , Inteligencia/fisiología , Masculino , Memoria/fisiología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Escalas de Valoración Psiquiátrica , Desempeño Psicomotor/fisiologíaRESUMEN
BACKGROUND: Abnormalities in cerebral lateralization are thought to reflect early neurodevelopmental defects in schizophrenia. The aim of this study was to examine whether there is abnormal brain lateralization in early onset schizophrenia (EOS) and whether it is related to the unusually early onset of the disorder. METHODS: Adolescent patients with recent onset schizophrenia and an equal number of matched control subjects participated in the study. The volumes of the occipitoparietal, sensorimotor, premotor, prefrontal, and temporal regions were measured bilaterally from magnetic resonance images using stereological methods. Asymmetry indexes were calculated for each region using the formula ([R - L]/[R + L]) x 100. A composite index of asymmetry (torque) was computed as the sum of the five index scores. RESULTS: A total of 40 patients with EOS and 40 age-matched controls were enrolled. There were no group differences in demographic characteristics. No group differences in brain asymmetry measures were seen in any of the brain regions examined. CONCLUSIONS: The unusually early onset of schizophrenia in this population does not appear to be associated with abnormalities in hemispheric lateralization.