RESUMEN
Few behavioral parent training (BPT) treatment studies for attention-deficit/hyperactivity disorder (ADHD) have included and measured outcomes with fathers. In this study, fathers were randomly assigned to attend a standard BPT program or the Coaching Our Acting-Out Children: Heightening Essential Skills (COACHES) program. The COACHES program included BPT plus sports skills training for the children and parent-child interactions in the context of a soccer game. Groups did not differ at baseline, and father ratings of treatment outcome indicated improvement at posttreatment for both groups on measures of child behavior. There was no significant difference between groups on ADHD-related measures of child outcome. However, at posttreatment, fathers who participated in the COACHES program rated children as more improved, and they were significantly more engaged in the treatment process (e.g., greater attendance and arrival on time at sessions, more homework completion, greater consumer satisfaction). The implications for these findings and father-related treatment efforts are discussed.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/psicología , Terapia Conductista/métodos , Relaciones Padre-Hijo , Padre/educación , Responsabilidad Parental/psicología , Adulto , Trastorno por Déficit de Atención con Hiperactividad/terapia , Niño , Consejo/métodos , Padre/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Conducta Paterna , Educación del Paciente como Asunto , Evaluación de Programas y Proyectos de Salud , Resultado del TratamientoRESUMEN
OBJECTIVE: The Strategies to Enhance Positive Parenting (STEPP) program was developed to address putative factors related to poor engagement in and outcomes following traditional behavioral parent training (BPT) for single mothers of children diagnosed with ADHD. METHOD: Twelve single mothers of children with ADHD were enrolled in an initial investigation of the feasibility and preliminary efficacy of the 9-week STEPP program. RESULTS: Results indicated that the STEPP program was effective in reducing problematic child behavior and improving parental stress and psychopathology at posttreatment. The STEPP program resulted in high rates of treatment attendance and completion and consumer satisfaction with the program. However, results also indicated that the STEPP program did not improve childrens' overall psychosocial impairment and resulted in small effect size findings across measures. CONCLUSION: The results of the pilot study are encouraging but indicate a need to improve the potency and delivery of certain aspects of the STEPP program.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/terapia , Terapia Conductista/educación , Madres/educación , Responsabilidad Parental/psicología , Evaluación de Programas y Proyectos de Salud , Padres Solteros/educación , Adaptación Psicológica , Adolescente , Adulto , Trastorno por Déficit de Atención con Hiperactividad/psicología , Déficit de la Atención y Trastornos de Conducta Disruptiva/psicología , Déficit de la Atención y Trastornos de Conducta Disruptiva/terapia , Terapia Conductista/métodos , Niño , Estudios de Factibilidad , Femenino , Grupos Focales , Humanos , Masculino , Relaciones Madre-Hijo , Madres/psicología , Relaciones Padres-Hijo , Proyectos Piloto , Solución de Problemas , Padres Solteros/psicología , Familia Monoparental/psicología , Estrés Psicológico/prevención & control , Estrés Psicológico/psicología , Resultado del TratamientoRESUMEN
BACKGROUND: We reviewed previous studies comparing schizophrenia patients and healthy subjects for performance on the Iowa Gambling Task (IGT) (a laboratory task designed to measure emotion-based decision-making), and found mixed results. We hypothesize that deficits in IGT performance in schizophrenia may be more specifically related to concurrent substance use disorders. To test this hypothesis, we compared schizophrenia patients with (SCZ((+))) or without (SCZ((-))) cannabis use disorders, to healthy subjects, on measures of cognition and IGT performance. METHODS: A comprehensive battery of cognitive tests and the IGT were administered to three groups of subjects: (1) 13 subjects with DSM-IV diagnosis of schizophrenia and no concurrent substance use disorders (mean age: 28+/-12 (SD); 54% males); (2) 14 subjects with schizophrenia and concurrent cannabis use disorders (mean age: 29+/-9 (SD); 71% males); and (3) 20 healthy subjects (mean age 33+/-10 (SD); 60% males). RESULTS: Compared to the healthy group, both schizophrenia groups were cognitively more impaired, and did worse on IGT performance. There were no differences between SCZ((+)) and SCZ((-)) patients on most of the cognitive tests, and IGT performance. CONCLUSIONS: Schizophrenia patients show widespread impairments in several cognitive domains and emotion-based decision-making. These results are consistent with the evidence that schizophrenia reflects a dorsolateral and orbitofrontal/ventromedial prefrontal cortex dysfunction. More intriguing, it appears that the concurrent abuse of cannabis has no compounding effects on cognition, as well as emotion/affect-based decision-making.
Asunto(s)
Trastornos Disruptivos, del Control de Impulso y de la Conducta/epidemiología , Juego de Azar/psicología , Abuso de Marihuana/epidemiología , Pruebas Psicológicas , Esquizofrenia/epidemiología , Adolescente , Adulto , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/epidemiología , Comorbilidad , Toma de Decisiones , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Trastornos Disruptivos, del Control de Impulso y de la Conducta/diagnóstico , Femenino , Humanos , Masculino , Abuso de Marihuana/diagnóstico , Persona de Mediana Edad , Pruebas Neuropsicológicas , Esquizofrenia/diagnóstico , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: To assess the effects of modafinil on fatigue, symptoms, attention, working memory, and executive functioning in schizophrenia patients treated with psychotropic medications. METHOD: Twenty-four patients with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder (10 men and 14 women) were randomly assigned to modafinil up to 200 mg a day (N = 13) or placebo (N = 11) as an adjunct therapy in an 8-week, double-blind, placebo-controlled study. Data were collected from May 18, 2001 to September 11, 2003. RESULTS: Four subjects terminated the study early, including one because of worsening of psychosis during the first week taking modafinil. In the modafinil (N = 10) and placebo (N = 10) groups, fatigue improved significantly over time (p < .01), but there were no differences between groups on changes in fatigue, positive and negative symptoms, or cognition. CONCLUSION: Fatigue improved in both groups, and there were no differences between groups on changes in fatigue, symptoms, attention, working memory, or executive functioning. Lack of differences between groups may be due to small sample size or possible regression to the mean in the placebo group.
Asunto(s)
Compuestos de Bencidrilo/uso terapéutico , Estimulantes del Sistema Nervioso Central/uso terapéutico , Trastornos del Conocimiento/inducido químicamente , Trastornos del Conocimiento/tratamiento farmacológico , Fatiga/inducido químicamente , Fatiga/tratamiento farmacológico , Psicotrópicos/efectos adversos , Esquizofrenia/tratamiento farmacológico , Adulto , Atención/efectos de los fármacos , Compuestos de Bencidrilo/farmacología , Estimulantes del Sistema Nervioso Central/farmacología , Cognición/efectos de los fármacos , Trastornos del Conocimiento/diagnóstico , Método Doble Ciego , Femenino , Lóbulo Frontal/fisiología , Humanos , Masculino , Memoria/efectos de los fármacos , Modafinilo , Pruebas Neuropsicológicas , Placebos , Trastornos Psicóticos/tratamiento farmacológico , Trastornos Psicóticos/psicología , Psicotrópicos/uso terapéutico , Psicología del Esquizofrénico , Resultado del TratamientoRESUMEN
BACKGROUND: The purpose of this review is to understand how changes in costs of illness are related to the effects of antipsychotic medications on symptoms in schizophrenia patients. METHOD: A search of the MEDLINE database was performed using the keywords costs, symptoms, and schizophrenia. Studies published between 1965 and 2003 in English, French, German, or Spanish that assessed costs, symptoms, and relationships between costs and symptoms were reviewed. RESULTS: Twenty studies were identified. Most of the reviewed clinical trials of antipsychotic medications reported a decrease in mean costs of illness and an improvement in symptoms. However, many of the studies did not examine the relationship between changes in costs and symptoms. CONCLUSION: There is little evidence that changes in costs of illness are directly related to the effects of antipsychotic medications on symptoms. This review emphasizes the need for standardizing the assessment of costs and clinical outcomes, looking more specifically at the relationship between types of costs and specific aspects of psychopathology and developing new statistical models relating changes in costs and clinical outcomes.
Asunto(s)
Antipsicóticos/uso terapéutico , Costos de la Atención en Salud/estadística & datos numéricos , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/economía , Psicología del Esquizofrénico , Antipsicóticos/economía , Ensayos Clínicos como Asunto/estadística & datos numéricos , Costo de Enfermedad , Análisis Costo-Beneficio , Costos de los Medicamentos , Investigación sobre Servicios de Salud , Humanos , Modelos Estadísticos , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Esquizofrenia/diagnóstico , Resultado del TratamientoRESUMEN
We examined the relationship between insight and the positive, negative, active, dysphoric, and autistic dimensions of symptoms in patients with a diagnosis of schizophrenia. Ninety-six patients with a diagnosis of schizophrenia were assessed using the Scale to Assess Unawareness of Mental Disorder, Revised Version (SUMD-R) and the Positive and Negative Syndrome Scale (PANSS). The PANSS data were analyzed based on a five-factor model defined by White et al (1997). The percentage of patients having a lack of awareness was 32.7% for illness, 58.2% for symptoms, 18.4% for treatment response, and 41.8% for social consequences. Lack of awareness of symptoms was significantly correlated with all five symptom factors. Lack of awareness of the illness and its social consequences was only correlated with the positive dimension. Lack of awareness of achieved effects of medication was correlated with the autistic preoccupation factor. There was no correlation between current misattributions for symptoms and PANSS factors. We conclude that poor insight is a common feature of schizophrenia and has a complex relationship to other symptoms of the illness. Our results suggest that (1) unawareness of symptoms is related to severity of illness; (2) insight into illness and its social consequences is more closely tied to positive symptoms than other aspects of insight; and (3) insight into the effects of medication is more closely related to cognitive impairment. Treatment studies that measure insight could answer the question of whether these deficits in awareness improve along with positive and cognitive symptoms.