Quality of life assessment in Turkish patients with schizophrenia and their relatives

Quality of life of first-degree relatives living in the same household with patients having schizophrenia has not been sufficiently explored. 30 patients with schizophrenia (16 women, 14 men), diagnosed using DSM-IV criteria, 31 of their relatives (15 women, 16 men), and 34 control subjects (21 women, 13 men) were included in the study. The mean age of the patients, their relatives, and the control subects were 39.8 +/- 10.9, 58.1 +/- 12.5 and 37.3 +/- 17.0, respectively. The World Health Oranization Quality of Life-Brief Form was administered to all subjects. Quality of life was worse for the patient group than for their relatives and control subjects, but relatives of the patients and control subjects were not significantly different on Quality of life. Quality of life was negatively correlated with the severity of psychopathology and extrapyramidal side effects induced by antipsychotic drugs in the patients.     

Personality and family functioning in families of depressed patients

In this cross-sectional study, the authors attempted to identify correlates of family functioning in 86 couples with a depressed member during the acute phase of the patient's depression. Demographic variables, psychiatric status, and personality traits of both the patient and spouse were investigated as potential predictors of family functioning. Regression analyses indicated that lower levels of personality pathology in the patient, higher levels of patient conscientiousness, and less psychological distress in the spouse were associated with healthier family functioning. Future research implications and clinical importance of these findings are discussed.     

Influence of perceived social support and functioning on the quality of life of patients with schizophrenia and their caregivers

Perception of social support and functioning of patients with schizophrenia and their primary caregivers and its relationship to quality of life are described. Forty-five patients and their 45 relatives, treated at the Mental Health Services in Arica, Chile, participated. Both patients and caregivers in the study have a poor perception of social support with regard to extra-family people, as well as a low social integration. However, patients showed adequate capacity to function within their immediate family. Unlike what was found in developed countries, these patients showed moderate levels of quality of life, with a strong relationship with perceptions of the social support they receive from family and significant others and the ability to establish and maintain social contacts. Quality of life of primary caregivers is linked to patients' ability to establish and maintain social contacts within the family group, as in other social instances, such as keeping a job. The results of the study suggest the need to consider the design and application of programs of support for these patients and their caregivers, with the central aim of the social functioning of the above-mentioned patients and their familiar and community integration.     

Quality of life and depression in haemodialysis patients

Chronic kidney disease is associated with a high prevalence of depression, which increases inversely with the glomerular filtration rate. This paper aims to evaluate the factors associated with a low quality of life and depression in patients on haemodialysis. Two hundred patients undergoing haemodialysis answered the Medical Outcomes Study 36 – Item Short – Form Health Survey (SF-36) and Beck Depression Inventory (BDI). Clinical and laboratory variables were analysed and correlated with these two tools. The prevalence of depression was 29%. Anaemia and hypoalbuminemia were independent risk factors for depression. All SF-36 domains showed worse results in patients with depression, and the pain domain presented the highest correlation. Our findings provide evidence that patients on haemodialysis have a low quality of life and a high prevalence of depression. A greater number of comorbidities, an excessive number of medications, diabetes mellitus, anaemia and hypoalbuminemia were associated with a reduced quality of life.     

Understanding the executive functioning heterogeneity in schizophrenia

Schizophrenia is characterized by heterogeneous brain abnormalities involving cerebral regions implied in the executive functioning. The dysexecutive syndrome is one of the most prominent and functionally cognitive features of schizophrenia. Nevertheless, it is not clear to what extend executive deficits are heterogeneous in schizophrenia patients. Furthermore, it is still unknown if the executive impairments observed in schizophrenia are better characterized as specific or as reflecting generalized cognitive factors. The four executive processes (i.e. updating, inhibition, shifting and divided attention) described in Miyake et al.'s (2000) theoretical model were examined in 62 individuals with schizophrenia and 49 healthy controls. At group level, impairments in all four executive processes confirmed the marked impairment in executive functioning in patients with schizophrenia. Statistical analysis indicated that executive performances in schizophrenia patients were more heterogeneous than in healthy controls. Compared with standardized norms, 94% of patients exhibited impairment in at least one of the executive tasks. Twenty-one percent of patients exhibited impairment in one executive task, 27% in two tasks, 23% in three executive tasks and 23% exhibited impairments in the four executive tasks. Six percent of patients had normal executive profile. Regression analysis indicated that only premorbid intellectual quotient and a general slowing in processing speed predicted the executive dysfunction severity. Executive functioning was not affected by age, duration of illness, psychotic status, or by antipsychotic dosage. Our results emphasize the heterogeneity of the dysexecutive syndrome in schizophrenia when individual profile analysis is considered, and extend the view that individual cognitive differences in schizophrenia are largely underlined by general cognitive factors such as intellectual level and general processing speed.     

Multigenerational stress and nuclear family functioning

This longitudinal study tested Bowen theorys assumption that stressors in the interdependent multigenerational family influence variation in nuclear family functioning. Forty-nine newly developing nuclear families and their multigenerational families were studied over five years. Quantitative analysis demonstrated an association between the perceived impact of multigenerational stressors and variation in nuclear family functioning. Multigenerational stressors, as compared to individual or nuclear family stressors, had a stronger association with nuclear family functioning. The stress response was manifested in symptomatic outcomes of the nuclear family emotional process. Generally, the number of stressors and the total impact of stressors increased over time, stressors in some years associated with functioning in subsequent years, nuclear family-of-origin stressors demonstrated a decreasing association over time, and developing nuclear family stressors demonstrated a somewhat increasing association over time.     

Purpose in life and cognitive functioning in adulthood

With an increasingly aging population, more work is needed to identify factors which may promote the maintenance of normal cognitive functioning. The current study tested the concurrent association between sense of purpose in life and the cognitive variables of episodic memory, executive functioning, and composite cognitive functioning in adults (N = 3489, M_age = 56.3 years, SD = 12.27, Range = 32–84 years) from the Midlife in the United States study (MIDUS). Correlational analyses suggested that purpose in life was associated with higher scores for memory, executive functioning, and overall cognition. Bootstrapping tests of moderation found no evidence for a moderating effect of age on purpose and the cognitive variables. Future studies should attempt to explain the mechanisms behind this relationship and explore the potential for interventions to promote healthy cognitive and purposeful aging.     

Migration patterns,family functioning,and life satisfaction among migrant children in China: A mediation model

There are three distinct patterns of migration among Chinese migrant children: whole‐family, single‐parent‐first, and both‐parents‐first migration. This study investigated the life satisfaction of children who migrated under the different migration patterns and examined the mediating role of family functioning in the relationship between the children's migration patterns and their life satisfaction. Participants consisted of migrant children (N = 703) from primary and junior middle schools in Chengdu, China. The results showed that (a) migrant children from the whole‐family and single‐parent‐first patterns of migration reported greater life satisfaction than did those from the both‐parents‐first pattern, and (b) family functioning partially mediated the association between migration patterns and life satisfaction. The present study highlights the importance of avoiding separation of children from both parents during migration and the need to develop interventions for migrant children's psychological adaptation by improving their families’ functioning.     

Therapists' perceptions of healthy family functioning

Abstract

For several decades family theorists, researchers, and clinicians have attempted to describe healthy and dysfunctional family functioning. The numerous articles and studies with this focus have been reviewed elsewhere (Riskin & Faunce, 1972; Jacob, 1975). Until recently a disproportionate amount of attention has been given to pathology. Several volumes in the past few years have tried to redress this bias by focusing primarily on healthy family functioning (Kantor & Lehr, 1976; Lewis, Beavers, Gossett & Phillips, 1976).     

A cross-cultural study of family functioning

The Family Assessment Device (FAD) was used to compare patterns of family functioning in two cultural settings, North America and Hungary. The sample size consisted of 95 nonclinical North American families and 58 nonclinical Hungarian families. No cross-cultural differences were found in the families' general functioning nor in their affective involvement or affective responsiveness as measured by the FAD. Hungarian families, however, perceived their functioning as significantly better than the North American families in problem-solving and in communication. North American families rated themselves significantly better than the Hungarians in setting family rules and boundaries and in meeting their family responsibilities. Results from this study suggest that cultural values can affect a family's functioning and that differences in areas of family functioning can be captured using the FAD. A discussion of broad societal values of the two cultures was used to interpret the contrasting patterns of family functioning.Cross-cultural studies serve many purposes. In general they provide knowledge about the different cultures under investigation. As such, they broaden and enrich our perspectives of ourselves and the world around us. More specifically they highlight similarities and differences across cultures, information that can be helpful in further refining our understanding of the impact of diverse and varying socio-political forces.A topic of particular interest to family therapists and researchers is family functioning in different cultural settings. In spite of continuing research in this area, few studies examine cross-cultural patterns of family interactions and even fewer do so with instruments specifically designed to assess family functioning.From a family perspective, particularly looking at pathology in family functioning, cross-cultural comparisons can be used to highlight areas of dysfunction common to families irrespective of the cultural context. From a cross-cultural perspective, family comparisons can be used to point out the cultural effects and emphases given to different dimensions of functioning within a common system (i.e., the family unit).Both conceptual and methodological problems have contributed to shortcomings in previous cross-cultural studies (Fabrega, 1974; Kleinman, 1987; Flaherty et al., 1988; Rogler, 1989). A basic criticism of such studies has been the assumption that meanings and values in one culture are equivalent to those in another.Another issue, which is particularly pertinent to our study, is the use of an instrument which is developed in one culture and administered in another cultural setting. A potential problem this raises is inferring cultural differences between groups when the translated and the original instruments are not actually comparable in meaning. In fact, one objective of the study was to see whether our own self-report measure of family functioning, the Family Assessment Device (FAD, Epstein et al., 1978, 1983), could be successfully used in another cultural setting.The following report is part of a larger research project, conducted in 1986–87, that compared depressed and nonclinical families across two cultures. The findings presented here are comparisons between nonclinical Hungarian and nonclinical North American families. In our earlier study differences in family interactions between clinically depressed and nonclinical families were evident in both cultural settings (Keitner et al., in press). It was not clear, however, if significant cross-cultural differences in family functioning would be found for the normal group of families and, if so, how these would differ from their ill counterparts. Inclusion of the normal families thus served two purposes, as controls in the larger study to test within cultural differences and as comparison groups in a separate analysis to test between cultural differences.A specific objective of this study was to contrast patterns of perceived family functioning in nonclinical Hungarian families and North American families. Another objective was to determine if the Family Assessment Device (FAD), a self-report measure of family functioning, could be successfully used in different cultural contexts. Hungary was chosen as an appropriate country of study for several reasons. It is at the crossroads of East and West, sharing enough similarities with western culture to validate comparisons, yet different enough in both its cultural and sociopolitical system that some differences could be expected to emerge. Because it is likely that the Hungarian social system is less familiar to readers than that of North American, the results are discussed with particular reference to Hungary.We would like to thank Drs. J. Furedi and T. Kurimay for help in translating the Family Assessment Device and Professors J. Szilard and Muszong-Kovacs for their support of this study. This work was supported in part by the Firan Foundation.     

Quality of life in patients before and after kidney transplantation

Abstract

The aim of the present study was to differentially determine quality of life (QOL) in patients with end-stage renal disease (ESRD) after successful kidney transplantation (RT, Group A) compared with ESRD patients on a waiting list for RT (Group B). and with healthy controls (Group C) because opinions vary as to which treatment modality can best assure ESRD patients a high QOL.

Groups A, B and C each consisted of 149 persons, matched for age and gender. The Munich Quality of Life Dimensions List (MLDL) was used to measure global aspects of QOL. Distinct aspects of QOL were investigated by the Brief Symptom Inventory (BSI) and the Questionnaire for Social Support (K-22).

Groups A and C reported similar QOL. Which was significantly higher than in group B (p < .0001). This was particularly true for the physical and psychological status and daily activities, but not for the social situation. Groups A and B reported similar social support, which was significantly, lower than in group C (p < 006). Both ESRD groups reported higher satisfaction with social support than healthy controls (p < .0001).

Successful RT nor only improved distinct aspects of QOL in patients with ESRD, but even put them on par with healthy controls regarding physical and psychological QOL.

Lower social support and higher satisfaction with social support in both groups of ESRD patients should be evaluated further. From a clinical viewpoint. the improvement of physical and psychological aspects of QOL in RT patients is impressive; but more attention should be paid to constantly low social support in this group of patients. International multi center longitudinal studies to investigate QOL in ESRD patients under different treatments am necessary.     

Quality of life in patients before and after kidney transplantation

Abstract The aim of the present study was to differentially determine quality of life (QOL) in patients with end-stage renal disease (ESRD) after successful kidney transplantation (RT, Group A) compared with ESRD patients on a waiting list for RT (Group B). and with healthy controls (Group C) because opinions vary as to which treatment modality can best assure ESRD patients a high QOL. Groups A, B and C each consisted of 149 persons, matched for age and gender. The Munich Quality of Life Dimensions List (MLDL) was used to measure global aspects of QOL. Distinct aspects of QOL were investigated by the Brief Symptom Inventory (BSI) and the Questionnaire for Social Support (K-22). Groups A and C reported similar QOL. Which was significantly higher than in group B (p < .0001). This was particularly true for the physical and psychological status and daily activities, but not for the social situation. Groups A and B reported similar social support, which was significantly, lower than in group C (p < 006). Both ESRD groups reported higher satisfaction with social support than healthy controls (p < .0001). Successful RT nor only improved distinct aspects of QOL in patients with ESRD, but even put them on par with healthy controls regarding physical and psychological QOL. Lower social support and higher satisfaction with social support in both groups of ESRD patients should be evaluated further. From a clinical viewpoint. the improvement of physical and psychological aspects of QOL in RT patients is impressive; but more attention should be paid to constantly low social support in this group of patients. International multi center longitudinal studies to investigate QOL in ESRD patients under different treatments am necessary.     

Caregiver burden and family functioning in different neurological diseases

Aim of this study is to examine caregiver burden and family functioning in different neurological conditions. Forty-two primary caregivers of patients with Amyotrophic Lateral Sclerosis (ALS), Alzheimer’s Disease and other dementia (AD), Parkinson’s Disease (PD), Acquired Brain Injuries (ABI) and Multiple Sclerosis (MS) were administered scales for the evaluation of caregiver burden (CBI) and family functioning (FACES IV). Caregiver burden was overall high, with caregivers of patients with ALS and ABI having exceeded the CBI cut-off score for possible burn-out. The average scores of caregivers of patients with AD or other dementia and PD were close to the cut-off score, whereas those of caregivers of patients with MS were significantly lower than the others. Family cohesion, family satisfaction and the quality of family communication were associated with reduced levels of caregiver burden, whereas disengagement was associated with a higher burden. The data from the present study confirm that caregiver burden is a relevant issue in the context of neurological diseases, especially for those causing higher degrees of impairment. Significant correlations with family functioning emerged as well, highlighting the importance of studying and treating caregiver burden within the context of family relations.     

The impact of family functioning on family racial socialization processes

This longitudinal study evaluated the relationship between family functioning and family racial socialization processes in a clinical sample of African American youth referred for drug abuse treatment. Participants were 77 African American adolescents and their parents. Results showed that participants assigned to structural ecosystems therapy experienced a greater increase in family racial socialization processes during treatment than participants assigned to the treatment as usual in community settings condition. Participants in structural ecosystems therapy also demonstrated a greater increase in family functioning than participants in community settings condition, and this improvement in family functioning mediated the relationship between treatment condition and family racial socialization processes. Research and clinical implications are discussed.     

Depressed youth: treatment outcome and changes in family functioning in individual and family therapy

This study explores the role of family functioning in therapeutic change in focused individual psychodynamic psychotherapy (FIPP) and time‐limited systems integrative family therapy (SIFT) for depressed children and adolescents. After a screening process, 72 participants aged 8 to 15 were randomized to either FIPP or time‐limited SIFT. Assessments took place prior to, at the end of, and 6 months after treatment. Families in both SIFT and FIPP showed a small but significant and sustained improvement in family functioning by the end of treatment in both mothers' self‐reports and family therapists' assessments. Better family functioning at baseline in mothers' self‐reports and improved family functioning during SIFT, as assessed by family therapists, predicted a sustained decrease in self‐reported depressive symptoms. Results indicated that time‐limited SIFT may be more effective with younger children and in patients without a diagnosis of double depression than adolescents.     

Eye-contact perception in schizophrenia: relationship with symptoms and socioemotional functioning

Accurately perceiving self-referential social signals, particularly eye contact, is critical to social adaptation. Schizophrenia is often accompanied by deficits in social cognition, but it is unclear whether this includes gaze discrimination deficits. This study investigated whether eye-contact perception is preserved or impaired and if it is related to symptoms and broader socioemotional functioning in schizophrenia. Twenty-six participants with schizophrenia (SCZ) and 23 healthy controls (HC) made eye-contact judgments for faces in varying gaze direction (from averted to direct in ten 10% increments), head orientation (forward, 30° averted), and emotion (neutral, fearful). Psychophysical analyses for forward faces showed that SCZ began endorsing eye contact with weaker eye-contact signal and their eye-contact perception was less of a dichotomous function, as compared with HC. SCZ were more likely than HC to endorse eye contact when gaze was ambiguous, and this overperception of eye contact was modulated by head orientation and emotion. Overperception of eye contact was associated with more severe negative symptoms. Decreased categorical gaze perception explained variance of socioemotional deficits in schizophrenia after taking basic neurocognition into consideration, suggesting the relationship was not solely due to a general deficit problem. These results were discussed in relation to the nature of categorical gaze perception and its significance to clinical and functional presentations of schizophrenia.     

Parent psychopathology and family functioning among childhood firesetters

The purpose of this study was to identify parent and family characteristics related to juvenile firesetting and antisocial behavior among severely disturbed children. Hospitalized children (ages 6–12) identified as firesetters (n=27) and nonfiresetters (n=27) were compared in terms of parental psychopathology, dyadic adjustment, and family environment. To separate the impact of conduct disorder in contributing to group differences, diagnosis and firesetting status were separated in the data analyses. The results indicated that parents of firesetters showed significantly greater dysfunction in terms of psychiatric symptoms, and higher levels of depression, and reported lower levels of affectional expresssion, consensus, and overall adjustment in their dyadic relationships. The findings suggest that among a clinical sample, specific parent and marital characteristics delineate firesetters. The contribution of parental and marital influences to antisocial behavior more generally and the need to focus specifically on firesetting in relation to these variables are discussed.Completion of this research was supported by grants (MH39976, MH35408) and by a Research Scientist Development Award (MH00353) from the National Institute of Mental Health. The authors appreciate the assistance of Debra Colbus and Antoinette Rodgers and the clinical research team of the Child Psychiatric Treatment Service.