Managed Mental Health Care (MMHC) began blanketing the United States when cost of care rose exponentially. MMHC is one avenue many employers and insurance companies have chosen to provide employees with mental health treatment at controlled costs. However, not all employers view supplying their employees with mental health treatment beneficial, as they do not know mental health problems can significantly decrease work productivity. Brown and Jones (2005) used the Social Role Scale (SR) of the Severe Outcome Questionnaire (SOQ) to estimate work productivity in employees under the assumption that the scale measures work productivity. The purpose of this study was to move closer to an estimation of the relationship between improved mental health and improved workplace functioning by examining the relationships among a self-report measure of mental health (i.e., the SR), a self-report measure of work productivity (i.e., the Work Productivity and Activity Impairment Scale [WPAI]), and objective measures of work productivity (i.e., the quality and timeliness of institutional records, supervisor ratings, and sick hours used). It was thought that understanding the relationships among these measures might assist in estimating the cost/benefit of investing in psychotherapy. Participants in this study were employees and inpatients at the Utah State Hospital. Statistical analyses indicated the SR did predict two WPAI scales (i.e., Presenteeism and Activity Impairment) for employees. Specific relationships among measures, and suggestions for future research, are discussed.

Background Compared with other malignancies, head and neck cancer (HNC) increases the risk of not returning to work (RTW). Methods Within a cross-sectional study, patients with HNC filled out the OncoFunction questionnaire, a version of the International Classification of Functioning Core Sets for HNC. In 231 patients below 65 years of age, associations of sociodemographic, clinical, functional, and psychological factors with employment and participation in rehabilitation program were explored. Results Unemployed patients reported more swallowing difficulties and speaking problems. Being unemployed was associated with higher levels of depressive and anxiety symptoms, fatigue, and lower global health. Rehabilitation participation was not significantly associated with any of the assessed factors except for smoking. Conclusions Unemployed patients with HNC are more burdened than employed patients with HNC regarding clinical, psychological, and functional factors. These differences are more evident later in recovery. Rehabilitation participation was not associated with psychological and functional burden which indicates the need for tailored HNC rehabilitation programs.

Background: Early differentiation between transient ischemic attack (TIA) and minor ischemic stroke (MIS) impacts on the patient’s individual diagnostic work-up and treatment. Furthermore, estimations regarding persisting impairments after MIS are essential to guide rehabilitation programs. This study evaluated a combined clinical- and serum biomarker-based approach for the differentiation between TIA and MIS as well as the mid-term prognostication of the functional outcome, which is applicable within the first 24 h after symptom onset. Methods: Prospectively collected data were used for a retrospective analysis including the neurological deficit at admission (National Institutes of Health Stroke Scale, NIHSS) and the following serum biomarkers covering different pathophysiological aspects of stroke: Coagulation (fibrinogen, antithrombin), inflammation (C reactive protein), neuronal damage in the cellular [neuron specific enolase], and the extracellular compartment [matrix metalloproteinase-9, hyaluronic acid]. Further, cerebral magnetic resonance imaging was performed at baseline and day 7, while functional outcome was evaluated with the modified Rankin Scale (mRS) after 3, 6, and 12 months. Results: Based on data from 96 patients (age 64 ± 14 years), 23 TIA patients (NIHSS 0.6 ± 1.1) were compared with 73 MIS patients (NIHSS 2.4 ± 2.0). In a binary logistic regression analysis, the combination of NIHSS and serum biomarkers differentiated MIS from TIA with a sensitivity of 91.8% and a specificity of 60.9% [area under the curve (AUC) 0.84]. In patients with NIHSS 0 at admission, this panel resulted in a still acceptable sensitivity of 81.3% (specificity 71.4%, AUC 0.69) for the differentiation between MIS (n = 16) and TIA (n = 14). By adding age, remarkable sensitivities of 98.4, 100, and 98.2% for the prediction of an excellent outcome (mRS 0 or 1) were achieved with respect to time points investigated within the 1-year follow-up. However, the specificity was moderate and decreased over time (83.3, 70, 58.3%; AUC 0.96, 0.92, 0.91). Conclusion: This pilot study provides evidence that the NIHSS combined with selected serum biomarkers covering pathophysiological aspects of stroke may represent a useful tool to differentiate between MIS and TIA within 24 h after symptom onset. Further, this approach may accurately predict the mid-term outcome in minor stroke patients, which might help to allocate rehabilitative resources.

No description available.

Lima-Silva TB. Funcionalidade e desempenho cognitivo na demência frontotemporal variante comportamental. [Dissertação]. São Paulo: Faculdade de Medicina, Universidade de São Paulo, 2012. Resumo Introdução: Existem poucos estudos sobre alterações funcionais na Demência Frontotemporal variante comportamental (DFTvc). Subtipos de demência menos estudados, como a DFTvc, vêm ganhando destaque, por também apresentarem importância epidemiológica. Objetivou-se no presente estudo: 1. Caracterizar o desempenho funcional e cognitivo de pacientes com diagnóstico prévio de DFTvc, atendidos em ambulatórios de Neurologia e Psiquiatria e compará-los a pacientes com Doença de Alzheimer (DA) e controles saudáveis; 2. Examinar a correlação entre o desempenho em escalas funcionais (DAFS-BR, DAD e PFAQ) e o desempenho cognitivo; 3. Avaliar a acurácia diagnóstica da DAFS-BR para a detecção da DFTvc e da DA. Métodos: Participaram 96 indivíduos com idade igual ou superior a 45 anos, com escolaridade formal acima de dois anos. Destes, 31 haviam recebido o diagnóstico de DFTvc, 31 de DA e 34 eram adultos saudáveis pareados aos pacientes com DFTvc e DA para idade e escolaridade. Foram aplicados: questionário sociodemográfico e de variáveis clínicas; Escala de Depressão Geriátrica (Geriatric Depression Scale - GDS) de 15 itens, Escala de Ansiedade Geriátrica (Geriatric Anxiety Inventory - GAI), Addenbrooke Cognitive Examination-Revised (ACE-R) que engloba as questões do Mini Exame do Estado Mental (MEEM), Executive Interview (EXIT-25), Direct Assessment of Functional Status (DAFS-BR). O protocolo dos acompanhantes conteve a Escala Cornell de Depressão em Demência, Pfeffer Functional Activities Questionnaire (PFAQ), Disability Assessment for Dementia (DAD), Inventário Neuropsiquiátrico (NPI) e a Escala de Avaliação Clínica da Demência (CDR). Resultados: Pôde-se observar que o grupo com DFTvc apresentou pior desempenho em Alimentação na DAFS-BR e nos domínios de Iniciação e Planejamento/Organização na DAD, comparado aos idosos com DA, sugerindo que a dependência na DFTvc é mais acentuada. A pontuação mais elevada na PFAQ, sugeriu que a dependência na DFTvc é mais acentuada. Foram encontradas correlações significativas entre o desempenho cognitivo e funcional. Os dados de acurácia para a DAFS-BR sugeriram que a escala pode auxiliar na identificação das demências, apresentando limitações no diagnóstico diferencial entre os subtipos. Considerações finais: Os resultados apresentados sugerem que indivíduos com DFTvc apresentam maior prejuízo funcional, quando comparados com participantes com DA e adultos saudáveis. Os resultados apresentados destacaram a importância da avaliação funcional de pacientes com suspeita de DFTvc, devido à relevância destas alterações para o diagnóstico e manejo clínico deste subtipo de demência. / Summary Introduction: There are but a few research studies on functional impairment in behavioral variant Frontotemporal Dementia. Less studied dementia subtypes, such as bvFTD, have been gaining prominence due to their epidemiological significance. The objectives of the present research were to: 1. Characterize the functional and cognitive performance of patients previously diagnosed with bvFTD treated at outpatient clinics of Neurology and Psychiatry, and compare their performance with that of patients with AD and normal controls; 2. Examine the correlation between performance in the functional scales (DAFS-BR, DAD e PFAQ) and cognitive performance; and 3. Evaluate the diagnostic accuracy of the DAFS-BR for detecting bvFTD and AD. Methodology: The sample consisted of 96 individuals aged 45 or older, with at least two years of formal education. Of these, 31 had been diagnosed with bvFTD, 31 with AD, and 34 were healthy adults paired with the patients with bvFTD and AD for age and education. The following instruments were used: sociodemographic and clinical questionnaire; 15-item Geriatric Depression Scale (GDS); Geriatric Anxiety Inventory (GAI); Addenbrooke Cognitive Examination-Revised (ACE-R), which includes the questions of the Mini Mental State Examination (MMSE); Executive Interview (EXIT-25); and the Direct Assessment of Functional Status Revised (DAFS-BR). The protocol for caregivers included the Cornell Scale for Depression in Dementia, Pfeffer Functional Activities Questionnaire (PFAQ), Disability Assessment for Dementia (DAD), Neuropsychiatric Inventory (NPI) and the Clinical Dementia Rating scale (CDR). Results: Individuals in the bvFTD group had lower performance in the ´Eating skills´ item of the DAFS-BR, and in ´Initiation´ and in ´Planning/Organization´ in the DAD, suggesting a higher level of dependence in bvFTD, and Higher scores in the PFAQ suggested that dependence in bvFTD is more pronounced. Significant correlations were found between cognitive and functional performances. The accuracy data for the DAFS-BR indicated that the scale can help identify dementia however, it has limitations in the differential diagnosis among subtypes. Final Considerations: The results suggest that individuals with bvFTD display greater functional impairment when compared to individuals with AD and to healthy adults. These results highlight the importance of assessing functionality status among patients suspected to have bvFTD. These deficits are relevant for the diagnosis and clinical management of this subtype of dementia.

Depression is a serious public health concern and leading cause of global disability; in the U.S., it is estimated that over 35 million individuals suffer from depression. Health-related dysfunction, including impairment and poor quality of life, are often associated with depressive symptoms; however, little research has examined the interrelationships between these factors. Functional impairment, or the experience of difficulty conducting necessary activities of daily living, may contribute to emotional distress directly but may also impact perceived quality of life. Health-related quality of life (HRQL), which is conceptualized as a holistic and subjective perception of one’s physical and mental quality of life, is a wellestablished indicator of overall general health. Given the dearth of research examining the linkages between these variables, we hypothesized that greater levels of functional impairment would be positively related to depressive symptoms and that physical and mental HRQL would mediate this association, such that greater functional impairment would be associated with poorer mental and physical HRQL and, in turn, to greater depressive symptoms. Our sample (N=100; 70.3% female (N=71); 93% Caucasian (N=94); Mean Age = 42.18, SD = 12.83) was recruited from a rural, Southern Appalachian primary care clinic serving working and uninsured patients. Participants completed self-report measures: Instrumental Activities of Daily Living Scale, World Health Organization Quality of Life Scale - Brief, and the Center for Epidemiological Studies Depression Scale. Simple mediation analyses, consistent with Preacher and Hayes, were conducted covarying age, sex and ethnicity. In support of our hypothesis, the direct effect of functional impairment on depressive symptoms decreased but remained significant (DE=-1.39, SE=.66, p=.03) when mental HRQL was included as a mediator (IE lower 95% CI=-3.27, upper 95% CI=-.877), indicating partial mediation. In addition, the direct effect of functional impairment on depressive symptoms fell out of significance (DE=-1.18, SE=.33, p=.15) when physical HRQL was included as a mediator (IE lower 95% CI=-3.79, upper 95% CI=-.83), indicating full mediation. Our findings suggest that individuals experiencing functional limitations are less likely to report good mental and physical HRQL and, in turn, endorse higher levels of depressive symptoms. Our findings may have clinical implications; therapeutic enhancement of coping skills and problem-solving strategies may reduce psychological distress, whereas engagement with social and instrumental support networks may provide assistance with physical limits, thereby reducing risk for depressive symptoms in individuals experiencing functional impairment.

Uppsatsens övergripande syfte var att undersöka profiler av samsjuklighet mellan depressiva symtom och olika undergrupper av social ångest hos unga vuxna (20-24 år) samt dess samband med livstillfredsställelse och upplevd social funktionsnedsättning inom yrkesliv/studier respektive sociala aktiviteter. Data har inhämtats via självskattningsformulär. Resultaten analyserades genom en klusteranalys. Två profiler med samsjuklighet mellan undergrupper av social ångest och depressiva symtom framkom. Denna samsjuklighet verkar vara relaterad till både en lägre grad av upplevd livstillfredsställelse samt till funktionsnedsättning inom två domäner, yrkesliv/studier och sociala aktiviteter. / The main purpose of this thesis was to investigate profiles of comorbidity between depressive symptoms and different subgroups of social anxiety in young adults (20-24 years) and its relationship to life satisfaction and social dysfunction within the domains occupation/education and social activities. The data used was gathered through questionnaires. The results were analyzed with cluster analysis.  Two profiles with comorbidity between subgroups of social anxiety and depressive symptoms were found. This comorbidity seems to be related to a lower level of experienced life satisfaction and to dysfunction within two domains, occupation/education and social activities.

Lima-Silva TB. Funcionalidade e desempenho cognitivo na demência frontotemporal variante comportamental. [Dissertação]. São Paulo: Faculdade de Medicina, Universidade de São Paulo, 2012. Resumo Introdução: Existem poucos estudos sobre alterações funcionais na Demência Frontotemporal variante comportamental (DFTvc). Subtipos de demência menos estudados, como a DFTvc, vêm ganhando destaque, por também apresentarem importância epidemiológica. Objetivou-se no presente estudo: 1. Caracterizar o desempenho funcional e cognitivo de pacientes com diagnóstico prévio de DFTvc, atendidos em ambulatórios de Neurologia e Psiquiatria e compará-los a pacientes com Doença de Alzheimer (DA) e controles saudáveis; 2. Examinar a correlação entre o desempenho em escalas funcionais (DAFS-BR, DAD e PFAQ) e o desempenho cognitivo; 3. Avaliar a acurácia diagnóstica da DAFS-BR para a detecção da DFTvc e da DA. Métodos: Participaram 96 indivíduos com idade igual ou superior a 45 anos, com escolaridade formal acima de dois anos. Destes, 31 haviam recebido o diagnóstico de DFTvc, 31 de DA e 34 eram adultos saudáveis pareados aos pacientes com DFTvc e DA para idade e escolaridade. Foram aplicados: questionário sociodemográfico e de variáveis clínicas; Escala de Depressão Geriátrica (Geriatric Depression Scale - GDS) de 15 itens, Escala de Ansiedade Geriátrica (Geriatric Anxiety Inventory - GAI), Addenbrooke Cognitive Examination-Revised (ACE-R) que engloba as questões do Mini Exame do Estado Mental (MEEM), Executive Interview (EXIT-25), Direct Assessment of Functional Status (DAFS-BR). O protocolo dos acompanhantes conteve a Escala Cornell de Depressão em Demência, Pfeffer Functional Activities Questionnaire (PFAQ), Disability Assessment for Dementia (DAD), Inventário Neuropsiquiátrico (NPI) e a Escala de Avaliação Clínica da Demência (CDR). Resultados: Pôde-se observar que o grupo com DFTvc apresentou pior desempenho em Alimentação na DAFS-BR e nos domínios de Iniciação e Planejamento/Organização na DAD, comparado aos idosos com DA, sugerindo que a dependência na DFTvc é mais acentuada. A pontuação mais elevada na PFAQ, sugeriu que a dependência na DFTvc é mais acentuada. Foram encontradas correlações significativas entre o desempenho cognitivo e funcional. Os dados de acurácia para a DAFS-BR sugeriram que a escala pode auxiliar na identificação das demências, apresentando limitações no diagnóstico diferencial entre os subtipos. Considerações finais: Os resultados apresentados sugerem que indivíduos com DFTvc apresentam maior prejuízo funcional, quando comparados com participantes com DA e adultos saudáveis. Os resultados apresentados destacaram a importância da avaliação funcional de pacientes com suspeita de DFTvc, devido à relevância destas alterações para o diagnóstico e manejo clínico deste subtipo de demência. / Summary Introduction: There are but a few research studies on functional impairment in behavioral variant Frontotemporal Dementia. Less studied dementia subtypes, such as bvFTD, have been gaining prominence due to their epidemiological significance. The objectives of the present research were to: 1. Characterize the functional and cognitive performance of patients previously diagnosed with bvFTD treated at outpatient clinics of Neurology and Psychiatry, and compare their performance with that of patients with AD and normal controls; 2. Examine the correlation between performance in the functional scales (DAFS-BR, DAD e PFAQ) and cognitive performance; and 3. Evaluate the diagnostic accuracy of the DAFS-BR for detecting bvFTD and AD. Methodology: The sample consisted of 96 individuals aged 45 or older, with at least two years of formal education. Of these, 31 had been diagnosed with bvFTD, 31 with AD, and 34 were healthy adults paired with the patients with bvFTD and AD for age and education. The following instruments were used: sociodemographic and clinical questionnaire; 15-item Geriatric Depression Scale (GDS); Geriatric Anxiety Inventory (GAI); Addenbrooke Cognitive Examination-Revised (ACE-R), which includes the questions of the Mini Mental State Examination (MMSE); Executive Interview (EXIT-25); and the Direct Assessment of Functional Status Revised (DAFS-BR). The protocol for caregivers included the Cornell Scale for Depression in Dementia, Pfeffer Functional Activities Questionnaire (PFAQ), Disability Assessment for Dementia (DAD), Neuropsychiatric Inventory (NPI) and the Clinical Dementia Rating scale (CDR). Results: Individuals in the bvFTD group had lower performance in the ´Eating skills´ item of the DAFS-BR, and in ´Initiation´ and in ´Planning/Organization´ in the DAD, suggesting a higher level of dependence in bvFTD, and Higher scores in the PFAQ suggested that dependence in bvFTD is more pronounced. Significant correlations were found between cognitive and functional performances. The accuracy data for the DAFS-BR indicated that the scale can help identify dementia however, it has limitations in the differential diagnosis among subtypes. Final Considerations: The results suggest that individuals with bvFTD display greater functional impairment when compared to individuals with AD and to healthy adults. These results highlight the importance of assessing functionality status among patients suspected to have bvFTD. These deficits are relevant for the diagnosis and clinical management of this subtype of dementia.

Le Trouble Déficit de l’Attention Hyperactivité (TDAH) est un trouble du neurodéveloppement associant des symptômes d’inattention, d’hyperactivité et/ou d’impulsivité. Fréquemment, le tableau clinique est marqué par une labilité émotionnelle pouvant se manifester sous différentes formes jusqu’à parfois s’agencer en un véritable syndrome : le Trouble Disruptif avec Dysrégulation Emotionnelle, récemment inclus dans le DSM-5. La labilité émotionnelle est-elle un symptôme du TDAH ou de troubles comorbides ? Est-elle caractéristique d’un tableau clinique du TDAH ? Ce travail de thèse propose d’étudier le profil psychopathologique associé à la labilité émotionnelle sous différentes approches, catégorielle et dimensionnelle, et à deux périodes clés du développement de l’enfant atteint de TDAH, l’âge préscolaire et l’âge scolaire. Quatre études composent ce travail de thèse : les trois premières en milieu clinique et la dernière en population générale. Les résultats ont indiqué que la labilité émotionnelle d’un point de vue dimensionnel mais également catégoriel au travers du diagnostic de Trouble Disruptif avec Dysrégulation Emotionnelle, était associée à des symptômes plus sévères et un retentissement fonctionnel plus important à l’âge préscolaire et scolaire. L’approche dimensionnelle s’est montrée plus pertinente pour identifier les enfants avec labilité émotionnelle ayant des besoins spéciaux de prises en charge au-delà de celle du TDAH. De plus, la labilité émotionnelle et l’irritabilité ont semblé être associées à des tableaux cliniques différents. Ces résultats suggèrent l’intérêt de l’évaluation de la labilité émotionnelle et des manifestations associées dans le diagnostic du TDAH chez l’enfant. Une approche clinique fine, à la fois quantitative et qualitative, semble prometteuse dans la prévention des formes prodromiques de TDAH et dans le pronostic de ce trouble afin de proposer des interventions adaptées afin d’infléchir de potentielles trajectoires développementales à risques. / Attention Deficit Hyperactivity disorder is a neurodevelopmental disorder characterized by inattentive, hyperactive and/or impulsive symptoms. Emotional lability is frequently associated with the disorder. It can cover several manifestations. These manifestations are sometimes that serious that there are parts of a disorder: the Disruptive Mood Dysregulation Disorder recently added to the DSM-5. Is emotional lability a core symptom of ADHD or one of a comorbid disorder? Is it featured with different symptoms and functional impairment in children with ADHD? This PhD work tried to provide elements to respond to these questions assessing the psychopathological profile associated with emotional lability as a categorical and dimensional feature at two crucial developmental periods: the preschool and the school aged. Four studies are part of this PhD work: three in clinical population and one in general population. Results emphasized that emotional lability is associated with more severe symptoms and functional impairment in both preschool a school aged children. Results were similar when emotional lability was assessed as a dimensional feature and as a categorical feature. Nevertheless, the dimensional approach of emotional lability seemed relevant identifying children with ADHD and emotional lability that were at special need for interventions, beyond the ADHD one. Moreover, emotional lability and irritability seemed associated with different clinical outcomes. These results suggested the value of the emotional lability assessment and of its others manifestations in the ADHD diagnosis in children. A qualitative and quantitative approach seems promising in preventing prodromal ADHD and in its prognostic. This might serve targeting adapted interventions in order to inflect potential harmful developmental trajectories.

A link between the gut and the brain has been proposed to influence psychiatric disorders. Probiotics have been suggested to modify the gut microbiota and thereby improve autism symptoms in children. Attention deficit hyperactivity disorder (ADHD) has high comorbidity with other neuropsychiatric diagnoses, including autism. This is a follow-up of the first study examining a synbiotic intervention in patients with ADHD (Skott et al., 2019). In the original study, 114 adults participated. In this study, 38 adults were evaluated. The aim was to examine if suggested improvements remained 18 months post treatment. Specifically, if reductions were detected in comorbid autism symptoms, emotional dysregulation or functional impairment. The endpoints were measured using questionnaires: Autism-Spectrum Quotient (AQ), Difficulties in Emotion Regulation Scale (DERS-16) and Weiss Functional Impairment Rating Scale (WFIRS). No Synbiotic2000-specific effect was detected. Synbiotic2000 and placebo improved emotion regulation and life skill-functioning equally well. More research is needed to draw reliable conclusions. / En koppling mellan magen och hjärnan har i studier antytts påverka psykiatriska tillstånd. Probiotika har föreslagits förändra mag- och tarmkanalens bakterieflora och därigenom förbättra psykiatriska symtom hos barn med autism. ADHD har hög komorbiditet med andra neuropsykiatriska diagnoser, däribland autism. Detta är en långtidsuppföljning av RCT-studien som var först med att undersöka en synbiotika-intervention hos patienter med ADHD (Skott et al., 2019). I uppföljningen undersöktes 38 av de 114 vuxna som deltagit i originalstudien. Syftet var att undersöka om indikationerna till förbättring höll i sig 18 månader efter studieavslutet. Frågeställningen var om reduktion i komorbida autismsymtom, svårigheter med emotionsreglering eller funktionsnedsättning kunde identifieras. Detta undersöktes genom självskattningsskalor: Autism-Spectrum Quotient (AQ), Difficulties in Emotion Regulation Scale (DERS-16) och Weiss Functional Impairment Rating Scale (WFIRS). Ingen behandlingsspecifik effekt detekterades. Förbättringar av samma grad identifierades av Synbiotic2000 och placebo, utifrån emotionsreglering samt delskalan färdigheter. Mer forskning på området krävs för att möjliggöra tillförlitliga slutsatser. / BAMBA (Behandla Adhd med MagBakterier)