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Garikana S, Jain P, Megna JL, Leontieva L. Borderline Personality Disorder With Atypical Traits in a 30-Year-Old Female: A Case Report. Cureus 2024; 16:e55166. [PMID: 38558669 PMCID: PMC10980538 DOI: 10.7759/cureus.55166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
In this paper, we report an atypical presentation of borderline personality disorder (BPD) in a 30-year-old female with a history of childhood molestation and trauma and a prior diagnosis of post-traumatic stress disorder (PTSD). The patient was hospitalized due to anxiety, depression, and guilt over her relapse into alcohol use disorder. During her hospital stay, we diagnosed her with BPD based on psychiatric examination, clinical interviews, and patient history. While the patient exhibited some of the typical characteristics of BPD, such as an instability of interpersonal and romantic relationships, there were numerous findings that were atypical of BPD. These include a demonstration of mature defense mechanisms such as sublimation and altruism, high levels of occupational functioning, strong maternal caregiving behavior, and no history of self-harm. Further analysis of the patient's personality traits helped us identify that this presentation could be best characterized as a high-functioning internalizing subtype of BPD as identified in prior literature.
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Affiliation(s)
- Sarah Garikana
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Pratik Jain
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - James L Megna
- Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, USA
| | - Luba Leontieva
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
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Cookey J, McGavin J, Crocker CE, Stewart SH, Tibbo PG. In Response to "Clinical Characteristics Associated With Early Phase Psychosis and Comorbid Substance Use": Methodological Concerns-Authors' Reply. Can J Psychiatry 2023; 68:949-950. [PMID: 37131325 PMCID: PMC10657582 DOI: 10.1177/07067437231173211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Jacob Cookey
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Early Psychosis Program, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada
| | - Jacob McGavin
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Candice E. Crocker
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Early Psychosis Program, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sherry H. Stewart
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Philip G. Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Early Psychosis Program, Nova Scotia Health Authority (Central Zone), Halifax, Nova Scotia, Canada
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von Wirth E, Breuer D, Mandler J, Schürmann S, Döpfner M. Prediction of Educational Attainment and Occupational Functioning in Young Adults With a Childhood Diagnosis of ADHD: Results from the Cologne Adaptive Multimodal Treatment (CAMT) Study. J Atten Disord 2022; 26:1018-1032. [PMID: 34697953 DOI: 10.1177/10870547211045740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This longitudinal study examined early predictors of educational attainment and occupational functioning in adults with a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD). METHOD Participants (n = 70) of the Cologne Adaptive Multimodal Treatment (CAMT) Study were diagnosed with ADHD and received adaptive multimodal ADHD treatment during childhood. They were then followed through adolescence into adulthood. RESULTS Hierarchical regression analysis revealed that poor reading skill and externalizing behaviors in childhood were early predictors of educational and occupational difficulties in adulthood. The use of stimulant medication in childhood predicted lower high school achievement, probably because medication use was confounded by indication. The regression models improved when intelligence scores and/or externalizing behaviors, especially delinquency, assessed in adolescence were considered as additional predictors. CONCLUSION Children with ADHD, who continue to show reading difficulties and externalizing behavior problems after initial treatment, are at risk for educational and occupational difficulties and may need additional support.
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Affiliation(s)
- Elena von Wirth
- University of Cologne, Faculty of Medicine and University Hospital Cologne, School for Child and Asolescent Cognitive Behavior Therapy (AKiP), Cologne, Germany
| | - Dieter Breuer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, School for Child and Asolescent Cognitive Behavior Therapy (AKiP), Cologne, Germany
| | - Janet Mandler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, School for Child and Asolescent Cognitive Behavior Therapy (AKiP), Cologne, Germany
| | - Stephanie Schürmann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, School for Child and Asolescent Cognitive Behavior Therapy (AKiP), Cologne, Germany
| | - Manfred Döpfner
- University of Cologne, Faculty of Medicine and University Hospital Cologne, School for Child and Asolescent Cognitive Behavior Therapy (AKiP), Cologne, Germany
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George CM, Thomas EM, Kuriakose N, Kshirsagar S, Samuel R. Psychosocial Difficulties (PSD) Experienced by People across Brain Disorders and the Implications for Occupational Therapy: A Cross-Sectional Study. Occup Ther Health Care 2021; 35:268-285. [PMID: 34057386 DOI: 10.1080/07380577.2021.1926045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Psychosocial difficulties are defined as impairments in mental and body functions, activity limitations and participation restrictions, experienced in common across brain disorders. This cross-sectional study compared the psychosocial difficulties among people with Parkinson's disease (n = 61), schizophrenia (n = 84) and stroke (n = 70). The extent of difficulties was found to be similar across the three disorders in most of the domains studied. Psychosocial difficulties were also found to be associated with sociodemographic and illness related factors. The results challenge the brain disorder-specific approach to psychosocial difficulties commonly carried out in neurological and psychiatric research. Implications to occupational therapy are presented.
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Affiliation(s)
- Catherine Mariam George
- Occupational Therapy Unit, Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Elizabeth Mary Thomas
- Occupational Therapy Unit, Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nicy Kuriakose
- Occupational Therapy Unit, Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Saloni Kshirsagar
- Occupational Therapy Unit, Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Reema Samuel
- Occupational Therapy Unit, Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract
Schizophrenia is associated with major functioning difficulties. Theory of mind (ToM), the ability to infer the mental states of others, is an important determinant of functioning. However, the contribution of ToM to each specific domain of functioning remains to be better understood. The objectives of this meta-analysis were to document and compare the magnitude of the associations between ToM and (1) different domains of functioning (social functioning, productive activities, and instrumental activities of daily living), each assessed separately for functional performance and functional outcome and (2) different aspects of functioning (functional performance and functional outcome) in schizophrenia. Fifty-nine studies (N = 4369) published between 1980 and May 2019 targeting patients with schizophrenia or schizoaffective disorder aged between 18 and 65 years old were included. Studies were retrieved from seven databases. Correlations were extracted from the articles, transformed into effect sizes Zr and combined as weighted and unweighted means. The strength of the associations between the domains and aspects of functioning were compared using focused tests. A moderate association was observed between ToM and all domains of functioning, with a stronger association between ToM and productive activities compared with social functioning (only for functional outcome [χ2(2) = 6.43, P = 0.040]). Regarding the different aspects of functioning, a stronger association was observed between ToM and functional performance, compared with functional outcome, for overall functioning (χ2(1) = 13.77, P < 0.001) and social functioning (χ2(1) = 18.21, P < 0.001). The results highlight a stronger association of ToM with productive activities and with functional performance, which should be considered in future studies to improve functional recovery in schizophrenia.
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Affiliation(s)
- Élisabeth Thibaudeau
- École de psychologie, Université Laval, Québec, Québec, Canada,CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, Québec, Canada,To whom correspondence should be addressed; Pavillon Félix-Antoine-Savard, 2325 Allée des Bibliothèques, local 1528, Québec, QC G1V 0A6, Canada; tel: 418-656-2131, e-mail:
| | - Caroline Cellard
- École de psychologie, Université Laval, Québec, Québec, Canada,CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, Québec, Canada
| | | | - Amélie M Achim
- CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, Québec, Canada,Département de psychiatrie et neurosciences, Université Laval, Québec, Québec, Canada
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de Waal A, Dixon LB, Humensky JL. Association of participant preferences on work and school participation after a first episode of psychosis. Early Interv Psychiatry 2018; 12:959-963. [PMID: 29052948 PMCID: PMC5910294 DOI: 10.1111/eip.12513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/06/2017] [Accepted: 09/13/2017] [Indexed: 01/30/2023]
Abstract
AIM To explore baseline ratings of importance (ROI) across life domains for participants in the Recovery After an Initial Schizophrenia Episode Connection Program (RAISE CP), and investigate whether ratings were correlated with intervention outcomes over time. METHODS At baseline, 63 participants rated the importance of reducing symptoms, side-effects, confusion, increasing energy and school/work functioning and improving social relations. ROIs were examined in relation to work/school participation (n = 41) and occupational functioning (n = 37) after 12 months. Participants' mean age was 22.3 (±4.2). RESULTS The ROI domain rated as most important was school/work functioning, and higher school/work ROI at baseline predicted work/school participation after 12 months of participation. CONCLUSIONS It is particularly important to assess participant preferences and priorities when treating psychotic disorders because most areas of life are affected. Understanding the impact of participant goals on outcomes is essential as programs design patient-centred treatment plans.
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Affiliation(s)
- Alexandra de Waal
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, New York
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University, New York, New York.,Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, New York
| | - Jennifer L Humensky
- Department of Psychiatry, Columbia University, New York, New York.,Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, New York
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Pitman A, Khrisna Putri A, De Souza T, Stevenson F, King M, Osborn D, Morant N. The Impact of Suicide Bereavement on Educational and Occupational Functioning: A Qualitative Study of 460 Bereaved Adults. Int J Environ Res Public Health 2018; 15:ijerph15040643. [PMID: 29614731 PMCID: PMC5923685 DOI: 10.3390/ijerph15040643] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/16/2022]
Abstract
People bereaved by suicide are at an increased risk of suicide and of dropping out of education or work. Explanations for these associations are unclear, and more research is needed to understand how improving support in educational or work settings for people bereaved by suicide might contribute to reducing suicide risk. Our objective was to explore the impact of suicide on occupational functioning. We conducted a cross-sectional online study of bereaved adults aged 18-40, recruited from staff and students of British higher educational institutions in 2010. We used thematic analysis to analyse free text responses to two questions probing the impact of suicide bereavement on work and education. Our analysis of responses from 460 adults bereaved by suicide identified three main themes: (i) specific aspects of grief that impacted on work performance, cognitive and emotional domains, and social confidence; (ii) structural challenges in work or educational settings including a lack of institutional support, the impact of taking time off, and changes to caring roles; and (iii) new perspectives on the role of work, including determination to achieve. Institutional support should be tailored to take account of the difficulties and experiences described.
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Affiliation(s)
- Alexandra Pitman
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London NW1 0PE, UK.
| | - Adelia Khrisna Putri
- UGM Faculty of Psychology, Universitas Gadjah Mada, Jl. Sosio Humaniora 1, Sleman, Yogyakarta 55281, Indonesia.
| | - Tanisha De Souza
- North East London NHS Foundation Trust, Memory Service, Broad Street Health Centre, Morland Road, Dagenham, Essex, RM10 9HU, UK.
| | - Fiona Stevenson
- UCL Research Department of Primary Care & Population Health, Rowland Hill St, London NW3 2PF, UK.
| | - Michael King
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - David Osborn
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London NW1 0PE, UK.
| | - Nicola Morant
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
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Pérez-Cuevas R, Doubova SV, Bazaldúa-Merino LA, Reyes-Morales H, Martínez D, Karam R, Gamez C, Muñoz-Hernández O. A social health services model to promote active ageing in Mexico: design and evaluation of a pilot programme. Ageing Soc 2015; 35:1457-80. [PMID: 26190874 DOI: 10.1017/S0144686X14000361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2014] [Indexed: 11/09/2022]
Abstract
The objective of the study was to design and evaluate a pilot programme aimed at promoting the active ageing of older adults at the Mexican Institute of Social Security. The study was conducted in three stages: (a) design; (b) implementation; and (c) before–after evaluation through analysis of changes in functional status, occupational functioning and health-related quality of life. To overcome the limitations of the study design, we evaluated the effect of 80 per cent adherence to the programme on the outcome variables using the generalised linear regression models (GLM). Two hundred and thirty-nine older adults agreed to participate, of whom 65 per cent completed the programme. Most were women; the average age was 77 years. Adherence to the programme was higher than 75 per cent for the group who completed active ageing services and less than 60 per cent for the drop-out group. Overall, 46 per cent of older adults reached an adherence level of 80 per cent or higher. Adherence was significantly associated with improved quality of life total score (coefficient 2.7, p<0.0001) and occupational functioning total score (coefficient 2.2, p<0.0001). Participation of older adults in an active ageing programme may improve their health-related quality of life and occupational functioning. It is necessary to identify the potential barriers and to implement strategies to improve the recruitment and retention rates during the intervention.
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Langdon R, Connors MH, Still M, Ward PB, Catts S. Theory of mind and neurocognition in early psychosis: a quasi-experimental study. BMC Psychiatry 2014; 14:316. [PMID: 25472859 PMCID: PMC4263012 DOI: 10.1186/s12888-014-0316-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 10/24/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND People with chronic psychosis often display theory of mind impairments that are not fully accounted for by other, more general neurocognitive deficits. In these patients, both theory of mind and neurocognitive deficits contribute to poor functioning, independently of psychotic symptoms. In young people with recent-onset psychosis, however, it is unclear the extent to which theory of mind impairment is independent of neurocognitive deficits. The primary aim of this study was to examine the evidence for specific theory of mind impairments in early psychosis. A secondary aim was to explore the relations between theory of mind, neurocognition, symptom severity, and functional outcomes. METHODS Twenty-three patients who were within two years of their first psychotic episode and 19 healthy controls completed theory of mind and neurocognitive batteries. Social functioning, quality of life, and symptom severity were also assessed in patients. RESULTS Patients demonstrated deficits in tasks assessing theory of mind and neurocognition relative to controls. Patients' deficits in theory of mind were evident even after adjusting for their deficits in neurocognition. Neither theory of mind nor neurocognition predicted social functioning or quality of life in this early psychosis sample. Severity of negative symptoms, however, was a significant predictor of both outcomes. CONCLUSIONS While a specific theory of mind impairment was evident in this early psychosis sample, severity of negative symptoms emerged as the best predictor of poor functional outcome. Further early psychosis research is needed to examine the longitudinal progression of theory of mind impairments - independent of neurocognitive deficits - and their impact on psychosocial function.
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Affiliation(s)
- Robyn Langdon
- ARC Centre of Excellence in Cognition and its Disorders, and Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia.
| | - Michael H Connors
- ARC Centre of Excellence in Cognition and its Disorders, and Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia.
| | - Megan Still
- Rehabilitation Services, Division of Mental Health, Sydney & South Western Sydney Local Health Districts, Liverpool, NSW, Australia.
| | - Philip B Ward
- School of Psychiatry, University of New South Wales and Schizophrenia Research Unit, South Western Sydney Local Health District, Liverpool, NSW, Australia.
| | - Stanley Catts
- School of Psychiatry, University of Queensland, Brisbane, QLD, Australia.
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Hacioglu Yildirim M, Alantar Z, Yildirim EA. The relationship between working status and symptoms, quality of life and self-esteem in patients with schizophrenia in Turkey. Int J Soc Psychiatry 2014; 60:646-55. [PMID: 24319053 DOI: 10.1177/0020764013511791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Schizophrenia is a severe mental disorder with substantial socioeconomic burden associated with poorer psychosocial functioning during the course of illness. In schizophrenia patients, multiple factors play a role in occupational functioning. AIM It was aimed to investigate the relationship between different working conditions and quality of life and self-esteem on patients with schizophrenia in Turkey. METHODS A total of 100 patients diagnosed as schizophrenic were divided into three groups: competitive working, supported working and unemployed. RESULTS The groups did not differ significantly with regard to psychotic symptoms, self-esteem and illness history. Working was associated with higher scores on quality of life subscales especially in supported working group, whereas unemployed patients had more depressive symptoms and autonomic drug side effects. CONCLUSION Structured working programs which may improve social life of patients with schizophrenia in many aspects is warranted in Turkey.
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Affiliation(s)
- Munevver Hacioglu Yildirim
- Department of Psychiatry, Psychotic Disorders Inpatient Clinic, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Zeynep Alantar
- Department of Psychiatry, Psychotic Disorders Inpatient Clinic, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Ejder A Yildirim
- Department of Psychiatry, Psychotherapy Outpatient Clinic, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
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Moitra E, Beard C, Weisberg RB, Keller MB. Occupational impairment and Social Anxiety Disorder in a sample of primary care patients. J Affect Disord 2011; 130:209-12. [PMID: 20934220 PMCID: PMC3831271 DOI: 10.1016/j.jad.2010.09.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 09/07/2010] [Accepted: 09/18/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND Social Anxiety Disorder (SAD) is the second most prevalent psychiatric condition in the US. Because of the inherent nature of SAD, it may cause impairments in workplace functioning, particularly compared to other anxiety disorders that do not necessarily lead to social impairments. In this study, we compared workplace functioning in primary care patients with SAD to patients with other anxiety disorders and comorbid Major Depressive Disorder (MDD). METHODS Data are obtained from the Primary Care Anxiety Project (PCAP), a naturalistic, longitudinal study of anxiety disorders in 539 primary care patients. We examined intake demographic and interviewer-assessed ratings of workplace functioning. RESULTS Results revealed that patients with SAD and MDD had significantly decreased workplace functioning, compared to individuals with other anxiety disorders. Furthermore, results showed that patients with SAD were greater than two-times more likely to be unemployed, but expected to work, than all other patients. LIMITATIONS Workplace functioning was not measured objectively and the sample may not be representative of the general population. CONCLUSIONS These findings highlight the particular need to assess for the presence of undereducation and underperformance at work and/or underemployment in individuals with SAD, as they are at most risk for these impairments. Additionally, early detection and intervention in individuals with or at risk for SAD may curb the future impact of social anxiety on occupational attainment.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States.
| | - Courtney Beard
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Risa B. Weisberg
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Department of Family Medicine, Alpert Medical School of Brown University
| | - Martin B. Keller
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
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McKnight PE, Kashdan TB. The importance of functional impairment to mental health outcomes: a case for reassessing our goals in depression treatment research. Clin Psychol Rev 2009; 29:243-59. [PMID: 19269076 PMCID: PMC2814224 DOI: 10.1016/j.cpr.2009.01.005] [Citation(s) in RCA: 243] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 12/12/2008] [Accepted: 01/21/2009] [Indexed: 11/22/2022]
Abstract
Outcomes in depression treatment research include both changes in symptom severity and functional impairment. Symptom measures tend to be the standard outcome but we argue that there are benefits to considering functional outcomes. An exhaustive literature review shows that the relationship between symptoms and functioning remains unexpectedly weak and often bidirectional. Changes in functioning often lag symptom changes. As a result, functional outcomes might offer depression researchers more critical feedback and better guidance when studying depression treatment outcomes. The paper presents a case for the necessity of both functional and symptom outcomes in depression treatment research by addressing three aims-1) review the research relating symptoms and functioning, 2) provide a rationale for measuring both outcomes, and 3) discuss potential artifacts in measuring functional outcomes. The three aims are supported by an empirical review of the treatment outcome and epidemiological literatures.
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Affiliation(s)
- Patrick E McKnight
- Department of Psychology, George Mason University, MSN 3F5, 4400 University Drive, Fairfax, VA 22030-4400, United States.
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