Functional outcomes following post-acute rehabilitation for moderate-to-severe traumatic brain injury.

OBJECTIVE: The objective of this study was to examine the benefits of long-term inpatient rehabilitation for individuals with moderate-to-severe traumatic brain injuries (TBIs). METHODS: Retrospective database review of 67 individuals with moderate-to-severe TBI admitted to a specialised inpatient TBI program. Outcome measures are as follows: (1) functional independence measure + functional assessment measure (FIM+FAM; admission, discharge, change scores); (2) discharge designation (community vs. long-term care (LTC)). RESULTS: There was a mean improvement on FIM+FAM of 54.19 points (SD = 35.63) or 67% between admission and discharge (t(66) = -12.45, p < 0.001). Mean time post-injury upon completion of therapy was 409.59 days (SD = 343.93). Upon completion of rehabilitation, 50 (75%) participants were discharged to community and 17 to LTC. Among those returning to community, those with longer length of stays were more severely disabled on admission (t(35.9) = -4.86, p < 0.001). Controlling for admission functional status, individuals returning to community following >90 days of therapy required a mean of 378.94 days (SD = 298.86) to achieve comparable gains to those less impaired who received shorter periods of rehabilitation (F(1) = 0.530, p = 0.47). CONCLUSION: Continued specialised inpatient services following acute inpatient rehabilitation for individuals with moderate-to-severe TBI can reduce the level of dependency and enhance the likelihood of return to community living.

Sound-Color Associations in Psychosis-Prone Individuals.

Synesthetic-pseudosynesthetic characteristics have been hypothesized to be a schizophrenia endophenotype, a developmental feature, and/or a symptom of psychosis. Few studies to date, however, have examined whether individuals at risk for psychosis have synesthetic symptoms. We examined the relationship between hue and pitch in high psychosis prone (HP; n = 30) and low psychosis prone individuals (LP; n = 31). Synesthesia was evaluated using self-report and two performance-based tasks. Results revealed that HP subjects experienced more synesthetic experiences than the LP only on the self-report measure. These results suggest that high psychotic prone patients report unusual experiences but are no more likely to exhibit synesthesia than LP individuals. HP individuals, however, were more likely to choose shorter wavelength colors than LP individuals on performance tasks. These results are consistent with the notion that psychosis vulnerability is associated with a preference to light wavelengths associated with increasing emotional valence and negative affect.

Impact of traumatic and violent victimization experiences in individuals with schizophrenia and schizoaffective disorder.

Individuals with schizophrenia or schizoaffective disorder (SZ) experience more violent victimization and noninterpersonal traumatic experiences than the general population. Earlier studies, however, have generally excluded one or grouped together victimization and trauma experiences into single outcome variables, which may obscure their contributory role to SZ symptoms. This issue is important because there is some evidence that intentionally induced violence produces higher rates of psychopathology than nonintentional traumatic experiences. We examined the independent contribution of both types of victimization experiences on SZ patients' symptomatology. We were also interested in determining whether SZ patients' pattern of acute symptom presentation could discriminate between SZ patients with and without posttraumatic stress disorder (PTSD) comorbidity. SZ inpatients (n = 70) were assessed for the presence of comorbid PTSD diagnosis, violent victimization, and noninterpersonal traumatic experiences. Patients were also rated on SZ symptom severity and general psychopathology measures. Past violent victimization experiences predicted severity of dysphoria and anxiety in SZ. Past traumatic experiences, however, predicted severity of psychosis. Victimization predicted severity of patients' autistic/cognitive symptoms. SZ patients with comorbid PTSD presented with significantly more anxiety and dysphoria symptoms and SZ illness chronicity than their non-PTSD counterparts. Discriminant function analysis revealed that the severity of positive, dysphoric, autistic/cognitive, and anxiety symptoms differentiated comorbid PTSD patients from their non-PTSD counterparts, with an overall 72.9% classification rate. Past traumatic and victimization experiences are significantly associated with SZ patients' symptom severity and illness course in partially overlapping domains. Use of common assessment strategies may be employed to increase detection of PTSD in SZ patients presenting for acute treatment.

Beliefs about voices and aggressive behavior in inpatients in an acute psychiatric setting.

OBJECTIVE: To examine the relationship between the personal beliefs that patients with auditory hallucinations have concerning their voices and the incidence of aggression toward self, others, and objects on the inpatient ward. METHOD: Forty actively hallucinating adults were recruited from the psychiatric inpatient service at Bellevue Hospital Center in New York. The beliefs that subjects had about their voices were measured using the revised Beliefs About Voices Questionnaire, and symptom severity was measured using the Positive and Negative Syndrome Scale. Frequency and severity of aggressive acts were measured retroactively over a 2-week period using the retroactive Overt Aggression Scale-Modified. The study was conducted from August 2007 to December 2007. RESULTS: Analyses revealed that hallucinators' beliefs that their voices are omnipotent, malevolent, and unable to be resisted accounted for 34% of the variance in predicting aggression on the psychiatric inpatient service. Subsequent stepwise regression analysis determined that hallucinators' belief in the omnipotence of their voices accounted for 21% of variance in predicting aggressive episodes on the inpatient service. Additionally, hallucinators with the strongest conviction in the omnipotence of their voices engaged in almost 10 times more aggressive acts on the inpatient service compared to voice hearers without these convictions. CONCLUSIONS: Individuals who believe their hallucinated voices to be all-powerful, malevolent, and irresistible are significantly more likely to engage in aggressive acts on the inpatient service. Examining the beliefs that an individual has about his/her voices may be a useful addition to current aggression risk batteries utilized on acute psychiatric inpatients.