Risk factors for postoperative cognitive and functional difficulties in abdominal aortic aneurysm patients: a three month follow-up.

BACKGROUND: Cognitive impairment and deficits in functional performance are major concerns following surgery, particularly for older patients. The objective of this study was to examine predictors of postoperative cognitive and functional difficulties and explore the relationship between presurgery and postsurgery cognitive ability and functional performance. METHODS: 89 patients undergoing elective abdominal aortic aneurysm (AAA) surgery were administered a battery of cognitive measures preoperatively, at the time of discharge from hospital and 3 months postoperatively. Functional performance was evaluated by the Portland Adaptability Inventory (PAI), both pre and postsurgery. Symptoms of delirium were assessed during the first six postoperative days. RESULTS: A diagnosis of delirium had a mild effect on functional performance 3 months postoperatively. The strongest predictors of postoperative functional performance were the level of functioning presurgery, a longer length of hospital stay and the total number of days delirious. Cognitive impairment postsurgery was predicted by presurgery cognitive measures of verbal memory and psychomotor speed performance and the total number of days delirious. CONCLUSIONS: Functional performance outcomes for AAA patients 3 months postsurgery revealed no significant loss of functioning relative to presurgery levels, although longer length of hospital stay and greater number of days delirious was associated with somewhat poorer outcome on indicators of social and physical functioning. Cognitive impairment postoperatively was fairly mild but when it was found it was associated with number of days delirious and preoperative deficits in verbal memory and psychomotor speed.

Patient factors associated with missed appointments in persons with schizophrenia.

OBJECTIVE: There is limited research on factors that may predict missed appointments. This study examined correlates to missed appointments in a sample of persons attending an outpatient schizophrenia program. METHOD: We measured the rate of missed appointments for 342 outpatients with severe and persistent mental illness (that is, with diagnoses of schizophrenia, schizoaffective disorder, and delusional disorder) attending a psychiatric outpatient clinic over a period of 2 years and 3 months. We collected and analyzed demographic and clinical variables to ascertain differences between patients with high and low rates of nonattendance. RESULTS: Patients who missed 20% or more of their appointments were significantly younger, were more likely to abuse drugs and alcohol, and manifested lower levels of community functioning. CONCLUSIONS: This profile may be useful in helping clinicians to schedule appointments for this clinical population, to identify those who may need community outreach services, and to improve their treatment prospects.

Comparative study of trauma-related phenomena in subjects with pseudoseizures and subjects with epilepsy.

OBJECTIVE: The purpose of this study was to examine potential differences in measures of trauma-related phenomena between subjects with pseudoseizures and subjects with intractable epilepsy. METHOD: Thirty-one adult subjects with pseudoseizures and 32 subjects with intractable epilepsy (confirmed by video-EEG) were recruited from the epilepsy unit of a tertiary care hospital. Each participant completed the Impact of Event Scale, the Davidson Trauma Scale, the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder (PTSD), the Dissociative Experience Scale, and the Pittsburgh Sleep Quality Index, as well as demographic, seizure history, and family functioning measures. RESULTS: Subjects with pseudoseizures had significantly higher mean scores on the Davidson Trauma Scale, Mississippi Scale for Combat-Related PTSD, Impact of Event Scale, and Pittsburgh Sleep Quality Index than subjects with epilepsy. In addition, a significantly higher percentage of subjects with pseudoseizures had scores above the clinical cutoff level of 30 on the Dissociative Experience Scale. CONCLUSIONS: Subjects with pseudoseizures exhibited trauma-related profiles that differed significantly from those of epileptic comparison subjects and closely resembled those of individuals with a history of traumatic experiences. Interventions aimed at trauma-related issues may be beneficial for patients with pseudoseizures.