Development and validation of an intrinsic capacity score in the UK Biobank study.

BACKGROUND: In 2015, the World Health Organization introduced the concept of intrinsic capacity (IC) to define the individual-level characteristics that enable an older person to be and do the things they value. This study developed an intrinsic capacity score for UK Biobank study participants and validated its use as a tool for health outcome prediction, understanding healthy aging trajectories, and genetic research. METHODS: Our analysis included data from 45,208 UK biobank participants who had a complete record of the ten variables included in the analysis. Factor adequacy was tested using Kaiser-Meyer-Olkin, Barthelt's, and the determinant of matrix tests, and the number of factors was determined by the parallel analysis method. Exploratory and confirmatory factor analyses were employed to determine the structure and dimensionality of indicators. Finally, the intrinsic capacity score was generated, and its construct and predictive validities as well as reliability were assessed. RESULTS: The factor analysis identified a multidimensional construct comprising one general factor (intrinsic capacity) and five specific factors (locomotor, vitality, cognitive, psychological, and sensory). The bifactor structure showed a better fit (comparative fit index = 0.995, Tucker Lewis index = 0.976, root mean square error of approximation = 0.025, root mean square residual = 0.009) than the conventional five-factor structure. The intrinsic capacity score generated using the bifactor confirmatory factor analysis has good construct validity, as demonstrated by an inverse association with age (lower intrinsic capacity in older age; (ß) =-0.035 (95%CI: -0.036, -0.034)), frailty (lower intrinsic capacity score in prefrail participants, ß = -0.104 (95%CI: (-0.114, -0.094)) and frail participants, ß = -0.227 (95%CI: -0.267, -0.186) than robust participants), and comorbidity (a lower intrinsic capacity score associated with increased Charlson's comorbidity index, ß =-0.019 (95%CI: -0.022, -0.015)). The intrinsic capacity score also predicted comorbidity (a one-unit increase in baseline intrinsic capacity score led to a lower Charlson's comorbidity index, ß = 0.147 (95%CI: -0.173, -0.121)) and mortality (a one-unit increase in baseline intrinsic capacity score led to 25 % lower risk of death, odds ratio = 0.75(95%CI: 0.663, 0.848)). CONCLUSION: The bifactor structure showed a better fit in all goodness of fit tests. The intrinsic capacity construct has strong structural, construct, and predictive validities and is a promising tool for monitoring aging trajectories.

Functional decline during the COVID-19 pandemic among U.S. military veterans: Results from the National Health and Resilience in Veterans Study.

OBJECTIVES: The coronavirus disease-2019 pandemic has contributed to widespread social and economic stressors, along with substantial health problems, including loss of life. To date, however, relatively few studies have examined the prevalence and correlates of declines in mental and physical functioning in U.S. military veterans, an older and potentially vulnerable segment of the U.S. adult population. METHODS: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative, longitudinal study of 3078 veterans. Veterans were surveyed prior to the pandemic (pre-pandemic) and 1 year later during the height of the pandemic (peri-pandemic). Multivariable analyses were conducted to identify risk and protective variables associated with pre-to-peri pandemic declines in self-reported physical and mental functioning. RESULTS: The prevalence of veterans who experienced functional decline (≥0.5 standard deviation reductions) pre-to-peri-pandemic was 18.1% (N = 541) for physical functioning and 18.3% (N = 547) for mental functioning. Older age, greater adverse childhood experiences (ACEs), and pandemic-related posttraumatic stress symptoms were the strongest correlates of physical functional decline, while greater ACEs, loneliness, pandemic-related posttraumatic and social restriction stress symptoms, and lower protective psychosocial characteristics were the strongest correlates of mental functional decline. CONCLUSIONS: Although the majority of U.S. Veterans showed functional maintenance or improvement 1 year into the pandemic, nearly one-in-five experienced a decline in physical or mental functioning. Results could help inform identification of veterans who may be at risk for functional decline during large-magnitude stressors, such as national or global pandemics.

Evaluation of Primary Allied Health Care in Patients Recovering From COVID-19 at 6-Month Follow-up: Dutch Nationwide Prospective Cohort Study.

BACKGROUND: Patients recovering from COVID-19 often experience persistent problems in their daily activities related to limitations in physical, nutritional, cognitive, and mental functioning. To date, it is unknown what treatment is needed to support patients in their recovery from COVID-19. OBJECTIVE: This study aimed to evaluate the primary allied health care of patients recovering from COVID-19 at 6-month follow-up and to explore which baseline characteristics are associated with changes in the scores of outcomes between baseline and 6-month follow-up. METHODS: This Dutch nationwide prospective cohort study evaluated the recovery of patients receiving primary allied health care (ie, dietitians, exercise therapists, occupational therapists, physical therapists, and speech and language therapists) after COVID-19. All treatments offered by primary allied health professionals in daily practice were part of usual care. Patient-reported outcome measures on participation, health-related quality of life, fatigue, physical functioning, and psychological well-being were assessed at baseline and at 3- and 6-month follow-up. Linear mixed model analyses were used to evaluate recovery over time, and uni- and multivariable linear regression analyses were used to examine the association between baseline characteristics and recovery. RESULTS: A total of 1451 adult patients recovering from COVID-19 and receiving treatment from 1 or more primary allied health professionals were included. For participation (Utrecht Scale for Evaluation of Rehabilitation-Participation range 0-100), estimated mean differences of at least 2.3 points were observed at all time points. For the health-related quality of life (EuroQol Visual Analog Scale, range 0-100), the mean increase was 12.3 (95% CI 11.1-13.6) points at 6 months. Significant improvements were found for fatigue (Fatigue Severity Scale, range 1-7): the mean decrease was -0.7 (95% CI -0.8 to -0.6) points at 6 months. However, severe fatigue was reported by 742/929 (79.9%) patients after 6 months. For physical functioning (Patient-Reported Outcomes Measurement Information System-Physical Function Short Form 10b, range 13.8-61.3), the mean increase was 5.9 (95% CI 5.9-6.4) points at 6 months. Mean differences of -0.8 (95% CI -1.0 to -0.5) points for anxiety (Hospital Anxiety and Depression Scale range 0-21) and -1.6 (95% CI -1.8 to -1.3) points for depression were found after 6 months. A worse baseline score, hospital admission, and male sex were associated with greater improvement between baseline and 6-month follow-up, whereas age, the BMI, comorbidities, and smoking status were not associated with mean changes in any outcome measures. CONCLUSIONS: Patients recovering from COVID-19 who receive primary allied health care make progress in recovery but still experience many limitations in their daily activities after 6 months. Our findings provide reference values to health care providers and health care policy makers regarding what to expect from the recovery of patients who receive health care from 1 or more primary allied health professionals. TRIAL REGISTRATION: ClinicalTrials.gov NCT04735744; https://tinyurl.com/3vf337pn. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2340/jrm.v54.2506.

Development of an ontology to characterize mental functioning.

PURPOSE OF THE ARTICLE: This article describes a conceptual and methodological approach to integrating functional information into an ontology to categorize mental functioning, which to date is an under-developed area of classification, and supports our work with the United States (U.S.) Social Security Administration (SSA). DESIGN AND METHODOLOGICAL PROCEDURES: Conceptualizing and defining mental functioning was paramount to develop natural language processing (NLP) tools to support our use case. The International Classification of Functioning, Disability, and Health (ICF) was the framework used to conceptualize mental functioning at the activities and participation level in clinical records. To address challenges that arose when applying the ICF as to what should or should not be classified as mental functioning, a mental functioning domain ontology was developed that rearranged, reclassified and incorporated all ICF key components, concepts, classifications, and their definitions. CONCLUSIONS: Challenges emerged in the extent to which we could directly align components in the ICF into an applied ontology of mental functioning. These conceptual challenges required rearrangement of ICF components to adequately support our use case within the social security disability determination process. Findings also have implications to support future NLP efforts for behavioral health outcomes and policy research.

Mental functioning in everyday life is an important area of inquiry from the perspectives of public health, health policy, healthcare, and overall individual level health and well-being.A domain ontology of mental functioning that defines concepts and their relationships, and provides a common terminology with definitions, would enable interdisciplinary communication, research, and collaboration.A clearer conceptual model of mental functioning can improve the development of software that can identify, codify, and organize mental functioning information within clinical records into data that can be analyzed.The International Classification of Functioning, Disability and Health was utilized to conceptualize mental functioning and to guide the development of a proposed domain ontology of mental functioning.

Computer-based mother-infant interaction analysis and mental functioning in postpartum depression.

BACKGROUND: Among mothers suffering from postpartum depression (PD), 10-13% additionally experience a mother-infant interaction disturbance that causes a severe mental health risk for the infant. Besides depressive symptomology, the underlying factors promoting dysfunctional maternal interaction behavior have not yet been sufficiently investigated. Therefore, we examined potential relationships between computer-based mother-infant interaction among postpartum depressed dyads and maternal mental functioning. METHODS: Mother-infant interaction was video-recorded and evaluated via a computer-based micro-interaction analysis program (INTERACT). We included only 25 hospitalized mother-infant dyads that fulfilled the diagnostic criteria of PD and tested mothers on their mental functioning (empathy, theory of mind, meta-cognition and alexithymia). RESULTS: Behavioral interaction analyses indicated that mothers with PD were prone to inactive maternal behavior, less positive maternal behavior along with more rejective behavior and also disengaged affect towards the infant. Distortions in mothers' mental functioning may have had an influence on the dysfunctional patterns of mother-infant dyads. CONCLUSIONS: Cognitive and social functioning could be an influencing factor on dysfunctional maternal interaction behavior. Early detection of distortions of mental processing in expectant mothers might help to inhibit the clinical manifestation of dysfunctional mother-infant bonding and negative child outcome in PD.

Socio-Demographic, Clinical and Psychological Profile of Frailty Patients Living in the Home Environment and Nursing Homes: A Cross-Sectional Study.

Introduction: Frailty syndrome, as a physiological syndrome, is characterized by a gradual decline in physiological reserve and a lowered resistance to stress-inducing factors, leading to an increased risk of adverse outcomes. It is significantly connected with dependence on care and frequent hospitalizations. Objectives: The aim of the study was to describe socio-demographic, clinical and psychological profile of frailty older adults living in their own homes and to nursing homes. Methods: The study was conducted with 180 patients who were over 60 years of age, the mean (±SD) was 74.1 (±8.8) years. Among the subjects, 90 individuals were community-dwelling older adults. The survey used a list of socio-demographic questions, as well as the following scales: Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), SHARE-FI, and The World Health Organization Quality of Life (WHOQOL-Bref). Results: Pre-frailty was confirmed in 49 (27.2%) patients, and frailty syndrome was noticed in 47 patients (26.1%). The prevalence of frailty syndrome in the study group was related to: place of living (p < 0.001), age (p < 0.001), widowhood (p < 0.001), a poor economic situation (p < 0.001), basic education level (p < 0.001), living alone (p < 0.001), longer duration of illness (p < 0.001), comorbidities (p < 0.001), more medications taken (p < 0.001), deterioration of hearing (p = 0.003), impairment of cognitive functions (p < 0.001), depression (p < 0.001), and decreased quality of life (p < 0.001). Discussion: A lot of socio-demographic and medical factors, particularly cognitive and mental functioning were connected with the prevalence and progression of frailty syndrome in the study group. Quality of life was significantly dependent on the presence of frailty syndrome, both in homes and in nursing homes.

Mental, Physical and Social Functioning in Independently Living Senior House Residents and Community-Dwelling Older Adults.

Senior houses provide social interaction and support, potentially supporting older people's physical and mental functioning. Few studies have investigated functioning of senior house residents. The aim was to compare functioning between senior house residents and community-dwelling older adults in Finland. We compared senior house residents (n = 336, 69% women, mean age 83 years) to community-dwelling older adults (n = 1139, 56% women, mean age 74 years). Physical and mental functioning were assessed using the SF 36-Item Health Survey. Loneliness and frequency of social contacts were self-reported. The analyses were adjusted for age, socioeconomic factors and diseases. Physical functioning was lower among men in senior houses compared to community-dwelling men (mean 41.1 vs. 46.4, p = 0.003). Mental functioning or the frequency of social contacts did not differ between type of residence in either sex. Loneliness was higher among women in senior houses compared to community-dwelling women (OR = 1.67, p = 0.027). This was not observed in men. Results suggest that women in senior houses had similar physical and mental functioning compared to community-dwelling women. Male senior house residents had poorer physical functioning compared to community-dwelling men. Women living in senior houses were lonelier than community-dwelling women despite the social environment.

Religiosidade e Funcionamento Mental em Idosos Portugueses: Uma Perspetiva Sociopsicológica / Religiosity and Mental Functioning in Portuguese Elderly: A Sociopsychological Perspective

Resumo O artigo tem como objetivo analisar a relação entre a religiosidade e o funcionamento mental em idosos portugueses. Os instrumentos metodológicos utilizados foram: um questionário sociodemográfico, a Escala de Orientação Religiosa-R e o Mental Health Inventory (MHI-5). Os resultados da análise mostraram que, embora sem uma relação estatisticamente relevante entre religiosidade e funcionamento mental de uma forma geral, existem, no entanto, diferenças significativas entre a frequência de participação em celebrações religiosas e melhores níveis de funcionamento mental.

Abstract This article aims to analyze the relationship between religiosity and mental functioning in the elderly Portuguese people. The methodological tools used included the Religious Orientation Scale-R and the Mental Health Inventory (MHI5) and also a socio-demographic questionnaire. The results of the analysis showed that there is no statistically significant relationship between religiosity and mental functioning; however, there are significant differences between the frequency of participation in religious celebrations and better levels of mental functioning.

What Is the Effectiveness of Different Duration Interdisciplinary Treatment Programs in Patients with Chronic Pain? A Large-Scale Longitudinal Register Study.

Chronic pain is a leading cause of disability globally. Interdisciplinary multimodal pain rehabilitation (IMPR) targets pain with a bio-psycho-social approach, often delivered as composite programs. However, evidence of optimal program duration for the rehabilitation to succeed remains scarce. This study evaluated the effectiveness of different duration IMPR-programs-using within- and between-effects analyses in a pragmatic multicenter register-based controlled design. Using the Swedish Quality Registry for Pain Rehabilitation, data from fifteen clinics specialized in chronic pain rehabilitation across Sweden were retrieved. Participants were patients with chronic musculoskeletal pain who had taken part in short (4-9 weeks; n = 924), moderate (10 weeks; n = 1379), or long (11-18 weeks; n = 395) IMPR programs. Longitudinal patient-reported outcome data were assessed at baseline, post-intervention, and at a 12-month follow-up. Primary outcomes were health-related quality of life, presented as perceived physical and mental health (SF-36). Secondary outcomes included the Hospital Anxiety and Depression Scale (HADS), pain intensity (NRS 0-10), the Multidimensional Pain Inventory (MPI), and perceived health (EQ-5D). Overall, all groups showed improvements. No clinically important effect emerged for different duration IMPR. In conclusion, while our results showed that patients following IMPR report improvement across a bio-psycho-social specter, a longer program duration was no more effective than a shorter one.

Regeneration of deprived neighbourhoods and indicators of functioning in older adults: A quasi-experimental evaluation of the Dutch District Approach.

This study examines the impact of the Dutch District Approach, a major urban regeneration programme that was started in 2008 in the Netherlands, on social, physical and mental functioning of older adults. Data from 1092 participants (58-93 years at baseline) across two waves (2005/06 and 2011/12) of the Longitudinal Aging Study Amsterdam were linked to detailed data on exposure to the programme. Using a difference-in-difference approach, we assessed differences from pre-intervention to the intervention period between the target and control districts in loneliness, social engagement, social isolation, physical activity, and anxiety and depressive symptoms. Regardless of programme intensity, the results indicate that the Dutch District Approach did not benefit or harm these aspects of functioning in older adults.

Correlates of respiratory admissions frequency in patients with obstructive lung diseases: coping styles, personality and anxiety. / Profil osobowosci, poziom leku i style radzenia sobie ze stresem a liczba hospitalizacji i konsultacji specjalistycznych u osób z chorobami obturacyjnymi pluc.

OBJECTIVES: Asthma and chronic obstructive pulmonary disease (COPD) are associated with a huge financial burden on the budget and healthcare in the world. Personality traits, ways of coping with stress and anxiety levels affect the functioning of sick people. Objective of the study was to evaluate correlation between those features and the frequency of hospital and outpatient clinic admissions among people with chronic pulmonary diseases. METHODS: Participants (n=100) with asthma and COPD were subjected to: a sociodemographic urvey, NEO-FFI Personality Inventory, State-Trait Anxiety Inventory (STAI) and Brief COPE Inventory. RESULTS: There was a relationship between the hospital admission frequency and neuroticism (positive correlation). The frequency of visits to the outpatient clinic was positively correlated with the level of conscientiousness, use of emotional support and negatively with cessation of action. CONCLUSIONS: The obtained results may indicate the need to offer patients with respiratory diseases psychotherapeutic activities aimed at building a more constructive functioning, reducing anxiety, increasing the sense of control.

Health-related quality of life in ischaemic stroke survivors after carotid endarterectomy (CEA) and carotid artery stenting (CAS): confounder-controlled analysis.

INTRODUCTION: Atherosclerotic carotid artery stenosis (CS)-related strokes are a significant overall stroke burden contributor. AIM: To evaluate the effect of surgical (carotid endarterectomy - CEA) vs. percutaneous (neuroprotected carotid artery stenting - CAS) carotid revascularization on health-related quality of life (HRQoL) in stroke survivors: analysis controlled for major HRQoL determinants beyond strokes. MATERIAL AND METHODS: Our database of 856 carotid revascularization procedures (48.7% symptomatic CS) performed over 3 years showed 42 pairs (CEA-CAS) of right hemispheric stroke patients matched for age, sex, marital and educational status, hyper-tension, heart failure and diabetes, who underwent uneventful carotid revascularization, experienced no major adverse clinical events, and completed the Short Form Outcome Study (SF-36) questionnaire within 7 days before, 14 days after, 6 months after, and 12 months after carotid revascularization. RESULTS: Baseline HRQoL was low and similar in both groups (30.8 ±4.6% vs. 29.1 ±3.9%, p = 0.68; data given for CEA vs. CAS). National Institute of Health Stroke Scale chronic severity was 5.4 ±2.8 vs. 5.9 ±3.1 (p = 0.44). Revascularization was associated with a major HRQoL improvement, that was significantly greater in CAS (60.4 ±9.2% vs. 71.5 ±6.2%, p < 0.001). At 6 months the CEA-CAS difference was narrower (70.7 ±9.7% vs. 74.6 ±5.9%, p = 0.026), becoming statistically insignificant at 12 months (72.6 ±6.7% vs. 75.1 ±5.1%, p = 0.062). The early CEA-CAS difference was driven by less bodily pain and better physical functioning/role-physical plus better role-emotional and higher general well-being scores in CAS (p < 0.05). CONCLUSIONS: Carotid revascularization has a major positive impact on stroke survivor patient-reported HRQoL. The improvement is initially greater in CAS, with the remaining difference small at 12 months and statistically insignificant.

Comparison of physical and mental functioning among moderate-to-severe psoriasis patients on biologic versus oral therapy.

With the extensive variety of available treatments for psoriasis, it is paramount that clinicians understand the differences between therapies. A critical literature gap exists regarding the effects of different systemic therapies on physical and mental functioning in the US psoriasis population. We sought to compare the impact of biologic versus oral therapy on measures of physical and mental functioning among US adults with moderate-to-severe psoriasis. We performed a nationwide, cross-sectional study of 2,431,282 (weighted) (183 non-weighted) US adults with psoriasis on biologic or oral therapy using the 2003-2015 Medical Expenditure Panel Survey (MEPS). Physical and mental functioning were measured with the Short Form-12 version 2 (SF-12v2) Physical Component Summary (PCS) and Mental Component Summary (MCS), respectively. The mean PCS score among patients on biologic therapy was significantly higher than that of patients on oral therapy (46.25 [95% CI 43.91-48.59] versus 42.39 [95% CI 41.05-43.73]; P < 0.01). The mean MCS score among patients on biologic therapy was also significantly higher than that of patients on oral therapy (52.46 [95% CI 50.51-54.41] versus 50.19 [95% CI 49.00-51.38]; P < 0.05). Based on adjusted multiple linear regression, biologic therapy was associated with a significantly greater increase in measures of physical functioning (P < 0.05) and mental functioning (P < 0.001) as compared to oral therapy. In conclusion, clinicians need to account for physical and mental health when making treatment decisions. Biologic therapy is associated with significantly greater increases in measures of physical and mental functioning when compared to oral therapy in the US adult psoriasis population.

Does cognitive flexibility training enhance subjective mental functioning in healthy older adults?

Declining cognitive abilities in older adults can contribute to significant changes in socioemotional health and substantially reduce their perception of well-being. Whereas much attention has been dedicated to creating cognitive training programs to improve cognitive health in old age, there is little emphasis on the consequences of such interventions for subjective mental functioning. We created a randomized controlled trial in which we evaluated the effects of an adaptive computerized cognitive flexibility training. Healthy older adults (60-80 years old) were assigned to one of three conditions (frequent or infrequent switching or active control group) and performed 58 half-hour sessions within a period of 12 weeks. We measured effects on subjective cognitive failures and executive dysfunctioning, everyday functioning, depressive symptoms, anxiety, and quality of life, before, and after training. Additionally, participants' proxies rated their cognitive failures and executive dysfunctioning. Subjective cognitive failures and executive dysfunctioning improved 4 weeks posttraining in all groups, although effect sizes were low (ɳp2 = .058 and .079, respectively) and there were no differences between groups (all p's > .38). No significant changes in subjective reports were seen directly after training, which was the case in all groups. Proxies did not report any functional changes over time, yet their evaluations were significantly more favorable than those of the participants, both pretraining (p < .0005) and posttraining (p = .004). Although we found no evidence of improvement on subjective mental functioning, we adduce several factors that encourage further research into the effects of computerized cognitive training on subjective performance.

Hacia una intervención psicosomática a medida / Pour une intervention psychosomatique sur mesure / Moving towards a tailor-made psychosomatic approach

En este texto se presentan la síntesis y las conclusiones de un trabajo psicoterapéutico realizado en equipo con pacientes oncológicos y sus familiares. Utilizando las herramientas, que son básicamente la psicosomática de la Escuela de París y la experiencia del trabajo en grupos, el equipo muestra la originalidad de organizar las psicoterapias de grupo y las sesiones individuales adaptadas a las capacidades del funcionamiento mental de cada paciente. (AU)

In this text, we present the synthesis and conclusions of a psychotherapeutic work done by a team with oncological patients and their relatives. Using tools that are basically the Psychosomatics of the Scof Paris and the experience of working in groups, the team demonstrates the originality of organizing group psychotherapies and individual sessions that are adapted to the capacities of the mental functioning of each patient. (AU)

Dans ce texte sont présentées la synthèse et les conclusions d’un travail psychothérapeutique mené en équipe avec des patients oncologiques et leurs proches. Utilisant les outils, qui sont essentiellement la psychosomatique de l’École de Paris et l’expérience du travail en groupe. L’équipe montre l’originalité de l’organisation de psychothérapies de groupe et des séances individuelles adaptées aux capacités du fonctionnement mental de chaque patient. (AU)

The impact of total sleep deprivation upon cognitive functioning in firefighters.

INTRODUCTION: Firefighters as a profession are required to maintain high levels of attention for prolonged periods. However, total sleep deprivation (TSD) could influence negatively upon performance, particularly when the task is prolonged and repetitive. PURPOSE: The aim of this study is to examine the influence of TSD on cognitive functioning in a group of firefighters. SUBJECTS AND METHODS: Sixty volunteers who were active male fire brigade officers were examined with a computerized battery test that consisted of simple reaction time (SRT) (repeated three times), choice reaction time, visual attention test, and delayed matching to sample. Six series of measurements were undertaken over a period of TSD. RESULTS: Performance in the second attempt in SRT test was significantly worse in terms of increased number of errors and, consequently, decreased number of correct responses during TSD. In contrast, the choice reaction time number of correct responses as well as the visual attention test reaction time for all and correct responses significantly improved compared to initial time points. CONCLUSION: The study has confirmed that subjects committed significantly more errors and, consequently, noted a smaller number of correct responses in the second attempt of SRT test. However, the remaining results showed reversed direction of TSD influence. TSD potentially leads to worse performance in a relatively easy task in a group of firefighters. Errors during repetitive tasks in firefighting routines could potentially translate into catastrophic consequences.

The relevance of Evelyne Kestemberg today.

Evelyne Kestemberg bequeathed rigorous metapsychological claims and she mapped out a way to approach the psychotic modes of being and formalise the specificities of the transference when delusion is at work, whether visibly or latently. The prime goal of the treatment is an attempt to restore the pleasure in mental functioning, a pleasure which psychotic suffering precisely obstructs.

ON BECOMING ABLE TO PLAY: INDIVIDUAL CHILD PSYCHOANALYTIC PSYCHODRAMA AND THE DEVELOPMENT OF SYMBOLIZATION.

In this paper, the authors analyze the relevance and transformative potential of individual psychoanalytic psychodrama in the treatment of children with severe impairments in symbolization. Central features of this modality, including promoting the representation of early traumatic experiences, are presented and discussed. Specific features include double-envelope containment of the co-therapists' group and play leader, consequent diffraction of the transference-determining portrayal, gradual integration, and initial figuration of coexisting split-off fragments. Drawing on in-depth clinical material, the authors show how psychodrama tempers the potentially traumatic effects of the encounter with the object, allowing these patients to access the transitional area of play.

Trajectories of mental and physical functioning among spouse caregivers of cancer survivors over the first five years following the diagnosis.

OBJECTIVE: Identify the trajectories of physical and mental functioning among spouse caregivers of patients with cancer over the first five years post-diagnosis and variables associated with low or deteriorating functioning. METHODS: Caregivers completed a survey at 6 months and 1, 2, 3.5, and 5 years post-patient diagnosis, including the SF-12 for quality of life (QOL). SF-12 Mental Component Summary (MCS, n=299) and Physical Component Summary (PCS, n=300) scores were analyzed using SAS. RESULTS: Five trajectories for PCS were identified, the top three were: (a) high PCS (53.0%); (b) steady decline in PCS (17.0%); and (c) steady increase, but remaining below population norm (16.7%). Five trajectories for MCS were also identified, the top two being: (a) high MCS (45.8%) and (b) MCS comparable to population norm (27.8%). Variables associated with low or deteriorating QOL included depression, social support, coping, burden, and/or unmet needs. CONCLUSIONS: This is the first study to document spouse caregivers' QOL over the first five years post-patient diagnosis. Although many participants experienced high functioning, almost a third reported low or deteriorating mental or physical functioning. PRACTICE IMPLICATIONS: Variables associated with low or deteriorating mental and physical functioning can be targeted in future interventions.