Capacity limitations in neurology patients, with and without comorbid mental disorders

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J Psychosom Res. 5 May 2022;159:110928. doi: 10.1016/j.jpsychores.2022.110928. Online ahead of print.

ABSTRACT

BACKGROUND: According to the International Classification of Functioning, Disability and Health (ICF), symptoms of illness and limitations in ability should be separated and assessed separately. Psychological abilities are more important than physical abilities in today’s world. Patients with neurological disorders not only show limitations in their physical abilities but also in their psychological abilities. As in many cases there is a comorbidity of neurological and mental disorders, the question is to what extent this may increase psychological disability.

METHODS: Using a cross-sectional study design, neurological patients with and without mental comorbidity were recruited from a phase D neurological rehabilitation service. A total of 114 inpatients with both neurological and mental disorders (NM) were compared to 214 unselected patients with only neurological disorders (N). Mental comorbidity was diagnosed using the standardized “International Neuropsychiatric Interview”. Capacity limitations were assessed with the “Activities and Participation in Psychological Disorders According to the International Classification of Functioning, Disability and Health” scale (Mini-ICF-APP). Qualitative patient reports were used to validate Mini-ICF-APP scores. Clinical diagnoses were derived from routine patient assessment.

RESULTS: Severe capacity limitations, requiring the support of others, could be observed in particular for endurance (NM: 73.7% against N: 59.8% of patients), flexibility (NM: 43, 0% vs. N: 22.4%), professional competence (NM: 36.0% vs. N: 16.8%), task structuring (NM: 32.5% vs. N: 15.0%). The least common disorders were dyadic relationships (NM: 23.7% versus N: 7.9%). The rank order and qualitative descriptions of the impairments were similar in the two groups.

CONCLUSION: Patients with neurological disorders in general show a relevant degree of capacity limitations. This is further greatly increased by mental comorbidity. Specific treatment is required.

PMID:35597116 | DO I:10.1016/j.jpsychores.2022.110928

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