High Psychological Burden Research Articles

Is Symptom Burden Associated with Treatment Status and Disease Stage among Adult HIV Outpatients in East Africa?

Symptom distress is poorly described in persons living with HIV, with limited attention paid to physical and psychological symptom prevalence to inform optimal clinical care. The study objective was to measure seven-day-period prevalence of symptoms among HIV-infected adult outpatients and determine if self-reported symptom burden is associated with antiretroviral therapy (ART), CD4 T-cell count, and clinical disease stage. Adult patients were consecutively recruited from HIV outpatient clinics at two referral and teaching hospitals in Uganda. Of 343 patients approached, 302 (88%) participated. Patients described symptoms during the previous week using the Memorial Symptom Assessment Scale Short Form, and level of physical functionality using the Karnofsky Performance Status (KPS) tool on the interview day. A high symptom burden was reported, with the most prevalent being worry (94%), feeling sad (92%), hunger (82%), feeling nervous (75%), and feeling drowsy/tired (62%). Patients with KPS scores of <70 reported more symptoms (23 versus 10; F=289.68, P<0.001) and higher symptom distress (P<0.04 for all analyses). Neither ART nor CD4 T-cell count were associated with symptom burden. WHO clinical stage 4 was associated with psychological symptom burden (OR 2.94, P=0.011, CI 1.281-6.735). Men were more likely to experience higher symptom burden. In the ART era, ambulatory HIV/AIDS patients continue to experience a high physical and psychological symptom burden. For those with advanced disease, psychological symptoms are particularly important. It is important to be observant of gender differences in patterns of symptom distress in HIV outpatient care settings. The high prevalence of hunger warrants attention as it may compromise ART initiation and adherence to ART.

Younger and older chronic somatoform pain patients in psycho-diagnostics, physician-patient relationship and treatment outcome

IntroductionPatients with chronic pain are found with highly variable clinical presentation and differing physical complaints. They are seen as a heterogenic group. Based on clinical observations, elderly patients seem to differ from younger patients with chronic pain. We examined whether there were systematic differences between young and old pain patients.MethodsAs part of a routine evaluation of university hospital care, a newly developed psychosomatic treatment model for chronic somatoform pain disorders was examined. The basis for treatment efficacy was a target-oriented, specific somatic and psychological intervention that included a stable physician-patient relationship. Particular attention was paid to differences in treatment outcome with regard to changes in both physical and psychopathological symptom levels. We hypothesised that younger pain patients had higher psychological burden and benefitted more from our treatment than older pain patients.ResultsOverall, 179 inpatients (57.5% women) with chronic pain were examined (age between 16 and 79 years). The group as a whole yielded high scores on the somatisation dimension (SCL-90) and showed a considerable amount of psychopathological symptoms, such as depressive mood and anxiety (HADS) and a great emotional instability (FPI-R). Age differences were only found with regards to patients’ degree of aggression (SCl-90): younger patients showed higher aggressive tendencies than older ones (p< 0.05). The treatment offered helped patients in both age groups especially with regard to reduction of depressive mood (HADS, p< 0.01) and anxiety levels (HADS, p< 0.01). Regression analysis showed different age groups and gender as significant predictors of anxiety reduction under therapy (R2=.108; model: p< 0.01).Discussion and conclusionResults show that younger chronic pain patients suffer more from a considerable amount of psychological distress than older ones, but our treatment approach was equally effective in both groups. However, age and gender differences, as well as the patient’s baseline level of anxiety influenced the outcome. These factors need to be studied in future research.

Isotretinoin and Risk for Inflammatory Bowel Disease

To examine the association between isotretinoin and the risk for inflammatory bowel disease (IBD) among women of reproductive age. Nested case-control study and meta-analysis. A US health claims database. We formed a cohort of women aged 18 to 46 years who had received at least 1 oral contraceptive prescription from May 1, 2001, through December 31, 2009. The IBD cases were required to have 3 health care contacts with documentation of IBD or a single health care contact followed by use of a drug to treat IBD. Twenty controls were selected for each case using incidence-density sampling, matched on age and date of diagnosis. Risk ratios (RRs) were formed for incident cases of IBD associated with the use of isotretinoin. A subgroup analysis examined the risk for IBD among those diagnosed as having Crohn disease (CD) and ulcerative colitis (UC). A meta-analysis of published and unpublished studies assessing isotretinoin and IBD used a random-effects model to estimate a pooled RR. In the case-control study, we identified 2159 IBD cases (1056 with UC and 1103 with CD) and matched them with 43 180 controls. Only 10 cases (0.46%) and 191 controls (0.44%) were exposed to isotretinoin. The adjusted RR for IBD was 0.99 (95% CI, 0.52-1.90). The RRs for UC and CD were 1.10 (95% CI, 0.44-2.70) and 0.91 (0.37-2.25), respectively. For the meta-analysis, the pooled RR for IBD for the 5 studies was 0.94 (95% CI, 0.65-1.36). The results of this study do not suggest an increase in the risk for IBD, including UC or CD, with use of isotretinoin. Because inflammatory acne in children and adolescents carries a high psychological burden, clinicians should not be discouraged from prescribing this drug owing to a putative association with IBD.

Poor Sleep in Patients with Multiple Sclerosis

BackgroundPoor sleep is a frequent symptom in patients with multiple sclerosis (MS). Sleep may be influenced by MS-related symptoms and adverse effects from immunotherapy and symptomatic medications. We aimed to study the prevalence of poor sleep and the influence of socio-demographic and clinical factors on sleep quality in MS- patients.MethodsA total of 90 MS patients and 108 sex-and age- matched controls were included in a questionnaire survey. Sleep complaints were evaluated by Pittsburgh Sleep Quality Index (PSQI) and a global PSQI score was used to separate good sleepers (≤5) from poor sleepers (>5). Excessive daytime sleepiness, the use of immunotherapy and antidepressant drugs, symptoms of pain, depression, fatigue and MS-specific health related quality of life were registered. Results were compared between patients and controls and between good and poor sleepers among MS patients.ResultsMS patients reported a higher mean global PSQI score than controls (8.6 vs. 6.3, p = 0.001), and 67.1% of the MS patients compared to 43.9% of the controls (p = 0.002) were poor sleepers. Pain (p = 0.02), fatigue (p = 0.001), depression (p = 0.01) and female gender (p = 0.04) were associated with sleep disturbance. Multivariate analyses showed that female gender (p = 0.02), use of immunotherapy (p = 005) and a high psychological burden of MS (p = 0.001) were associated with poor sleep among MS patients.ConclusionsPoor sleep is common in patients with MS. Early identification and treatment of modifiable risk factors may improve sleep and quality of life in MS.

COPD referrals to specialist palliative care services (SPCS) in Salford: are we improving practice?

BackgroundCOPD is a leading cause of morbidity and mortality worldwide with a high physical and psychological symptom burden. A joint Palliative Care and COPD Working Group was established in 2007...

Assessment of the psychological burden associated with pruritus in hemodialysis patients using the kidney disease quality of life short form

To assess whether depression symptoms, poor sleep and dry skin bother explain association between pruritus and the burden of kidney disease in maintenance hemodialysis (MHD) patients. Cross-sectional study of 980 patients from a prospective study in dialysis units of Salvador, Brazil (PROHEMO). The Kidney Disease Quality of Life Short Form was used to determine scores of kidney disease burden (KDB) and sleep with higher scores indicating lower perceived burden and better sleep quality, respectively. The Center for Epidemiological Studies Depression Scale was used for depression symptoms. Prevalence of severe pruritus (very much or extreme) was 19.4%. Significantly (P < 0.001) lower mean KDB score by 11.44 points was observed for patients with severe pruritus (34.18 ± 27.51) than for those with no pruritus (45.62 ± 30.73). Severe pruritus was associated with poorer sleep quality, higher odds of dry skin bother and higher depression symptoms score. Association of pruritus with KDB score was virtually eliminated after adjustment for sleep, dry skin bother and depression symptoms. This study shows strong associations of severe pruritus with higher depression symptoms, poorer sleep and dry skin bother among MHD patients. The results support special attention to MHD patients with pruritus who often face high psychological burden.

Krank oder krank gemacht? Rezidivierende Episoden kutaner Ulzera, Aphten, Kolitis, Arthralgien, Haarausfall... eine systemische Erkrankung oder iatrogen?

Recurrent episodes of cutaneous and subcutaneous ulcers, especially in the oral cavity, represent a high psychological and painful burden for the patient. If there in addition are symptoms of arthralgia and/or colitis, an autoimmune disease with vasculitis, particularly a Morbus Behçet has to be considered as a possible differential diagnosis. The therapy therefore would be an immunosuppressive one. Also a wide immunologic diagnostic process has to be started. Furthermore, a chronic inflammatory bowel disease has to be excluded by colonoscopic biopsy. An infectious etiology of the symptoms (viral/bacterial/parasitic) should be investigated by microbiological and laboratory tests. A thrush or a herpes-infection caused by immunosuppression (toxic or due to illness) has to be considered as a further differential diagnosis. Also a precise medical and drug history is very important because of possible toxic adverse effects. Until confirmation of a final diagnosis, only a symptomatic analgetic or antifungal or antiviral therapy in case of a positive thrush or herpes culture respectively should be initiated with respect to the very different kinds of treatment of the diseases included in the differential diagnosis.

Successive switching of antiretroviral therapy is associated with high psychological and physical burden

HIV treatment and management is constantly evolving. This is as a result of more treatment options coming on stream, tolerance changes and progress in treatment management. HIV infection today, in resource-rich countries and in the presence of combination therapies, is experienced as lifelong treatment punctuated by adjustments to antiretroviral therapy (ART) regimens. People who are diagnosed as HIV positive face a number of challenges and changes around the decision to commence treatment, responses to treatment and changes in treatment regimens. This study was set up to examine the experience of switching treatments and the impact of such switches on psychological parameters. The method used was a cross-sectional questionnaire study. A group of 779 HIV-positive clinic attendees at four clinics in London and South East England participated in the study (86% response rate). They provided detail of their treatment switching experiences as well as demographic details, risk and optimism evaluations, quality of life, symptom burden, adherence and disclosure information. The sample (n=779) comprised 183 (24%) females, 76 (10%) heterosexual males and 497 gay males (66%). Self-reported ethnicity was 67% white, 25% black, 3% Asian and 5% mixed/other ethnicity. One hundred and fifty-five (21%) were ART-naïve and 624 (79%) were ART experienced; 161 (22%) were receiving their first regimen, 135 (18%) had experienced one regimen switch, 196 (26%) had multiple switches and 99 (13.3%) had stopped treatment. Treatment naïve, non-switchers and single switchers generally reported lower symptom burden and higher quality of life. Multiple switchers reported higher physical symptom burden and higher global symptom distress scores. Those who had stopped treatment had significantly lower quality-of-life scores than all other groups. Suicidal ideation was high across the groups and nearly a fifth of all respondents had not disclosed their HIV status to anyone. Reported adherence was suboptimal -- 79% of subjects were at least 95% adherent on self-report measures of doses taken over the preceding week. In conclusion, nearly half this clinic sample will have switched treatments. A holistic approach is needed to understand the psychological effects of such switches if lifelong treatment is to be maintained and those on antiretroviral treatment are to attain good quality of life and minimize symptom burden.

Women living with facial hair: the psychological and behavioral burden

Objective While unwanted facial hair is clearly distressing for women, relatively little is known about its psychological impact. This study reports on the psychological and behavioral burden of facial hair in women with suspected polycystic ovary syndrome. Methods Eighty-eight women (90% participation rate) completed a self-administered questionnaire concerning hair removal practices; the impact of facial hair on social and emotional domains; relationships and daily life; anxiety and depression (Hospital Anxiety and Depression Scale); self-esteem (Rosenberg Self-esteem Scale); and quality of life (WHOQOL-BREF). Results Women spent considerable time on the management of their facial hair (mean, 104 min/week). Two thirds (67%) reported continually checking in mirrors and 76% by touch. Forty percent felt uncomfortable in social situations. High levels of emotional distress and psychological morbidity were detected; 30% had levels of depression above the clinical cut off point, while 75% reported clinical levels of anxiety; 29% reported both. Although overall quality of life was good, scores were low in social and relationship domains—reflecting the impact of unwanted facial hair. Conclusion Unwanted facial hair carries a high psychological burden for women and represents a significant intrusion into their daily lives. Psychological support is a neglected element of care for these women.

Alcohol problems, mental disorder and mental health among suicide attempters 5–9 years after treatment by child and adolescent outpatient psychiatry

Many studies report associations between alcohol problems, mental disorder, mental health and suicidal behaviour. Still, more knowledge is needed about possible differential characteristics of these factors in risk groups. This naturalistic and retrospective study included former patients who received emergency treatment in child and adolescent outpatient clinics for their mental health problems. One hundred patients were personally interviewed 5–9 years after treatment referral about alcohol problems and mental disorders. Also, they completed questionnaires about 11 indicators of mental health. At the follow-up, those who had attempted suicide during the follow-up period had more alcohol problems and mental disorders than the non-attempters. However, no association was found between suicide attempt in the follow-up period and the mental health indicators. Among the attempters, a high psychological burden as indicated by mental health disorders and poor mental health were associated with suicide re-attempt (lifetime) and an intention to die.