Hospital Anxiety And Depression Scale Scale Research Articles

Clinical significance of echocardiographic signs of right heart dysfunction in patients with chronic heart failure with preserved left ventricular ejection fraction

Aim: To analyze the features of clinical signs, quality of life and psycho-emotional state in patients with heart failure with preserved left ventricular ejection fraction (HFpEF) and non-obstructive atherosclerosis of the coronary arteries, depending on the presence of echocardiographic criteria for dysfunction of the right heart.Material and Methods. Patients underwent an extended protocol of echocardiography with an assessment of the structure and function of the right heart; ultrasound examination of the lungs with the determination of the number of B-lines; a six-minute walk test, a test for the presence of a symptom of bendopnea with the determination of blood oxygen saturation (SpO2) before and during the test. In addition, quality of life was assessed using the Minnesota questionnaire and the SF-36 questionnaire (The Short Form-36); the psycho-emotional state of patients was analyzed according to the HADS (Hospital Anxiety and Depression Scale), the level of adherence to treatment was analyzed according to the Morisky – Green questionnaire. Patients were divided into two groups depending on signs of right heart dysfunction: Tei index more than 0.54, tricuspid annulus systolic excursion (TAPSE) less than 17 mm, tricuspid annulus systolic velocity (RV S’) less than 9,5 cm/sec.Results. Echocardiographic signs of right heart dysfunction in patients with HFpEF was associated with lower quality of life indicators according to the SF-36 questionnaire, in particular, general health status (p = 0.008) and role limitations due to emotional problems (p = 0.03). During the bendopnea test (p = 0.04), the majority of patients with signs of dysfunction of the right heart (66.7%) had a decrease in SpO2, while in the comparison group the proportion of such patients was 36.7% (p = 0.04). The psycho-emotional state according to the HADS scale and adherence to treatment did not differ in both groups (p > 0.05). The frequency of detection of B-lines according to lung ultrasound was also comparable.

Dynamics of heart rhythm disorders in combatants with acute myocarditis during a 6-month follow-up

The main factors of an unfavorable prognosis, are life-threatening heart rhythm disorders which determine the severity of the clinical course of myocarditis, in addition to impaired contractility and dilatation of the left ventricle (LV). The aim of the study was to assess the frequency and nature of arrhythmias and establish predictors of their long-term persistence, assess the severity of anxiety and depression, changes in heart rate variability in combatants on the background of changes in the structural and functional state of the left ventricle during a 6-month follow-up. The study included 52 male servicemen (combatants) with acute myocarditis (AM) with an average age of 33.4±2.5 years. All patients were assessed by Questionnaire according to the Hospital Anxiety and Depression Scale (HADS) and underwent 24 hour ECG monitoring, transthoracic echocardiography and cardiac magnetic resonance (CMR) with late enhancement using gadovist. At the onset of AM frequent supraventricular (30.7% of cases) and frequent ventricular (42.3% of cases) extrasystolic arrhythmia, as well as paroxysms of non-sustained ventricular tachycardia (26.9% of cases) on the background of heart rhythm variability disorders were recorded. After 6 months, there was an improvement in the structural and functional state of the heart, which was characterized by a decrease in dilatation and an improvement of LV systolic function, a decrease in the volume of the inflammatory lesion and the total number of affected LV segments revealed on cardiac MRI, which was associated with a decrease in the number of ventricular rhythm disorders and reduction of clinical manifestations of anxiety according to the HADS scale. The obtained data indicate that the persistence of supraventricular rhythm disorders is associated with the long-term presence of anxiety and low values of standard deviation of RR intervals (SDNN) and root mean square of successive differences between normal heartbeats (RMSSD). Also predictors of persistence of non-sustained ventricular tachycardia paroxysms were established – SDNN value ≤80.0 ms, LV end-diastolic volume index ≥95 ml/m2, total number of affected LV segments ≥6 segments, presence of delayed contrasting in ≥3 LV segments, pre­sence of ≥12 points on the HADS scale and predictors of atrial fibrillation – SDNN value ≤80.0 ms, RMSSD value ≤12.0 ms, total number of affected segments of LV≥6 seg. and ≥12 points on the HADS anxiety scale, determined at the onset of AM.

Relationship Between Dialysis Adequacy and Depression and Anxiety in Hemodialysis Patients

Background: Chronic kidney disease (CKD) is an irreversible condition that demands hemodialysis treatment until a kidney transplant is carried out. If dialysis is not sufficient, the patient might experience numerous physical and psychological consequences. This study aimed to examine the relationship between depression and anxiety and dialysis adequacy in patients receiving hemodialysis in Birjand, Iran.
 Methods: In this cross-sectional study, 100 patients undergoing hemodialysis treatment at Shahid Beheshti Hemodialysis Center in Birjand were examined. The state of depression and anxiety in them was evaluated according to the Hospital Anxiety and Depression Scale (HADS), and the adequacy of the patients’ dialysis was extracted from their medical records. In this study, scores ≤ 11 on the HADS scale were considered healthy. Moreover, dialysis adequacy was calculated with the KT/V formula, and cases ≥ 1.2 were considered adequate. Data analysis was performed using SPSS 19 software, independent samples t-test, and Pearson correlation coefficient.
 Results: The results showed that 18% and 82% of the participants had depression and anxiety, respectively. The patients’ depression and anxiety scores did not significantly correlate with the adequacy of dialysis (P = 0.82 and P = 0.86, respectively). The prevalence of depression and anxiety was not significantly influenced by gender or marriage; however, the results indicated that as patients aged, the prevalence of depression increased (P = 0.009) and anxiety decreased (P = 0.003).
 Conclusions: The adequacy of dialysis in patients undergoing hemodialysis treatment remains unaffected by mental disorders, such as anxiety and depression. Age has a significant impact on depression and anxiety levels in patients receiving hemodialysis treatment. To reduce anxiety and depression in younger and older patients, it is recommended to initiate support and educational programs.

OP23 Early Detection Tools For Emotional Distress In Adult Cancer Patients In Spain: A Health Technology Assessment Report

IntroductionPatient-reported outcome measures are being increasingly considered both in clinical practice and in the field of health technology assessment. Although emotional distress is currently recognized as the sixth vital sign in cancer care, its early detection and screening is not yet included in routine clinical practice in Spain. The main objective of this study was to assess the psychometric properties and diagnostic accuracy of validated tools for the early detection of distress among adults with cancer in the Spanish context, at the request of the Spanish National Health System (NHS) Cancer Strategy.MethodsA systematic review was carried out to analyze development and validation studies. The Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) was used for the risk of bias assessment, and a multicriteria global assessment was used for the tests. Ethical and organizational aspects were also addressed.ResultsFifteen validation studies were included, corresponding to seven tests. The tools considered were the Distress Thermometer (DT), the Brief Symptom Inventory-18 (BSI-18), the Edmonton Symptom Assessment System-revised (ESAS-r), the Hospital Anxiety and Depression Scale (HADS), the Visual Analog Scale for Anxiety and Depression (VAS-AD), the Detection of Emotional Distress (DED) scale, and the Psychosocial and Spiritual Needs Evaluation (ENP-E) scale. Evidence of validity, reliability (internal consistency), and diagnostic accuracy (sensitivity, specificity, and area under the receiver operating characteristic curve) were summarized. Three scales were rated as poor (VAS-AD, BSI-18, and ESAS-r), the ENP-E scale was rated as acceptable, and three scales were rated as moderate (DT, DED, and HADS).ConclusionsThe DT (single-item measure) stands out as an appropriate tool for early detection of emotional distress in the Spanish NHS. The use of this scale could be considered a first stage, to be combined later with a longer scale to improve screening specificity. The HADS scale could be utilized for this purpose. The use of these tools should be framed within a structured screening program that ensures further evaluation and subsequent psychological care when needed.

PRKCA and TCF4 Genetic Variants in Anxiety Symptoms and Generalized Anxiety Disorder in a Sample of Colombian Subjects Selected on the Basis of High Anxiety Scores

Objective: There are several anxiety disorders leading to a high burden of disease around the world, including Generalized Anxiety Disorder (GAD). The heritability of GAD suggests that genetic factors play an important role in its development; however, further research in this area is needed in Latin America. This study aimed to analyze the possible association between two single nucleotide polymorphisms (SNPs), rs2244497 and rs1452789, located in the PRKCA and TCF4 genes with anxiety symptoms and GAD based on high anxiety scores in a sample of selected Colombian subjects. Methods: We evaluated 303 participants using the Hospital Anxiety and Depression Scale (HADS) and Zung’s Self-Rating Anxiety Scale (ZSAS). Subjects with high scores in both scales (according to established cut-off points) participated in a psychiatric evaluation for the diagnosis of GAD. TaqMan assays were employed to genotype the SNPs, and statistical analyses were performed using logistic and linear regression. Results: In a sample of Colombian subjects selected on the basis of high anxiety scores, we found a significant association between the rs2244497 SNP in the PRKCA gene and higher scores in anxiety symptoms, where people carrying the T/T genotype had the highest scores for HADS scale. However, we did not observe this association in people diagnosed with GAD. In addition, the SNP in TCF4 (rs1452789) did not have an association with anxiety symptoms or GAD diagnosis. Conclusion: This study contributes to the analysis of the molecular basis of anxiety disorders in selected Latin American samples. However, further studies are necessary to understand the role of rs2244497 SNP in the PRKCA gene and the risk for higher scores in anxiety symptoms.

Anxiety and depression disorders in oncological patients under palliative care at a hospital service: a cross-sectional study

BackgroundThis study aimed to evaluate the risk and protective factors associated with anxiety and depression symptoms in cancer patients at an advanced stage of cancer.MethodsA cross-sectional study was conducted on patients with advanced cancer who were receiving palliative care. Cancer patients aged 18 years or older, with preserved cognitive function who completed the questionnaires were eligible. The questionnaires of Hospital Anxiety and Depression Scale (HADS) and health related of quality of life questionnaire; the European Organization for Research and Treatment of Cancer (EORTC-C30) were applied. Outcome variables were the depression and anxiety symptoms of cancer patients under palliative care, according to the answers to the 14 items that make up the HADS Scale. The analysis used the R software, version 4.2.0.ResultsSeventy cancer patients with advanced cancer were included. The colon was the most common neoplastic diagnostic (20%), followed by breast (12.9%) and lung (10%). The prevalence of depression was 44.3%, 25.7% anxiety and 52.9% had both symptoms. Patients with a high level of functionality had a lower chance of anxiety (OR = 0.80;p = 0.025), depression (OR = 0.82; p = 0.007), and anxiety and depression (OR = 0.82p = 0.008). We observed a lower chance of depression and depression/anxiety who showed a high level of Overall Performance. Three symptoms increased the chance of depression/anxiety: nausea/vomiting (p = 0.019), fatigue (0.031), loss of appetite (0.048).ConclusionThis study found high prevalence of anxiety and depression.Better quality of life and functionality were negatively associated with these outcomes. Examining the patient’s functions will assist the clinician in alleviating symptoms of anxiety and depression, giving cancer patients in palliative care more dignity.Trial registrationNot applicable.

Anxiety disorders and depression are associated with resistant hypertension.

Anxiety and depression can adversely affect the prognosis following cardiovascular diseases (CVDs) and may be associated with resistance to hypertension (HT) treatment. A better understanding of the complex biological substratum of resistant HT complicated by depression and anxiety is crucial for designing future primary care strategies. To evaluate the relationship between anxiety and depression and resistant HT, which will help to look at resistant HT from a broader perspective and aid the development of new strategies for diagnosis and treatment. We used a stratified random sampling method to select HT patients aged 18 and older in primary care setting. A total of 300 consecutive patients with persistent HT who were diagnosed with essential HT and uncontrolled blood pressure (BP) despite antihypertensive therapy were prospectively included in the study. Anxiety and depression were investigated, and scoring was evaluated using the Hospital Anxiety and Depression Scale (HADS). The study included 108 controlled and 91 uncontrolled HT patients. The HADS scales were higher in the controlled HT group compared to the uncontrolled HT group (6 (0-18) compared to 9 (0-20), p = 0.001; 5 (0-17) compared to 7 (0-16), p < 0.001, respectively). Body mass index (BMI) and C-reactive protein (CRP) were also significantly higher in the uncontrolled HT patients compared to the normotensive group. Anxiety was associated with a 2.18 times increased risk of HT and a 1.99 times increased risk of depression. Thus, anxiety and depression predicted resistant HT in both univariate and multivariate analyses. During the treatment of HT, efforts should be made to improve the psychological and social functions of the patients beyond the primary therapy for control of the disease. As such, we hope to draw attention to the importance of psychological factors, especially anxiety and depression, in any field of medicine related to managing resistant HT.

Dynamics of anxiety, depression, and quality of life after early physical rehabilitation of patients who underwent surgical correction of acquired mitral valve defect: clinical prospective randomized study

BACKGROUND: The activation of the patient from the day after an acquired mitral valve (MV) defect with standard cardiorehabilitation surgery and further physical training at an early uncomplicated inpatient stage of the postoperative period appears promising to improve not only the functional status but also the quality of life (QL).&#x0D; AIM: Our aim was to examine the effect of early physical rehabilitation on the dynamics of anxiety, depression, and QL in patients after surgical correction of the MV defect.&#x0D; MATERIALS AND METHODS: The study included 80 patients (median age 60.8 [47.5; 69.0] years) who underwent surgical correction of an acquired MV defect. Starting from the 7th day after the surgery, patients were assessed for functional status, and the intensity of the training load was selected, and this was done again on the 24th day after the surgery. Moreover, the QL parameters on the SF-36 scale and levels of anxiety and depression on the Hospital Anxiety and Depression Scale (HADS) were evaluated. The control group (n=47) underwent a standard cardiac rehabilitation program from 1st day after surgery. In the main group (n=33), based on the results of the cardiopulmonary exercise testing, physical training on a treadmill was initiated for 14 days, from the 8th day after the surgery, in addition to a personalized training program.&#x0D; RESULTS: In addition to improving the functional state, early physical training improved the dynamics of QL indicators in the main group. After 14 days of treadmill training, the physical health component increased from a median of 35.1 to 64.4 (p=0.03), and the mental health component from a median of 49.1 to 82.1 (p=0.03). In addition, after the early physical rehabilitation program in the main group, the number of people without anxiety and depression, according to the HADS scale, significantly increased from 9% to 27.3% (p=0.04), whereas the dynamics of the QL, anxiety, and depression levels in the control group were not significant.&#x0D; CONCLUSION: Early physical rehabilitation, including moderate-intensity workouts with an individual calculation of the speed / angle of the treadmill, starting from 8 days after surgical correction of the acquired MV defect demonstrated efficacy in improving the QL and reducing anxiety and depression levels 24 days after surgery.

Psychological assistance to patients with thyroid cancer

Introduction. Thyroid cancer has a favorable prognosis but in long term patients are observed to be in psychological distress manifesting through elevated anxiety and depression which disrupt social adaptation. Studies have shown that 2–4 years after diagnosis and treatment of this malignant tumor, the majority of patients report dissatisfaction with family relationships and difficulties in performing everyday activities. These data demonstrate the necessity of rehabilitation aimed at patient adaptation to everyday life after therapy completion. Psychological help is an important aspect of rehabilitation.Aim. To evaluate the effectiveness of psychological help in patients with thyroid cancer.Materials and methods. The study included 42 women with thyroid cancer, stages I–III, Т1–3N0–1М0. Mean patient age was 44.5 ± 1.1 years. The patients were randomly divided into 2 groups matched by age, disease stage and type of surgical intervention: treatment and control groups. The treatment group (n = 24) included patients who underwent psychological training in the postoperative period, the control group (n = 18) included patients who did not receive psychological help. Mental state was evaluated using the Hospital Anxiety and Depression Scale (HADS). The patients’ mental state was evaluated dynamically: 1st testing was performed after surgery, 2nd testing 12 months after surgery. Psychological training was performed in the postoperative period and included 5 individual classes teaching self-regulation skills.Results. After the surgery, HADS scale showed insignificant increase in anxiety in both groups. Analysis of repeat testing showed decreased anxiety levels in patients in the treatment group from 7.7 ± 0.2 to 6.3 ± 0.2, i. e. to normal level. In the control group, anxiety significantly increased from 7.8 ± 0.2 to 9.2 ± 0.2 (Student’s t-test = 5.17; p = 0.000168). Additionally, 12 months after surgical treatment statistically significant differences in anxiety levels between groups were observed: 6.3 ± 0.2 and 9.0 ± 0.2, respectively (Student’s t-test = 9.55; р &lt;0.05). Primary examination showed subthreshold depression in patients of both groups: 7.9 ± 0.1 and 8.1 ± 0.2, respectively. No statistically significant differences between the groups were observed (Student’s t-test = 0.89; р &gt;0.05). Repeat examination showed decreased depression level (in treatment group from 7.9 ± 0.1 to 7.4 ± 0.2, in the control group from 8.1 ± 0.2 to 7.7 ± 0.1), however it remained in the range of mean values. No statistically significant differences between the groups were observed (Student’s t-test = 1.34; р &gt;0.05).Conclusion. Psychological training using self-regulation techniques performed in the early postoperative period normalizes anxiety level and prevents its elevation in long term in patients with thyroid cancer.

Incidence of cognitive, depressive and anxiety disorders in COVID‐19 patients

AbstractBackgroundThe COVID‐19 pandemic has become a serious global problem that has affected almost all aspects of modern society, especially public health. Among the significant health problems one can single out ‐ an increase in the number of people with cognitive, depressive and anxiety disorders in COVID‐19 patients. These disoders may be due to the severity of the patient’s condition during the period of COVID‐19 disease, the presence of significant events after suffering COVID‐19 or premorbid cognitive (vascular pathology or Alzheimer’s disease) and emotional status.MethodWe examined 60 patients after COVID‐19, 33 (55%) were men, at 7.34 ± 0.14 months follow‐up after hospital treatment. Mean age ‐ 59.93±1.32. Participants were completed the Montreal Cognitive Assessment (MoCA) and The Frontal Assessment Battery (FAB). Depression and anxiety were identified using the Hospital Anxiety and Depression Scale (HADS).ResultAccording to the measured MoCA, 30 (50%) of the examined patients had mild cognitive impairments, no severe cognitive impairments were detected. According to the FAB scale, 25 (41.7%) patients had moderate frontal dysfunction, no severe frontal dysfunction were detected. According to the HADS scale: anxiety was detected in 10 (16.6%) patients; depression — in 3 (5%) patients. The study found evidence that cognitive impairment was more common in patients with a low level of education, atherosclerosis of the brachiocephalic arteries, and chronic heart failure (p&lt;0.05). Cognitive impairment and anxiety disorders were significantly more frequently recorded in older patients (p&lt;0.05).ConclusionCOVID‐19 survivors showed a considerable prevalence of cognitive impairment. Considering the alarming impact of COVID‐19 infection on mental health, we recommend to assess cognitive and emotional status of COVID‐19 survivors for early diagnosis and treatment of cognitive and emotional disorders.

Psychoemotional state and bioelectrical brain activity in patients of different ages with metabolic syndrome after COVID-19

The aim of this study was to find out the impact of COVID-19 infection on the psycho-emotional state and bioelectrical brain activity in persons of different ages with metabolic syndrome. Material and methods. We examined 53 people who were divided into groups depending on age (40–59 years and 60 years and older) and status with regard to COVID-19 infection (contracted, not contracted). Patients had metabolic syndrome (ATP III), underwent comprehensive clinical and laboratory examinations, electroencephalography (an 18-channel electroencephalograph Nihon Kohden, Japan) and answered the Hospital Anxiety and Depression Scale (HADS) questionnaire. Results. Symptoms of anxiety or depression after COVID-19 were found in both age groups of MS. Anxiety symptoms were more often found in the group of 60 years and older. At the same time, subclinical anxiety was noted in persons of 60 years and older, while clinical anxiety – in middle-aged individuals. The latter also showed a trend towards an increase in clinically evident depression after COVID-19. Persons after COVID-19 with symptoms of anxiety or depression (according to the HADS scale) demonstrated changes in the frequency-amplitude indicators of the electroencephalogram (EEG) characterized by a power increase in the range of theta rhythm and accompanied by subclinical and clinical manifestations of depression. About 80 % of people who did not suffer from COVID-19 had normal EEG since 9 Hz alpha rhythm power was registered. In patients after COVID-19, there was a redistribution of alpha-rhythm power range: an increase in the ranges of alpha-1 rhythm and decrease in alpha-2 rhythm power as well as an increase in the delta and theta rhythm power range. Conclusions. 1–3 months following the acute period of COVID-19, the frequency of depression is 3 times higher in middle-aged patients with metabolic syndrome. In elderly patients with metabolic syndrome after COVID-19, anxiety is predominantly diagnosed – almost in every second. These manifestations of anxiety and depression are accompanied by disorganization of the bioelectrical brain activity.

The non-negligible association between SYNTAX score and anxiety-depressive disorders.

Anxiety-depressive disorders are more common in patients with coronary artery disease (CAD) and are strongly associated with higher morbidity and mortality rates. The Hospital Anxiety and Depression Scale (HADS) is a wellvalidated diagnostic tool for screening of anxiety-depression disorders. The SYNTAX score (SS) is the angiographic scoring system and is commonly used to evaluate the severity and complexity of CAD. The aim of this study was to evaluate the association between the HADS and SS. The HADS questionnaire was filled in by subjects before the coronary angiography procedure. Biochemical, clinical and echocardiographic parameters, and SS were evaluated in all patients. Patients were assessed using the HADS. The patients were divided into two groups according to the SS [≥ 23: high SYNTAX score group (HSSG), < 23 low]. The HADS scale was significantly higher in HSSG (24.8 ± 10.7 vs 11.3 ± 6.4 p < 0.001). There was no significant difference between the groups regarding laboratory parameters. On multivariate analysis, diabetes mellitus, hyperlipidaemia and the HADS were independent predictors of high SYNTAX score. In our study, we found that diabetes mellitus, hyperlipidaemia and the HADS were independent predictors of a higher SS.

Rehabilitation experience of a patient with severe form of COVID-19 at the pulmonological climatic resort of the Southern Coast of Crimea

Introduction. The increase in the number of patients with post-COVID syndrome determines the relevance of their rehabilitation in sanatorium and resort institutions, of both local and climate-therapeutic resorts.Aim. To identify the possibility for the rehabilitation of patients with severe forms of COVID-19 in the conditions of the climatic pulmonological resort of the South Coast of Crimea in the winter season.Materials and methods. Clinical-anamnestic, laboratory, functional and computed-tomographic results of the examination of the thorax of a patient who had a severe form of COVID-19. Rehabilitation was carried out 21 days complexly using climatotherapy, therapeutic exercise, respiratory, medication and physiotherapy. The effectiveness of treatment was assessed using a 6-minute step test, Borg scale, mMRC dyspnea scale, oxygen assessment chart, rating of health status, Hospital Anxiety and Depression Scale (HADS), Fatigue Assessment Scale (FAS), dyspnea assessment index (DDI/TDI), questionnaires of life quality EQ-5D and SF-36.Results. At the end of the rehabilitation course, general well-being improved, shortness of breath decreased, exercise tolerance increased, positive dynamics of spirographic parameters, Borg scale scores and a 6-minute step test were noted. The indicators of depression on the HADS scale normalized, positive dynamics was noted according to the SF-36 questionnaire of the psychological component of health. The severity of pain/discomfort and anxiety/depression according to the EQ-5D questionnaire decreased. The X-ray picture has improved. When determining the diffusion capacity of the lungs (DLCО), an increase of 30% from the initial value was revealed.Conclusion. Rehabilitation of a patient who had a severe form of COVID-19 with bilateral lung damage in the conditions of the climatic pulmonology resort of the South Coast of Crimea in the winter season is effective. To assess the lung function of patients who have undergone COVID-19, the most effective method can be considered the determination of lung diffusion capacity (DLCО). Spirogram indicators do not always objectively reflect the severity of the condition.

Evaluation of the effects of ethylmethylhydroxypyridine succinate on cognitive function and clinical-functional status of patients with chronic obstructive pulmonary disease and ischemic heart disease

Objective — to assess the effects of ethylmethylhydroxypyridine succinate on cognitive function and clinical and functional status of patients with chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD). Materials and methods. The study was conducted among outpatients at the clinic of the GI «L.T.Mala National Therapy Institute of NAMS of Ukraine». Examinations involved 67 patients with mean age 61.64±9.17 years. Among them, 27 were patients with COPD and IHD combination, 22 patients with isolated COPD, and 18 patients with isolated IHD. According to the study design, during telephone contact 6 months after the start of observation, all patients were administered the drug ethylmethylhydroxypyridine succinate 500 mg per day for 3 months. The evaluation of its effects on cognitive function in patients with COPD and IHD was carried at visit‑2 (after 12 months from the start of observation). All patients underwent general clinical examination, anthropometric measurements, calculation of body mass index, and spirometry before taking ethylmethylhydroxypyridine succinate (at visit‑1) and after three months of taking the drug (visit‑2). To verify the degree of dyspnea intensity, the following scales were used: five‑point scale Mediсal Research Council Dyspnea Scale in Fletcher’s modification (mMRC) and modified 10‑point Borg scale (Borg, 1982). Questionnaire САТ (COPD Assessment Test) was used to assess COPD effects on the well‑being and everyday life of the patient. Physical load tolerance was evaluated based on the 6‑minute walk test. To assess the cognitive status of patients, the Hospital Anxiety and Depression Scale scale (HADS), Generalized Anxiety Disorder test (GAD‑7), and Montreal Cognitive Assessment were used. Results. In patients with COPD, both with concomitant IHD and without it, the manifestations of shortness of breath decreased and the tolerability of physical exertion improved against the background of administration ethylmethylhydroxypyridine succinate 500 mg per day for three months. Patients with isolated IHD demonstrated improved cognitive function and reduced depressive symptoms. The anxiety decrease was observed in patients with IHD with or without concomitant COPD. Conclusions. Ethylmethylhydroxypyridine succinate can be recommended to improve cognitive function in patients with COPD and IHD.

Suicide risk in epilepsy: Clinical variables, psychiatric disorders, and social support.

To explore the relationship between suicide risk, the perception of social support and quality of life (QoL), and with the clinical variables of adult people with epilepsy (PWEs). A total of 98 consecutive PWEs cared for in the outpatient setting, with a mean age of 48.1±15.9 years, having had epilepsy for 26.4±16.4 years and 48 (48.9%) female cases participated in this study. The MINI suicide module, the Social support satisfaction scale (SSSS), the Quality of life in epilepsy inventory (QOLIE-31), and the Hospital anxiety and depression scale (HADS) were used. A logistic regression was conducted to assess the factors associated with the suicide risk. Suicide risk was present in 33 cases. Younger age, earlier age at epilepsy onset, depression and anxiety in the HADS scale, and lower MMSE, QOLIE-31, and SSSS scores were significantly associated with suicide risk in the univariate analysis. The logistic regression analysis identified that lower scores in the MMSE (OR 0.826, 95%CI 0.705-0.969), presence of anxiety (OR 0.197, CI 0.073-0.530), and a low perception regarding satisfaction with family (OR 0.953, CI 0.920-0.988) are the factors associated with the highest risk of suicide. Suicide risk and recurrence of a suicide attempt was high in the PWEs. Suicide risk was associated with clinical variables, the presence of anxiety and the perception of less social support from the family.

The psychological impact of working in an oncology center

IntroductionParamedical staffs in oncology are among the most exposed to stress factors in the workplace, predisposing them to develop certain psychiatric pathologies, in particular anxiety disorders, depressive syndromes and burnout.ObjectivesThe objective of this study was to study these psychosocial risk factors and to detect the psychological repercussions on this professional category.MethodsOur cross-sectional, mono-centric, descriptive and analytical study was conducted between November 1st and 8th, 2022 at the Salah Azaiez Institute in Tunis. The screening of anxiety and depression was performed with the Hospital Anxiety and Depression Scale (HADS), the assessment of Burnout was performed with the Maslach Burnout Inventory (MBI).ResultsFifty-four workers were included (mean age 39.72 years and sex ratio 0.22). According to the HADS scale, 68.5% had definite or doubtful anxiety symptoms, 51.8% had definite or doubtful depression symptoms. According to the Maslach scale, 59.3% had a high burnout score, 37% had a high depersonalization score and 38.9% had a low personal accomplishment score. A combination of all three was present in 7.4% of the staff. Anxiety was associated with workplace violence and lack of career prospects, depression was associated with lack of leisure activities, and burnout was associated with age, emergency management for the emotional exhaustion score, and the number of children, workload and workplace violence.ConclusionsWorking in an oncology environment seems to be associated with a number of factors that could significantly increase the risk of psychiatric pathology. Some of these factors are perfectly modifiable, which opens up prospects for targeted preventive actions.Disclosure of InterestNone Declared

Impact of Psychological Factors on Functional Performance among Patients with Chronic Obstructive Pulmonary Disease.

The role of anxiety and depression in functional performance during walking in patients with chronic obstructive pulmonary disease (COPD) is controversial. In this cross-sectional study, we aimed to assess the effects of anxiety, depression, and health-related quality of life (HRQOL) on the functional performance of this patient population. Seventy COPD patients aged 63 ± 11 years participated in the study. To measure their functional performance, the six-minute walk test (6MWT) was used. Anxiety and depression were assessed using two questionnaires: the Anxiety Inventory for Respiratory Disease (AIR) scale and the Hospital Anxiety and Depression Scale (HADS). The St. George’s Respiratory Questionnaire (SGRQ) was used to assess HRQOL. Based on their anxiety levels, the patients were divided into a no anxiety group and a high anxiety group. There were no significant differences between the two groups in terms of pulmonary function profile or smoking status. The mean AIR and HADS (depression) scores were high (12.78 ± 4.07 and 9.90 ± 3.41, respectively). More than one-third of the patients (46%) reported high anxiety levels (above the standard cutoff score of 8). The mean score of the aggregated HADS scale was significantly higher in the high anxiety group (20.87 ± 6.13) than in the no anxiety group (9.26 ± 4.72; p = 0.01). Patients with high anxiety had poorer functional performance (6MWT: 308.75 ± 120.16 m) and HRQOL (SGRQ: 56.54 ± 22.36) than patients with no anxiety (6MWT: 373.76 ± 106.56 m; SGRQ: 42.90 ± 24.76; p < 0.01). The final multivariate model explained 33% of the variance in functional performance after controlling for COPD severity (F = 8.97). The results suggest that anxiety, depression, and poor health status are significantly associated with poor functional performance. This study highlights the need to screen patients with COPD at all stages for anxiety and depression.

Effects of the Treatment of Carpal Tunnel Syndrome with Surgery and Injections on the Hospital Anxiety and Depression Scale (HADS)

Background: The prevalence of carpal tunnel syndrome (CTS) and of anxiety and depression in primary care practice are high. Different studies had shown an increased prevalence of anxiety and depression in CTS patients. Nevertheless, few papers had been published studying the anxiety and depression scales in the treatment of CTS, either with corticosteroid injections (I) or with surgical decompression (S). Objective: To assess whether clinical improvement observed after the treatment of CTS either with I or with S correlates with an improvement in the punctuations of the Hospital Anxiety and Depression scales (HADS), at 3, 6 and 12-month follow-up. Methods: Randomized and open-label clinical trial, comparing I and S. Patients with symptoms suggestive of CTS (nocturnal paraesthesias) of at least 3 months duration and neurophysiological confirmation were included. Patients with clinically apparent motor impairment were excluded. The subjective evaluation of symptoms was carried out using the visual-analogue scale of pain (VAS-p). Clinical reviews were performed 3, 6 and 12 months after treatment. Each patient completed the HADS questionnaire and a VAS-p at 0, 3, 6, and 12 months. Statistical significance was established using the Student’s t test and the Mann-Whitney U test when necessary. A linear regression analysis was used to know the effect of the treatment adjusted for the initial score of both scales. Results: 65 patients were included (30 in group I and 35 in group S). There was no statistical difference between both groups in terms of age, gender distribution, disease duration, VAS-p, neurophysiological testing severity of CTS or the 8 subscales of HADS. Both groups improved significantly in relation to the baseline VAS-p values, in the reviews at 3, 6 and 12 months, with no significant differences between I and S. At 6 months, the reduction in the anxiety scale was around 3 points for both treatments (S = 3.6 and I = 3.2), without reaching significant differences. At 12 months, it was somewhat higher for those treated with I, but always around 3 points and without significant differences. The Depression scale score was slightly reduced at 6 months, and in a similar way for both groups (I = 1 and S = 1.19; p = 0.8). After 12 months, group I doubled the previous reduction, with group S experiencing a very slight change (I = 1.96 and S = 1.03; p = 0.3). When analysing the effect of group S on group I, the result was a reduction of 0.25 points for Anxiety (p = 0.7) and of 0.02 points for Depression (p = 0.9). Conclusions: Treatment of CTS with I or S results in a similar and discrete improvement in Anxiety scores on the HADS scale at 6 and 12 months. For both types of treatment, the Depression scores barely changed at 6 months, being somewhat higher in group I after 12-month follow-up. The independent effect of the S on both scales is small and not significant.

The relationship between exam anxiety, depression, and back pain in physicians preparing for the specialty exam.

This study aims at examining the possibility of anxiety and depression in physicians preparing for the specialty exam and the back pain caused by continuous working with these depressive symptoms. The research was started by getting approval from the local Ethics Committee of Gazi Yaşargil Training and Research Hospital. Socio-demographic data form, EQ-5D general quality of life scale, Oswestry low back pain disability scale, and Hospital anxiety and depression scale (HADS) were applied to volunteers. Among the physicians participating in our study, both anxiety and depression scores from the HADS scale scores applied to the exam preparation group were statistically significantly higher than those of students who did not prepare for the exam. In our study, the highness of the scale scores in the exam preparation group was statistically high. It should not be ignored that there may be complaints of anxiety, depression, and low back pain during the preparation period for the specialty examination in physicians. During the exams' periods, psychosocial support mechanisms should be activated, and active exercise activities should be recommended. For more detailed data, large-scale participatory studies are needed.

Quality of Life and Psychological Wellbeing of Breast Cancer Survivors in the Kingdom of Saudi Arabia.

Breast cancer is the most common cancer among Saudi population. Breast cancer patients suffer from several negative consequences after treatment and these include pain, fatigue, sexual problems, appearance and body image concerns, with psychological dysfunction. This could affect the patient quality of life and psychological well-being. a multicenter cross-sectional study to assess quality of life and psychological wellbeing and their predictors for female breast cancers survivors diagnosed between 1 January 2015 and May 2017 with the assessment conducted at 12 to 36 months after initial diagnosis. Assessment was performed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Breast Module (QLQ-BR23) and the Hospital Anxiety and Depression Scale (HADS). 246 Breast cancer patients participated in the study with a mean age of 49.5±10.9. The mean global health status has a mean of 72.7±23.5. The worst domain of the functioning scales was physical functioning (mean score of 62.14±26.03, while the best scores were for social functioning of 80.06±29.18. For the symptom scales, the worst scores were reported for fatigue and pain. Results of HADS scale showed that 57% had moderate to severe depression, while 44% had moderate to severe anxiety. Only 6.8% of the participants reported receiving psychosocial support. Breast cancer survivors in the KSA have overall good quality of life scores when compared with patients from Western countries. However, their psychological wellbeing is more impaired. There is an urgent need for psychosocial support programs and psychological screening and consultation for breast cancer patients at cancer care centers in the KSA.