Intensity Of Physical Symptoms Research Articles

Stress, Floods, and other Disasters

Floods are the most frequent disasters in the world, they are full of stressors, and result in numerous victims and consequences for the physical and mental health of people.The purpose of this paper is to examine the impact of floods as a crisis event on the physical and mental health of the affected population. During the data collection, two new crises emerged. Part of the sample was affected by the COVID-19 pandemic and devastating earthquakes. Therefore, the paper additionally analyzes the effects of these events on the results.Data were collected through a field and online survey on a sample of the Croatian population living in the flood-prone area (n = 42) and a sample of the population of the nearby area that was not exposed to the floods (n = 38). The questionnaire contained questions about the socio-demographic characteristics of the participants, and measures of stress (Physical Stress Reactions and Depression, Anxiety and Stress Scale 21).The results show that residents of flooded areas showed on average more physical stress reactions (t (78) = 4.19, p <.01) and fewer psychological reactions to stress (t (78) = 5.79, p <.01) compared to residents of non-flooded areas. Participants affected by the pandemic and earthquake on average showed significantly more symptoms of psychological stress, especially depression and anxiety compared to participants unaffected by these crises (t (78) = 2.96 - 5.46, p <.01), while the difference in the intensity of physical symptoms did not appear.The obtained results are difficult to interpret due to the interference of three crisis events and factors that may have influenced the results. However, this specific and unplanned research situation leads to the conclusion that crisis events have a significant stressful impact and consequences on the physical and mental health of the affected population.

The costs of celiac disease: a contingent valuation in Switzerland

This paper proposes a first monetary measure of the private costs of celiac disease, including intangible costs (physical symptoms, logistical constraints, etc.) in Switzerland. This auto-immune disease damages the intestine when patients ingest gluten. The only treatment currently available is a gluten-free diet, which implies great nutritional constraints. To get a monetary equivalent of the costs borne by celiac patients, we used a contingent valuation. The scenario suggested to celiac patients a treatment in form of a daily pill, which would allow them to eat normally and avoid any physical pain from celiac disease. Mean Willingness To Pay (WTP) for the treatment is found to be around CHF 87 (approx. USD 87) per month. WTP is positively influenced by direct and indirect costs of the disease. Oppositely, individuals, who find the gluten-free diet healthier are willing to pay less. Finally, unlike symptoms before diagnostic, the current presence or intensity of physical symptoms are found to be insignificant. The latter result can be explained by the fact that, individuals facing stronger symptoms are more likely to adhere strictly to the GFD and hence to reduce their frequency.

The association between health-related quality of life and achievement of personalized symptom goal.

The aim of study was to explore the potential association between patient's self-reported physical symptom management goals as personalized symptom goal (PSGs) and health-related quality of life (HRQOL) in cancer patients. The secondary outcome was to investigate the relationship between number of physical symptoms not achieving the PSGs and HRQOL in cancer patients. This single-center prospective observational study comprised 140 consecutive outpatients. We evaluated the PSGs and HRQOL using the Functional Assessment of Cancer Therapy-General (FACT-G). Patients were administered a self-report questionnaire, including reports on their physical symptom intensity and PSGs using Edmonton Symptom Assessment System-revised (ESAS-r) scores. We investigated the correlation between PSGs achievement (ESAS-r score ≤ PSG score) and FACT-G total scores, and relationship between and number of physical symptoms not achieving the PSGs (ESAS-r score > PSG score) and FACT-G total scores. The patients who did not achieve PSGs of pain, tiredness, lack of appetite, and shortness of breath had a lower FACT-G total score (p < 0.05). Multivariate linear regression showed that higher number of physical symptoms not achieving the PSGs correlated with lower FACT-G scores (decreasing by 1.826 points for each such symptom, p< 0.01). Predictors of increased number of physical symptoms not achieving the PSGs were younger age and a higher symptom intensity of anxiety. PSGs achievement was associated with HRQOL in cancer patients. Additionally, the number of unachieved PSGs were independent determinant of poor HRQOL, particularly in younger cancer patients and those with higher symptom intensity of anxiety.

Perception of illness by patients treated with haemodialysis

Introduction: Perception of illness is the way in which a condition is perceived, which reflects the patient’s attitude towards illness and treatment. Aim: The aim of the research was to understand the perception of illness among patients treated with haemodialysis. The specific goal was to determine the factors affecting the perception of the illness and their interrelationships. Material and methods: The study included 98 people treated with haemodialysis as part of the international project “Health, coping, and quality of life in people with chronic kidney disease and in their families”. As research tools the following were used: the Barthel Index, Instrumental Activities of Daily Living Scale (IADL), Edmonton Symptom Assessment Scale – Revised (ESAS – R), and the Brief Illness Perception Questionnaire (Brief IPQ) Scoring Instructions. Results: The perception of illness in the study group was significantly influenced by the intensity of physical symptoms (p = 0.007), especially dyspnoea or fatigue. Whereas, the following areas of the perception of illness: Consequences, Treatment control, Timeline, Illness concern, and Comprehensibility were mainly affected by functional efficiency, age, and education level. A worse perception of illness was observed with the increase in IADL dependency, younger age, and lower education level. Conclusions: 1. Perception of illness in the study group was at a moderate level. 2. Perception of illness in the study group was most strongly influenced by the intensity of symptoms, especially dyspnoea and fatigue. 3. Functional efficiency, age, and education significantly affected the perception of illness.

Ketamine as augmentation for the treatment of major depression and suicidal risk in advanced cancer: Case report

Major depressive disorder (MDD) is common in patients diagnosed with advanced cancer (AC), with a prevalence of 16.5%. It is associated with great disability and worsened quality of life, increased number and intensity of physical symptoms, and lower survival. It is the main factor for the presence of suicidal ideation. Antidepressants show modest efficacy, and response requires several weeks. Ketamine has demonstrated a fast and robust antidepressant effect in subanesthetic doses. This effect may prove useful in patients with AC, MDD, and suicidal risk. We report a case of a patient with advanced cervical cancer who presented with uncontrollable pain, MDD, and a suicide attempt. A 39-year-old woman diagnosed with cervical cancer stage IVB presented to the Emergency Department after a suicide attempt by hanging. Upon evaluation by the palliative care psychiatrist, she reported intense pain, unresponsive to analgesics, and had a history of persistent suicidal ideation. Antidepressant treatment was started (sertraline 50mg/d) after a single dose of ketamine hydrochloride IV (0.5 mg/kg) was administered. Treatment response was measured using the Brief Edinburgh Depression Scale before and after the intervention. The depressive symptoms decreased by 17% on day 1, 39% on day 3, and 72% on day 17. This case report shows ketamine's efficacy as an augmentation agent alongside conventional antidepressant treatment in patients with AC. Moreover, it shows rapid response in suicidal ideation that has not been achieved with treatment as usual. More clinical trials are needed to support the potential benefit and safety of ketamine in patients with AC, MDD, and persisting suicidal ideation.

Symptom Prevalence in Patients with Advanced, Incurable Illness in Bangladesh.

Context:There is a significant need for palliative care for patients living in low- and middle-income countries. The presence and intensity of physical symptoms is a major factor influencing the suffering of patients at the end of life.Objectives:The primary aim of this study was to determine the prevalence and characteristics of common physical symptoms experienced by patients with advanced, incurable illness in a developing country.Method:This study used semi-structured interviews in patients with advanced cancer or HIV/AIDS in Bangladesh.Results:Pain was the most common symptom (70.6%) and was frequently reported to be severe (62.6%). Very few patients received strong opioids to treat their pain (13.7%). Other frequent symptoms included loss of appetite (23.5%) and fever (19.9%). The average number of physical symptoms reported was 3 (range: 0–23). The majority of patients rated their most recent symptom (excluding pain) as severe (64.3%), with 35.8% continuing to have severe symptom intensity despite treatment.Conclusions:This study reveals the significant burden of symptoms, and the associated suffering for patients living with incurable illness, in a developing country. Very few patients received strong opioids, despite frequently having severe pain. Frequently, the treatments that patients received did not alleviate their symptoms. Palliative care is vital for the relief of suffering for patients with advanced and incurable diseases, especially in low- and middle-income countries where access to curative treatments may be limited and patients often present to medical personnel when their illness is in an advanced stage or incurable.

Severe Menopausal Symptoms Are Widespread among Survivors of Breast Cancer Treatment Regardless of Time Since Diagnosis

The intensity and persistence of treatment-related symptoms among breast cancer survivors is incompletely understood. The objective of the study was to estimate prevalence of severe symptoms well after initial treatment for breast cancer, to test whether symptom intensity diminishes with time or varies by treatment received. This was a cross-sectional survey of female survivors of stage I-III invasive breast cancer, seen for routine follow-up a year or more after diagnosis. Data was derived from three validated questionnaires indicating physical and emotional domains. Symptoms rated in the top two levels of four- or five-item Likert scales were "severe." Associations with symptom intensity were tested using multivariate linear regression. Survey response was 68.5% (50/73). Respondents were age 55.4 (±9.1) years, median 2.2 (1.0-13.1) years since diagnosis; 64% were receiving endocrine therapy. Severe levels of hot flashes (42% of respondents), weight gain (32%), low libido (32%), and joint pain (30%) were common; (36%) of respondents rated sleep "fairly poor" or "very bad;" 30% were fatigued at least half the day. For 34%, health typically limited vigorous activities "a lot." Most (84%) respondents were experiencing at least one severe symptom. Symptom intensity did not vary with time since diagnosis. Of seven symptoms, three (hot flashes, weight gain, low libido) were more intense when systemic treatment had included endocrine therapy. Time in past month feeling down, nervous, or worn out increased with intensity of physical symptoms. Given their severity, persistence, and association with emotional burden, treatment-related symptoms among breast cancer survivors (BCS) merit greater attention toward clinical management, patient education, and longitudinal study.

Kinesitherapy alleviates fatigue in terminal hospice cancer patients—an experimental, controlled study

The study was focused on the influence of the kinesitherapy on fatigue and the quality of life in the terminal hospice cancer patients. Forty-nine patients were included into the study and divided into experimental group A (with kinesitherapy) with 30 subjects and control group B (without kinesitherapy) with 19 subjects. Patients from group A did the exercises three times a week, for 20-30 min, for the period of 3-4 weeks. The exercises were individually supervised by a physiotherapist, following a carefully worked out pattern. In both groups, the changes in the intensity of fatigue and the quality of life were observed by means of using Rotterdam symptom checklist, brief fatigue inventory, and visual analogue fatigue scale. In group A, the intensity of fatigue decreased significantly after 3 weeks of kinesitherapy. In group B, fatigue deteriorated significantly in comparison with the initial measurement. The intensity of physical symptoms in group A decreased significantly after 2 weeks of kinesitherapy, whereas in group B, increased after 2 weeks of observation. The quality of life in group A remained stable throughout the study. A tendency towards the deterioration of the quality of life with the time passing in group B was noticeable. Our analysis showed that, on average, after 3 weeks of kinesitherapy, a significant decrease of the intensity of fatigue was observed, while in the control group, it increased after 2 weeks of observation. The obtained results provide evidence that a planned set of exercises decreases cancer-related fatigue effectively.

Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting

Mood disorders are among the most distressing psychiatric conditions experienced by patients with advanced cancer; however, studies have not shown a direct association of physical symptoms with depression and anxiety. The purpose of this study is to determine the relationship between the frequency and intensity of patients' physical symptoms and their expressions of depression and anxiety. We retrospectively reviewed the records of 216 patients who had participated in three previous clinical trials conducted by our group. We assessed patients' demographic data using descriptive statistics. We analyzed physical symptom frequency and intensity using the Edmonton Symptom Assessment System (ESAS) and anxiety and depression using the respective subscales of the Hospital Anxiety and Depression Scale (HADS-A and HADS-D). Sixty-two percent were male; the median age was 59 years (range 20-91 years). Seventy nine (37%) of the patients had depressive mood (HADS-D > or = 8), and 94 (44%) had anxiety (HADS-A > or = 8). Patients with depressive mood expressed higher frequency of drowsiness (68/78, 64%; p = 0.0002), nausea (52/79, 66%; p = 0.0003), pain (74/79, 94%; p = 0.0101), dyspnea (68/79, 86%; p = 0.0196), worse appetite (72/79, 91%; p = 0.0051), and worse well-being (78/79, 99%; p = 0.0014) and expressed higher intensity of symptoms (ESAS > or = 1) [median (Q1-Q3)] including drowsiness [4 (3-7), p = 0.0174], fatigue [7 (5-8), p < 0.0001], and worse well-being [6 (5-7), p < 0.0001]. Patients with anxiety expressed higher frequency of nausea (59/94, 57%; p = 0.0006), pain (88/94, 89%; p = 0.0031), and dyspnea (84/94, 96%, p = 0.0002) and expressed a higher intensity of pain [6 (3-8), p = 0.0082], fatigue [6 (5-8), p = 0.0011], worse appetite [6 (4-8), p = 0.005], and worse well-being [5 (3-7), p = 0.0007]. Spearman's correlation showed a significant association between HADS-A and HADS-D and other symptoms in the ESAS. Spearman's correlations of HADS with ESAS-Anxiety and ESAS-Depression were 0.56 and 0.39, respectively (p < 0.001). Expression of physical symptoms may vary in frequency and intensity among advanced cancer patients with anxiety and depression. Patients expressing high frequency and intensity of physical symptoms should be screened for mood disorders in order to provide treatment for these conditions. More research is needed.

Does personality moderate the relationship between stress and health behavior? Expanding the nomological network of the five-factor model

The present study tested the hypothesis that personality would moderate the stress to health behavior relationship. Using a community sample, 706 adults (Mean age = 37 years) were administered a set of five-factor model adjective rating scales, measures of stress and distress (i.e., negative life stress, physical symptom intensity, negative mood), health behaviors, as well as a demographic questionnaire. Using hierarchical multiple regression, Openness to Experience, Extraversion, and Neuroticism were found to moderate the stress to health behavior relationship. Supplementary analyses were conducted to determine if the five-factors would also moderate a life event to distress relationship. While several main effects were found, Conscientiousness was found to buffer the stress to distress connection. The factors that may influence both moderator models, suggestions for integration, and future research are discussed.

Are anxiety and depressed mood related to physical symptom burden? A study in hospitalized advanced cancer patients

Background : Anxiety and depressed mood are common symptoms in hospitalized advanced cancer patients. It is often presumed that anxiety and depression affect the occurrence and experience of physical symptoms. Purpose : To analyse the relation between anxiety, depressed mood and the presence and intensity of physical symptoms. Patients and methods : Anxiety and depressed mood were assessed in a hospitalized advanced cancer population (n = 79) primarily by the Hospital Anxiety and Depression Scale (HADS), and also by a single-item question `Are you anxious and/or depressed?' and by the Edmonton Symptom Assessment System (ESAS). Physical symptoms were assessed by a semi-structured interview and by the ESAS. Results : Thirty-four percent of the patients reported anxiety, 56% depressed mood and 29% both, as assessed by the HADS. The correlations between HADS, the single-item question and the ESAS were low. No association was found between anxiety or depressed mood and the presence of physical symptoms. Patients who were anxious or depressed had higher ESAS scores for insomnia and drowsiness; scores for pain, anorexia, asthenia, nausea and dyspnea were independent of anxiety and/or depressed mood. Conclusion : The relationship between anxiety, depressed mood and the presence and intensity of physical symptoms in hospitalized advanced cancer patients is very limited. Palliative Medicine 2007; 21: 341—346

Differentiation of Somatizing Patients in Primary Care

The heterogeneity of somatizing patients influences outcomes, especially in unselected samples in primary care. A cluster analysis was performed as secondary analysis on an existing data set of 127 somatizing patients included in a randomized controlled clinical trial. Anxiety and depression (HADS), number and intensity of physical symptoms (SOMS), physical and emotional functioning (short form of the SF-36 Health Survey), health beliefs (KKU-G), and psychological distress (General Health Questionnaire) were used for clustering. Outcome, treatment satisfaction, and diagnosis were calculated and compared for the clusters. We differentiated three groups from this analysis: one with elevated emotional and physical stress, one in which emotional stress dominated, and one with low emotional and physical stress. The three groups did not differ in diagnoses of somatoform disorders. The high-stress groups improved over time, whereas the depression and emotional-functioning scores in the low-stress group deteriorated. All patients were satisfied with the treatment provided. Deterioration in the scores of the low-stress group may be a result of a clinically valuable change process, in that patients who were initially in denial were able to open up and admit their problems. The increased satisfaction with treatment supports this interpretation. This so-called response shift must be taken into account in the planning of studies.

Psychiatric disorders in adolescents in primary care.

Little is known about psychiatric disorders in adolescents who attend primary care. Prospective study of 13- to 16-year-olds consecutively attending general practice. Information was obtained from adolescents, parents and general practitioners, using questionnaires and research interviews. 136/200 (68%) of adolescent attenders took part. Two per cent presented with psychiatric complaints. From research interviews with adolescents, psychiatric disorder in the previous year was found in 38%, with moderate impairment of functioning in over half (according to Children's Global Assessment Scale scores). Most disorders (42/50, 84%) were emotional ('internalising') disorders. Psychiatric disorders were significantly associated with high levels and intensity of physical symptoms and with increased health risks. General practitioner assessment of psychiatric disorders was low on sensitivity (20.8%) but high on specificity (90.7%). Doctors identified most severely affected adolescents. Depressive and anxiety disorders are common among adolescent general practice attenders and linked to increased physical symptoms; general practitioner recognition is limited.

Romance and Help-Seeking Among College Women: "It Hurts So Much to Care"

Although previous research shows that adult women in intimate relations tend to enjoy better health than women without partners, this study finds the opposite tends to be true for late adolescent women. We followed a college entering class prospectively for 4 years and measured romantic involvement and various aspects of health and illness behavior in a questionnaire. Health service use was determined from the medical record, and disaggregated into distress and health maintenance visits, as well as visits expressly for psychological counseling. First year students who were romantically involved had more physical symptoms, more medical visits, but not more counseling visits, than non-involved women. At senior year, they continued to have more health maintenance, more counseling, but not more distress visits, and they tended to experience greater interference in social role performance due to illness when compared to non-involved women. When several mediators of the relationship between romantic involvement and health service use were controlled-number and intensity of physical symptoms, sexual activity, stress in the relationship, and social network characteristics--the differences persisted. Romance appears to motivate help-seeking among late adolescent women for reasons that are not easily explained empirically. Recent work on adolescent women's development offers theoretical leads that can guide future investigations.

Body-Image Correlates of Anxiety in a Sample of Male Alcoholics

Body-image testing of 10 male alcoholics with and 7 without anxiety disorders showed those with panic disorder had low barrier scores. Those with phobias emphasized their hearts and those with Posttraumatic Stress Disorder emphasized their backs. The barrier score correlated positively with both intensity of physical symptoms and with sense of blocked body openings.