Presence Of Emotional Distress Research Articles

Prognostic factors of trochanteric bursitis in surgical-staged patients: a prospective study.

Trochanteric bursitis or greater trochanteric pain syndrome is a common disorder and frequent cause of lateral hip pain. It can lead to severe functional impairment with increase morbidity and poor quality of life.The purpose of the current study was to identify and evaluate relationship between health-related factors, as prognostic indicators, and clinical outcomes. A single-centre, prospective study was conducted and 60 patients (62 hips) were included with a minimum 12 months of follow-up. Clinical outcomes were evaluated using Hip Outcome Scale, Single Assessment Numeric Evaluation and Visual Analogue Scale. Radiological assessments and health-related factors were documented in an attempt to understand their validity as predictors of clinical outcomes. Complications and recurrence rates were also analyzed. Univariate model revealed that an increased BMI (p = 0.001; OR = 1.05; 95% CI, 1.02-1.07); number of previous corticosteroid infiltrations (p = 0.001; OR = 1.28, 95% CI, 1.11-1.48); longer time from symptom onset to surgery (p = 0.001; OR = 1.19; 95% CI, 1.12-1.28); smoker status (p = 0.001; OR 11.2; 95% CI, 3.30-44.2); and the presence of prior lumbosacral fusion (LSF) (p = 0.001; OR 13.8; 95% CI, 2.96-101); were prognostic factors predisposing for poor clinical outcomes.Among prognostic health-related factors were medical comorbidities such as emotional distress (p < 0.001; OR 26.1; 95% CI, 5.71-192); fibromyalgia (p = 0.026; OR 3.56; 95% CI, 1.16-11.7); and hyporthyroidism (p = 0.005, OR = 6.55, 95% CI, 1.73-28.7). Better overall physical function was predicted by lower number of corticosteroid infiltrations, shorter time span from symptom onset to surgery, non-smoker status and the absence of prior lumbosacral fusion. Obesity, smoking, the presence of emotional distress, fibromyalgia and hypothyroidism seem to increase the risk of poor clinical outcomes. A proper selection and/or correction of modifiable prognostic factors could reduce the incidence of endoscopic treatment failure and, as a consequence, improve patient outcomes and quality of life. However, future efforts should focus on experimental and randomised studies to fully determine these associations.

COMPASSIONATE EXTUBATION IN ADULT ICUS: A QUALITY IMPROVEMENT PROJECT

SESSION TITLE: Advances in Patient-Centered and Compassionate Care SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Compassionate extubation is an interdisciplinary process that involves the withdrawal of mechanical ventilation, leading to the end of life. Around 40-50% of patients who are compassionately extubated may experience discomfort. Appropriate practices can alleviate the suffering of patients and families during the end of life. Studies have shown that clinicians who spend a longer time caring for their patients establish an emotional bond with them and are more vulnerable to feelings of loss when these patients die. The purpose of this study was to assess the practices, outcomes, and clinicians’ emotions surrounding compassionate extubation in our institution. METHODS: We conducted a quality improvement project to collect information related to compassionate extubation in all adult intensive care units (ICUs) at an academic hospital between September 2019 and December 2019. Demographic data, ventilator settings, symptoms present, and symptom management were collected via chart review. A survey was designed to collect details about the compassionate extubation and was completed by the respiratory therapist who performed the extubation. Results were analyzed using descriptive and Chi-square statistics. RESULTS: During the study period, 65 adult patients underwent compassionate extubation. Data was collected on 62 of those patients. The mean age was 63.35 ±16.75 years and 54.8% were males. Twenty four (38.7%) compassionate extubations occurred in the neuroscience ICU, followed by 22 (32.3%) in medical ICU, 8 (12.9%) in surgical ICU, 7 (11.3%) in cardiac ICU, and 3 (4.8%) in inpatient hospice. Overall, nurse and respiratory therapists were present in all the extubations. A physician was present in 19.4% of cases, and a chaplain was present in 19.4% of cases. Ventilator weaning was performed in 11.3% patients. Twenty (32.2%) patients had signs of agonal breathing and 6 (9.7%) presented with excessive secretions after extubation. Opioids were used in 83.9% patients before extubation. Most (64.5%) respiratory therapists reported no emotional distress and 35.5% reported some level of emotional discomfort during compassionate extubation. Presence of agonal breathing after compassionate extubation was significantly associated with presence of emotional distress among respiratory therapists (p=0.001). CONCLUSIONS: There is significant practice variability in patient care during compassionate extubation. Based on this data, interdisciplinary protocols should be developed to standardize practices surrounding compassionate extubation, to improve symptom control and reduce the presence of agonal breathing. Additionally, measures should be established to support clinicians that are involved in patients care during compassionate extubation. CLINICAL IMPLICATIONS: Using standardized compassionate extubation process could alleviate patient suffering at the end of life and cause less emotional discomfort to the clinicians. DISCLOSURES: No relevant relationships by Elaine Chen, source=Web Response No relevant relationships by Ihuoma Erondu, source=Web Response No relevant relationships by Ramandeep Kaur, source=Web Response No relevant relationships by Blaine Stringer, source=Web Response No relevant relationships by Maliha Syed, source=Web Response

Episodes of violence suffered by migrants transiting through Libya: a cross-sectional study in \u201cM\xe9decins du Monde\u2019s\u201d reception and healthcare centre in Seine-Saint-Denis, France

IntroductionThe Central Mediterranean Route, passing through Libya, is one of the most dangerous for migrants. Episodes of violence have been documented but have not been accurately quantified. The objective of the study was to estimate the prevalence of episodes of violence suffered in Libya by migrants consulting the Médecins du Monde reception and healthcare centre in Seine-Saint-Denis (Ile-de-France).MethodologyA monocentric cross-sectional study was conducted from February to May 2019 including migrants over the age of 18 years who had passed through Libya and arrived in Europe from 2017. The presence of emotional distress was considered as exclusion criterion. The proportion, frequency and factors associated to physical, deprivation and sexual violence in Libya were estimated through a bespoke questionnaire, as well as healthcare access in Libya and psychosocial support needs.ResultsNinety eight people were recruited and 72 were interviewed (17 refused to participate and 9 were excluded). 76.4% were men, with a mean age of 31.9 years, 76.4% had low educational level, 66.7% came from Ivory Coast and 59.7% had left their country for security reasons. The median length of stay in Libya was 180 days. The overall proportion of participants having suffered from violence was 96.4% among men and 88.2% among women. The prevalence of physical, deprivation and sexual violence for men and women were 94.2, 81.7 and 18% and 80.0, 86.7 and 53.3%, respectively. Access to healthcare in Libya was 2.8 and 63.9% of participants were oriented to psychosocial support after the interview.ConclusionsThe vast majority of migrants reported having been victims of violence during their transit through Libya. Women were at particular risk of sexual violence. Access to health care in Libya was almost non-existent. Psychosocial support for this population is urgent.

Assessment of the needs for palliative care in advanced chronic patients on discharge

ObjectivesTo describe the advanced chronic patients admitted to an internal medicine department and to identify whether they meet the criteria for the need for palliative care at the time of hospital discharge according to the NECPAL-CCOMS.ICO® instrument. Material and methodsObservational, descriptive and cross-sectional study performed on patients admitted to the internal medicine department of the Hospital Clínico Universitario Lozano Blesa (Saragossa), with a diagnosis of advanced progressive chronic diseases, from May 1, 2017 to September 1, 2017 Variables: sex, age, advanced chronic disease, reason for admission, primary caregiver, origin (residence, address, etc.), number of readmissions in the previous year, existence of advance directives, disability of the patient, existence of order not to resuscitate, Charlson Index and all the variables contained in the NECPAL Instrument CCOMS-ICO® VERSION 3.0 2016. The data collection was done when the patient was scheduled to be discharged, having resolved the acute circumstance that led to the admission. Resultsthe sample size was 142 patients who met the inclusion criteria: diagnosis of disease advanced evolutionary chronic ages, Charlson Index ≥3 at the time the patient was scheduled to be discharged and signed their informed consent. The average age was 85.80 years and 50.7% were men. The average age of the women was higher than that of the men. The most prevalent advanced chronic disease was chronic heart disease. None of the patients had advance care directives in place. Nutritional, functional, cognitive and severe dependence was determined in more than 50%. In more than 90% there was the presence of geriatric syndromes and persistent symptoms. The presence of emotional distress was also evident, as was the use of resources. ConclusionsA palliative approach in the care of chronicity would have a very positive impact on the quality of life of the patient and family, would positively influence health systems and would result in cost savings.Implementing the NECPAL CCOMS-ICO® instrument in the health services that serve high proportions of chronically ill patients, accompanied by training measures for health personnel and adaptation of resources, can introduce a qualitative and quantitative change that is very relevant in our the health system.

Letters to Lord Ganesha

Letters to Lord Ganesha

Neuropathy and presence of emotional distress and depression in longstanding diabetes: Results from the Canadian study of longevity in type 1 diabetes

AimTo determine the association of neuropathy and other complications with emotional distress and depression among patients with longstanding type 1 diabetes (T1DM). MethodsCanadians with ≥50years of T1DM completed a questionnaire including assessment of distress and depression by the Problem Areas in Diabetes Scale (PAID) and Geriatric Depression Scale (GDS), respectively. Complications were determined using the Michigan Neuropathy Screening Instrument (Questionnaire Component), fundoscopy reports, renal function tests, and self-reported peripheral-(PVD) and cardiovascular (CVD) disease. Associations were analyzed by Poisson regression. ResultsAmong 323 participants, 137 (42.4%) had neuropathy, 113 (36.5%) nephropathy, 207 (69.5%) retinopathy, 95 (29.4%) CVD, and 31 (9.8%) PVD. The neuropathy subgroup had higher prevalence of distress (13 (9.5%) vs. 6 (3.3%), p=0.029) and depression (34 (24.9%) vs. 12 (6.5%), p<0.001). Adjusting for diabetes complications, neuropathy was associated with higher PAID (adjusted RR 1.44 (95% CI 1.14–1.82), p=0.003) and GDS scores (adjusted RR1.57 (1.18–2.11), p=0.002). Independent of potential confounders, neuropathy remained associated with higher PAID (adjusted RR 1.39 (1.10–1.76), p=0.006) and GDS scores (adjusted RR 1.37 (1.03–1.83), p=0.032). Associations with neuropathy were not fully explained by neuropathic pain. ConclusionCompared to other complications, neuropathy had the greatest association with distress and depression in longstanding T1DM, independent of pain. Strategies beyond pain management are needed to improve quality of life in diabetic neuropathy.

Prevalence and correlates of perceived stress in young medical undergraduates

IntroductionEmotional distress–specifically symptoms of anxiety and/or depression–in undergraduate medical student represent a major health issue for university life and for the entire society, as the onset of negative affectivity in young age is lowering quality of life of the affected individual and implicitly, the professional evolution.ObjectiveThe purpose of this study is to investigate the prevalence of perceived stress in medical undergraduates and relationship between perceived stress and emotional distress.MethodsThe study comprised a randomised population of 356 students from 1st and 2nd year in Faculty of Medicine who signed the informed consent for the research. Mean age in the group was 20.04 ± 0.9 years old. Instruments used in the study were self-rated Zung Anxiety Scale and Zung Depression Scale and Perceived Stress Scale. Data were analysed with SPSS 16. Statistical significance was at P &lt; 0.05.ResultsPerceived stress of medium and high intensity was found in 62.5% of the students in the study. There is a significant effect of perceived stress on presence of emotional distress (F(3,352) = 36,431, P &lt; 0.001). In the emotional distressed group, perceived stress in the period before the exams session is predicting emotional distress in the period of exams (academic stress) with OR = 1.145, P = 0.04, IC 95% = 1.006–1.303.ConclusionsThere is a high prevalence of perceived stress and perceived stress in the period before session of exams is a predictive factor for having emotional distress in session of exams. Therefore, we are signaling the necessity of implementation of stress management programs in medical undergraduates from the pre-clinical years.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Abstract P4-19-05: Efficacy of screening and treatment of breast cancer patients reporting high level of distress

Abstract Background: Cancer patients (pts) are burdened by symptoms related to the disease itself or to the toxicities of treatment. A recent meta-analysis has shown that anxiety is the most common mental health issue among cancer survivors [Mitchell AJ, 2013]. The ASCO clinical oncology guideline adaptation recommends all health care providers routinely screen for the presence of emotional distress and symptoms of anxiety from the point of diagnosis onward [Andersen BL, 2014]. Consensus-based recommendations have been published to help cancer centers meet the American College of Surgeons Commission on Cancer's accreditation requirement to screen for distress [Pirl, 2014] At our comprehensive community cancer center we perform distress screening using the M.D. Anderson Symptom Inventory (MDASI), composed of 27 questions. Pts who report moderate and severe levels of distress (≥5) on the MDASI are identified and referred for therapeutic interventions offered by the facility's integrative oncology services. Materials and Methods: The MDASI is an assessment tool that captures pts' perceived symptom burden for real-time clinical intervention, taken at the point of no intervention (baseline) and every 21 days or greater. The 27-question MDASI is comprised of the M.D. Anderson Symptom Inventory (MDASI), a validated 19-item assessment instrument, with a Symptom Inventory Tool (SIT) added by our center of 8 questions and a free-text box. Symptoms are rated “at the worst” on an 11-point numeric scale ranging from 0 (“none present”) to 10 (“as bad as you can imagine”), as experienced by the patient in the past 24 hours. Results: Over a ten-month period (9/1/2014 to 6/30/2015), 247 breast cancer (BC) pts completed the MDASI at intake and again ≥ 21 days after. Analysis of their initial surveys identified 69 pts (27.9%) who rated their distress as ≥ 5 (1st MDASI mean = 6.83), scores which would have initiated a support system response with referrals to integrative medicine services for intervention. Second MDASI results from these 69 BC pts revealed an average 2.29 distress score reduction (2nd MDASI mean = 4.48), with 51 pts (73.9%) reporting a decrease in distress, 7 pts (10.1%) having no change, and 11 pts (15.9%) reporting increased distress. More specifically, the group with decreased distress levels documented a mean distress score of 3 on their 2nd MDASI, averaging a significant 4-point diminution of distress for three-fourths of the BC pts heavily burdened by this symptom. The integrative services most utilized by these pts were Nutrition Therapy (100%), Spiritual Care (96.1%), Mind-Body Counseling (82.4%), Rehabilitation Therapy (41.2%), Acupuncture (35.3%), and Massage Therapy (35.3%). Conclusions: Distress is a relevant symptom reported by cancer pts. This study demonstrates that early intervention in BC pts using integrative oncology approaches reduced distress in 74% of cases. Citation Format: Daneker SR, Bendinger GM, Thomas JW, Smith E, Kendrick D, Hartman S, Gordon C, Barber K, Langlois C, Pabbathi H, McKnight JE, Johnson AT, Lammersfeld C, Denny D, Markman M, Alvarez RH. Efficacy of screening and treatment of breast cancer patients reporting high level of distress [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-19-05.

Efficacy of screening and treatment of breast cancer patients reporting high level of distress.

101 Background: Cancer patients (pts) are burdened by symptoms related to the disease itself or to the toxicities of treatment. The ASCO clinical oncology guideline adaptation recommends all health care providers routinely screen for the presence of emotional distress and specifically symptoms of anxiety from the point of diagnosis onward [Andersen BL, 2014].At Cancer Treatment Centers of America (CTCA) we perform screening assessments using a Symptom Inventory Tool (SIT) composed of 27 questions. Pts with moderate and severe levels of anxiety are evaluated by the Integrative Resource Assessment Program (IRAP) and subsequently referred to integrative oncology consultation. Methods: The SIT is an assessment tool that captures pts’ perceived symptom burden for real-time clinical intervention, taken at the point of no intervention (baseline) and every 21 days or greater. The SIT is comprised of 27 questions utilizing the M.D. Anderson Symptom Inventory tool (MDASI) and validated assessment instrument with 8 questions and a free text box added by CTCA. Symptoms were rated “at the worst” on an 11-point numeric scale ranging from 0 (“no present”) to 10 (“as bad as you can imagine”) in the previous 24 hours. Results: Between 9/1/2014 and 2/27/2015, 842 pts with multiple types of cancer were screened for distress and 435 (51.6%) scored 5 or greater, of which 212 completed a second screening assessment.58 breast cancer pts provided SIT distress scores at baseline and then again at least 23 days after the initial assessment. The average reduction in the distress scores for breast cancer patients was 2 (1st SIT mean = 6.2, 2ndSIT mean = 4.2) with 40 pts (69%) reporting a decrease, 7 pts (12%) having no change, and 11 pts (19%) reporting an increase in distress. The 4 interventions most frequently referred and completed by the pts were mind body therapy (100%), rehabilitation (66%), acupuncture (50%), and massage therapy (45%). Conclusions: Distress is a relevant symptom reported by cancer pts. This study demonstrates that early intervention in breast cancer pts using integrative oncology approaches will reduce the distress in 69% of cases.

Breast cancer screening in women with mental illness: comparative meta-analysis of mammography uptake.

There is a higher mortality rate due to cancer in people with mental illness and previous work suggests suboptimal medical care in this population. It remains unclear if this extends to breast cancer population screening. To conduct a systematic review and meta-analysis to establish if women with a mental health condition are less likely to receive mammography screening compared with those without mental ill health. Major electronic databases were searched from inception until February 2014. We calculated odds ratios (OR) with a random effects meta-analysis comparing mammography screening rates among women with and without a mental illness. Results were stratified according to primary diagnosis including any mental illness, mood disorders, depression, severe mental illness (SMI), distress and anxiety. We identified 24 publications reporting breast cancer screening practices in women with mental illness (n = 715,705). An additional 5 studies investigating screening for those with distress (n = 21,491) but no diagnosis of mental disorder were identified. The pooled meta-analysis showed significantly reduced rates of mammography screening in women with mental illness (OR = 0.71, 95% CI 0.66-0.77), mood disorders (OR = 0.83, 95% CI 0.76-0.90) and particularly SMI (OR = 0.54, 95% CI 0.45-0.65). No disparity was evident among women with distress alone. Rates of mammography screening are lower in women with mental illness, particularly women with SMI, and this is not explained by the presence of emotional distress. Disparities in medical care due to mental illness clearly extend into preventive population screening.

Burnout among doctors in residency training in a tertiary hospital

The mental health of doctors is an issue of growing concern all over the world as it frequently interplays with their professional trainings and responsibilities. This study was done to determine the pattern and correlates of burnout among 204 doctors undergoing residency training. Eligible participants were interviewed using designed questionnaire, General Health Questionnaire (GHQ-12) and Maslach Burnout Inventory (MBI). The mean age of participants was 33.44±4.50. Ninety-three (45.6%) respondents reported burnout in the dimension of emotional exhaustion (EE), 118 (57.8%) in the dimension of depersonalization (D), and 126 (61.8%) in the dimension of reduced personal accomplishment (RPA). Factors that were significantly associated with all the dimensions of burnout were perceived heavy workload and presence of emotional distress (based on GHQ score of ≥3). The perception of call duty as being not stressful was negatively predictive of burnout in the emotional exhaustion subscale (odds ratio [OR]=0.52; 95%confidence interval [CI]=0.29–0.97; p=0.03), while emotional distress was a positive predictor (OR=6.97; 95%CI=3.28–14.81; p<0.001]. Absence of doctor-to-doctor conflict negatively predicted burnout in the depersonalization subscale (OR=0.36; 95%CI=0.17–0.76); p<0.01), while older age (OR=0.66; 95%CI=0.47–0.95; p=0.03) and adequate support from the management (OR=0.45; 95%CI=0.22–0.90; p=0.02) constituted negative predictors of burnout in the reduced personal accomplishment subscale. Burnout is highly prevalent among resident doctors. Evolvement of comprehensive mental health services, training supports, conflict de-escalation/resolution mechanisms, and periodic assessment are indicated to mitigate work related distress with burn out among resident doctors, while improving their productivity.

The effect of emotional distress on persistent pelvic girdle pain after delivery: a longitudinal population study

To study the prognosis for pelvic girdle pain, and to explore the association between presence of emotional distress during pregnancy and pelvic girdle syndrome 6 months after delivery. Longitudinal population study. Norway, for the period 1999-2008. A follow-up of 41 421 women in the Norwegian Mother and Child Cohort who reported pelvic girdle pain at 30 weeks of gestation. Data were obtained by self-administered questionnaires in weeks 17 and 30 of gestation, and 6 months after delivery. Pelvic girdle syndrome 6 months after delivery, defined as pain in the anterior pelvis and on both sides in the posterior pelvis. Six months after delivery, 78.0% of the women had recovered, 18.5% reported persistent pain in one or two pelvic locations, 3.0% reported pelvic girdle syndrome and 0.5% reported severe pelvic girdle syndrome. The recovery rates decreased with increasing levels of pain severity in pregnancy. Being emotionally distressed at two time points during pregnancy was associated with the presence of pelvic girdle syndrome (adjusted OR 1.5, 95% CI 1.2-1.9) and severe pelvic girdle syndrome (adjusted OR 1.9, 95% CI 1.1-3.1), after adjustment for pain severity in pregnancy, other medical conditions, body mass index, age at menarche, previous low back pain, and smoking during pregnancy. In this follow-up of women with pelvic girdle pain in pregnancy, the recovery rates after delivery were high. Our findings suggest that the presence of emotional distress during pregnancy is independently associated with the persistence of pelvic girdle pain after delivery.

Mode of delivery and postpartum emotional distress: a cohort study of 55 814 women

To assess the association between mode of delivery and maternal postpartum emotional distress. A prospective study of women from 30 weeks of gestation to 6 months postpartum. Pregnant women in Norway during the period 1998-2008. A total of 55,814 women from the Norwegian Mother and Child Cohort Study. Emotional distress was reported in a short form of the Hopkins Symptom Checklist-25 (SCL-8) at 30 weeks of gestation and at 6 months postpartum. Information on mode of delivery was obtained from the Medical Birth Registry of Norway. Changes in SCL-8 score from 30 weeks of gestation to 6 months postpartum and presence of emotional distress at 6 months postpartum. Women with instrumental vaginal, emergency caesarean or elective caesarean deliveries had similar changes in SCL-8 score between 30 weeks of gestation and 6 months postpartum, as compared with women with unassisted vaginal delivery (adjusted regression coefficient, 0.00, 95% CI -0.01 to 0.01; 0.01, 95% CI 0.00-0.02; and -0.01, 95% CI -0.02 to 0.00, respectively). The corresponding odds ratios (ORs) associated with the presence of emotional distress at 6 months postpartum (SCL-8 ≥ 2.0) were: OR 1.01, 95% CI 0.86-1.18; OR 1.13, 95% CI 0.97-1.32; and OR 0.96, 95% CI 0.79-1.16, respectively. These estimates were adjusted for emotional distress during pregnancy and other potential confounding factors. Emotional distress during pregnancy showed the strongest association with the presence of emotional distress at 6 months postpartum (adjusted OR 14.09, 95% CI 12.77-15.55). Mode of delivery was not associated with a change in SCL-8 score from 30 weeks of gestation to 6 months postpartum or with the presence of emotional distress postpartum.

Maternal emotional distress in pregnancy and delivery of a small-for-gestational age infant

To assess the association between maternal emotional distress in pregnancy and delivery of a small-for-gestational age offspring. A cohort study in pregnancy. Fifty hospitals with a maternity ward in Norway during 1998-2008. Seventy-one thousand eight hundred and ninety-eight women with a singleton pregnancy in the Norwegian Mother and Child Cohort Study were followed from early pregnancy to delivery. Information on presence of emotional distress was obtained through self-administered questionnaires in pregnancy weeks 17 and 30 and on birthweight, gestational length at delivery and sex by linkage to the Medical Birth Registry of Norway. Emotional distress was measured by short forms of the Hopkins Symptom Checklist-25. Small-for-gestational age offspring (birthweight <2.5th percentile). Being emotionally distressed at gestational weeks 17 and 30 was not significantly associated with subsequent delivery of a small-for-gestational age infant (adjusted odds ratio 1.16; 95% confidence interval 0.87-1.54). This estimate was adjusted for smoking in pregnancy, parity, diabetes, pre-eclampsia, body mass index, education and maternal age. Emotional distress during pregnancy was not associated with subsequent delivery of a small-for-gestational age infant.

Emotional status, cognitive performance and quality of life in HIV-infected patients. Results of an exploratory study

ZusammenfassungHintergrundBedingt durch den Wandel der HIV-Infektion von einer akut lebensbedrohlichen Erkrankung hin zu einer chronischen Infektion treten neben kausaltherapeutischen Bestrebungen immer häufiger psychosoziale Aspekte in den Fokus wissenschaftlicher Forschung. Ziel der vorliegenden Studie war es, emotionale Befindlichkeitsstörungen, gesundheitsbezogene Lebensqualität und kognitive Leistungsfähigkeit bei HIV-Patienten zu erfassen und die HIV-Diagnosestellung als „life event“ mit besonderen Eigenschaften und Auswirkungen auf mögliche posttraumatische Belastungssyndrome zu berücksichtigen.MethodeIn unserer explorativen Studie konnten wir insgesamt 37 HIV-infizierte ambulante Patienten einschließen und hinsichtlich depressiver (BDI) sowie posttraumatischer Belastungssymptome in Folge der HIV-Diagnosestellung (IES), der gesundheitsbezogenen Lebensqualität (SF-36) und der kognitiven Leistungsfähigkeit (SKT) untersuchen. Weiters wurde das neue diagnostische Konzept der Anpassungsstörungen als Stressreaktionssyndrome nach Maercker berücksichtigt.ErgebnisseVon 37 Patienten wiesen 67,6% (n=25) ein posttraumatisches Belastungssyndrom (HIV-PTSS) nach IES auf, das eine Anpassungsstörung nach Maercker darstellte. 14 Patienten (37,8%) litten an depressiven Syndromen. 27% (n=10) zeigten kognitive Beeinträchtigungen (minimale: n=8; leichte: n=1; mäßige: n=1). Im Vergleich zu HIV-Patienten ohne PTSS hatten HIV-Patienten mit PTSS signifikant ungünstigere Werte in den SF-36-Domänen allgemeine Gesundheit (p=0,003), Vitalität (p=0,007), soziale Funktionsfähigkeit (p=0,000), emotionale Rollenfunktion (p=0,016) und psychische Gesundheit (p=0,000).SchlussfolgerungHIV-infizierte Patienten zeigen möglicherweise ein erhöhtes Risiko für PTBS im Sinne von Anpassungsstörungen nach Maercker, depressive Syndrome und kognitive Beeinträchtigungen. Das Vorhandensein emotionaler Befindlichkeitsstörungen ist bei ihnen mit Einbußen in der Lebensqualität assoziiert. Folglich raten wir zu einer frühzeitigen und umfänglichen biopsychosozialen Diagnostik und Therapie von HIV-Patienten.

Der Zusammenhang zwischen emotionalen Befindlichkeitsstörungen, kognitiver Leistungsfähigkeit und gesundheitsbezogener Lebensqualität bei mit dem Hepatitis-C-Virus infizierten Patienten vor einer antiviralen Therapie

Recent epidemiologic studies suggest that more than 175 million individuals are infected with hepatitis C virus (HCV) worldwide. In the past few years, outcome studies in chronic HCV patients are no longer focusing solely on traditional end points such as mortality rates but on psychosocial well-being such as health-related quality of life (HRQoL), emotional states, and neuropsychological functioning. The purpose of our exploratory study was to assess cross sectionally the frequency of depression, posttraumatic stress symptoms, cognitive deficits, and impairments in HRQoL in chronic HCV patients prior to antiviral treatment, and to investigate how cognitive impairments and emotional distress were related to quality of life. We recruited 34 chronic HCV patients who had presented for initial assessment of the need for antiviral therapy. Psychometric observer-rating and self-rating scales were administered to evaluate posttraumatic stress symptoms (PTSS-10), depressive symptoms (BDI), HRQoL (SF-36 Health Status Questionnaire), and cognitive functioning (SKT). 32.4 % (n = 11) of the sample suffered from clinical depression, and 8.8 % (n = 3) had a posttraumatic stress syndrome. 8.8 % (n = 3) of the sample showed cognitive impairments. Significant impairments in HRQoL were found in the health-related domains vitality, role-emotional, and role-physical. The severity of emotional distress as measured on the BDI and PTSS-10 was associated with decrements in HRQoL. However, lower cognitive function scores on the SKT were not associated with lower HRQoL SF-36 values. Chronic HCV patients seem to face a major risk of depression, posttraumatic stress symptoms, and cognitive dysfunction, and the presence of emotional distress is associated with impairments in quality of life. We therefore underscore the need for early and comprehensive bio-psycho-social diagnosis and therapy of chronic HCV patients in order to treat emotional distress and enhance patients; quality of life at an early stage before initiating antiviral therapy, as well as to expand the pool of patients eligible to receive antiviral therapy.

Decisional strategies for the attribution of emotional distress in primary care.

In primary care the General Health Questionnaire (GHQ) is used to provide an independent assessment of probable caseness of psychological disorder against which to test the ability of the general practitioner (GP) to recognize patients with current emotional problems. The aim of the present study was to identify those clinical and psychosocial data on patients that increase the likelihood of GPs' attribution of emotional distress (GP model) and those that predict patients' emotional distress as defined by the GHQ-12 (GHQ model). The associations were explored using a classification tree technique (CHAID) and compared using bivariate logistic regression. Six GPs and 444 primary care patients took part. The accuracy indices of the hierarchical GP and GHQ models were 72% and 69% respectively. The availability of information on patients' psychopharmacological and psychiatric/psychological treatment in the last year was the most important predictor of attribution. Occupational, financial and housing problems and life events of loss were the most important predictors of the GHQ-12 case definition. The overall accuracy of the bivariate model was 73%. Compared with the GHQ-12, GPs gave significantly more importance to psychiatric treatment, psychopharmacological drug use and chronic illness. The findings suggest that to improve the detection of current emotional distress in primary care patients GPs should pay foremost and systematic attention to social problems and recent life events of loss. These problems are important clues for the possible presence of emotional distress, whereas critical patient data, in particular psychiatric history and psychopharmacological treatment, increase the probability of attribution errors.

Intensive rehabilitation of emotionally distressed patients after coronary by-pass grafting.

To evaluate whether the status of emotionally distressed post coronary by-pass surgery patients can be improved by a comprehensive, in-patient rehabilitation programme. Cross-sectional. Rehabilitation hospital. One hundred and fifty-two post coronary by-pass surgery patients referred to an intensive rehabilitation programme. The study group was divided into two subgroups, according to the level of emotional distress. Forty-three (30%) out of 142 patients who completed the Nottingham Health Profile were considered to be distressed. The comprehensive 4-week inpatient rehabilitation programme consisted of daily physical exercise, lectures about coronary disease and risk factors, psychological support and nutrition counselling. Physical fitness, blood lipids and quality of life questionnaires. The two-way analysis of variance showed that emotionally distressed patients achieved equally good results as those obtained by nondistressed patients in performance regarding the maximal exercise stress test, maximum rate pressure product achieved, or the level of resting heart rate. Significant improvement in psychological well-being as assessed by a seven-point rating scale was observed in both groups. Both groups of patients were also equally successful in weight reduction and lowering of total cholesterol and triglycerides. Of all the patients who were employed at admission, twice the number of patients in the distressed group were in receipt of a permanent disability pension and half the number of patients was employed, compared to the initially nondistressed group, at 1-year follow-up. Distressed patients were very successful in improving their functional status and reducing risk factors when offered an intensive rehabilitation programme but they were much less successful in returning to work. Secondly, patients who were emotionally distressed after surgery did not differ in regard to disease status or physical capacity from nondistressed patients. They did, however, experience more angina pectoris both in daily life and when exposed to a maximal exercise stress test. Finally, the presence of emotional distress was easily detected by any measure of psychological status.

Family burden in relatives of schizophrenics and of people with mental retardation: A comparative study

The pattern of family burden was compared in 32 relatives of schizophrenic patients and 32 relatives of people with mental retardation, using a standardised semistructured interview named "Accertamento della Disabilità e del Carico Familiare" (Assessment of Disability and Family Burden). There were few quantitative differences between the two samples of relatives, although relatives of schizophrenics presented a tendency for a higher degree of both objective and subjective burden in some areas. Problems frequently reported were the presence of emotional distress, poor social relationships and lack of holidays or free time activities. Relatives of schizophrenics specifically claimed the presence of financial difficulties, while those of people with mental retardation were concerned by problems with neighbours.

Hot Cogs and Divine Proportions

Hot Cogs and Divine Proportions Advances in Cognitive-Behavioral Research and Therapy (Vol. 5). P. C. Kendall (Ed.). Orlando, FL: Academic Press, 1986. (285 pp.) This is the fifth volume of an annual series devoted to reviewing cognitivebehavioral topics that may be of interest to research workers and clinical therapists. It contains a diverse collection of seven contributions, whose value may be best conveyed and appreciated by a brief description of the content of each. The first article, by Robert Schwartz and Gregory Garamoni, suggests that psychological well-being may be a function of holding both positive and negative cognitions in the divine proportion (the so-called "golden section hypothesis" of Pythagoras) of roughly three to two, that is, three positive cognitions to every two negative ones. They argue that this cognitive asymmetry enables one to feel generally positive while at the same time being prepared to cope with any negative events that may arise, and they present evidence that seems to support this rather intriguing idea. They go on to develop a "states of mind model" which proposes that certain psychological problems are the result of deviations from this proportion. For example, hypomania and mania are the consequences of holding too many positive self-statements. Although the implications of this model are not drawn out for the practicing clinician, it suggests that the more astute therapist may be able to monitor the progress of therapy by paying careful attention to the evaluative content of the client's comments. In the following contribution, Timothy Smith and Kenneth Allred provide a useful and detailed critical review of the appropriate empirical evidence on the original version of Ellis's rational-emotive theory. This simple and attractive theory suggests that inappropriate emotional distress arises from holding irrational beliefs. Despite its appeal, there is at present little methodologically sound support for it. Most of the relevant research is cross-sectional in design, assessing the presence of emotional distress and irrational beliefs at one point in time, which means that it is not possible to infer the causal nature of any obtained relationship. In addition, the two most frequently used measures of irrational beliefs, the Irrational Beliefs Test and the Rational Behavior Inventory, do not appear to possess strong discriminant validity. This may be partly attributable to the affective content of some of the items on these tests, which overlaps with that of the psychological distress measures. Consequently, the observed relationship between emotional distress and irrational beliefs may be to some extent a function of overlap in content of general dissatisfaction. Although not reported here, there are now measures of irrational beliefs that should overcome this problem. The third article, by John Marzillier, is most probably of greatest general interest to the clinical practitioner. In it, he begins by outlining Beck's cognitive theory of the accompanying therapy for depression. He suggests that it may be more appropriate for the cognitive therapist to view the dysfunctional beliefs that are associated with the patient's depression as reflecting an alternative set of values rather than being illogical in themselves. For example, the dysfunctional statement, "If I make a mistake, it means I am a complete failure as a person," may not be illogical or untrue as such but may embody a very high value being placed on perfection as a way of guiding one's life. He backs up this point of view by describing Rowe's personal construct therapy. She makes a distinction between rational beliefs and metaphysical beliefs, and argues that it is metaphysical beliefs (such as, "No matter how good or nice I appear, I am really bad") that are central to depression. Unlike rational beliefs, these cannot be changed by reasoned argument or empirical validation. What the therapist can do, however, is to discuss the advantages and disadvantages of holding such a philosophy and to suggest alternative and less harmful sets of values that may be held instead. …