Psychological Factors In Patients Research Articles

Correspondence of Patient Word Choice with Psychologic Factors in Patients With Upper Extremity Illness

Studies of patients with back pain, cancer, and in a general medical practice note that the use of certain phrases by a patient when communicating with their health provider can indicate greater disability and distress than expected for patients with a given disorder. However, it is unclear whether such phrases apply to patients with hand and arm disorders. We assessed whether specific patient phrases are associated with symptoms, disability, and psychologic factors in patients with hand and arm disorders. We recorded and coded 61 interviews of new patients. Specific expressions of patients were listed and categorized into six phrase categories: "I can't", "Find it and fix it", "Something is wrong", "It's serious", "Deemphasis (hoping)", and "Protective mindset". Patients completed questionnaires for arm-specific disability (DASH), depression (Patient Health Questionnaire [PHQ-9]), pain catastrophizing (Pain Catastrophizing Scale [PCS]), and heightened illness concern (Whiteley Index). Patients who endorsed phrases in the category "I can't" had higher scores on the PCS, Whiteley, DASH, and pain; they also had longer visits. Patients expressing "Something is wrong" had higher scores for the PCS, pain, and duration of visit. Patients using "It's serious" had a higher score for pain. Finally, patients using "Protective mindset" had lower PHQ-9 scores and younger age. Patient word choice may indicate underlying distress or ineffective coping strategies that represent important opportunities for empathy and support, including evidence-based cognitive and behavioral interventions. Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Psychology of earthquake‐induced stress cardiomyopathy, myocardial infarction and non‐cardiac chest pain

To compare psychological factors in patients presenting to hospital with earthquake-induced stress cardiomyopathy, myocardial infarction (MI) and non-cardiac chest pain. We hypothesised that patients with stress cardiomyopathy and non-cardiac chest pain would be more psychologically vulnerable than those with MI. Cardiology admitting staff in the week following the September 2010 Christchurch earthquake prospectively identified patients with earthquake-precipitated chest pain. Males were excluded. All consenting women met diagnostic criteria for one of the three conditions. Patients underwent a semistructured interview with a senior clinical psychologist who was blind to the cardiac diagnosis. Premorbid psychological factors, experience of the earthquake and psychological response were assessed using a range of validated tools. Seventeen women were included in the study, six with stress cardiomyopathy, five with MI and six with non-cardiac chest pain. Earthquake experiences were notably similar across the groups. Patients with non-cardiac chest pain scored high on the hospital anxiety and depression scale, the health anxiety questionnaire, the Eysenck neuroticism scale and the Impact of Event scale. Women with stress cardiomyopathy scored as the most psychologically robust. Depression and extroversion scores were the same across groups. Our hypothesis was incorrect. Women with non-cardiac chest pain following an earthquake have higher anxiety and neuroticism scores than women with either MI or stress cardiomyopathy. Stress cardiomyopathy following an earthquake is not specific to psychologically vulnerable women. The psychology of natural disaster-induced stress cardiomyopathy may differ from that of sporadic cases.

Short-Term Effect of Superficial Heat Treatment on Paraspinal Muscle Activity, Stature Recovery, and Psychological Factors in Patients With Chronic Low Back Pain

Lewis SE, Holmes PS, Woby SR, Hindle J, Fowler NE. Short-term effect of superficial heat treatment on paraspinal muscle activity, stature recovery, and psychological factors in patients with chronic low back pain. ObjectiveTo test the hypothesis that patients with chronic low back pain (CLBP) would have reduced paraspinal muscle activity when wearing a heat wrap and that this would be associated with increased stature recovery and short-term improvements in psychological factors. DesignA within-subject repeated-measures design. Muscle activity and stature recovery were assessed before and after a 40-minute unloading period, both without a heat wrap and after 2 hours of wear. Questionnaires were completed after both sessions. SettingHospital physiotherapy department. ParticipantsPatients with CLBP (n=24; age, 48.0±9.0y; height, 166.6±7.3cm; body mass, 80.2±12.9kg) and asymptomatic participants (n=11; age, 47.9±15.4y; height, 168.7±11.6cm; body mass, 69.3±13.1kg) took part in the investigation. Patients on the waiting list for 2 physiotherapist-led rehabilitation programs, and those who had attended the programs during the previous 2 years, were invited to participate. InterventionSuperficial heat wrap. Main Outcome MeasuresParaspinal muscle activity, stature recovery over a 40-minute unloading period, pain, disability, and psychological factors. ResultsFor the CLBP patients only, the heat wrap was associated with a reduction in nonnormalized muscle activity and a positive short-term effect on self-report of disability, pain-related anxiety, catastrophizing, and self-efficacy. Changes in muscle activity were correlated with changes in stature recovery, and both were also correlated to changes in psychological factors. ConclusionsUse of the heat wrap was associated with a decrease in muscle activity and a short-term improvement in certain aspects of well-being for the CLBP patients. The results confirm the link between the biomechanical and psychological outcome measures.

Psychological factors unrelated to activity level in patients with chronic musculoskeletal pain

Enhancement of physical activities is an important goal in rehabilitation programmes for patients with chronic musculoskeletal pain (CMP). A relationship between activity level and psychological factors is suggested but studied scarcely. To explore the relationship between the activity level and psychological factors in patients with CMP. Study design is cross-sectional, explorative. Participants are patients with CMP, included for outpatient multidisciplinary pain rehabilitation. Activity level was measured by the RT3 accelerometer during 1 week; pain intensity was measured with a 100-mm visual analogue scale; depression, somatization and distress were measured with Symptom Checklist-90-Revised (SCL-90-R), coping strategy with the Utrecht Coping List (UCL, scales active coping, passive coping, avoiding), fear of movement measured with Tampa Scale of Kinesiophobia (TSK), scale activity avoidance. Depending on data distribution, correlations between the mean number of activity counts and psychological factors were tested with Pearson or Spearman correlation coefficients. Fifty three patients were included: age mean 39.9 years [standard deviation (SD) 11.3]; activity counts per day mean 198,243 (SD 78,000); pain intensity mean 58 (SD 27.7); SCL-90-R mean 149.4 (SD 42.5); UCL active coping mean 17.9 (SD 3.7); UCL passive coping mean 12.3 (SD 3.7); UCL avoiding mean 15.3 (SD 3.0); TSK total mean 35.4 (SD 7.4); TSK activity avoidance mean 16.9 SD (4.7). Correlations between psychological factors and the mean number of activity counts per day ranged from r = -0.27 to r = 0.01 and were all non-significant (p ≥ 0.05). Psychological factors and activity level were unrelated in patients with CMP.

Mindfulness, cancer, and pain

Pain is the most distressing and incapacitating symptom experienced by cancer patients. While mindfulness-based stress reduction (MBSR) interventions have been conducted with cancer patients, no study has explored psychological and pain- related factors in patients with cancer-related pain. The effects of an eight-week MBSR intervention were investigated on pre- post scores for pain catastrophizing, pain-related anxiety, pain intensity ratings, and mental adjustment to cancer in breast cancer patients with pa in. Forty-one women diagnosed withcancer-related pain participated in the study. The MBSR was conducted for 1.5 hours/week for eight-weeks; participants were trained in the body scan, sitting meditation, and hatha yoga. Results showed significant reduction in scores for pain catastrophizing, pain anxiety, and painratings; also significant positive changes occurred for mental adjustment to cancer. This study is the first to investigate MBSR effects for psychological factors in patients with cancer pain. Much more research is needed in this area.

The Usefulness of Clinical Measures of Psychologic Factors in Patients with Spinal Pain

Objective The purposes of this study were to investigate whether a screening procedure could capture important psychologic factors with minimum burden to the patient and to investigate whether correlations exist among the various psychologic factors. Methods A screening procedure consisting of the 11-item Tampa Scale for Kinesiophobia, a 2-question coping strategies screen, and the depression and anxiety subscales of the Bournemouth Disability Questionnaire was provided to consecutive patients with neck pain (NP) or low back pain (LBP) as part of the usual initial assessment process at a busy spine center, which includes chiropractic and physical therapy. Correlations and associations between these variables were determined. Results Data were collected on 95 patients with NP and 260 patients with LBP. Statistically significant correlations and associations were found between all measures in both cohorts with the exception of depression and coping in patients with NP. Statistically significant associations were found among all measures in both cohorts with the exception of depression and coping and coping and fear in patients with NP. Conclusion This study showed that a screening procedure may provide useful clinical information regarding psychologic factors that are of potential relevance in patients with NP and LBP.

Psychological factors in patients with various vague oral complaints

Psychological factors in patients with various vague oral complaints

Psychological factors in patients with complaints of taste abnormality

Psychological factors in patients with complaints of taste abnormality

Psychological factors in patients with recurrent aphtha

Psychological factors in patients with recurrent aphtha

The relationships between measures of stature recovery, muscle activity and psychological factors in patients with chronic low back pain

Individuals with low back pain (LBP) often exhibit elevated paraspinal muscle activity compared to asymptomatic controls during static postures such as standing. This hyperactivity has been associated with a delayed rate of stature recovery in individuals with mild LBP. This study aimed to explore this association further in a more clinically relevant population of NHS patients with LBP and to investigate if relationships exist with a number of psychological factors. Forty seven patients were recruited from waiting lists for physiotherapist-led rehabilitation programmes. Paraspinal muscle activity while standing was assessed via surface electromyogram (EMG) and stature recovery over a 40-min unloading period was measured on a precision stadiometer. Self-report of pain, disability, anxiety, depression, pain-related anxiety, fear of movement, self-efficacy and catastrophising were recorded. Correlations were found between muscle activity and both pain ( r = 0.48) and disability ( r = 0.43). Muscle activity was also correlated with self-efficacy ( r = −0.45), depression ( r = 0.33), anxiety ( r = 0.31), pain-related anxiety ( r = 0.29) and catastrophising ( r = 0.29) and was a mediator between self-efficacy and pain. Pain was a mediator in the relationship between muscle activity and disability. Stature recovery was not found to be related to pain, disability, muscle activity or any of the psychological factors. The findings confirm the importance of muscle activity within LBP, in particular as a pathway by which psychological factors may impact on clinical outcome. The mediating role of muscle activity between psychological factors and pain suggests that interventions that are able to reduce muscle tension may be of particular benefit to patients demonstrating such characteristics, which may help in the targeting of treatment for LBP.

Relationship between radiological severity and clinical and psychological factors in knee osteoarthritis

This study was designed to investigate the relationship between radiological severity and clinical and psychological factors in patients with knee osteoarthritis (OA). Patients with knee OA (n = 100) were included in the study. Radiographic staging was done using Kellgren-Lawrence (KL) radiological rating scale. Stage 1-2 changes according to KL were grouped as 'early' and stage 3-4 as 'late' radiological OA. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used for self-reported disability. Performance-based functional assessments were measured as time needed to walk 15m and time needed to climb ten steps. Health-related quality of life was assessed by Nottingham Health Profile (NHP). Beck Depression Inventory (BDI) was used to assess the presence and severity of depression. Social isolation was assessed by a related NHP subscale. Significantly higher scores were found in the late stage group for NHP pain, physical mobility and social isolation subscales and all WOMAC subscales. Mean BDI score was significantly higher (p = 0.001) and performance-based functional score was significantly worse (p < 0.001) in the late stage group compared to the early stage. In logistic regression analysis, NHP social isolation subscore was found to be associated with WOMAC pain subscore (p = 0.013, odds ratio [OR] = 1.163; 95% confidence interval [CI], 1.032-1.309) and radiological severity (p = 0.018, OR = 2.924; 95% CI, 1.198-7.136). Radiological severity is an important indicative factor for pain, disability, depression and social isolation. We believe that assessment of psychological involvement in addition to pain and disability might provide benefit in the management of patients with advanced radiological knee OA.

Salivary cortisol and dehydroepiandrosterone (DHEA) levels, psychological factors in patients with oral lichen planus

ObjectiveThe aim of this study was to determine the salivary levels of dehydroepiandrosterone (DHEA) and cortisol and scores of depression, anxiety and stress in patients with oral lichen planus (OLP). Study designThirty-one patients with a diagnosis of OLP were selected; they were matched by sex and age with 31 control patients. Symptoms of depression, anxiety and stress were investigated by the instruments Beck Depression Inventory, Beck Anxiety Inventory and Lipp's Inventory of Stress Symptoms for Adults, respectively. Saliva was collected in the morning and at night for the determination of DHEA and cortisol levels by radioimmunoassay. ResultsThere was no significant difference between the groups with respect to depression (P=0.832), anxiety (P=0.061) or stress (P=0.611), or with respect to morning and night salivary levels of DHEA (P=0.888, P=0.297) and cortisol (P=0.443, P=0.983). ConclusionsThe results suggest an association of OLP with anxiety. However, DHEA and cortisol levels did not differ between groups, which does not support any neuroendocrine aetiology for OLP.

Psychological and behavioral factors in patients with comorbidobstructive sleep apnea and insomnia

Objective Insomnia symptoms in patients with obstructive sleep apnea (OSA) are commonly assumed to be secondary to respiratory disturbances. Previous studies, however, showed that insomnia might persist after treatment for OSA. Higher levels of emotional disturbances were reported in OSA patients with insomnia than those without insomnia, which suggests that psychological factors may play an important role for their sleep difficulties. This study aimed to further explore sleep-related psychological/behavioral factors that may contribute to insomnia in OSA patients. Methods This study included 88 men, of which 33 had OSA (OSA group); 29, primary insomnia; (Insomnia group); and 26, both OSA and insomnia (OSA+Insomnia group). All subjects underwent polysomnography (PSG) overnight and completed a package of questionnaires, including the Insomnia Severity Index (ISI), Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), Sleep Hygiene Practice Scale (SHPS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Pre-Sleep Arousal Scale (PSAS). Results The OSA+Insomnia and Insomnia groups had significantly more dysfunctional sleep beliefs, more arousal-inducing sleep-related behaviors, and higher levels of pre-sleep arousal, anxiety, and depression than did the OSA group. The respiratory indices and arousal index were higher for OSA and OSA+Insomnia groups than for the Insomnia group. Conclusion Although OSA patients with insomnia showed a similar degree of respiratory disturbances as patients with OSA only, their psychological and behavioral profiles resembled the features of primary insomnia patients. The results support the concept of comorbid insomnia and suggest the importance of evaluating and treating both physiological and psychological factors in these patients.

Effects of psychological intervention on perioperative rehabilitation in patients with esophageal carcinoma

Objective To evaluate effects of psychological intervention on perioperative rehabilitation in patients with esophageal carcinoma. Methods Sixty patients with esophageal carcinoma hospitalized at thoracic surgery department of Sun Yat-sen University Cancer Center from January to October 2008 were randomly divided into intervention group (IG, n = 31 ) and control group ( CG, n = 29). The patients' psychological status was assessed with SCL-90 (symptom check list-90) scores. Psychological intervention was implemented by means of health education, psychological support, stress management,coping strategy and behavior training given by qualified medical interns in the University at three phases,i. e. , pre-operation, post-operation I and post-operation II. Effects of intervention were evaluated in IG as compared with those in CG. Results Scores in domains of somatization, obsession, depression, anxiety,paranoia, hostility and phobbia were all higher in both IG and CG before surgical operation than those of national norm (P<0.05) set in 1986 by JIN Hua et al, but without significant difference between IG and CG (P = 0. 31). Scores of psychological factors in patients of IG demonstrated a steady decreasing tendency,which apparently differed from those of CG four and 24 weeks after surgical operation (t_4=4.71,P_4=0.002;t_(24)=3.82,P_(24)=0.005), respectively. Conclusions Appropriate psychological intervention will help improve psychological status in patients with esophageal carcinoma and benefit their perioperativerehabilitation. Key words: Esophageal carcinoma; Psychotherapy; Rehabilitation

Psychiatric Comorbidity and Other Psychological Factors in Patients with “Chronic Lyme Disease”

Background There is no evidence of current or previous Borrelia burgdorferi infection in most patients evaluated at university-based Lyme disease referral centers. Instead, psychological factors likely exacerbate the persistent diffuse symptoms or “Chronic Multisymptom Illness” (CMI) incorrectly ascribed to an ongoing chronic infection with B. burgdorferi. The objective of this study was to assess the medical and psychiatric status of such patients and compare these findings to those from patients without CMI. Methods There were 240 consecutive patients who underwent medical evaluation and were screened for clinical disorders (eg, depression and anxiety) with diagnoses confirmed by structured clinical interviews at an academic Lyme disease referral center in New Jersey. Personality disorders, catastrophizing, and negative and positive affect also were evaluated, and all factors were compared between groups and with functional outcomes. Results Of our sample, 60.4% had symptoms that could not be explained by current Lyme disease or another medical condition other than CMI. After adjusting for age and sex, clinical disorders were more common in CMI than in the comparison group ( P <.001, odds ratio 3.54, 95% confidence interval, 1.97-6.55), but personality disorders were not significantly more common. CMI patients had higher negative affect, lower positive affect, and a greater tendency to catastrophize pain ( P <.001) than did the comparison group. Except for personality disorders, all psychological factors were related to worse functioning. Our explanatory model based on these factors was confirmed. Conclusions Psychiatric comorbidity and other psychological factors are prominent in the presentation and outcome of some patients who inaccurately ascribe longstanding symptoms to “chronic Lyme disease.”

The Effect of a Multimodal Intervention on Treatment-Related Symptoms in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Randomized Controlled Trial

Studies applying exercise, relaxation training, and psychoeducation have each indicated a positive impact on physical performance and/or psychological factors in patients diagnosed with cancer. We explored the longitudinal effect of a combination of these interventions on treatment-related symptoms in patients undergoing myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT). Forty-two patients (18–65 years) were randomized either to an intervention or a control group. The intervention group received standard treatment and care, and a supervised four- to six-week structured exercise program, progressive relaxation, and psychoeducation during hospitalization, one hour per day for five days per week. The control group received standard treatment, care, and physiotherapy. A 24-item symptom assessment questionnaire was completed weekly during hospitalization, and at three and six months after allo-HCST. Through principal component analysis with varimax rotation, individual symptoms were grouped into five symptom clusters: mucositis, cognitive, gastrointestinal, affective, and functional symptom clusters. Then, a subsequent general estimate equation analysis revealed similar longitudinal patterns of intensity in all symptom clusters for intervention and control groups, but in the intervention group, there was an overall significant reduction (P < 0.05) in symptom intensity over time for all clusters except the affective symptom cluster. This study provides beginning evidence for the efficacy of an exercise-based multimodal intervention in reducing the intensity of a spectrum of symptoms in this small sample of patients undergoing allo-HSCT.

Evaluation of salivary cortisol and psychological factors in patients with oral lichen planus

Lichen planus is a relatively common chronic inflammatory disease of oral mucosa and skin. Cortisol, also called as "stress hormone", has been used as an indicator in various stress evaluation studies. Salivary cortisol measurement is an indicator of free cortisol or biologically active cortisol in human serum and provides noninvasive and easy technique. Recent studies have been conflicting, and hence, in the present study, evaluation of salivary cortisol levels and psychosocial factors in oral lichen planus (OLP) patients was done. A total of 30 patients with clinically and histopathologically proven cases of OLP, along with the age and sex-matched healthy controls were included in the study. Samples of stimulated saliva were collected, centrifuged and analyzed for the level of cortisol with cortisol enzyme linked immunosorbent assay. Psychosocial factors of study and control groups were measured by depression anxiety and stress scale. Student's t-test was used to compare the psychological factors and salivary cortisol levels between patients with the OLP and the control group. Irrespective of sex, significantly higher depression (83.4 +/- 15.4%), anxiety (80.5 +/- 11.3%), and stress (94.2 +/- 6.2%) scores were observed in OLP patients compared to controls. Increased cortisol levels were observed among 17 (56.6%) OLP patients in the study group. A positive correlation was found between psychological factors and salivary cortisol levels in the OLP patients. The values of Pearson's correlation coefficient "r", between depression, anxiety, and stress with salivary cortisol was: +0.42,S; +0.27,NS; and +0.65,HS, respectively among the study group.

Role of psychiatric comorbidity in chronic Lyme disease

To evaluate the prevalence and role of psychiatric comorbidity and other psychological factors in patients with chronic Lyme disease (CLD). We assessed 159 patients drawn from a cohort of 240 patients evaluated at an academic Lyme disease referral center. Patients were screened for common axis I psychiatric disorders (e.g., depressive and anxiety disorders); structured clinical interviews confirmed diagnoses. Axis II personality disorders, functional status, and traits like negative and positive affect and pain catastrophizing were also evaluated. A physician blind to psychiatric assessment results performed a medical evaluation. Two groups of CLD patients (those with post-Lyme disease syndrome and those with medically unexplained symptoms attributed to Lyme disease but without Borrelia burgdorferi infection) were compared with 2 groups of patients without CLD (patients recovered from Lyme disease and those with an identifiable medical condition explaining symptoms attributed to Lyme disease). After adjusting for age and sex, axis I psychiatric disorders were more common in CLD patients than in comparison patients (P = 0.02, odds ratio 2.64, 95% confidence interval 1.30-5.35), but personality disorders were not. Patients with CLD had higher negative affect, lower positive affect, and a greater tendency to catastrophize pain (P < 0.001) than comparison patients. All psychological factors except personality disorders were related to level of functioning. A predictive model based on these psychological variables was confirmed. Fibromyalgia was diagnosed in 46.8% of CLD patients. Psychiatric comorbidity and other psychological factors distinguished CLD patients from other patients commonly seen in Lyme disease referral centers, and were related to poor functional outcomes.

"It doesn't do any harm, but patients feel better": a qualitative exploratory study on gastroenterologists' perspectives on the role of antidepressants in inflammatory bowel disease

BackgroundInterest in psychological factors in patients with inflammatory bowel disease (IBD) has increased in recent years. It has even been proposed that treating psychological co-morbidities with antidepressants may control disease activity and improve quality of life. Despite this, there is no data on gastroenterologists' attitudes to, and experiences with, antidepressant therapy in patients with IBD.MethodsWe conducted semi-structured interviews with 18 gastroenterologists associated with metropolitan teaching hospitals. Qualitative content analysis was used to examine their responses.ResultsSeventy-eight percent of gastroenterologists had treated IBD patients with antidepressants for pain, depression and/or anxiety, and insomnia. Antidepressants were reported to be useful in improving psychosocial well-being, quality of life, and self-management of the disease by patients. However, in this group of gastroenterologists, there appears to be skepticism towards psychological disorders themselves or antidepressant therapy having a central role in either the causation of IBD or its clinical course. Nevertheless, these gastroenterologists were receptive to the idea of conducting a trial of the role of antidepressants in IBD.ConclusionWhile the majority of specialists have treated IBD patients with antidepressants, there is considerable skepticism with regard to efficacy of antidepressive therapy or the role of psychological factors in the outcome of IBD patients.

Relative-Assessed Psychological Factors Predict Sedation Requirement in Critically Ill Patients

Sedation is frequently required in critically ill, mechanically ventilated patients. Sedation and analgesia requirements may vary substantially among patients. This study examined whether psychological factors predict amount of sedation requirements beyond the effects of other biomedical parameters. This study used a prospective correlative design in an eight-bed medical intensive care unit at a tertiary university hospital. Fifty-five adult patients requiring mechanical ventilation were included. We evaluated by questionnaires three psychological factors of patients--hostility, anxiety and desire for control (DC)--as completed by patients' relatives at entry to the intensive care unit. Daily doses of sedatives required were monitored. The primary outcome measurement was midazolam dose expressed in mg/kg/h. There was a statistically significant correlation between psychological factors and midazolam dose (mg/kg/h): r values = 0.40 for anxiety, 0.43 for hostility, and 0.46 for DC. Age and pulmonary edema were inversely related to midazolam requirements, whereas smoking, chronic obstructive pulmonary disease, fentanyl dose, and therapeutic intervention scoring system were positively correlated with midazolam doses. In a multiple regression, DC accounted for an additional and significant 5.4% of the variance in midazolam after controlling statistically for the effects of the significant background and biomedical predictors. In the final regression equation, DC and fentanyl were the only significant factors associated with higher sedation requirement. Premorbid psychological profile independently predicts sedation requirement in critically ill, mechanically ventilated patients. Early identification of such a profile may help in sedation management and patient care. The possible mechanisms and clinical implications are discussed.