Use Of Strategies In Patients Research Articles

Pain-Related Coping Behavior in ALS: The Interplay between Maladaptive Coping, the Patient's Affective State and Pain.

Background: Pain is a common symptom in patients with amyotrophic lateral sclerosis (ALS). Coping plays a central role in adjustment to pain. Objective: This study evaluates the use of different pain coping strategies in patients with ALS and investigates the interplay of maladaptive coping, and the patient’s affective state and pain. Methods: One hundred and fifty ALS patients from three German outpatient clinics completed the Brief Pain Inventory (BPI), the ALS-Functional Rating Scale-Extension (ALSFRS-EX), the ALS Depression Inventory (ADI-12), the subscale “emotional functioning” of the ALS Assessment Questionnaire (ALSAQ-40) and the Coping Strategies Questionnaire (CSQ). Based upon the results of correlational analyses, multiple regression analyses were performed to identify predictors of pain severity and to explore factors contributing to maladaptive coping. Results: Pain was prevalent in 56% (n = 84) of the patients. Patients applied different adaptive coping strategies as well as the maladaptive strategy “catastrophizing”. Regression analysis indicated that the CSQ-subscale “catastrophizing” significantly predicted pain intensity, explaining 34.0% of the variance (p < 0.001). Pain-related catastrophizing was associated with higher pain-related functional impairments and worse emotional functioning. The ADI-12 sum score as an indicator for depressive symptoms contributed significantly to the maladaptive coping strategy “catastrophizing” (p < 0.001) and explained 40.8% of the variance. Conclusion: Patients with ALS apply different strategies to cope with pain. Catastrophizing is an important determinant of higher pain intensity ratings and is associated with higher pain interferences and decreased emotional well-being. Pain-related catastrophizing is promoted by depressive symptoms. Catastrophizing and depressive symptoms thus represent important targets of individualized pain-management strategies.

The Sequential Combination of Pharmacotherapy and Psychotherapy in Mood Disorders

The aim of this review was to consider the literature concerned with a sequential use of pharmacotherapy and psychotherapy in mood disorders. Review of the clinical trials where treatment components were used in a sequential order were identified by using MEDLINE, a manual search of the literature and the Index Medicus. In unipolar recurrent depression, the sequential use of pharmacotherapy and psychotherapy was found to improve relapse rate. In bipolar disorder, the use of psychotherapeutic strategies in patients who were already assuming mood stabilizers was also found to yield clinical benefits. The sequential model has the potential for improving the logic and timing of interventions. A conceptual shift in current assessment methods (staging) is needed.

Abstract 2751: Preoperative Cardiothoracic Computed Tomographic Angiography is Associated with Increased Adoption of Preventive Surgical Techniques in Patients Undergoing Redo Open Heart Surgery after Prior Coronary Artery Bypass Grafting

Introduction: Redo cardiothoracic surgery (CTS) is associated with increased morbidity and mortality, compared to first-time CTS. Multi-detector computed tomography angiography (MDCTA) reliably delineates the course of previous coronary artery bypass grafts (CABG) and proximity of mediastinal structures to chest wall. We sought to determine if high risk preoperative MDCTA findings impacted use of preventive surgical strategies in patients with prior CABG undergoing re-CTS. Methods: We studied 167 patients (mean age 69 ± 9 years, 79% men) with prior CABG referred for re-CTS who underwent contrast-enhanced MDCTA (16 – 64 MDCT, 2 mm slice thickness) to assess CABG location and relationship of aorta/right ventricle (RV) to chest wall. Demographic, laboratory, and clinical data were used to determine the Higgins preoperative risk score. Prevalence of high risk MDCTA findings, use of preventive surgical strategies, frequency of severe intraoperative bleeding and postoperative mortality were recorded. Results: Mean preoperative risk score was high (7.5 ± 3) and 49% patients underwent combined redo CABG plus valve surgery. Incidences of 2 nd , 3 rd and 4 th operations were 78%, 19% and 3%, respectively. High-risk CT findings were as follows: adherence/ proximity (≤ 1 cm) of RV/aorta to chest wall (24%) or bypass graft crossing midline (≤ 1 cm antero-posteriorly) (38%). Preventive surgical strategies included: surgery cancelled (4%), non-midline incision (8%), deep hypothermic circulatory arrest (5%), initiation of peripheral cardiopulmonary bypass (11%), and extrathoracic vascular exposure prior to incision (53%). These surgical strategies were used at a significantly higher frequency in patients with high risk MDCTA findings compared to those without (88% vs. 28%, p&lt;0.0001). After adjustment for multiple clinical variables, only high risk MDCTA finding was significantly associated with operative changes (OR=16 [95% CI 7–36], p&lt;0.001). Frequency of severe bleeding, graft injuries, and 1 month mortality were 3%, 5% and 3 %, respectively. Conclusions: In high risk re-CTS patients with prior CABG, use of preoperative MDCTA plays a significant role in planning and performance. Impact of preoperative MDCTA on outcomes requires further evaluation.

Strategy implementation in obsessive-compulsive disorder and trichotillomania.

The use of strategies to aid performance when undertaking neuropsychological tasks is dependent on intact fronto-striatal circuitry, and growing evidence suggests impaired spontaneous use of strategies in patients with obsessive-compulsive disorder (OCD). However, studies to date have not examined the effects of strategy training on task performance in OCD or in trichotillomania (compulsive hair-pulling, a condition that has been argued to share overlap with OCD in terms of phenomenology and co-morbidity). The ability to generate novel visuospatial sequences using a computer interface was examined before and after undertaking optimal strategy training in 20 OCD patients, 17 trichotillomania patients, and 20 controls (matched for age, education, and IQ). OCD patients failed to improve ability to generate novel sequences above baseline despite successfully completing strategy training to the same extent as other groups. In contrast, performance of trichotillomania patients improved significantly after training to the same extent as controls. Groups did not differ on memory span, trial-by-trial action monitoring, or ability to generate novel visuospatial sequences prior to strategy training. Strategy implementation deficits, suggestive of cognitive inflexibility and fronto-striatal dysfunction, appear integral to the neurocognitive profile of OCD but not trichotillomania. Future research should investigate cognitive flexibility in obsessive-compulsive spectrum disorders using a variety of paradigms, and clarify the contribution of specific neural structures and transmitter systems to deficits reported.

Inadequate Use of Preventive Strategies in Patients Receiving NSAIDs

Little is known about the factors that influence the decision to use NSAIDs in combination with gastroprotective drugs. The aims of this observational study were to evaluate the extent to which NSAID users are prescribed concomitant gastroprotective drug regimens ('preventive strategies'), and to determine how patient risk factors for NSAID-associated gastrointestinal toxicity and physician prescribing preferences influenced the decision to prescribe a gastroprotective drug in combination with an NSAID. The study was conducted on 29 June 2004 and comprised 109 eligible adult patients hospitalised at the Clinical Hospital Center, Zagreb. Use of NSAIDs and gastroprotective drugs, risk factors for NSAID-associated gastrointestinal toxicity, and physician prescribing preferences were monitored throughout the study. Sixty-six percent of patients receiving proton pump inhibitors or histamine H(2)-receptor antagonists with NSAIDs had no risk factors for gastrointestinal toxicity. Furthermore, 29% of patients who used NSAIDs had risk factors for gastrointestinal toxicity but were not receiving gastroprotective drugs. Even though patients at risk of NSAID-associated gastrointestinal complications had higher odds of receiving preventive strategies (odds ratio 1.25), the absolute rate of utilisation of these therapies in at-risk populations was unacceptably low (69%). However, the strongest independent correlation for gastroprotective drug use was the prescribing physician, with an odds ratio of 6.40. This study demonstrates that an individual physician's prescribing style largely determines the odds of receiving preventive strategies with NSAID treatment and is more important than the patient's risk factors for gastrointestinal toxicity.