1,721,053 research outputs found
Somatization and somatic symptom presentation in cancer: a neglected area
No full textThe recognition of somatization process in cancer patients is a challenging and neglected area, for the extreme difficulty in differentiating and assessing the psycho(patho)logical components from those biologically determined and related to cancer and cancer treatment, as well as for the scarce usefulness of rigid categorical DSM criteria. However, several dimensions of somatization (and the interconnected concept of abnormal illness behavior) have been shown to be diagnosable in cancer patients and to negatively influence coping and quality of life outcomes. An integration of the formal DSM-ICD nosology with a system specifically taking into account the patients’ emotional responses to cancer and cancer treatment, such as the Diagnostic Criteria for Psychosomatic Research (DCPR), is suggested. More data on some specific symptom dimensions, including pain, fatigue, sexual disorders, are needed to examine their possible psychological components. More research is also needed regarding the association of somatization with personality traits (e.g., type D – distressed personality, alexithymia), developmental dimensions (e.g. attachment), and cultural issues (e.g. culturally-mediated attributional styles to somatic symptoms). Also the impact and effectiveness of specific therapeutic intervention in “somatizing” cancer patients is necessar
Pre-loss symptoms related to risk of complicated grief in caregivers of terminally ill cancer patients
No full textAbstract: Purpose: A number of studies have underlined a 10-20% prevalence of complicated grief
(CG) among caregivers of cancer patients. The study aimed at examining the relationship between preloss
criteria for CG and post-loss diagnosis of CG and at evaluating the validity and factor structure of a
predictive tool, the Inventory of Complicated Grief (ICG), in order to identify the risk of developing CG
in a sample of Italian caregivers.
Methods: Sixty family members of terminally ill patients admitted to hospice and receiving a Palliative
Prognostic Score (PaP) predictive 30 day survival time <30% completed the Pre-Death ICG (ICG-PL)
(T0). Family members were met again six months after the death of their loved one (T1) and
submitted to the interview for Complicated Grief (Post-loss interview-PLI).
Results: Caseness for CG was shown in 18.3% of caregivers at T1. ICG-PL score (T0) were higher
among those who developed CG at T1 than non-cases. A cut off score ≥ 49 on the ICG-PL (AUC= 0.98)
maximized sensitivity (92%) and specificity (98%) on caseness at T1. Pre-loss criteria related to
traumatic distress, separation distress and emotional symptoms in general were significantly related
to a post-loss diagnosis of CG, while no effect was shown on duration of pre-loss distress.
Conclusions: The use of short screening tools, like the ICG-PL, may help health care professionals to
identify subjects at risk for CG
Au-delà de la classification psychiatrique en oncologie: aspects psychosociaux du cancer et répercussions pour les soins
No full textAlthough the field of psychological reactions of patients in response to cancer and cancer treatment has been the object of intense psycho-oncology research, the DSM and ICD nosological systems fail to give proper space to this area. Both the ICD and DSM rubrics Psychological Factors affecting a Medical Condition fail to fully describe the several psychosocial implications of cancer. The development of Diagnostic Criteria for Psychosomatic Research (DCPR) is in line with the psychosomatic and biopsychosocial tradition and has given a new impulse to this area by translating psychosocial variables into operational tools for psychosocial variables with prognostic and therapeutic implications in medically ill patients. The application of the DCPR has been shown to be useful in a more precise identification of several psychological conditions affecting cancer patients. The DCPR dimensions of health anxiety, demoralization and alexithymia have been recognized in oncology, with a low overlap with a formal DSM
psychiatric diagnosis; the DCPR dimensions dealing with
the patients’ ways of perceiving, experiencing, evaluating,
and responding to their health status (abnormal illness
behaviour) have also been demonstrated, while more data
are needed with regard to the complex area of somatization
and somatic symptom presentation of distress in cancer
patients, for which the DCPR clusters of somatization (functional somatic symptoms secondary to psychiatric disorders, persistent somatization, conversion symptoms, and anniversary reaction) can be of help. More research and the possible refinement of DCPR clustering dimensions are needed in order to understand the several and multiform psychosocial
responses of cancer patients across the trajectory of the
disease
Tumori.
No full textUn testo di facile consultazione, organizzate per schede pratiche ed esempi di casi clinici, a cui lo psichiatra potrà (e dovrà) fare riferimento nella sua attività quotidiana, confrontandosi con pazienti: che lamentano sintomi fisici a patogenesi psichiatrica, affetti da disturbi mentali che che si presentano con concomitanti disturbi fisici ad esempio alcune malattie reumatologiche), con effetti collaterali della terapia farmacologica (ad esempio la sindrome metabolica nei pazienti in trattamenti con antipsicotici di seconda generazione), che hanno malattie fisiche con sintomi psichiatrici (ad esempio le malattie della tiroide), che presentano malattie fisiche e/o che sono in terapia con altri farmaci, e ai quali si deve prescrivere un trattamento psicofarmacologico.
Il libro è composto da 27 capitoli, ognuno dedicato a un diverso distretto anatomico (ad esempio Malattie Gastroenterologiche) o ad un aspetto funzionale (ad esempio Disturbi della Gravidanza) o ad un preciso agente patogeno (ad esempio HIV e AIDS). Ogni capitolo offre un inquadramento della patologia considerata, l'elenco e la descrizione dei più frequenti disturbi psichiatrici associati a quella patologia, la sintesi delle competenze di base che lo psichiatra deve avere, e alcune indicazioni pratiche sugli aspetti di farmacoterapia
Bipolar disorder preceding the onset of multiple sclerosis
No full textMultiple sclerosis (MS) is the most common inflammatory demyelinating brain disease. The occurrence of psychiatric disorders, especially for major depression, in the course of MS is high. Reports concerning bipolar disorder (BD) remain rather scarce although early descriptions were found in the old neurological literature. The purpose of this article is to provide a critical review of the epidemiology, comorbidity and treatment findings regarding BD preceding the onset of MS
Psycho-oncology and optimal standards of cancer care: developments, multidisciplinary team approach and international guidelines
No full textThe development of psycho-oncology over the last thirty-forty years has had a main role in sensitizing the general population, oncology health professional and health care administrators about the need for psychosocial care in cancer. The increase of awareness on the importance of psychosocial issues in medical illness has brought to the development of psychosomatic medicine as a sub-specialty of psychiatry and psychosocial oncology as a special area within cancer disciplines.
Psychosocial oncology standards and guidelines are now available in several countries, with Cancer National Plan or Acts indicating psychosocial care in oncology as a mandatory requirement for optimal clinical care.
In the chapter the authors review the state of the art of psychosocial care in different countries, underline the criteria to be met for the development of psychosocial oncology services, programs and departments, present the most important recommendations and conclusions of the countries with special experience in the field (e.g Canada, USA, Australia), and the position statement on psychosocial care as a human right for cancer patients and their families
Dignity in Medicine: Definition, Assessment and Therapy
No full textPurpose of review: Over the last 20 years, dignity and dignity-conserving care have become the center of investigation, in many areas of medicine, including palliative care, oncology, neurology, geriatrics, and psychiatry. We summarized peer-reviewed literature and examined the definition, conceptualization of dignity, potential problems, and suggested interventions. Recent findings: We performed a review utilizing several databases, including the most relevant studies in full journal articles, investigating the problems of dignity in medicine. It emerged that dignity is a multifactorial construct and that dignity-preserving care should be at the center of the health organization. Dignity should be also regularly assessed through the tools currently available in clinical practice. Among dignity intervention, besides dignity models of care, dignity intervention, such as dignity therapy (DT), life review and reminiscence therapy, have a role in maintaining both the extrinsic (preserved when health care professionals treat the patient with respect, meeting physical and emotional needs, honors the patient's wishes, and makes attempts to maintain privacy and confidentiality) and intrinsic dignity (preserved when the patient has appropriate self-esteem, is able to exercise autonomy and has a sense of hope and meaning). Unified trends across diverse medical contexts highlight the need for a holistic, patient-centered approach in healthcare settings. Challenges compromising dignity are pervasive, underscoring the importance of interventions and systematic efforts to address these issues. Future research and interventions should prioritize the multifaceted nature of dignity, striving to create healthcare environments that foster compassion, respect, and dignity across all medical settings
Psychopharmacology in Psycho-Oncology
No full textPsychopharmacological intervention is a major clinical and research area in oncology and palliative care. Over the last 35 years, psychotropic drugs have been shown to have a number of important indications for the treatment of the most common psychiatric disorders, such as depression, anxiety, stress-related syndromes, severe adjustment disorders, sleep disorders and delirium, which combined affect at least 30-40% of patients with cancer and even a higher percentage of patients in an advanced phase of illness. The availability of new drugs, with less side-effects and safer pharmacological profiles, has been a major advance in clinical psycho-oncology. Interestingly, several drugs have also been found to be helpful for the adjuvant treatment of cancer-related symptoms, such as pain, hot flashes, pruritus, nausea and vomiting, fatigue, and cognitive impairment, making psychopharmacology an important tool for the improvement of cancer patients’ quality of life. The aim of this paper is to summarize recent relevant data concerning the use of psychotropic drugs, namely antidepressants, anxiolytics, antipsychotics, anticonvulsants and psychostimulants in patients with cancer
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