64 research outputs found
Psychological correlates of vasovagal versus medically unexplained syncope
No full textObjective
Psychiatric morbidity is quite common in vasovagal syncope (VVS), but findings are sometimes contradictory. Among patients with suspected VVS, up to 40% has a negative response to Head-Up Tilt test (HUT), the cause of syncope remaining unexplained (US). The authors evaluated and compared the psychological and psychosomatic profile in patients with positive (VVS) and negative HUT (US).
Method
A consecutive series of 67 patients with suspected VVS underwent HUT: 45 patients had a positive HUT, 22 negative. They were evaluated by means of observer- and self-rated measures.
Results
Of the total sample, 95.5% had at least one Diagnostic and Statistical Manual of Mental Disorders diagnosis or one psychosomatic syndrome, such as specific and social phobias, illness denial and demoralization. Comparing VVS and US patients, no statistical differences on diagnoses' frequencies were found. However, the US group had significantly poorer health habits, lower levels of well-being and higher psychological distress. They also reported to be more anxious, depressed and hostile. VVS patients were significantly more blood and social phobic than US patients.
Conclusion
Despite similar and remarkable observer-rated psychopathology, US patients reported higher self-perceived psychological distress than VVS patients. Psychological evaluation of patients undergoing HUT should incorporate both clinical and subclinical methods to better address syncope management
Type d personality in cardiovascular psychosomatics: association with type a behavior, demoralization and depression.
No full textIntroduction: Some authors pointed out that there is the need to include personality assessment in the early identification of patients at greater risk for distress-related cardiac events. Furthermore, despite the well-known role of depression in the clinical course of cardiovascular diseases, an increasing body of literature highlights that also sub-clinical depression should be considered.
Objectives of this study were: 1) to assess specific configuration of personalities (type A/D) and clinical and subclinical depression (major/minor depression, dysthymia and demoralization) among patients in cardiac rehabilitation (CR); 2) to detect overlaps among syndromes.
Methods: 246 patients (72.8% males), most of whom undergone angioplasty (38.6%) or valve surgery (30.9%), were enrolled in the study. Assessment included Structured Clinical Interview for DSM–IV (SCID), Interview for the Diagnostic Criteria for Psychosomatic Research (DCPR) and 14-item Type D scale (DS14).
Results: Within the sample, DSM diagnoses occurred in 33.3% of cases, DCPR in 41.5% (demoralization=24.8%, type A=28%), and type D personality in 17.9%. Among type D patients, only 18.2% did not show other comorbid diagnoses: 63.6% also presented demoralization, 45.5% type A behavior and 50% DSM depression. On the contrary, 45.9% of demoralized, 29% of type A and 27.2% of depressed patients showed type D traits.
Discussion/conclusion: The use of psychosomatic and personality assessments may contribute to a better understanding of patients’ psychological distress than traditional psychiatric nosography. Moreover, it may help to identify early specific subgroups of patients who might be at greater risk for further psychological and cardiac problems
The modification of quality of life, well-being, psychosomatic and psychopatological distress in cardiac rehabilitation.
No full textIntroduction: Several studies documented the positive effects of cardiac rehabilitation (CR) on psychological distress. However, most of the research is focused on depression and anxiety, neglecting aspects with relevant clinical implications, such as psychosomatic diseases and well-being. The aim of this research was to evaluate the impact of CR on psychiatric and psychosomatic pathology, quality of life, psychological well-being and sub-clinical distress.
Methods: The experimental group (N=108), undergoing CR, was compared to a control group (N=85) of patients affected by cardiovascular diseases, not undergoing CR. The assessment included: the Structured Clinical Interview for DSM-IV (depression and anxiety), the structured interview based on Diagnostic Criteria for Psychosomatic Research (DCPR), MOS 36-Item Short Form Health Survey (SF-36), Symptom Questionnaire (SQ) and Psychological Well-Being Scales (PWB).
Results: 40.4% of the sample showed a DSM diagnosis, 62.1% suffered from at least one DCPR syndrome. Compared to the control group, CR was associated to the reduction of the most frequently observed psychiatric and psychosomatic diagnoses at baseline and to the enhancement of quality of life. On the contrary, there were no relevant effects on sub-clinical distress and well-being, except for purpose in life (PWB).
Discussion/conclusion: The findings suggest that psychopathology and psychosomatic suffering observed at baseline could be reactive to the cardiac event. However, persisting residual subclinical distress and impairments in well-being should be evaluated in a comprehensive psychosomatic assessment, since they could be linked with the exacerbation of psychiatric or cardiac diseases
Trattamento cognitivo-comportamentale atto anche a promuovere il benessere in pazienti depressi affetti da sindrome coronarica acuta: il progetto TREATED-ACS.
No full textLe Sindromi Coronariche Acute (SCA) spesso si associano a disturbi depressivi che influenzano lo stato di salute del paziente e sono associati ad esiti psicosociali negativi a lungo termine. Tali presupposti implicano la necessità di interventi mirati alla risoluzione degli stati affettivi di questi pazienti. Sebbene i farmaci antidepressivi siano efficaci nel ridurre la depressione in pazienti con SCA, il loro uso nei setting cardiaci rimane controverso. La terapia cognitivo-comportamentale (CBT) è un trattamento di provata efficacia per la depressione. Anche se l’unico studio che prevedeva un intervento di tipo comportamentale nel ridurre la morbilità e la mortalità cardiache in pazienti con SCA depressi (studio ENRICHD, 2003) ha mostrato che la diminuzione della depressione non è associata ad un miglioramento della sopravvivenza, è necessario verificare in studi ulteriori se il trattamento della depressione possa ridurre il rischio cardiovascolare in questi pazienti.
Molti studi sottolineano l’influenza del benessere psicologico nell’alterare la vulnerabilità individuale alla malattia o la qualità di vita. Ryff e Singer hanno ridefinito la specificità del concetto di salute in termini positivi, in base alla considerazione degli aspetti bio-psico-sociali dell’individuo. Gli approcci psicoterapici che si sono focalizzati su diversi aspetti del benessere hanno dimostrato efficacia nel migliorare la qualità di vita nei pazienti affetti da malattie croniche ed invalidanti. La terapia del Well-Being (WBT) sviluppata da GA Fava (1999) è una strategia psicoterapeutica a breve termine, basata sul modello di Ryff, che promuove il benessere. Essa può essere introdotta come ingrediente aggiuntivo della CBT nei setting cardiaci
Stati depressivi, personalità di tipo D e comportamento di tipo A in pazienti cardiopatici.
No full textScopo dello studio è stato quello di indagare la frequenza e la comorbilità tra diagnosi DSM dell’area depressiva (depressione maggiore/minore e distimia), specifiche diagnosi DCPR (demoralizzazione e comportamento di tipo A) e personalità di tipo D, in pazienti cardiopatici.
Il campione è composto da una serie consecutiva di 161 pazienti afferenti ad un programma di cardiologia riabilitativa in seguito ad un intervento di cardiochirurgia (principalmente bypass, sostituzione/plastica valvolare e angioplastica). L’assessment psicologico si è avvalso degli adattamenti italiani della SCID-I (moduli A e D), dell’intervista sui DCPR (moduli riguardanti demoralizzazione e comportamento di tipo A) e del questionario DS-14 (per la diagnosi di personalità di tipo D).
All’interno del campione le diagnosi DSM considerate ricorrono nel 34.8% dei casi, le diagnosi DCPR nel 31.7% e la personalità di tipo D nel 16%. Per quanto riguarda la valutazione delle comorbilità, è emerso come i 26 soggetti con personalità di tipo D presentino tutti una comorbilità con o una diagnosi di demoralizzazione o di comportamento di tipo A. È emersa inoltre una comorbilità significativa tra Depressione Maggiore e diagnosi di comportamento di tipo A e demoralizzazione.
I risultati suggeriscono la necessità di considerare, nell’assessment di pazienti cardiopatici, sia gli stati depressivi e le sindromi psicosomatiche che la presenza di personalità di tipo D, prestando particolare attenzione alle comorbilità fra queste diagnosi. In Cardiologia Riabilitativa l’assessment delle diagnosi depressive e delle sindromi psicosomatiche potrebbe condurre alla strutturazione di interventi specifici maggiormente mirati alla riduzione della sintomatologia
The role of psychiatric and psychosomatic correlates on lifestyles modification in cardiac rehabilitation.
No full textIntroduction: Cardiac rehabilitation (CR) is considered the most effective intervention for secondary prevention of patients with cardiovascular diseases. However, the role of psychiatric and psychosomatic complaints on the modification of unhealthy lifestyles is not clear. The aim of this research was to evaluate the impact of CR on risky lifestyles, considering the potential moderating role of depression, anxiety and psychosomatic syndromes on lifestyles modification.
Methods: 108 patients undergone CR (experimental group) were compared with 85 people affected by cardiovascular diseases, not undergoing CR (control group). The assessment included: the Structured Clinical Interview for DSM-IV, the structured interview based on Diagnostic Criteria for Psychosomatic Research (DCPR), GOSPEL questionnaire on lifestyles, Pittsburgh Sleep Quality Index, and Morisky Medication Adherence Scale.
Results: 32.1% and 19.2% of the sample suffered from depression and anxiety disorder, respectively. The most frequent DCPR syndromes were type A (31.9%), irritable mood (30.4%) and demoralization (29.3%). CR was associated with maintenance of physical activity, improvement of correct dietary behaviors and stress management, enhancement of quality of sleep. On the contrary, CR was not found to be associated with weight loss, healthy dietary habits, medications adherence. Depression and DCPR clusters of abnormal illness behavior, somatization and psychological factors affecting medical conditions mediated the modification of physical activity, stress management and pharmacological compliance.
Discussion/conclusion: The findings underline the need of a psychosomatic assessment and an evaluation of psychological sub-clinical symptomatology in cardiac rehabilitation, in order to identify and address specific factors potentially associated with the clinical course of the heart disease
Psychological factors affecting cardiologic conditions.
No full textThere are substantial data supporting a strong relationship between cardiovascular diseases and psychological conditions. However, the criteria for scientific validation of the entities currently subsumed under the DSM-IV category of 'Psychological factors affecting a medical condition' have never been clearly enumerated and the terms 'psychological symptoms' and 'personality traits' that do not satisfy traditional psychiatric criteria are not well defined; moreover, it is difficult to measure these subtypes of distress and there is always the need for a clinical judgment. In recent years psychosomatic research has focused increasing attention on these clinical and methodological issues. Psychosocial variables that were derived from psychosomatic research were then translated into operational tools, such as Diagnostic Criteria for Psychosomatic Research; among these, demoralization, irritable mood, type A behavior are frequently detected in cardiac patients. The joint use of DSM-IV criteria and Diagnostic Criteria for Psychosomatic Research allow then to identify psychological factors that seem to affect cardiologic condition. There remains the need to further investigate if treating both clinical and subsyndromal psychological conditions can improve quality of life and reduce the risk of morbidity and mortality in these patients
Correlati psicosomatici, modificazione di stili di vita e qualità della vita in pazienti sottoposti a riabilitazione cardiologica: uno studio di follow-up a 12 mesi.
No full textObiettivi: Lo scopo della ricerca è valutare l’impatto della Riabilitazione Cardiologica (RC) sulla modificazione di stili di vita e qualità di vita, considerando il possibile effetto moderatore delle sindromi psicosomatiche.
Metodi: Il gruppo sperimentale (N=108), sottoposto a RC, è stato confrontato con un gruppo di controllo (N=85), composto da pazienti cardiopatici non sottoposti a RC, sia alla baseline che ad un follow-up di 12 mesi. L’assessment includeva: Intervista DCPR, MOS 36-Item Short Form Health Survey; Questionario GOSPEL sugli stili di vita; Pittsburgh Sleep Quality Index; Morisky Medication Adherence Scale.
Risultati e conclusioni: La RC, rispetto alla condizione di controllo, è risultata associata a: mantenimento dei livelli di attività fisica, aumento dei comportamenti alimentari corretti e della capacità di gestione dello stress, miglioramento della qualità di vita e del sonno. Al contrario, non è risultata associata a: stile alimentare sano, perdita di peso e miglioramento dell’aderenza farmacologica; non ha inoltre svolto un ruolo protettivo nei confronti delle recidive cardiache. La presenza di somatizzazione e di comportamento abnorme di malattia sono risultati mediatori nell’influenzare rispettivamente la gestione dello stress e l’aderenza farmacologica. I risultati evidenziano l’importanza della valutazione psicosomatica in riabilitazione cardiologica, per identificare e gestire fattori potenzialmente associati al decorso clinico della patologia cardiaca
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