[Chronic obstructive pulmonary disease: sense of coherence and family support versus anxiety and depression].

Chronic Obstructive Pulmonary Disease (COPD) is mainly related to smoking habit and is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Worldwide and in Greece, COPD constitutes a major epidemiological issue. Incidence of depression and anxiety is high in the COPD population. Most studies on depression and anxiety in COPD deal with factors that are positively correlated with both of these comorbidities. The aim of our study was to assess whether two variables, sense of coherence (SOC) and perception of family support (FS), are negatively correlated with depressive and anxiety symptoms in outpatients with COPD. According to Aaron Antonovsky, sense of coherence refers to the ability of individuals to make sense of and manage events. Studies in other diseases suggest that sense of family support has a significant impact on the course and outcome of the disease, yet a limited number of reports across literature addresses the role of family support in COPD patients. In our present study one hundred twenty two (98 men and 24 women) outpatients with pure COPD were included. Age and years of education were recorded. Severity of COPD was assessed with spirometry before and after bronchodilation. All patients replied to self- administered questionnaires on depression (Beck Depression Inventory, BDI), anxiety (Spielberger State-Trait Anxiety Scale, STAI), family support (Family Support Scale, FSS-13) and sense of coherence (Sense of Coherence Scale, SOC). According to our results the mean BDI depression score was 11.65 (SD 7.35), mean trait anxiety score was 40.69 (SD 11.19), mean SOC score was 54.62 (SD 7.40) and mean FS score was 64.58 (SD 11.63). Women patients had higher anxiety scores and lower sense of family support compared to men. Significant negative correlations were evidenced between depression and sense of coherence as well as between anxiety and family support. Step-wise multiple linear regression analysis verified the results and quantified the aforementioned correlations. Notably, raising scores in sense of family support by one point reduces anxiety scores by 0.14 points, and increasing sense of coherence scores by one point reduces depression scores by 0.21 points. In sum, our study confirms the presence of high levels of anxiety and depressive symptoms in COPD patients, with females being in a more disadvantaged position as they tend to have higher levels of both. Sense of coherence and family support are both protective psychological factors against the risk of developing anxiety and depressive symptoms in these patients.

[Psychological and psychiatric problems in cancer patients: relationship to the localization of the disease].

Cancer may be localized in a variety of areas in the human body. This localization is associated with significant issues concerning not only therapy and prognosis but also psychological and psychiatric problems that the patient may be confronted with. The psychic impact on the patient is determined to a significant degree by the symbolism the affected organ carries. The symbolic significance of a sick body area triggers emotions and sets in motion self-defence mechanisms. In this way, patients deal with the new psychic reality that cancer creates. Therapeutic choices may include interventions, involving mutilation, which cause disfigurement and major consequences in the body image which result in narcissistic injuries. The phenomenology of anxiety and depressive disorders is connected to the affected body area. The appearance of cancer not only in sexual organs but also in other body areas, may disturb sexual function and therefore lead to sexual disorders. Especially, head and neck are connected with vital functions. This area of the body has had a major impact on psychic reality since early life. Complicated psychic functions have developed in relation to organs of the head and neck. Therefore, localization of cancer in this area leads to individual psychological and psychiatric problems, since eating and breathing are harmed, verbal communication becomes difficult and body image alters. Also, increased incidence of alcohol and nicotine abuse in these patients reflects special aspects of psychic structure and personality. Because of severe somatic symptoms and poor prognosis, lung cancer patients feel hopelessness and helplessness. Patients with gynaecological cancer are confronted with a disease that affects organs like breast and internal female sexual organs associated with femininity, attractiveness and fertility. Dietary habits are often a source of guilt for patients who suffer from cancer of the gastrointestinal tract. Additionally, stomas, as colostomy, affect body image and cause feelings of embarrassment with severe consequences on the patient's sense of wellbeing, his or her daily activities, interpersonal relationships or sexuality. Depressive symptoms often occur in prodromal stages of pancreatic cancer. Depression is a common diagnosis in patients with prostate cancer. Prostatectomy negatively affects patient's self-esteem, because it might be experienced as a threat to his sexual life. Disfigurement is related to skin cancer because of both cancer and surgical procedures. Therefore, it is a challenge for modern psycho-oncology to identify those patients who are vulnerable in developing psychiatric symptoms, to early diagnose anxiety and depression and to use psychotherapeutic interventions targeting individual psychological and psychiatric problems in relation to the localization of disease in the human body.

[Psychological dimension of cancer genetics: Doctor-patient communication].

Cancer is a disease that threatens life and body integrity. A method of cancer prediction is genetic testing, thus the primary detection of individuals who have oncogenes and are at risk of a hereditary cancer. Genetic counseling is the translation of technical information by physicians and the analysis of the problems subsequent to this information, into the therapeutic relationship. Generally, the communication between medical staff and patient must follow certain rules. There are two goals; the physician's comfort when he is dealing with giving news, especially bad news and the maintenance of patient's hope during making decisions for his health and his life. Communication skills focus on emotional reaction and empathy towards the patient.

[Psychological and psychiatric problems in cancer patients in the general hospital].

Cancer is the most common cause of death after heart disease. The patient diagnosed with cancer confronts high levels of emotional distress, while he has to make crucial decisions about his treatment. As a life threatening illness, it is a traumatic stressor which triggers overwhelming feelings and affects the patient's functioning. There is a variety of psychological responses. Anger, fear, anxiety, hopelessness attend the diagnosis of cancer. Fifty percent of affected individuals develop psychiatric disorders, such as Stress Response Syndromes like Acute Response Syndromes, Post-traumatic Stress Disorder, Major Depression, Adjustment Disorders, and Delirium. The members of consultation-liaison psychiatry intervene in a wide spectrum of psychiatric complications of cancer. Also, there are patients with major psychiatric disorders such as schizophrenia who develop cancer and the psychiatrist has to give them an understanding of the illness and to facilitate their active participation in the medical treatment. The main purpose is co-operation between consultation liaison psychiatrists and physicians. Psychiatrists make efforts to promote a better understanding of schizophrenia among physicians and to fight the stigma attached to the disease. The risk of suicide is higher in cancer patients, than in general population and the identification of patients at increased risk of suicide among affected individuals such as those with major depression, alcohol abusers, uncontrolled pain, advanced illness is a very important step in suicide prevention. When the end of life is approaching, psychiatrists have to face physical problems, psychological symptoms and issues of existence, which pose special challenges for the patient. The psychiatrist has to help him to reduce the psychological pain and to encourage his family to listen to his wishes. The consultationliaison psychiatrists intervene at every stage of cancer from the prevention and the preclinical cancer, to palliative care and end-of-life, with diagnosis and effective therapy.