ABSTRACT
BACKGROUND: Information on the prevalence of adjustment disorders among cancer patients and the value of psychological interventions in this group of patients is limited. This study investigates the prevalence of adjustment disorders among cancer patients as well as the reach, effectiveness, cost-utility and budget impact of a tailored psychological intervention. METHOD: This study consists of two parts. Part 1 is an observational study among a representative group of mixed cancer patients after cancer treatment on the prevalence of adjustment disorder as well as the uptake (i.e. reach) of psychological treatment. In Part 2, patients diagnosed with an adjustment disorder are invited to participate in a randomized controlled trial. Patients will be randomized to the intervention (access to the tailored psychological intervention) or control group (waitlist period of 6 months). The psychological intervention consists of three modules: one module containing psycho-education (3 sessions, all patients) and two additional modules (maximum of 6 sessions per module) provided as continuum, in case needed. Module 2 and 3 can consist of several evidence-based interventions (e.g. group interventions, mindfulness, eHealth) The primary outcome is psychological distress (HADS). Secondary outcomes are mental adjustment to cancer (MAC) and health-related quality of life (EORTC QLQ-C30). To assess the cost-utility and budget impact, quality of life (EQ-5D-5 L) and costs (iMCQ and iPCQ) will be measured. Measures will be completed at baseline and 3 and 6-months after randomization. DISCUSSION: This study will provide data of the prevalence of adjustment disorders and the reach, effectiveness, cost-utility and budget impact of a tailored psychological intervention. TRIAL REGISTRATION: Netherlands Trial Register identifier: NL7763. Registered on 3 June 2019.
Subject(s)
Adjustment Disorders/epidemiology , Neoplasms/psychology , Psychotherapy , Adjustment Disorders/etiology , Adjustment Disorders/therapy , Adult , Clinical Protocols , Cost-Benefit Analysis , Female , Humans , Male , Mindfulness , Netherlands , Prevalence , Psychotherapy/economics , Psychotherapy, Group , Quality of Life , Research Design , Telemedicine , Treatment OutcomeABSTRACT
BACKGROUND: Humor trainings have positive effects on mental health and well-being. However, studies investigating the effects of humor trainings in clinical samples are still rare. This study investigated the efficacy and feasibility of a humor training for people suffering from depression, anxiety and adjustment disorders. METHODS: Based on a diagnostic interview (SCID I and II), 37 people were randomized into a training (n = 19) or wait list control group (n = 18) and completed questionnaires at pre, post, and 1 month follow-up. After the training group had completed its training and evaluation measures, the wait list control group received the training and the outcomes of the group were additionally evaluated (post2 and follow-up2). RESULTS: After training, improvements in humor-related outcomes were observed for the training group, but these were relativized when compared to the wait list control group. Secondary outcomes remained unaffected by the training. In addition, the training group reported interpersonal difficulties. Within-group analyses of the wait list control group after completion of their training showed effects on almost all primary and secondary outcomes and feedback indicated a better atmosphere. CONCLUSIONS: In summary, the different outcomes of the two groups are surprising and can show potential moderators of efficacy, such as interpersonal and group-specific climate variables. Since moderators of humor trainings in clinical samples have not been investigated at all, future studies should consider integrating them into their design. TRIAL REGISTRATION: The study was retrospectively registered in the German Clinical Trials Register ( DRKS00012443 ) on May 16, 2017.
Subject(s)
Adjustment Disorders/therapy , Anxiety Disorders/therapy , Depressive Disorder/therapy , Laughter Therapy/methods , Wit and Humor as Topic , Adjustment Disorders/epidemiology , Adjustment Disorders/psychology , Adult , Aged , Anxiety Disorders/epidemiology , Anxiety Disorders/psychology , Depressive Disorder/epidemiology , Depressive Disorder/psychology , Feasibility Studies , Female , Humans , Laughter Therapy/psychology , Male , Middle Aged , Retrospective Studies , Surveys and Questionnaires , Treatment Outcome , Waiting Lists , Wit and Humor as Topic/psychologyABSTRACT
OBJECTIVE: Similar to the spectrum of the traditional anxiety disorders, there are also different types of workplace-related anxieties. The question is whether in different professional settings different facets of workplace-related anxieties are predominant. METHODS: A convenience sample of 224 inpatients (71% women) from a department of psychosomatic medicine was investigated. They were assessed with a structured diagnostic interview concerning anxiety disorders and specific workplace-related anxieties. RESULTS: Office workers suffer relatively most often from specific social anxiety, insufficiency, and workplace phobia. Service workers suffer predominantly from unspecific social anxiety. Health care workers are characterized by insufficiency, adjustment disorders, posttraumatic stress disorder, and workplace phobia. Persons in production and education are least often affected by workplace-related anxieties. CONCLUSIONS: Different types of anxiety are seen in different professional domains, parallel to workplace characteristics.
Subject(s)
Anxiety/etiology , Occupational Diseases/etiology , Workplace/psychology , Adjustment Disorders/epidemiology , Adjustment Disorders/etiology , Adult , Aged , Anxiety/epidemiology , Female , Humans , Interview, Psychological , Male , Middle Aged , Occupational Diseases/epidemiology , Occupations/statistics & numerical data , Phobic Disorders/epidemiology , Phobic Disorders/etiology , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/etiology , Surveys and Questionnaires , Young AdultABSTRACT
OBJECTIVE: Patients with intracranial tumours often suffer from clinically relevant psychological distress. However, levels of distress and contributing factors have not been systematically evaluated for the early course of the disease. Using the National Comprehensive Cancer Network's Distress Thermometer (DT), we evaluated the extent and sources of distress within a population of patients with intracranial neoplasms. METHODS: One hundred and fifty-nine patients were included who underwent craniotomy for newly diagnosed intracranial tumours at our department. All patients completed the DT questionnaire, a single-item 11-point visual analogue scale measuring psychological distress. The appendant problem list (PL) consists of 40 items representing problems commonly experienced by cancer patients. Patients were asked to mark any experienced sources of distress. RESULTS: Percentage of patients suffering from relevant distress was 48.4% (cut-off ≥6). DT-scores were significantly associated with depression and anxiety as well as reported number of concerns. On average, patients reported 6.9 sources of cancer-related distress. Objective medical data (e.g. tumour stage) as well as sociodemographic data (e.g. gender, IQ) were not associated with psychological distress at this early phase. CONCLUSIONS: Prevalence of elevated distress is high shortly after primary neurosurgical treatment in patients with intracranial tumours and cannot be predicted by objective data. As a consequence, sources of distress can and should be routinely assessed and targeted in these individuals in this particular period. Further studies are needed to help to identify patients who are at risk of suffering from long-term emotional distress in order to enable targeted psychosocial intervention.
Subject(s)
Adjustment Disorders/diagnosis , Adjustment Disorders/psychology , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Brain Neoplasms/diagnosis , Brain Neoplasms/psychology , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Pain Measurement , Adaptation, Psychological , Adjustment Disorders/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Anxiety Disorders/epidemiology , Brain Neoplasms/epidemiology , Brain Neoplasms/surgery , Craniotomy/psychology , Cross-Sectional Studies , Depressive Disorder/epidemiology , Disability Evaluation , Female , Humans , Male , Middle Aged , Sick Role , Social Support , Surveys and QuestionnairesABSTRACT
OBJECTIVE: The 2008 Institute of Medicine's Report, Cancer Care for the Whole Patient (IOM, 2008), recommends screening cancer patients for distress. Cancer programs throughout the United States are struggling to achieve this standard. The IOM report indicates that only 14% of 1000 randomly selected American Society of Clinical Oncology (ASCO) members and eight of 15 National Comprehensive Cancer Network (NCCN) centers reported screening for distress in at least some of their patients [J Natl Compr Cancer Netw 2007;5:99-103]. Without adequate screening, distress often goes unnoticed by cancer professionals and there is little information about the prevalence of distress. The main objective of this article is to present data from 1281 distress screenings completed by patients treated within a community cancer center. Specifically, this article reports the intensity of distress, frequency of problem endorsement, and requests for specific psychosocial providers by cancer patients. METHOD: Medical and radiation oncology patients completed a distress screener before their first physician appointment. The screening instrument included the Distress Thermometer, a symptom checklist, and a list of psychosocial providers that the patient could request to meet. RESULTS: Thirty-two percent of this sample rated distress above the threshold level. Worry was the most common problem endorsed followed by financial issues. Emotional concerns were endorsed by 59% of the sample. The cancer dietitian was the psychosocial professional most frequently requested by patients. CONCLUSION: Distress screening can be accomplished within a community cancer center but the provision of psychosocial services is difficult given the high volume of need.
Subject(s)
Adjustment Disorders/diagnosis , Adjustment Disorders/epidemiology , Cancer Care Facilities/statistics & numerical data , Depressive Disorder/diagnosis , Depressive Disorder/epidemiology , Mass Screening/statistics & numerical data , Neoplasms/psychology , Adjustment Disorders/psychology , Adult , Aged , Aged, 80 and over , Colorado , Cross-Sectional Studies , Depressive Disorder/psychology , Female , Humans , Male , Middle Aged , Neoplasms/epidemiology , Neoplasms/therapy , Stress, Psychological/complicationsABSTRACT
BACKGROUND & OBJECTIVES: It is difficult for a single investigator to study the psychosocial changes that occur over the life span of an individual affected with a chronic illness like ß-thalassaemia major. Therefore, a developmental epidemiological perspective is required to understand the chain of events and problems of psychological nature. We aimed to construct the picture of developmental epidemiology for psychosocial aspects in families of ß-thalassaemia major patients attending a tertiary care hospital in north India. METHODS: The accelerated longitudinal design was used. The sample consisted of 100 children with ß-thalassaemia and their 150 parents, both groups were subdivided further so that each group represented the continuum of longitudinal course. The sampling was done for a period of 16 months from January 2004 to April 2005. RESULTS: Overall 54 per cent of children had significant psychopathology. Within the parents groups, 10 per cent had adjustment disorder, 33.3 per cent depressive disorder, and 10 per cent had anxiety disorder and 11 per cent somatoform disorder; 95 per cent of the parents of newly diagnosed children expressed feeling of dazed and shock, fear of death, hopelessness, separation anxiety and problems with their memory and concentration. There was significant difference only in the domain of psychological health in all the three groups of parents with respect to the quality of life. Among children, quality of life improved with their progression of illness. Growing up with ß-thalassaemic family was analyzed. INTERPRETATION & CONCLUSIONS: The developmental epidemiological perspective was constructed in ß -thalassaemic children and their family using an accelerated longitudinal design. Such a design can test the hypothesized aetiological or developmental function of a targeted risk factor within a developmental path and may be used in studying the psychological impact of even other chronic illnesses over the life span of an individual for conceptual and holistic understanding.
Subject(s)
Adjustment Disorders/epidemiology , Anxiety Disorders/epidemiology , Depressive Disorder/epidemiology , Family , Somatoform Disorders/epidemiology , beta-Thalassemia/epidemiology , beta-Thalassemia/psychology , Adult , Attitude to Health , Child , Data Collection , Humans , India/epidemiology , Longitudinal Studies/methods , Parents/psychology , Psychology , Quality of Life/psychology , Statistics, NonparametricABSTRACT
Objetivo. Analizar el índice de concordancia diagnóstica entre atención primaria y salud mental. Diseño. Estudio descriptivo, retrospectivo. Emplazamiento. Centro de Salud Mental de Estella (Navarra). Participantes. Inclusión de pacientes adultos nuevos consecutivos remitidos a salud mental (n = 1.005) entre julio de 2002 y marzo de 2005. Mediciones principales. Análisis de los diagnósticos realizados en atención primaria y salud mental en el período de tiempo establecido. Cálculo del índice kappa de concordancia interjueces. Resultados. La concordancia global diagnóstica tiene un índice kappa = 0,385 (± 0,018). En los trastornos por uso de alcohol y otras sustancias y los trastornos psicóticos se obtienen índices de concordancia elevados (kappa > 0,7). Los trastornos de la alimentación y el trastorno mental orgánico reflejan una concordancia moderada (índice kappa entre 0,4 y 0,7). Sin embargo, en los trastornos de ansiedad, adaptativos y afectivos se obtiene una concordancia baja (kappa < 0,3). Conclusiones. En general, la concordancia entre los diagnósticos realizados en atención primaria y salud mental es baja. En concreto, destaca la dificultad para identificar adecuadamente los trastornos adaptativos, y se observa una importante tendencia por parte de atención primaria a filiar como cuadros ansiosos o afectivos estos trastornos
Objective. To analyse the diagnostic concordance index between primary care and mental health. Design. Retrospective and descriptive study. Setting. Mental health centre, Estella, Navarra, Spain. Participants. New consecutive adults patients referred to mental health (n=1005) from july 2002 to march 2005. Main Measurements. Analysis of diagnoses made in primary care and mental health during the time period. Calculation of kappa index for inter-observer concordance. Results. General diagnostic concordance had a kappa index =0.385 (±0.018). High concordance index (>0.7) was obtained for alcohol and other substance use disorders and psychotic disorders. Moderate concordance index (0.4-0.7) was obtained for eating disorders and organic mental disorders. However, low concordance index (<0.3) was obtained for anxiety, adaptative, and affective disorders. Conclusions. In general, diagnostic concordance between primary care and mental health is weak. Particularly noticeable was difficulty in identifying adaptative disorders adequately. There was a strong tendency in primary care to identify these disorders as anxiety or affective disorders
Subject(s)
Humans , Male , Female , Adult , Primary Health Care/methods , Mental Health , Mood Disorders/epidemiology , Personality Disorders/epidemiology , Diagnosis, Differential , Clinical Diagnosis , Comorbidity , Mental Disorders/epidemiology , Adjustment Disorders/epidemiology , Retrospective Studies , Anxiety Disorders/epidemiology , Adaptation, Physiological/physiology , Adaptation, Psychological/physiology , Adjustment Disorders/complicationsABSTRACT
Ginkgo biloba special extract EGb 761, an anti-dementia drug, enhances cognitive functioning and stabilizes mood in cognitively impaired elderly subjects. Moreover, EGb 761 had been found to alleviate symptoms of anxiety in people with mental decline, therefore it was now tested for clinical efficacy in younger patients suffering from anxiety. One hundred and seven patients with generalized anxiety disorder (GAD, n=82) or adjustment disorder with anxious mood (ADWAM, n=25) according to the diagnostic and statistical manual of mental disorders, third edition - revised (DSM-III-R) were randomized to daily doses of 480 mg EGb 761, 240 mg EGb 761 or placebo for 4 weeks. Intention-to-treat (ITT) analyses were performed on the primary outcome measure, the Hamilton rating scale for anxiety (HAMA), and the secondary variables, the clinical global impression of change (CGI-C), the Erlangen anxiety tension and aggression scale (EAAS), the list of complaints (B-L'), and the patient's global rating of change. The HAMA total scores decreased by -14.3 (+/-8.1), -12.1 (+/-9.0) and -7.8 (+/-9.2) in the high-dose EGb 761, the low-dose EGb 761 and the placebo group, respectively. Changes were significantly different from placebo for both treatment groups with p=0.0003 (high-dose group) and p=0.01 (low-dose). Regression analyses revealed a dose-response trend (p=0.003). EGb 761 was significantly superior to placebo on all secondary outcome measures. It was safe and well tolerated and may thus be of particular value in elderly patients with anxiety related to cognitive decline.
Subject(s)
Adjustment Disorders/drug therapy , Adjustment Disorders/epidemiology , Affect , Anxiety Disorders/drug therapy , Anxiety Disorders/epidemiology , Phytotherapy/methods , Plant Extracts/therapeutic use , Cognition Disorders/epidemiology , Dose-Response Relationship, Drug , Double-Blind Method , Drug Administration Schedule , Female , Ginkgo biloba , Humans , Male , Middle Aged , Plant Extracts/administration & dosageABSTRACT
The wacinko syndrome in the Oglala Sioux varies from a nonclinical reaction to pathological degrees of anger, pouting, withdrawal, depression, psychomotor retardation, mutism, immobility, and even to suicide. Although indigenous proctitioners recognize the syndrome as a distinctive disorder, it has not been described by non-Indian practitioners. The author presents a case report and suggests that most cases are diagnosable as reactive depressive illness.