Prevalence of adjustment disorder among cancer patients, and the reach, effectiveness, cost-utility and budget impact of tailored psychological treatment: study protocol of a randomized controlled trial.

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.

Different workplace-related strains and different workplace-related anxieties in different professions.

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.

Involvement of a psychiatric consultation service in a palliative care team at the Japanese cancer center hospital.

OBJECTIVE: Close collaboration between the cancer care team service and the psychiatric consultation service is recommended to provide adequate comprehensive care to cancer patients. In Japan, specialized palliative care teams work in conjunction with consultation-liaison psychiatrists as an essential members. There are, however, few studies reporting on these services. METHODS: We obtained the characteristics, physical and psychiatric symptoms and outcomes of cancer patients by analyzing the database of patients referred to the palliative care team at the National Cancer Center Hospital East, Japan. RESULTS: Among consecutive 2000 referrals, most patients referred to the palliative care team present both physical and psychiatric symptoms. Psychiatric diagnoses were provided for ∼70% of these patients. Consultation-liaison psychiatrists provided medical care to 80% of all the referrals. The main symptoms for psychiatric consultation were delirium (28%), adjustment disorder (18%), major depression (7.6%) and dementia (6.6%). CONCLUSIONS: Psychiatric problems are common in cancer patients of the palliative care team. The palliative care team should assess the psychiatric problems in cancer patients, and the involvement of the consultation-liaison psychiatrists in the palliative care teams may be one of the strategies to establish the psychosocial support for cancer patients in the acute hospital settings.

Cognitive and behavioral treatments for anxiety and depression in a patient with an implantable cardioverter defibrillator (ICD): a case report and clinical discussion.

Implantable cardioverter-defibrillators (ICDs) are the treatment of choice for patients at risk for potentially life threatening arrhythmias. The associated stress of living with an implanted device and receiving ICD shock therapy has been noted to exert a psychological toll on the individual patient and family. Anxious and depressive symptomatology is frequently reported by these patients, thus creating a demand for tailored psychological interventions for this population. The current case report describes the components, delivery, and effectiveness of a targeted treatment approach for anxiety and depression in an individual with an ICD. Test results and interview data revealed significant improvements in multiple domains of cognitive, emotional, and behavioral functioning. Improvements in marital relations were also achieved. These treatment effects were maintained at follow-up and in the context of acute, medical stressors. Future clinical and research directions are also discussed.

[Adjustment disorders in oncology: a conceptual framework to be refined]. / Le trouble de l'adaptation en oncologie: un cadre conceptuel à préciser.

The use of stringent sets of diagnostic criteria often represents a daily clinical challenge for mental health professionals caring for cancer patients. Many nosological classification systems were not specifically developed to meet the peculiarities associated with the emotional experience of cancer. In particular, the diagnosis of adjustment disorder according to the Diagnostic and Statistical Manual of mental disorders appears inappropriate in this context. It is questionable, indeed, how to assess the "excessive" nature of psychological distress ari-sing in response to such a burdening event as a cancer diagnosis. Furthermore, the conceptual validity of the adjustment disorder construct may be of poor clinical relevance in patients suffering from a life-threatening medical condition and its widespread consequences. In this paper, we intend to offer an operational definition of adjustment and we argue that a vast majority of cancer patients currently receiving a diagnosis of adjustment disorder actually suffer from either subthreshold depression or from full or partial presentation of post-traumatic stress disorder. We first briefly review some available models of psychological adaptation. We also argue that trying to explain the experience of cancer alongside a continuum of psychological distress does not help us to better understand underlying adjustment processes and to treat emotional disturbances more effectively. The literature is currently scanty about the critical role of a psychological trauma, namely the diagnosis of cancer, in generating emotional, cognitive and behavioral responses. The very fact that an average of 10% of cancer patients have been shown to meet criteria for PTSD might suggest that the existence of a specific trauma stress adaptation process in this particular patient population. The confirmation of these hypotheses by clinical observation, experimental psychology paradigms or functional brain imagery studies could have substantial implications for the treatment of psychological distress in patients with cancer. Issues such as the relevance of pharmacological treatment of subthreshold depression--which has received little attention in the general literature--or the role of psychodynamic approaches in the management of cancer-related traumatic dimensions, should be addressed systematically.

Effects of a modified group intervention with early-stage breast cancer patients.

The aim of this study was to investigate the clinical effectiveness of a psychiatric intervention program consisting of 5 weekly structured interventions and 3 additional group meetings every two months. Previous studies revealed that a 5 weekly structured intervention program was effective for alleviating psychological discomforts in Japanese breast cancer patients, and that the effectiveness persisted for 6 months for patients without lymph node metastasis or adjustment disorders. Since this 5-session intervention did not have persistent effects in patients with lymph node metastasis and/or adjustment disorders, 3 additional group meetings every two months were added after completion of the 5 weekly structured interventions. A total of 43 breast cancer patients completed the full program. The Profile of Mood States (POMS) scores were compared before, immediately after 5 sessions, immediately after the 3 additional interventions, and 6 months after all programs. As analyzed by POMS scores, the clinical effectiveness of a structured group intervention program persisted for 6 months for patients even with nodal metastases and/or adjustment disorders. These findings of the present study suggested that the 5 weekly intervention program was sufficient for patients without lymph node metastasis or adjustment disorders. In contrast, this intervention program alone was insufficient for patients with nodal metastases and/or adjustment disorders. For them, a new psychiatric intervention program consisting of 5 weekly structured interventions and 3 additional group meetings every two months were effective and sufficient.

Dolor abdominal recurrente: un trastorno somatomorfo / Recurrent abdominal pain: a somatomorf disorder

El dolor abdominal recurrente es un problema común en pediatría. La etiología es desconocida, aunque se relaciona con un origen psicosomático. En este trabajo analizamos el dolor abdominal recurrente como trastorno somatomorfo indiferenciado, según los criterios del DSM-IV, y estudiamos los factores psicológicos asociados a la etiología, fisiopatología, diagnóstico y tratamiento (AU)

Factors associated with the effects of a structured psychiatric intervention on breast cancer patients.

The authors developed a structured group intervention for Japanese breast cancer patients. This program is a series of five 90-minute sessions including psycho-education, problem-solving, psychological support, relaxation training, and guided imagery. The aim of this study was to investigate discriminating factors between the improving and non-improving group. From November 1996 through November 1998, 110 patients participated in this study. Out of 110 patients, 9 failed to complete the five sessions. Nine did not return the questionnaire 6 months later, due to death of 3 individuals and re-location of 6. The remaining 92 patients were analyzed. The subjects were administered the Profile of Mood States (POMS) at entry and 6 months after the completion. According to the overall change in Total Mood Disturbances scores of the POMS, 69 subjects were categorized into the improving group and 23 into the non-improving group. This study defined several factors which discriminated between the improving and the non-improving group. These factors can be summarized as: (1) 'good relationship with doctors', (2) 'family support/understanding', (3) 'more intervention benefit', and (4) 'no comorbid adjustment disorders' at entry. Further modification is suggested such as an educational approach for family members to increase their understanding/support and also additional support for patients with adjustment disorders is suggested.

[Calcium channel blockers as antidepressants--a property of the class or of the individual preparation?]. / Blokatory kal'tsievykh kanalov kak antidepressanty--svoistvo klassa ili otdel'nogo preparata?

Only did nifedipine and fendiline decrease immobilization time in mice in the tail suspension test. 5-Hydroxytryptophan-induced head-twitches were slightly (insignificantly) diminished by nifedipine and verapamil. The two drugs potentiated the hypothermic action of reserpine. Fendiline and cinnarizine increased the effect of 5-hydroxytryptophan, but did not modify the effect of reserpine. Diltiazem was virtually inactive in these tests. All the calcium channel blockers decreased the cataleptic action of haloperidol. It is concluded that nifedipine and fendiline are promising in stress-induced reactive depression.

Contingent and non-contingent biofeedback training for Type A and B healthy adults: can Type As relax by competing?

This paper investigates an alternative approach to the modification of cardiovascular reactivity in healthy Type A adults using contingent (true) and non-contingent (false) heart rate biofeedback. Sixteen Type A and sixteen Type B subjects were either given instructions to compete for heart rate reduction or were given no competitive instructions. There were four relaxation sessions. In one, subjects were given contingent heart rate biofeedback and in another they were given no feedback. In two sessions 'feedback' was non-contingent: in one condition feedback suggested that heart rate decreased across the session; in the other the suggestion was of increase. Results showed that overall, biofeedback was an effective method for heart rate reduction but non-contingent feedback (decreased heart rate) was found to be as effective as contingent feedback. Overall, Type A subjects reduced heart rate significantly more than Type Bs. More importantly, Type As reduced heart rate significantly more when competing than when competition was not mentioned. These results suggest that core elements of Type A behaviour, in particular competition, could be exploited in the modification of physiological hyperactivity in healthy Type A individuals.

[Psychosomatic medicine in intensive care units (author's transl)]. / Psychosomatik der Intensivmedizin.

Psychosomatic medicine in intensive care units is essentially characterized by problems arising from the emotional involvement of the intensive care unit team. That is why the functions of a psychosomaticist are not only the diagnostics of psychosyndromes and the psychotherapy of dangerously ill patients, but especially the study of psychological interrelations within the unit team. Hypochondriac depressive psychosyndromes caused by the experience of dread, confusion, exhaustion and communication problems, as well as psychosyndromes characterized by a reduction of consciousness and orientation are discussed. Anaclitic psychotherapy, i.e. supporting and encouraging care, and emergency psychotherapy actually required in precarious situations, are described. The specific interrelations within and between the individual groups of the intensive care unit team (physicians, female and male nurses), which are important to the working conditions in the unit, and the possibilities of their psychological activation (e. g. in Balint groups) are outlined. The status and responsibility of a psychosomaticist within the unit team is critically reflected. Finally, the permanent confrontation of the team with death and dying is emphasized, and the psychological aspect of discontinuing intensive care is discussed.

A culturally patterned depression in a mother after loss of a child.

The phenomenology of clinical psychiatric syndromes is conditioned by the cultural ambience of the patient. This paper describes a reactive depression in an Amerindian woman (Trio group) of Surinam, which followed the form, onset, and outcome prescribed by her tribal tradition.