Cognitive-behavioral therapy for patients with somatoform disorders: A pilot preliminary randomized controlled trial.

Background and objective: Cognitive-behavioral therapy (CBT) for somatoform disorders (SFDs) is understudied in China. Western findings may not be applicable to Chinese culture. This preliminary study evaluated the efficacy of CBT for patients in China, relative to treatment-as-usual (TAU). Methods: Seventy patients with SFDs randomly received either combined CBT and TAU (CBT + TAU), or TAU alone between January 2018 to May 2019. The CBT + TAU group received 12 weekly individual 50-minute CBT sessions. Participants were blindly assessed at 4 timepoints (baseline, week 6, end of treatment: week 12; 12 weeks post-treatment: week 24) using the following outcome measures: SQSS (Self-screening Questionnaire for Somatic Symptoms); PHQ-15 (Patient-Health-Questionnaire-15) and the WI (Whiteley Index); GAD-7 (General Anxiety Disorder-7); HAMD-17 (Hamilton Depression Rating Scale-17); Family Burden Interview Schedule (FBIS); Sheehan Disability Scale (SDS); and the Short Form of Quality-of-Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF). The primary endpoint was the difference between the SQSS total score at week 24 and the baseline. A mixed model for repeated measures was used to analyze inter- and intra-group changes from the baseline. Results: At week 24, The least-squares mean (LSM) change of the total score on the SQSS was -18.87 points and -9.69 points, respectively in the CBT + TAU group and in the TAU group (LSM difference, -9.18 points; 95% confidence interval, -15.72 to -2.64; P = 0.0068). At week 24, the LSM changes from baseline in the WI, HAMD, PHQ15, FBIS and SDS total scores were significantly different between the two groups, however, there was no significant difference in the Q-LES-Q-SF. The SQSS of group effect sizes were 0.63 at 24 weeks. The dropout rates of the CBT + TAU and TAU groups were comparable (22.9% and 19.3%). Conclusions: These preliminary findings suggest that CBT may be helpful for improving the symptoms of patients with SFDs in China.

Association between quality of life and mental stress-induced myocardial ischaemia in high-risk patients after coronary revascularization.

OBJECTIVE: We sought to determine the association between mental stress-induced myocardial ischaemia (MSIMI) and quality of life (QoL) in patients with coronary artery disease (CAD) after coronary revascularization. METHODS: This cohort study involved patients with high-risk MSIMI who received coronary revascularization between Dec 2018 and Dec 2019. Patients who screened positive for depression/anxiety were enrolled in this study. Mental stress was induced by the Stroop Colour and Word Test 1 month after coronary revascularization. All participants underwent single photon emission computed tomography (SPECT) scans at rest and under mental stress. MSIMI was defined as the presence of four abnormal SPECT phenomena. QoL was assessed using the Seattle Angina Questionnaire (SAQ) prior to treatment and 1 month after coronary revascularization. RESULTS: Of the 1845 consecutive patients who received coronary revascularization, 590 (31.9%) had depression/anxiety, and 205 agreed to accept the mental stress test. During the average observation period of 33 days, 105 (51.2%) patients exhibited MSIMI. All SAQ subscales showed significant improvement, except for QoL, in the MSIMI group. The QoL score was lower (- 0.2 ± 32.7 vs. 13.1 ± 29.9, P = 0.005), and the proportion of deterioration in QoL was higher (50.5% vs. 31.9%, P = 0.010) in the MSIMI group than in the non-MSIMI group. Those with a deterioration in QoL had approximately twice the rate of MSIMI than those with an improvement in QoL (unadjusted OR: 2.019, 95% CI 1.122-3.634, P = 0.026; adjusted OR: 1.968, 95% CI 1.083-3.578, P = 0.017). CONCLUSION: Among patients with CAD who received coronary revascularization and had depression/anxiety, deterioration in QoL increased the likelihood of MSIMI. Hence, our results indicate that deterioration in QoL is a predictor of MSIMI. Trail Registration ChiCTR2200055792, retrospectively registered, 2022.1.20, www.medresman.org.cn.

Factors associated with depression and anxiety among caregivers of patients with atrial fibrillation.

AIMS AND OBJECTIVES: To assess the prevalence and associated factors of depression and anxiety among caregivers of patients with atrial fibrillation. BACKGROUND: Depression and anxiety are common in caregivers of patients with cardiovascular diseases, including heart failure and coronary artery disease. However, studies about depression and anxiety among caregivers of patients with atrial fibrillation are limited. DESIGN: Cross-sectional study. METHODS: We enrolled 465 dyads of patients with atrial fibrillation and their primary family caregivers from Beijing Anzhen Hospital between September 2020 and March 2021. The patient-caregiver dyads were excluded if primary family caregivers had previous mental disorders before the patient diagnosis of atrial fibrillation. Depression and anxiety of patients and caregivers were measured by Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scale. Multivariate logistic regression analysis was used to assess factors associated with depression and anxiety of caregivers. STROBE guidelines were followed to report this study. RESULTS: The prevalence of caregiver depression (Patient Health Questionnaire-9 score ≥5) and anxiety (Generalized Anxiety Disorder-7 score ≥5) was 14.0% and 13.5% respectively. Caregiver number of comorbidities ≥2 and patient depression were significantly associated with caregiver depression. Caregiver age ≥65 years, caregiver female sex and patient anxiety were predictors of caregiver anxiety. CONCLUSIONS: Depression and anxiety are common in caregivers of patients with AF. Better management of caregiver mental problems and associated factors may benefit both patients and caregivers. RELEVANCE TO CLINICAL PRACTICE: Clinicians and nurses should pay more attention to depression and anxiety in caregivers of patients with atrial fibrillation, and provide support to caregivers in most need.

Severe sleep disturbance is associated with executive function impairment in patients with first-episode, treatment-naïve major depressive disorders.

BACKGROUND: Sleep disturbance and executive function impairment are common in patients with major depressive disorder (MDD), though the relationship between the two remains unclear. We investigated this association in first-episode, treatment-naïve patients with MDD. METHODS: We analyzed data from 242 patients with MDD. We divided the patients into 2 groups based on sleep disturbance severity and compared the executive function odds ratios between the groups. RESULTS: A total of 121 pairs of patients were matched (age 39.4 ± 10.1, 70.2% female). After propensity score matching, the odds ratios for cognitive impairment in patients with MDD and severe sleep disturbance were 1.922 (1.068-3.459, P = 0.029, q = 0.044) in executive functioning; 2.023 (1.211-3.379, P = 0.007, q = 0.021) in executive shifting. CONCLUSIONS: Sleep disturbance is associated with executive functioning impairment in first-episode, treatment-naïve patients with MDD. Severe sleep disturbance can be a marker and aid in recognizing executive function impairment in patients with first-episode treatment-naïve MDD. Severe sleep disturbance can be a potential modifiable factor to improve executive function in MDD, as well as an effective measurement to improve cognition for sleep symptom management that should be enforced at initial treatment of first-episode MDD. Further study is required to confirm our results. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02023567 ; registration date: December 2013.

Influence of Hostility on 24-Hour Diastolic Blood Pressure Load in Hypertension Patients with Depressive Disorders.

BACKGROUND Hostility in hypertension patients combined with depressive disorders indicates a worse outcome for hypertension management. This study was designed to explore the influence of hostility on 24-h diastolic blood pressure in hypertension patients who also had depressive disorders. MATERIAL AND METHODS A total of 130 people with primary hypertension and depressive disorders were collected through unstructured psychiatric interview by a professional psychiatrist and ambulatory blood pressure monitor in this cross-sectional study. During the study, dynamic blood pressure was examined for 24 h by ambulatory blood pressure monitoring. Patients were divided into 3 groups according to the hostility level. Hostility was defined by hostile factors of the Symptom Checklist 90. The association between hostility and 24-h dynamic blood pressure was analyzed by multivariable logistic regression. RESULTS 30.8% (40 of 130) patients had a high level of 24-h dynamic blood pressure load (>30%), in which 14.6% was for male and 16.2% for female respectively. In male, the proportion of high 24 h DBP load (>30%) in highest hostility group was greater than that of low hostility group and median hostility group significantly (p=0.03). No significant differences were revealed among 3 groups in female. The age-adjusted odds-ratio (OR) 95% confidence interval of diastolic blood pressure across the categories of hostility were: in males, 1.44 (0.60, 3.47) (1 for reference), and in females, 5.86 (0.58, 59.06) (P for trend=0.04). CONCLUSIONS Our results showed that hostility may be a risk factor for increased 24-h diastolic blood pressure in hypertension patients who also have depressive disorders, especially in males. The clinical meaning of the study is that hypertension management should contain psychological interventions for better effects.