Sexual functioning in patients with multiple sclerosis and its association with social support and self-esteem.

Sexual dysfunction is very commonly reported by people with multiple sclerosis (MS). However, this problem often remains under-diagnosed and under-treated. Furthermore, still very little is known about protective psychosocial factors that may help to improve sexual functioning in MS patients. Thus, we aimed to assess the associations between social support, self-esteem and sexual functioning in MS patients when controlled for clinical and sociodemographic variables. The Expanded Disability Status Scale (EDSS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Rosenberg Scale of Self-esteem (RSE) were used to assess the independent variables. Sexual functioning was assessed by the Incapacity Status Scale (ISS). We found a significant association between social support and sexual functioning (p = 0.01). However, this association attenuated (p < 0.05) when self-esteem (p < 0.01) was added to the model. Furthermore, we found that sexual dysfunction in MS patients was associated with older age (p < 0.001). Self-esteem was associated with sexual functioning more strongly compared to social support and sexual functioning, even though both of these variables were associated with sexual functioning as well. Our findings support the biopsychosocial model of treatment of sexual dysfunction in MS patients.

Fatigue and Suicidal Ideation in People With Multiple Sclerosis: The Role of Social Support.

Fatigue and poor sleep quality are among the most common patient-reported problems associated with multiple sclerosis (MS). Social support, on the other hand, is often found to be positively associated with quality of life in patients with neurological diseases. Studies also show that suicidal ideation (SI) levels in MS are elevated compared to the general population. Thus, the aim of this study is to assess the associations between fatigue, social support, and SI in patients with MS. Out of 184 MS patients asked to participate in this cross-sectional study, 156 agreed (RR 69.8%; 75% female; mean age: 39.95 ± 9.97 years). Patients filled-in the Multidimensional Fatigue Inventory-20, the Pittsburgh Sleep Quality Index, the Multidimensional Scale of Perceived Social Support and the subscale of the General Health Questionnaire-28 focused on assessing SI. Models were controlled for age, gender, disease duration, functional disability, and sleep quality. Data were analyzed using multiple linear regressions. SI was positively associated with lower sleep quality and four types of fatigue: general, mental, reduced activity, and reduced motivation (p < 0.05). Physical fatigue was not significantly associated with SI. Social support was negatively associated with SI in all models. The final models under study explained from 24.3 to 29.7% of the total variance in SI. SI yielded associations with both sleep quality and fatigue, with the exception of physical fatigue. Information provided by physicians on sleep management, and a psychosocial intervention focused on people who provide support for patients with MS (family, friends, and significant others) may reduce levels of SI.

[Barriers of the initiation of insulin treatment in type 2 diabetic patients - conquering the "psychological insulin resistance"]. / Az inzulinkezelés elkezdésének gyakorlati akadályai 2-es típusú cukorbetegekben ­ a "pszichológiai inzulinrezisztencia" leküzdése.

Type 2 diabetes is a progressive disease and its consequence is the gradual decrease of endogenous insulin secretion to a very low level. Beyond this point, without insulin it is not possible to achieve proper metabolic compensation. The authors are trying to explain why the insulin therapy is often delayed in type 2 diabetic patients despite existing guidelines about its initiation and continuation. The causes of delay can be divided into two groups. One is the fear and disagreement of the patients (psychological insulin resistance - PIR) arising from different cognitive, emotional and other reasons. The second is the "clinical inertia", when the physicians are not able to explain in an effective and persuasive way the rationale and necessity of insulin treatment to their patients. The common background of both causes is the lack of sufficient knowledge about the pathogenesis of type 2 diabetes and the rationale of insulin treatment together with an insufficient level of communication between doctor and patient. The authors see the solution in the improvement of pre- and postgradual education of doctors and other health care providers (nurses, educators, psychologists), in their mutual cooperation and the translation of their knowledge towards a system of successful patient education. Orv Hetil. 2019; 160(3): 93-97.