Psychosocial characteristics and self-reported functional status in patients on maintenance dialysis in Hungary.

AIMS: This survey was conducted to assess psychosocial problems and functional status among patients on maintenance dialysis in Hungary. METHODS: All adult patients (n = 4,321) receiving maintenance dialysis in the 56 dialysis centers in Hungary in 2006 were approached to participate in a national, cross-sectional survey. Patients completed a brief self-reported questionnaire. Socio-demographic parameters, disease-related information and data about functional status were collected. Self-rated health and depressive symptoms were also assessed. RESULTS: Mean age was 62 ± 14 y; 52% were males. The prevalence of diabetes was 30%. 46% of participants reported having depressive symptoms. Significant functional limitation was frequent. In multivariable regression models, female gender, poor self-reported finances, less education, history of acute myocardial infarction (AMI) or cerebrovascular disease, the presence of visual or hearing impairment and difficulties with basic activities of daily living were independently associated with the presence of depressive symptoms. In a separate model, age, dialysis vintage, history of AMI or cerebrovascular disease, the presence of visual or hearing impairments, difficulties with basic activities of daily living and also having depressive symptoms were independently associated with self-rated health score. CONCLUSIONS: Chronic dialysis patients in Hungary have disadvantaged socioeconomic status, frequent depressive symptoms and many functional limitations. Professional psychosocial help would be particularly important for this underprivileged patient population in addition to high quality dialysis to optimize outcomes.

Paradigm shifts in medical and dental education: behavioural sciences and behavioural medicine.

Psychosomatic and behavioural medicine have a long tradition in Hungary. In this paper, we highlight the possibilities of teaching behavioural medicine and behavioural science in the medical and dental curricula, particularly in the field of health promotion and prevention. There are a number of possibilities for dentists in the fields of behavioural science in both research and health policy. There is a need for closer integration of teaching, research and health policy in both general medicine and dentistry, and both doctors and dentists must approach their patients in a holistic way.

Psychosocial risk factors, inequality and self-rated morbidity in a changing society.

The aim of this study was to analyse the interaction of social, economic, psychological and self-rated health characteristics of the Hungarian population in representative, stratified nation-wide samples during the period of sudden political-economic changes. In 1988 20,902 and in 1995 12,640 persons, representing the Hungarian population over the age of 16 by age, sex and place of residence were interviewed. Self-rated morbidity characteristics, shortened Beck Depression Inventory, hopelessness, hostility, ways of coping, social support, control over working situation and socioeconomic characteristics were examined. Age dependent changes could be observed between 1988 and 1995 with increasing depressive symptomatology, hopelessness, lack of control over working situation in the population above 40 years, while in the younger population improvements in depressive symptomatology could be seen. According to hierarchical loglinear analysis, depressive symptom severity mediates between relative socioeconomic deprivation and higher self-rated morbidity rates, especially among men. Depressive symptomatology is closely connected with hostility, low control in working situation, low perceived social support and emotional ways of coping. A vicious circle might be hypothesised between socially deprived situation and depressive symptomatology, which together has a major role in higher self-rated morbidity rates.

Depressive symptomatology and vital exhaustion are differentially related to behavioral risk factors for coronary artery disease.

OBJECTIVE: This study proposes to assess the differences of two psychosocial risk indicators for coronary artery disease (CAD), ie, depressive symptoms and vital exhaustion. METHOD: In a representative, stratified, nation-wide sample of the population of Hungary over the age of 16 years (N = 12,640), analyses were made of whether those risk indicators were differentially related to several illness behaviors (including history of cardiovascular treatment and cardiovascular sick days), cognitions, mood states, and socioeconomic characteristics that may generally be associated with increased CAD risk. The sample was stratified by age, sex, and composition of the population of all counties in Hungary. RESULTS: Although depressive symptoms and vital exhaustion correlated strongly, there were clear and significant differences in strength of association between depressive symptoms, vital exhaustion and several variables under study. Dysfunctional cognitions, hostility, lack of purpose in life, low perceived self-efficacy, illegal drug use, alcohol and drug abuse, several forms of subjective disability complaints and history of treatment because of congenital disorders, and chronic skin and hematological disorders were more often associated with depressive symptoms, whereas loss of energy, use of stimulants, chest-pain-related disabilities, history of treatment because of cardiovascular disorders, and self-reported cardiovascular sick days were significantly more often associated with vital exhaustion. CONCLUSIONS: Vital exhaustion and depressive symptomatology are differentially associated with relevant external criteria. Vital exhaustion is associated with perceived cardiovascular complaints and history of cardiovascular treatment, whereas depressive symptomatology seems to be more closely connected to disabilities and complaints related to alcohol, drug, and congenital-disorder, and to dysfunctional cognitions and hostility.

Socioeconomic factors, severity of depressive symptomatology, and sickness absence rate in the Hungarian population.

We analysed the relationships between socioeconomic factors, severity of depressive symptomatology, and sickness absence rate in an active (working and studying) population of 20,902 persons representative of the Hungarian population over the age of 16 by age, sex, and place of residence. The severity of depression was very closely correlated with sick leave. Hierarchical log linear analysis was performed to investigate the interactive effects of socioeconomic factors, severity of depressive symptomatology, and sickness absence rate. Material socioeconomic factors such as housing situation, access to a car, and owning properties had no direct impact on sick leave, unless mediated by the effect of depression. All of the measured socioeconomic factors, with the exception of place of residence, were closely connected with depressive symptomatology, and depression appeared to mediate between socioeconomic factors and higher sickness absence rate. A vicious circle might be hypothesized between depression and a socially deprived situation, which plays a significant causal role in ill health.

Basal adrenocortical activity and DST in electrodermally differentiated subgroups of panic patients.

Twenty nine patients with panic disorder or agoraphobia with panic attacks were studied. The relationship between pre- and postdexamethasone serum cortisol level and electrodermal lability as reflected in electrodermal habituation rate and resting non-specific electrodermal activity was investigated. The frequency of non-suppression of cortisol following dexamethasone (DST non-suppressors) (at 5 micrograms/dl cut-off level) was 29.6% for the total group of patients. The basal plasma cortisol concentration showed positive correlation with the electrodermal habituation rate. The basal plasma cortisol level of slow habituator panic patients was significantly higher compared to rapid habituator patients, and it was above the normal range. On the contrary in rapid habituator panic patients the pre- and postdexamethasone cortisol difference was significantly less than in slow habituator patients, due to the normal basal plasma cortisol level and the relatively reduced rate of feedback suppression of cortisol following dexamethasone. Of the rapid habituator panic patients, 50% were non-suppressors following dexamethasone (at 5 micrograms/dl cut-off level). The above results might reflect two relatively different patterns of hypothalamic-pituitary-adrenal dysregulation in connection with two extremes of electrodermal habituation rate in panic patients.

Psychophysiological characteristics of anxiety patients and controls.

87 patients with panic syndrome or agoraphobia with panic were compared with 28 generalized anxiety patients and 29 controls. Psychophysiological measures included rating scales, autonomic responses patterns, auditory thresholds and vigilance characteristics. In panic patients the state anxiety and the blood and injury phobia were significantly higher than in generalized anxiety patients. The generalized anxiety group could be characterized by high trait anxiety, suicidal ideation and lower capacity for sustained attention. Phasic electrodermal response amplitudes to the first verbal stimulus were significantly higher on the nondominant hands of the panic patients and on the dominant hands of the generalized anxiety patients. At 8,000 Hz panic and generalized anxiety patients showed opposite asymmetries of auditory thresholds with a left ear advantage for generalized anxiety patients and a right ear advantage for panic patients. These results suggest a relative left-hemispheric activation dominance in panic patients and a relative right-hemispheric dominance in generalized anxiety patients. The most consistent background factors in both anxiety groups were the highly significantly increased dysfunctional attitudes, first of all the high level of external control compared to controls.

Neurotics at risk and suicidal behaviour in the Hungarian population.

On the basis of a study of 5,871 persons representative of the Hungarian population over the age of 20 by age, sex, place of residence and occupation, an analysis was made of the relationships between neurosis risk, suicidal behaviour, drinking habits and social and lifestyle characteristics. Measured by the Juhász Neurosis Rating Scale, the proportion of those at neurosis risk in the population was 23.6%, but considerable regional differences were found. Suicide attempts and the suicide rate by county proved relatively independent of each other. In the counties with higher suicides rates (South-East Hungary) and in the counties around the capital which have high rates of suicide attempts the proportion of those at neurosis risk was very high. The closest correlation with suicide attempts was found in the case of suicide in the family. Where there had been a suicide in the family, 26% of the subjects attempted suicide in the course of their life and where there had been no suicide, the proportion of persons making attempts was only 1%.

Electrodermally differentiated subgroups of anxiety patients. I. Automatic and vigilance characteristics.

A total of 32 anxiety patients (agoraphobia, panic syndrome, generalized anxiety syndrome) selected according to the DSM-III criteria were compared with 16 controls to determine distinguishing features of autonomic response patterns to a sequence of verbal and acoustic stimuli. In addition sensorimotor tasks were performed. The anxiety patients were classified into electrodermally stabile and labile subgroups on the basis of two reliably measurable psychophysiological parameters: the rate of electrodermal habituation to neutral stimuli and non-specific electrodermal activity. The electrodermally labile anxiety group was characterized by a high degree of variability in respiratory and pulse rate during the autonomic activation procedure. Within the control group the electrodermally labile subjects were characterized by a significantly higher pulse rate during the entire autonomic activation procedure. The reduced habituation capacity of the labile subgroup of anxiety patients compared to the controls was reflected in both retarded habituation and long durations of electrodermal responses to all verbal stimuli. This group also tolerated monotony; their performance did not drop during the 256 sensorimotor reaction time tasks and even exceeded the performance of the control group by the end of the test. The stabile anxiety subgroup had a significantly longer reaction time in all reaction time tasks than the labile subgroup of anxiety patients.

Electrodermal characteristics in psychosomatic patient groups.

Specific autonomic reaction patterns in different psychosomatic patient groups have been observed by several authors. In our study 50 male hypertensive patients and 47 male duodenal ulcer patients both in the early mild reversible stage of disease were compared with 65 male control persons to determine distinguishing features of electrodermal activity in response to a sequence of verbal, acoustic and colour stimuli. The two patient groups show opposite characteristics in respect to the initial skin resistance level, response amplitude and non-specific responses. Slower recovery can be seen only in an emotionally disturbing situation in the duodenal ulcer group. On the contrary, in orienting situations the control persons tend to show slower electrodermal recovery. According to the results of factor analysis, the components of electrodermal activity belong to 3 different factors, underlining the relative independence of these parameters. The first factor contains the electrodermal amplitude values. The temporal characteristics of electrodermal responses belong to two different factors, the first being in connection with the orienting situation and the second with the emotionally disturbing situation. The longer recovery in orienting situations is associated positively with facilitating achievement anxiety and negatively with debilitating achievement anxiety. The anxiety and neurosis scores belong to the third factor in connection with the prolonged electrodermal responses in emotionally disturbing situations. Anxiety and depression scores are higher in both patient groups, in accordance with the results of earlier studies. The parameters of electrodermal responses were analyzed as a function of psychological characteristics.

Autonomic and psychologic correlates in hypertension and duodenal ulcer.

Psychophysiologic response patterns of 47 male duodenal-ulcer patients, 50 male hypertensive patients, and a control group of 65 men were compared by recording skin resistance level and responses, finger pulse volume, and surface integrated electromyograms during a series of verbal, acoustic, and color stimuli. Personality characteristics were examined on the basis of the Eysenck Personality Inventory, the Lüscher Test, Juhász' Neurosis Scoring Scale, and the Achievement Anxiety Scale of Alpert and Haber. Using stepwise discriminant analysis of these psychophysiologic data for the control and the hypertensive groups and the control and duodenal ulcer groups, errorless postdiction of group membership was obtained, which indicates that the autonomic parameters and psychologic traits selected as characteristics show relationships that are relevant from the diagnostic viewpoint in the groups of patients. The method could be developed into a screening test procedure for use in the early detection of persons potentially at risk.