A multidisciplinary approach for patients with non-specific chronic low back pain: study protocol and preliminary findings

Non-specific chronic low back pain is a frequent cause for disability and a recurrent cause for medical consultation with high costs to public health. Although physiotherapy usually reduces disability and pain-related anxiety-depressive symptoms, many patients still report partial improvement and recurrent and disabling pain episodes. Therefore, a new approach to rehabilitate chronic low back pain that includes other modulating psychosocial factors is necessary. This article presents preliminary findings from the chronic low back pain study protocol (N= 71; Clinical Trials Reference NCT01993355) aimed to assess the effects on patients’ health-related quality of life of two complementary interventions to standard physiotherapy (n= 22); sophrology (n= 26) and cognitive-behavioral group intervention (n= 23). After 6 months, intervention groups showed no improvements in any of the variables assessed. Only the control group showed lower mean scores for self-perceived pain. Characteristics of the interventions (e.g. specific contents, abilities trained, intensive planning, group format, etc.) could explain these counterintuitive results. More research is needed to investigate the efficacy, efficiency and specific characteristics of multidisciplinary interventions that better address the needs of this population with chronic low back pain (AU)

No disponible

Protocolo unificado para la evaluación psiquiátrica y psicológica de candidatosa trasplante de órganos y tejidos, PSI-CAT / Unified Protocol for psychiatric and psychological assessment of candidates for transplantation of organs and tissues, PSI-CAT

Introducción. El trasplante es la opción terapéutica que ofrece mayor supervivencia y calidad de vida frente al fallo de un órgano. Los aspectos psiquiátricos y psicológicos de los candidatos a trasplante son relevantes, especialmente en la etapa de evaluación previa, pues la influencia de estos factores puede dificultar la evolución posquirúrgica, tanto en la supervivencia del órgano implantado como en la calidad de vida de la persona trasplantada. Son de especial importancia los factores vinculados a la patología por uso de sustancias, los trastornos psicopatológicos y el soporte psicosocial. Actualmente, existen pocas Guías que orienten sobre la correcta evaluación de los pacientes candidatos a estos procedimientos complejos. Método. Diecinueve psiquiatras y psicólogos clínicos de 6 hospitales públicos de Cataluña realizaron un trabajo sistemático de consenso para llegar al diseño de un protocolo unificado de evaluación psicológica y psiquiátrica. Se implementó un plan de trabajo anual, se definieron objetivos y se realizó una revisión bibliográfica, se discutieron los criterios de inclusión y exclusión, se seleccionaron los cuestionarios y se elaboró la entrevista estructurada. Resultados. Con el cumplimiento del plan de trabajo, se diseñó el Protocolo de Evaluación que se presenta en este artículo. Conclusiones. El trabajo sistematizado y la colaboración intercentros de psiquiatras y psicólogos clínicos ha facilitado homogeneizar y consensuar un protocolo unificado de evaluación (AU)

Introduction. Transplantation is the treatment option that offers improved survival and quality of life as compared to organ failure. Psychiatric and psychological aspects of transplant candidates are important, especially in the pre-assessment stage, as the influence of these factors can hinder post-surgical outcome in both the implanted organ survival and the quality of life of the transplanted person. Of particular importance, are the factors related to pathology due to substance use, psychopathology, and psychosocial support. There are currently few guidelines on the correct evaluation of patients eligible for these complex procedures. Method. Nineteen psychiatrists and clinical psychologists from six public hospitals in Catalonia conducted a systematic consensus to determine the design of a Unified Protocol psychological and psychiatric evaluation. An annual work plan was implemented, during which; the objectives were defined, a literature review was conducted, the inclusion and exclusion criteria were discussed, questionnaires were selected, and a structured interview was developed. Results. With the implementation of the work plan, the Assessment Protocol presented in this article was designed. Conclusions. systematic work and improving cooperation between psychiatrists and clinical psychologists, has led to homogeneity and consensus on a unified evaluation protocol (AU)

Unified Protocol for psychiatric and psychological assessment of candidates for transplantation of organs and tissues, PSI-CAT.

INTRODUCTION: Transplantation is the treatment option that offers improved survival and quality of life as compared to organ failure. Psychiatric and psychological aspects of transplant candidates are important, especially in the pre-assessment stage, as the influence of these factors can hinder post-surgical outcome in both the implanted organ survival and the quality of life of the transplanted person. Of particular importance, are the factors related to pathology due to substance use, psychopathology, and psychosocial support. There are currently few guidelines on the correct evaluation of patients eligible for these complex procedures. METHOD: Nineteen psychiatrists and clinical psychologists from six public hospitals in Catalonia conducted a systematic consensus to determine the design of a Unified Protocol psychological and psychiatric evaluation. An annual work plan was implemented, during which; the objectives were defined, a literature review was conducted, the inclusion and exclusion criteria were discussed, questionnaires were selected, and a structured interview was developed. RESULTS: With the implementation of the work plan, the Assessment Protocol presented in this article was designed. CONCLUSIONS: systematic work and improving cooperation between psychiatrists and clinical psychologists, has led to homogeneity and consensus on a unified evaluation protocol.

Optimismo disposicional y estrategias de afrontamiento en pacientes con trasplante renal / Dispositional optimism and coping strategies in patients with a kidney transplant

Introducción: El optimismo disposicional aparece como un recurso personal que determina el estilo de afrontamiento y respuesta adaptativa ante enfermedades crónicas. Los objetivos de este estudio fueron averiguar las relaciones entre el constructor de optimismo disposicional y las estrategias de afrontamiento en pacientes con trasplante renal reciente, y evaluar diferencias en la utilización de estrategias de afrontamiento según el grado de optimismo disposicional. Material y métodos: Consecutivamente se eligen pacientes hospitalizados en el servicio de nefrología tras realizar el trasplante renal. Los instrumentos de evaluación fueron el Life Orientation Test-Revised y el Inventario de Estrategias de Afrontamiento. Los datos son analizados con medidas de tendencia central, análisis correlacional y comparación de medias con la prueba t de Student. Resultados: Participan 66 pacientes con trasplante renal. El estilo de afrontamiento que caracteriza a pacientes con trasplante renal reciente sería la Retirada social y la Evitación de problemas. Las correlaciones entre optimismo disposicional y estrategias de afrontamiento son significativas, en sentido positivo en Resolución de problemas (p < 0,05) y Reestructuración cognitiva (p < 0,01), y en sentido inverso con Autocrítica (p < 0,05). Las diferencias en optimismo disposicional generan diferencias significativas en la dimensión de Autocrítica (t = 2,58; p < 0,01). Conclusiones: Las puntuaciones en optimismo disposicional aportan diferencias en la respuesta de afrontamiento tras el trasplante renal. Además, las estrategias de afrontamiento podrían estar influyendo en la percepción del paciente sobre el bienestar emocional tras el trasplante renal (AU)

Introduction: Dispositional optimism is a personal resource that determines the coping style and adaptive response to chronic diseases. The aim of this study was to assess the correlations between dispositional optimism and coping strategies in patients with recent kidney transplantation and evaluate the differences in the use of coping strategies in accordance with the level of dispositional optimism. Material and method: Patients who were hospitalised in the nephrology department were selected consecutively after kidney transplantation was performed. The evaluation instruments were the Life Orientation Test-Revised, and the Coping Strategies Inventory. The data were analysed with central tendency measures, correlation analyses and means were compared using Student’s t-test. Results: 66 patients with a kidney transplant participated in the study. The coping styles that characterised patients with a recent kidney transplantation were Social withdrawal and Problem avoidance. Correlations between dispositional optimism and coping strategies were significant in a positive direction in Problem-solving (p<.05) and Cognitive restructuring (p<.01), and inversely with Self-criticism (p<.05). Differences in dispositional optimism created significant differences in the Self-Criticism dimension (t=2.58; p<.01). Conclusions: Dispositional optimism scores provide differences in coping responses after kidney transplantation. Moreover, coping strategies may influence the patient's perception of emotional wellbeing after kidney transplantation (AU)

Dispositional optimism and coping strategies in patients with a kidney transplant.

INTRODUCTION:  Dispositional optimism is a personal resource that determines the coping style and adaptive response to chronic diseases. The aim of this study was to assess the correlations between dispositional optimism and coping strategies in patients with recent kidney transplantation and evaluate the differences in the use of coping strategies in accordance with the level of dispositional optimism.  MATERIAL AND METHOD: Patients who were hospitalised in the nephrology department were selected consecutively after kidney transplantation was performed. The evaluation instruments were the Life Orientation Test-Revised, and the Coping Strategies Inventory. The data were analysed with central tendency measures, correlation analyses and means were compared using Student’s t-test.  RESULTS:  66 patients with a kidney transplant participated in the study. The coping styles that characterised patients with a recent kidney transplantation were Social withdrawal and Problem avoidance. Correlations between dispositional optimism and coping strategies were significant in a positive direction in Problem-solving (p<.05) and Cognitive restructuring (p<.01), and inversely with Self-criticism (p<.05). Differences in dispositional optimism created significant differences in the Self-Criticism dimension (t=2.58; p<.01).  CONCLUSIONS: Dispositional optimism scores provide differences in coping responses after kidney transplantation. Moreover, coping strategies may influence the patient’s perception of emotional wellbeing after kidney transplantation.

Calidad de vida en pacientes con dolor lumbar crónico / No disponible

Objetivo: describir la calidad de vida en relación a la salud (CVRS) de pacientes lumbalgia crónica inespecífica, así como su relación con distintas variables médicas, socio-demográficas y psicosociales. Diseño: estudio descriptivo-correlacional transversal. Participantes: 94 pacientes con dolor lumbar crónico inespecífico pertenecientes al área de Rehabilitación (Algias) del hospital de referencia. Instrumentos de evaluación: los datos médicos y socio-demográficos fueron obtenidos a partir de las historias clínicas y de una entrevista semiestructurada. Asimismo, se administraron cuestionarios de CVRS, dolor autopercibido, discapacidad, sintomatología ansioso-depresiva, apoyo social y satisfacción vital. Resultados: el aspecto físico de la CVRS fue el más deteriorado y éste estuvo explicado en gran parte (R2 =47.3%) por la edad del paciente y su disfunción valorada a partir de la escala Oswestry. Asimismo, el aspecto mental de la CVRS, que se mostró más cercano al promedio poblacional, se explicó por la disfunción y la ansiedad-rasgo (STAI/R) de los pacientes (R2 =47.3%). Conclusiones: la disfunción, la edad y la ansiedad-rasgo de los participantes con lumbalgia crónica han mostrado ser factores clave para explicar su CVRS global. Así pues, es preciso tomarlos en consideración a la hora de favorecer un adecuado abordaje integral y multidisciplinar de esta población

Objective: To describe health-related quality of life in (HRQoL) in a sample of patients with nonspecific chronic low back pain, and their relationship with various medical, socio-demographic and psychosocial variables. Design: Descriptive-correlational cross-sectional study. Participants: A total of 94 patients with nonspecific chronic low back pain treated in the Rehabilitation Department from the reference hospital. Assessment tools: Medical and socio-demographic data were obtained from medical records and a semi-structured interview. Furthermore, HRQoL, self-perceived pain, functional disability, anxiety-depressive symptoms, social support and life satisfaction questionnaires were administered. Results: The physical domain of HRQoL was the most impaired and it was largely explained (R2 = 47.3%) by patient age and functional dysfunction assessed by means of the Oswestry scale. Similarly, the mental domain of HRQoL, that showed average mean scores more similar to normative population, was also explained by functional dysfunction and anxiety trait (STAI/T) of patients (R2 = 47.3%). Conclusions: Functional dysfunction, age and anxiety trait of participants with chronic low back pain have been shown to be key factors in explaining their overall HRQoL. Thus, these factors should be properly considered when designing appropriate comprehensive and multidisciplinary approaches to address the needs of this population

[Psychological adjustment and prevalence of psychiatric disorders in cancer patients]. / Adaptación psicológica y prevalencia de trastornos mentales en pacientes con cáncer.

BACKGROUND AND OBJECTIVE: The main objective of this study was to determine the prevalence and the predictors of mental disorders in cancer patients. PATIENTS AND METHOD: 400 ambulatory cancer patients were included in the study. All the patients with a score of 14 or higher in the Hospital Anxiety and Depression Scale (HADS) received a structured clinical interview (SCID-I. DSMIV) with the objective of determining the prevalence of mental disorders. RESULTS: 24% cancer patients had criteria for a mental disorder. The predictors of mental disorders were radiotherapy treatment, psychopharmacological treatment and pain. CONCLUSIONS: These results support the need to assess the possible anxious and depressive symptoms during cancer treatment and follow up. The predictors found can help to detect possible psychiatric cases in cancer patients.

Adaptación psicológica y prevalencia de trastornos mentales en pacientes con cáncer / Psychological adjustment and prevalence of psychiatric disorders in cancer patients

Fundamento y objetivo: El principal objetivo del estudio ha sido determinar la prevalencia y los predictores de trastornos mentales en pacientes con cáncer. Pacientes y método: Se entrevistó a 400 pacientes oncológicos ambulatorios. A aquellos con una puntuación igual o mayor de 14 en la Escala de Ansiedad y Depresión Hospitalaria (HADS) se les administró la Entrevista Clínica Estructurada para los Trastornos del Eje I (SCID-I) del Manual Diagnóstico y Estadística de los Trastornos Mentales, cuarta edición (DSM-IV), con el fin de determinar la prevalencia de trastornos mentales en la muestra estudiada. Resultados: Un 24% de los pacientes con cáncer presentaba criterios de trastorno mental. En el análisis multivariante los predictores de presencia de trastorno mental fueron: haber recibido radioterapia, estar en tratamiento psicofarmacológico y la presencia de dolor. Conclusiones: Los datos aportados por el estudio señalan la necesidad de realizar un adecuado cribado de los posibles síntomas ansiosos y depresivos que el paciente puede desarrollar durante el proceso oncológico y que le incapacitan para su adaptación emocional a éste. El uso de los predictores hallados puede ayudar a identificar posibles casos de trastorno mental entre los pacientes con cáncer

Background and objective: The main objective of this study was to determine the prevalence and the predictors of mental disorders in cancer patients. Patients and method: 400 ambulatory cancer patients were included in the study. All the patients with a score of 14 or higher in the Hospital Anxiety and Depression Scale (HADS) received a structured clinical interview (SCID-I. DSMIV) with the objective of determining the prevalence of mental disorders. Results: 24% cancer patients had criteria for a mental disorder. The predictors of mental disorders were radiotherapy treatment, psychopharmacological treatment and pain. Conclusions: These results support the need to assess the possible anxious and depressive symptoms during cancer treatment and follow up. The predictors found can help to detect possible psychiatric cases in cancer patients