Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 68
Filtrar
1.
Allergy ; 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32531110

RESUMO

BACKGROUND: The Coronavirus disease 2019 (COVID-19) has evolved as a pandemic infectious disease transmitted by the severe acute respiratory syndrome coronavirus (SARS-CoV-)2. Allergists and other health care providers (HCPs) in the field of allergies and associated airway diseases are in the front line, taking care of patients potentially infected with SARS-CoV-2. Hence, strategies and practices to minimize risks of infection for both HCPs and treated patients have to be developed and followed by allergy clinics. METHOD: The scientific information on COVID-19 was analyzed by a literature search in Medline, Pubmed, national and international guidelines from the European Academy of Allergy and Clinical Immunology (EAACI), the Cochrane Library and the Internet. RESULTS: Based on diagnostic and treatment standards developed by EAACI, on international information regarding COVID-19, on guidelines of the World Health Organization (WHO) and other international organizations as well as on previous experience, a panel of experts including clinicians, psychologists, IT experts and basic scientists along with EAACI and the "Allergic Rhinitis and its Impact on Asthma (ARIA)" inititiative have developed recommendations for the optimal management of allergy clinics during the current COVID-19 pandemic. These recommendations are grouped into nine sections on different relevant aspects for the care of patients with allergies. CONCLUSIONS: This international Position Paper provides recommendations on operational plans and procedures to maintain high standards in the daily clinical care of allergic patients whilst ensuring necessary safety in the current COVID-19 pandemic.

2.
Allergy ; 2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32324902

RESUMO

The placebo (Latin "I will please") effect commonly occurs in clinical trials. The psychological and physiological factors associated with patients' expectations about a treatment's positive and negative effects have yet to be well characterized, although a functional prefrontal cortex and intense bidirectional communication between the central nervous system and the immune system appear to be prerequisites for a placebo effect. The use of placebo raises certain ethical issues, especially if patients in a placebo group are denied an effective treatment for a long period of time. The placebo effect appears to be relatively large (up to 77%, relative to pre-treatment scores) in controlled clinical trials of allergen immunotherapy (AIT), such as the pivotal, double-blind, placebo-controlled (DBPC) randomized clinical trials currently required by regulatory authorities worldwide. The European Academy of Allergy and Clinical Immunology (EAACI) therefore initiated a Task Force, in order to better understand the placebo effect in AIT and its specific role in comorbidities, blinding issues, adherence, measurement time points, variability, and the natural course of the disease. In this Position Paper, the EAACI Task Force highlights several important topics regarding the placebo effect in AIT such as i) regulatory aspects, ii) neuroimmunological and psychological mechanisms, iii) placebo effect sizes in AIT trials, iv) methodological limitations in AIT trial design and v) potential solutions in future AIT trial design. In conclusion, this Position Paper aims to examine the methodological problem of placebo in AIT from different aspects and also to highlight unmet needs and possible solutions for future trials.

3.
Support Care Cancer ; 28(10): 4667-4675, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31955277

RESUMO

PURPOSE: Patients with advanced cancer often receive suboptimal end-of-life (EOL) care. Particularly males with advanced cancer are more likely to receive EOL care that is more aggressive, even if death is imminent. Critical factors determining EOL care are EOL conversations or advance care planning. However, information about gender-related factors influencing EOL conversations is lacking. Therefore, the current study investigates gender differences concerning the content, the desired time point, and the mode of initiation of EOL conversations in cancer patients. METHODS: In a cross-sectional study, 186 female and male cancer patients were asked about their preferences for EOL discussions using a semi-structured interview, focusing on (a) the importance of six different topics (medical and nursing care, organizational, emotional, social, and spiritual/religious aspects), (b) the desired time point, and (c) the mode of discussion initiation. RESULTS: The importance of EOL topics differs significantly regarding issue (p = 0.002, η2 = 0.02) and gender (p < 0.001, η2 = 0.11). Males wish to avoid the engagement in discussions about death and dying particularly if they are anxious about their end-of-life period. They wish to be addressed regarding the "hard facts" nursing and medical care only. In contrast, females prefer to speak more about "soft facts" and to be addressed about each EOL topic. Independent of gender, the majority of patients prefer to talk rather late: when the disease is getting worse (58%), at the end of their therapy, or when loosing self-sufficiency (27.5%). CONCLUSION: The tendency of patients to talk late about EOL issues increases the risk of delayed or missed EOL conversations, which may be due to a knowledge gap regarding the possibility of disease-associated incapability. Furthermore, there are significant gender differences influencing the access to EOL conversations. Therefore, for daily clinical routine, we suggest an early two-step, gender-sensitive approach to end-of-life conversations.


Assuntos
Planejamento Antecipado de Cuidados/normas , Neoplasias/psicologia , Assistência Terminal/psicologia , Estudos Transversais , Feminino , Identidade de Gênero , Humanos , Masculino
5.
Transl Psychiatry ; 7(5): e1132, 2017 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-28509904

RESUMO

Major depression (MD) is associated with peripheral inflammation and increased cardiovascular risk. Regular physical exercise can have anti-inflammatory effects. The present study examined whether behavioral activation with exercise affects inflammatory processes in MD. Ninety-eight patients with MD were randomly assigned to cognitive-behavioral therapy (CBT) emphasizing exercise during behavioral activation (CBT-E), CBT with pleasurable low-energy activities as an active control condition (CBT-C) or a passive waiting list control group (WL). Plasma levels of C-reactive protein (CRP), interleukin (IL)-6, IL-10, lipopolysaccharide (LPS)-stimulated IL-6 production, and blood immune cell counts were analyzed at baseline and weeks 8 (post-behavioral activation) and 16 (post-treatment). Thirty non-depressed age- and sex-matched controls were included to examine potential immunological alterations in MD at baseline. Patients with MD exhibited higher levels of CRP, higher neutrophil and monocyte counts, lower IL-10 levels and reduced LPS-stimulated IL-6 production compared to controls (P<0.001-0.045). Multilevel modeling indicated that CBT-E was associated with increased anti-inflammatory IL-10 at weeks 8 and 16 compared to CBT-C and WL (P=0.004-0.018). CBT-E did not significantly affect other immunological makers in the total sample. A subgroup analysis including patients with potentially higher cardiovascular risk (CRP ⩾1 µg ml-1) indicated that CRP was reduced in CBT-E compared to CBT-C (P<0.007) and marginally reduced compared to WL (P<0.085) after week 16. The present findings provide new insights into immunological effects of behavioral treatments against depression. Behavioral activation in conjunction with exercise may have the potential to reverse, in part, immunological alterations in MD.


Assuntos
Doenças Cardiovasculares/complicações , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo Maior/imunologia , Terapia por Exercício/métodos , Inflamação/complicações , Adulto , Proteína C-Reativa/análise , Contagem de Células , Transtorno Depressivo Maior/terapia , Exercício Físico/fisiologia , Terapia por Exercício/psicologia , Feminino , Alemanha/epidemiologia , Humanos , Inflamação/sangue , Interleucina-10/sangue , Interleucina-6/sangue , Lipopolissacarídeos/metabolismo , Masculino , Pessoa de Meia-Idade , Monócitos/citologia , Monócitos/metabolismo , Neutrófilos/citologia , Neutrófilos/metabolismo , Fatores de Risco
6.
Psychol Med ; 47(10): 1719-1732, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28179046

RESUMO

BACKGROUND: DSM-5 introduced a fundamental revision of the category of somatoform disorders, which resulted in the new somatic symptom disorder (SSD) and related disorders. However, prognostic validity of SSD remains unclear, while other classification proposals, such as bodily distress disorder (BDD) or polysymptomatic distress disorder (PSDD), might be promising alternatives for the new ICD-11. Therefore, the comparison of the different approaches concerning long-term prognosis of disorder-relevant factors is of special interest. METHOD: In a longitudinal design (baseline, 1-year, and 4-year follow-up), the three proposals (SSD, BDD, PSDD) were compared in an age-representative sample of the German general population (N = 321). To this end, the baseline sample was divided into three independent pairs of groups (with/without SSD, with/without BDD, with/without PSDD). It was tested how well each approach differentiated with regard to medium- and long-term healthcare utilization, number of symptoms, and impairment. RESULTS: Criteria for BDD distinguished best with regard to future healthcare utilization resulting in a large-sized effect (f = 0.44) for the difference between persons with and without BDD, while SSD and PSDD revealed only medium-sized effects (f = 0.28 and f = 0.32) between subjects with and without diagnosis. The three proposals distinguished equally well with regard to future subjective impairment (between f = 0.39 and f = 0.41) and the number of reported symptoms (between f = 0.77 and f = 0.83). CONCLUSION: In accordance with our data regarding prognostic validity, the current draft of the WHO group is based on the BDD proposal. However, existing limitations and weaknesses of the present proposal for the ICD-11 are further discussed.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Transtornos Somatoformes/classificação , Transtornos Somatoformes/diagnóstico , Adulto , Idoso , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Alemanha/epidemiologia , Humanos , Classificação Internacional de Doenças/normas , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prognóstico , Reprodutibilidade dos Testes , Transtornos Somatoformes/epidemiologia , Fatores de Tempo
7.
Ann Oncol ; 27(10): 1909-15, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27551051

RESUMO

BACKGROUND: This study aims to determine the role of patient expectations as potentially modifiable factor of side-effects, quality of life, and adherence to endocrine treatment of breast cancer. PATIENTS AND METHODS: A 2-year prospective clinical cohort study was conducted in routine primary care with postoperative patients with hormone-receptor-positive breast cancer, scheduled to start adjuvant endocrine treatment. Structured patient-reported assessments of side-effects, side-effect expectations, quality of life, and adherence took place during the first week post-surgery and after 3 and 24 months of endocrine treatment. RESULTS: Of 111 enrolled patients, at 3 and 24 months, 107 and 88 patients, respectively, were assessed. After 2 years of endocrine treatment, patients reported high rates of side-effects (arthralgia: 71.3%, weight gain: 53.4%, hot flashes: 46.5%), including symptoms not directly attributable to the medication (breathing problems: 28.1%, dizziness: 25.6%). Pre-treatment expectations significantly predicted patient-reported long-term side-effects and quality of life in multivariate models controlling for relevant medical and psychological variables. Relative risk of side-effects after 2 years of endocrine treatment was higher in patients with high negative expectations at baseline than in those with low negative expectations (RR = 1.833, CI 95%, 1.032-3.256). A significant interaction confirmed this expectation effect to be particularly evident in patients with high side-effects at 3 months. Furthermore, baseline expectations were associated with adherence at 24 months (r = -0.25, P = 0.006). CONCLUSIONS: Expectations are a genuine factor of clinical outcome from endocrine treatment for breast cancer. Negative expectations increase the risk of treatment-specific side-effects, nocebo side-effects, and non-adherence. Yet, controlled studies are needed to analyze potential causal relationships. Optimizing individual expectations might be a promising strategy to improve side-effect burden, quality of life, and adherence during longer-term drug intake. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02088710.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Terapia de Reposição Hormonal/efeitos adversos , Tamoxifeno/administração & dosagem , Adolescente , Adulto , Idoso , Inibidores da Aromatase/administração & dosagem , Inibidores da Aromatase/efeitos adversos , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Estudos de Coortes , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/classificação , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Receptor alfa de Estrogênio/genética , Feminino , Humanos , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Qualidade de Vida , Tamoxifeno/efeitos adversos , Resultado do Tratamento
8.
Psychol Med ; 46(10): 2179-88, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27269768

RESUMO

BACKGROUND: A considerable proportion of people with schizophrenia spectrum disorders do not take antipsychotic medication but seem to be functioning well. However, little is known about this group. To test the assumption that absence of medication is compensated for by more effective coping and increased social support, this study compared symptoms, functioning, coping strategies and social support in non-medicated and medicated individuals with schizophrenia spectrum disorders. METHOD: In all, 48 participants with a DSM-IV schizophrenia spectrum disorder who were taking (n = 25) or not taking antipsychotic medication (n = 23) were included. Assessment consisted of self-ratings of symptoms, symptom-related distress and social support combined with a semi-structured interview that assessed general and social functioning, subjective evaluation of symptoms and coping strategies. RESULTS: Symptom severity and distress did not differ between the groups. However, the non-medicated participants had significantly higher levels of general functioning than medicated participants and a longer duration of being non-medicated was significantly associated with a higher level of general functioning. In contrast to the hypotheses, not taking medication was not associated with more effective coping strategies or with higher levels of social support. Medicated participants more frequently reported the use of professional help as a coping strategy. CONCLUSIONS: Our results corroborate previous studies finding improved functioning in individuals with schizophrenia spectrum disorders who do not take medication compared with those who take medication, but do not support the notion that this difference is explicable by better coping or higher levels of social support. Alternative explanations and avenues for research are discussed.


Assuntos
Adaptação Psicológica/fisiologia , Antipsicóticos/uso terapêutico , Esquizofrenia/tratamento farmacológico , Esquizofrenia/fisiopatologia , Apoio Social , Adulto , Feminino , Humanos , Entrevista Psicológica , Masculino , Pessoa de Meia-Idade
9.
Transl Psychiatry ; 6: e773, 2016 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-27045843

RESUMO

Epigenetic signatures such as methylation of the monoamine oxidase A (MAOA) gene have been found to be altered in panic disorder (PD). Hypothesizing temporal plasticity of epigenetic processes as a mechanism of successful fear extinction, the present psychotherapy-epigenetic study for we believe the first time investigated MAOA methylation changes during the course of exposure-based cognitive behavioral therapy (CBT) in PD. MAOA methylation was compared between N=28 female Caucasian PD patients (discovery sample) and N=28 age- and sex-matched healthy controls via direct sequencing of sodium bisulfite-treated DNA extracted from blood cells. MAOA methylation was furthermore analyzed at baseline (T0) and after a 6-week CBT (T1) in the discovery sample parallelized by a waiting time in healthy controls, as well as in an independent sample of female PD patients (N=20). Patients exhibited lower MAOA methylation than healthy controls (P<0.001), and baseline PD severity correlated negatively with MAOA methylation (P=0.01). In the discovery sample, MAOA methylation increased up to the level of healthy controls along with CBT response (number of panic attacks; T0-T1: +3.37±2.17%), while non-responders further decreased in methylation (-2.00±1.28%; P=0.001). In the replication sample, increases in MAOA methylation correlated with agoraphobic symptom reduction after CBT (P=0.02-0.03). The present results support previous evidence for MAOA hypomethylation as a PD risk marker and suggest reversibility of MAOA hypomethylation as a potential epigenetic correlate of response to CBT. The emerging notion of epigenetic signatures as a mechanism of action of psychotherapeutic interventions may promote epigenetic patterns as biomarkers of lasting extinction effects.


Assuntos
Terapia Cognitivo-Comportamental , Metilação de DNA , Epigênese Genética , Monoaminoxidase/genética , Transtorno de Pânico/genética , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Transtorno de Pânico/terapia , Análise de Sequência de DNA
10.
Life Sci ; 146: 139-47, 2016 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-26772822

RESUMO

AIMS: The objective of this study was to assess the efficacy profile of Nx4 (Neurexan ®) in an acute experimental stress setting. An acute stress reaction is a biopsychological condition arising in response to an event that is individually regarded as emotionally stressful. Medications can mitigate stress perception and stress reactions, but may also have side effects. MATERIALS AND METHODS: Sixty-four healthy male and female volunteers participated in this prospective two-arm two-site study following an explorative randomized placebo-controlled double-blind study design. Participants took six tablets of either Nx4 or placebo during a time period of 2.5h before exposure to an acute psychological stressor (Trier Social Stress Test), and were subsequently monitored for 1.5h. Subjective stress ratings as well as cardiovascular and neuroendocrine parameters were analyzed before and after stress exposure. KEY FINDINGS: All changes in primary and secondary efficacy parameters corresponded well with the experimental acute stress setting. Nx4 did not affect subjective stress ratings but significantly diminished stress-induced increases in salivary cortisol and plasma adrenaline. Nx4 was as safe as placebo and very well tolerated. SIGNIFICANCE: The results suggest an attenuated neuroendocrine stress response in healthy volunteers induced by Nx4. However, further investigations are needed to confirm these observations as well as to better understand why some parameters were affected while others were not. Future investigations should be extended to chronically stressed individuals with a greater disposition to experience stress in everyday life. ClinicalTrials.gov Identifier: NCT01703819.


Assuntos
Extratos Vegetais/uso terapêutico , Estresse Psicológico/tratamento farmacológico , Estresse Psicológico/psicologia , Adulto , Doença Crônica , Método Duplo-Cego , Emoções , Epinefrina/sangue , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Hidrocortisona/sangue , Masculino , Extratos Vegetais/efeitos adversos , Estudos Prospectivos , Caracteres Sexuais , Resultado do Tratamento
11.
Psychol Med ; 46(1): 103-15, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26281857

RESUMO

BACKGROUND: Severe health anxiety is frequent and costly, yet rarely diagnosed or treated. Earlier treatment studies show problems with recruitment, dropout and recovery. In the current study, the authors aimed to test the effect of acceptance and commitment group therapy (ACT-G) compared to waitlist in patients with severe health anxiety. METHOD: During March 2010 to April 2012, 126 consecutively referred patients meeting research criteria for severe health anxiety were block-randomized (1:1) to ACT-G or a 10 months' waitlist (Clinicaltrials.gov, no. NCT01158430). Patients allocated to ACT-G were treated in seven groups of nine patients between December 2010 and October 2012 and received nine weekly 3-h group sessions and a booster session consisting of ACT techniques. The primary outcome was decided a priori as the mean change in self-reported illness worry on the Whiteley-7 Index (WI) from baseline to 10 months' follow-up. Secondary outcomes were improvement in emotional distress and health-related quality of life at 10 months' follow-up. RESULTS: Intention-to-treat analysis showed a statistically significant mean difference of 20.5 points [95% confidence interval (CI) 11.7-29.4, p < 0.001] on the WI between the groups at 10 months, and the between-group effect sizes were large (Cohen's d = 0.89, 95% CI 0.50-1.29). The number needed to treat was 2.4 (95% CI 1.4-3.4, p < 0.001). Diagnosis and treatment were well accepted by the patients. CONCLUSIONS: ACT-G seems feasible, acceptable and effective in treating severe health anxiety.


Assuntos
Terapia de Aceitação e Compromisso/métodos , Transtornos de Ansiedade/terapia , Hipocondríase/terapia , Avaliação de Resultados em Cuidados de Saúde , Psicoterapia de Grupo/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Neurosci Biobehav Rev ; 60: 51-64, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26616735

RESUMO

Emerging evidence indicates that treatment context profoundly affects psychopharmacological interventions. We review the evidence for the interaction between drug application and the context in which the drug is given both in human and animal research. We found evidence for this interaction in the placebo response in clinical trials, in our evolving knowledge of pharmacological and environmental effects on neural plasticity, and in animal studies analyzing environmental influences on psychotropic drug effects. Experimental placebo research has revealed neurobiological trajectories of mechanisms such as patients' treatment expectations and prior treatment experiences. Animal research confirmed that "enriched environments" support positive drug effects, while unfavorable environments (low sensory stimulation, low rates of social contacts) can even reverse the intended treatment outcome. Finally we provide recommendations for context conditions under which psychotropic drugs should be applied. Drug action should be steered by positive expectations, physical activity, and helpful social and physical environmental stimulation. Future drug trials should focus on fully controlling and optimizing such drug×environment interactions to improve trial sensitivity and treatment outcome.


Assuntos
Antidepressivos/administração & dosagem , Antipsicóticos/administração & dosagem , Encéfalo/efeitos dos fármacos , Meio Ambiente , Transtornos Mentais/tratamento farmacológico , Plasticidade Neuronal/efeitos dos fármacos , Animais , Encéfalo/fisiopatologia , Humanos , Transtornos Mentais/fisiopatologia , Plasticidade Neuronal/fisiologia
13.
J Psychosom Res ; 79(6): 492-7, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26553385

RESUMO

OBJECTIVE: The study investigates the association between somatosensory amplification and the reporting of side effects. It establishes a German version of the Somatosensory Amplification Scale and examines its psychometric properties in a representative sample of the German population. METHODS: Sample size was 2.469, with 51% taking any medication. Participants answered the Somatosensory Amplification Scale, Generic Assessment of Side Effects Scale, and indicated whether they were taking any medication and the type of medication. Correlational analysis and binary logistic regression were performed. RESULTS: When examining a subsample reporting both medication intake and general bodily symptoms, participants higher in somatosensory amplification rated more of their general bodily symptoms as medication-attributed side effects. However, somatosensory amplification scores were not associated with the intake of any type of medication. In the overall sample, higher somatosensory amplification scores were associated with an increased report of bodily symptoms. Additionally, participants with higher somatosensory amplification reported intake of a greater number of different medications. The psychometric properties of the translated scale were good, and previously established associations of somatosensory amplification with demographic variables (age, sex) were replicated. CONCLUSION: Results suggest a possible attributional bias concomitant to somatosensory amplification which in turn may increase the reporting of side effects after medication intake.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/psicologia , Córtex Somatossensorial/fisiopatologia , Adulto , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Fatores de Risco
14.
Nervenarzt ; 86(7): 800-6, 2015 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-26154130

RESUMO

OBJECTIVE: The number and type of traumatic experiences show differential associations with posttraumatic stress disorder (PTSD). OBJECTIVE: The associations of number and type of traumatic experiences with PTSD were investigated in a representative population sample in Germany. MATERIAL AND METHODS: Traumatic experiences and PTSD were assessed with a self-rating questionnaire in a sample of 2510 participants from the general German population. RESULTS: The risk of (partial) PTSD increased with an increasing number of traumatic experiences. In contrast interpersonal and accidental traumatization showed no substantial differences with respect to the risk of PTSD. CONCLUSION: To quantify the relevance of the number and type of traumatic experiences for onset and persistence of PTSD, a multidimensional and complex assessment of those experiences is necessary. This is a great challenge in epidemiological research on this topic.


Assuntos
Acidentes/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Violência/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/psicologia , Acidentes/psicologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Causalidade , Comorbidade , Autoavaliação Diagnóstica , Feminino , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Distribuição por Sexo , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Inquéritos e Questionários , Índices de Gravidade do Trauma , Violência/psicologia , Ferimentos e Lesões/diagnóstico , Adulto Jovem
15.
J Behav Ther Exp Psychiatry ; 46: 99-106, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25302658

RESUMO

BACKGROUND AND OBJECTIVES: Obsessive-compulsive (OC) checkers have been shown to be impaired in memory. However, when encoding OC-related material, OC checkers exhibit superior recall. This study aims to investigate emotion-related memory performance in relation to checking using newly developed OC-specific material. Additionally, metacognitive characteristics such as cognitive confidence were considered. METHOD: In a sample of 63 participants (including 26 participants with obsessive-compulsive disorder), immediate and delayed recall for neutral stories and for OC-specific stories containing checking- and washing-related content were assessed. Regression analyses were applied to investigate the relationship to checking symptoms. The influence of metacognitive characteristics on recall was also examined. RESULTS: Higher checking was related to significantly better memory performance for a checking-related story as compared to two neutral stories. However, higher checking was also related to higher rates of forgetting of the OC-specific material over the delay period. Rates of forgetting in relation to checking were mediated by cognitive confidence. Diagnostic status was not predictive of any outcome variables. LIMITATIONS: The use of typical and not idiosyncratic verbal material may limit the ecological validity of these findings. CONCLUSIONS: In relation to high checking, different disorder-related cognitive and affective processes seem to interfere with memory encoding and retrieval at different stages. Metacognitive therapy methods might address these processes and thereby lead to a reduction of both cognitive impairment and OC symptoms.


Assuntos
Comportamento Compulsivo/fisiopatologia , Transtornos da Memória/etiologia , Rememoração Mental/fisiologia , Transtorno Obsessivo-Compulsivo/complicações , Transtorno Obsessivo-Compulsivo/psicologia , Adolescente , Adulto , Cognição/fisiologia , Feminino , Humanos , Masculino , Transtornos da Memória/diagnóstico , Testes Neuropsicológicos , Escalas de Graduação Psiquiátrica , Análise de Regressão , Adulto Jovem
16.
Ann Oncol ; 25(3): 707-711, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24504443

RESUMO

BACKGROUND: Evaluation of the SPIKES protocol, a recommended guideline for breaking bad news, is sparse, and information about patients' preferences for bad-news delivery in Germany is lacking. Being the first actual-theoretical comparison of a 'breaking bad news' guideline, the present study evaluates the recommended steps of the SPIKES protocol. Moreover, emotional consequences and quality of bad-news delivery are investigated. PATIENTS AND METHODS: A total of 350 cancer patients answered the MABBAN (Marburg Breaking Bad News Scale), a questionnaire representing the six SPIKES subscales, asking for the procedure, perception and satisfaction of the first cancer disclosure and patient's assign to these items. RESULTS: Only 46.2% of the asked cancer patients are completely satisfied with how bad news had been broken to them. The overall quality is significantly related to the emotional state after receiving bad news (r = -0.261, P < 0.001). Patients' preferences differ highly significantly from the way bad news were delivered, and the resulting rang list of patients' preferences indicates that the SPIKES protocol do not fully meet the priorities of cancer patients in Germany. CONCLUSIONS: It could be postulated that the low satisfaction of patients observed in this study reflects the highly significant difference between patients' preferences and bad-news delivery. Therefore, some adjunctions to the SPIKES protocol should be considered, including a frequent reassurance of listeners' understanding, the perpetual possibility to ask question, respect for prearrangement needs and the conception of bad-news delivery in a two-step procedure.


Assuntos
Neoplasias/diagnóstico , Neoplasias/psicologia , Relações Médico-Paciente , Revelação da Verdade , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Satisfação do Paciente , Prognóstico , Inquéritos e Questionários , Adulto Jovem
17.
Ann Oncol ; 25(2): 372-7, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24355487

RESUMO

BACKGROUND: This prospective study evaluated the relationship between arthralgia and compliance during the first year of adjuvant anastrozole therapy in postmenopausal women with hormone receptor-positive early breast cancer. PATIENTS AND METHODS: COMPliance and Arthralgia in Clinical Therapy (COMPACT) was an open-label, multicenter, noninterventional study conducted in Germany. Patients had started adjuvant anastrozole 3-6 months before the study start. The primary end points were arthralgia, compliance, and the relationship between compliance and arthralgia, assessed at specific time points. RESULTS: Overall, 1916 patients received upfront anastrozole. Mean arthralgia scores were increased from baseline at each visit up to 9 months. Compliance with anastrozole therapy gradually decreased over time from baseline to 9 months (P<0.001). At 9 months, investigators estimated that >95% of patients were compliant versus patient reports of <70%. There was a significant association between arthralgia mean scores and noncompliance at 6 months (P<0.0001), 9 months (P<0.0001), and overall (P<0.0001). Over time, new events or impairment of existing arthralgias were reported in 14% (3 months), 11% (6 months), and 9% (9 months) of patients. CONCLUSION: Arthralgia is important in the clinical management of women with early breast cancer and may contribute to noncompliance and clinical outcomes. CLINICALTRIALSGOV IDENTIFIER: NCT00857012.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Artralgia/epidemiologia , Neoplasias da Mama/tratamento farmacológico , Nitrilos/efeitos adversos , Triazóis/efeitos adversos , Idoso , Anastrozol , Antineoplásicos Hormonais/uso terapêutico , Artralgia/induzido quimicamente , Quimioterapia Adjuvante , Substituição de Medicamentos , Feminino , Humanos , Incidência , Adesão à Medicação , Pessoa de Meia-Idade , Nitrilos/uso terapêutico , Estudos Prospectivos , Resultado do Tratamento , Triazóis/uso terapêutico
19.
Nervenarzt ; 83(9): 1115-27, 2012 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-22892943

RESUMO

Patients with somatoform symptoms are considered to be difficult to treat. Clinical studies on treatment of this condition are underrepresented compared to other mental and psychosomatic disorders. Cognitive-behavioral treatment for patients with somatoform symptoms was found to have a significant effect; additionally, some evidence of recently published findings supports psychodynamic therapy. This report provides information on how to effectively deal with those patients. Furthermore it describes transtherapeutic targets and explains three therapeutic phases: establishing a therapeutic relationship, developing a model of the disorder and establishing coping strategies. As a last point a cognitive-behavioral treatment study, a psychodynamically-oriented study, a group intervention study and a new approach, a combination of cognitive-behavioral therapy and emotion regulation training, are presented.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Terapia Psicanalítica/métodos , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/terapia , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...