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1.
Medicine (Baltimore) ; 99(9): e19302, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118748

RESUMO

Perioperative anxiety could negatively affect surgery outcomes, and cardiac diseases have long been known to be an independent risk factor for anxiety development. However, little is known about preoperative anxiety in Nepalese adult cardiac patients waiting for surgery. The primary objectives of this study were to: (1) clarify the levels of preoperative anxiety in Nepalese adult cardiac patients waiting for open heart surgery; (2) identify factors associated with preoperative anxiety; and (3) evaluate any possible factors associated with patients' desire to obtain information related to their heart surgery.This is a prospective observational study for patients already scheduled for cardiac surgery at a core medical institution in Kathmandu, Nepal. We collected sociodemographic and clinical characteristics of the patients from their medical charts, and assessed their preoperative anxiety using the Amsterdam Preoperative Anxiety and Information Scale. We performed descriptive analyses of the collected data. Further, we employed regression models to assess to the objectives of the study.In total, 140 patients participated, and data of 123 (87.9%) were used for analysis. 58.5% of the participants had preoperative anxiety. Female gender (OR 0.31, 95% CI 0.15-0.65, P < .001) and past anesthesia exposure (OR 2.38, 95% CI 1.01-5.62, P < .05) were identified as risk factors for developing anxiety before cardiac surgery. Further, female gender (IRR 0.80, 95% CI 0.67-0.94, P < .001), higher education levels (IRR 1.18, 95% CI 1.01-1.40, P < .05), and higher preoperative anxiety (IRR 1.44, 95% CI 1.21-1.73, P < .001) could lead to higher levels of desire to acquire information related to the procedure.The study concluded that more than a half of the cardiac surgery patients experiences preoperative anxiety; female gender and having past anesthesia exposure are the risk factors. Anxious patients have more desire to acquire knowledge about the procedure. Thus, the evaluation and adequate management of preoperative anxiety should be proposed in high-risk groups.


Assuntos
Ansiedade/diagnóstico , Procedimentos Cirúrgicos Cardíacos/psicologia , Adulto , Ansiedade/classificação , Ansiedade/psicologia , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nepal , Estudos Prospectivos , Psicometria/instrumentação , Psicometria/métodos , Fatores de Risco , Inquéritos e Questionários
2.
Adv Exp Med Biol ; 1191: 219-235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002932

RESUMO

Although anxiety and depression have been considered as two distinct entities according to the diagnostic criteria, anxious depression (comorbid anxiety and depression) is relatively a common syndrome. According to the DSM-5 criteria, it uses "with anxious distress specifier" to define anxious depression in its MDD section. Anxious depression is known to have different neurobiological profiles compared to non-anxious depression. Several studies have revealed significant differences between anxious depression and non-anxious depression regarding the hypothalamic-pituitary-adrenal (HPA) axis function, structural and functional brain imaging findings, inflammation markers, etc. Patients with anxious depression were significantly more likely to be found in primary care setting and more likely to be associated with female gender, non-single, unemployed, less educated, and more severe depression. Previous reports also showed that patients with anxious depression had more frequent episodes of major depression and a higher risk of suicidal ideation and previous suicide attempts than those with non-anxious depression. Although anxious depression is known to be associated with poor treatment outcomes in several studies, recent researches have sought to find better treatment strategy to improve patients with anxious depression.


Assuntos
Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/terapia , Transtorno Depressivo Maior/complicações , Transtorno Depressivo Maior/terapia , Ansiedade/complicações , Ansiedade/diagnóstico , Ansiedade/terapia , Transtornos de Ansiedade/diagnóstico , Comorbidade , Depressão/complicações , Depressão/diagnóstico , Depressão/terapia , Transtorno Depressivo Maior/diagnóstico , Humanos
3.
Adv Exp Med Biol ; 1191: 561-576, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002946

RESUMO

Recent data has linked anxiety and its disorders in late life to increased morbidity and mortality, especially related to a higher cardiovascular burden and an increased cognitive decline. Clinically, anxiety symptoms may be more difficult to elicit in older adults who are less accurate in identifying anxiety symptoms and tend to minimize symptoms and to attribute symptoms to physical illness. Although SSRIs have proven more effective than psychotherapy in late-life anxiety, many elderly anxious subjects prefer psychotherapeutic interventions. These interventions appear to work best when tailored for the needs, expectations, and cultural background of older anxious subjects.


Assuntos
Transtornos de Ansiedade , Idoso , Ansiolíticos/uso terapêutico , Ansiedade/complicações , Ansiedade/diagnóstico , Ansiedade/psicologia , Ansiedade/terapia , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Doenças Cardiovasculares/complicações , Comorbidade , Humanos , Psicoterapia , Inibidores de Captação de Serotonina/uso terapêutico
4.
Biosci Trends ; 14(1): 35-41, 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32023559

RESUMO

Our study explored the potential relationship between time perception and the level of anxiety in cancer patients prior to starting chemotherapy. Time perception was assessed in 162 chemonaïve patients with solid tumors by evaluating each subject's prospective estimation of how fast one minute passed compared to the actual amount of time passed. The median value of time perception was used to stratify the patients into two categories of fast and slow time perception. We used the generalized anxiety disorder questionnaire (GAD-7) as a screening tool for detecting levels of anxiety. Scores ≥ 10 were considered high. In total, 45 (27.8%) patients had high levels of anxiety. The pattern of the time perception distributions significantly changed according to the reported levels on the GAD-7 scale. Scores ≥ 10 correlated with fast time perception and the female gender. Patients with a fast time perception had significantly higher levels of anxiety (8.44 ± 5.1) than patients with a slow time perception (3.49 ± 4.3). ROC analysis revealed that at the optimal cut-off value of time perception, clinically significant levels of anxiety can be discriminated with an AUC = 0.78 (95% CI: 0.70-0.85, p < 0.001), a sensitivity of 82.2% and a specificity of 64.1%. Moreover, in a multivariate logistic regression model, fast time perception was an independent predictor of clinically significant levels of anxiety (OR: 8.24; 95% CI: 3.16-21.41, p < 0.001). Time perception is a novel potent indicator for high levels of anxiety in cancer patients.


Assuntos
Ansiedade/diagnóstico , Neoplasias/psicologia , Percepção do Tempo , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Inquéritos e Questionários
5.
Health Qual Life Outcomes ; 18(1): 9, 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31910859

RESUMO

BACKGROUND: Anxiety and depression symptoms are common among cardiac patients. The Hospital Anxiety and Depression Scale (HADS) is frequently used to measure symptoms of anxiety and depression; however, no study on the validity and reliability of the scale in Danish cardiac patients has been done. The aim, therefore, was to evaluate the psychometric properties of HADS in a large sample of Danish patients with the four most common cardiac diagnoses: ischemic heart disease, arrhythmias, heart failure and heart valve disease. METHODS: The DenHeart study was designed as a national cross-sectional survey including the HADS, SF-12 and HeartQoL and combined with data from national registers. Psychometric evaluation included analyses of floor and ceiling effects, structural validity using both exploratory and confirmatory factor analysis and hypotheses testing of convergent and divergent validity by relating the HADS scores to the SF-12 and HeartQoL. Internal consistency reliability was evaluated by Cronbach's alpha, and differential item functioning by gender was examined using ordinal logistic regression. RESULTS: A total of 12,806 patients (response rate 51%) answered the HADS. Exploratory factor analysis supported the original two-factor structure of the HADS, while confirmatory factor analysis supported a three-factor structure consisting of the original depression subscale and two anxiety subscales as suggested in a previous study. There were floor effects on all items and ceiling effect on item 8. The hypotheses regarding convergent validity were confirmed but those regarding divergent validity for HADS-D were not. Internal consistency was good with a Cronbach's alpha of 0.87 for HADS-A and 0.82 for HADS-D. There were no indications of noticeable differential item functioning by gender for any items. CONCLUSIONS: The present study supported the evidence of convergent validity and high internal consistency for both HADS outcomes in a large sample of Danish patients with cardiac disease. There are, however, conflicting results regarding the factor structure of the scale consistent with previous research. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01926145.


Assuntos
Ansiedade/diagnóstico , Doenças Cardiovasculares/psicologia , Depressão/diagnóstico , Qualidade de Vida , Idoso , Ansiedade/epidemiologia , Ansiedade/psicologia , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Dinamarca/epidemiologia , Depressão/psicologia , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Reprodutibilidade dos Testes , Inquéritos e Questionários
6.
Oral Dis ; 26(1): 96-110, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31650646

RESUMO

OBJECTIVES: To validate the Hospital Anxiety and Depression Scale (HADS) and the 10-item Perceived Stress Scale (PSS-10) for use in patients with oral lichen planus (OLP) and to provide cross-sectional analysis of anxiety, depressive and distress symptoms in patients with OLP. METHODS: Validity and reliability of both instruments were assessed in 260 participants with OLP in one tertiary oral medicine centre through confirmatory factor analysis and calculation of reliability coefficients. Prevalence, clinical and demographic predictors of the presence of psychological symptoms in OLP were calculated and identified using multivariated logistic regression. RESULTS: Factor analysis results demonstrated that a bifactor model described the underlying structure of both scales better than other models. Values of omega indicated adequate reliability of total HADS and PSS-10 score while low coefficient omega hierarchical values limit clinical applicability of their subscale scores. The prevalence of anxiety, depressive and distress symptoms in OLP was 39.23%, 20.77% and 27.69%, respectively. Pain intensity, disease comorbidities, age, smoking and alcohol consumption were found to be independent predictors of the presence of psychological symptoms in OLP. CONCLUSION: The HADS and PSS-10 are appropriate to use as general measures of psychological distress and perceived stress in patients with OLP.


Assuntos
Líquen Plano Bucal/psicologia , Testes Psicológicos , Estresse Psicológico/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/diagnóstico , Estudos Transversais , Depressão/diagnóstico , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários
7.
J Abnorm Psychol ; 129(1): 29-37, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31868385

RESUMO

Researchers in clinical psychophysiology make several methodological decisions during the analysis of event-related potentials (ERPs). In the current study, we review these choices from the perspective of individual differences. We focus on baseline period and reference scheme (i.e., average, mastoid, current source density), as well as choices regarding where (i.e., single electrode site vs. pooling of sites), when (i.e., area, area around peak), and how (i.e., subtraction- or regression-based difference scores) to quantify ERPs. To illustrate the impact of these analytic pathways on internal consistency reliability and individual differences, we focus on the error-related negativity (ERN) and anxiety-and present data from 2 samples: 1st, in adults with diagnosed generalized anxiety disorder (GAD); 2nd, in relation to continuous self-reported symptoms of GAD in a large community sample of female adolescents. Results generally indicated similar internal consistency and between-subjects effect sizes across all evaluated methods. Nonetheless, some patterns of variation emerged, such as that, across both data sets, difference-based ERN measures, especially with mastoid reference, yielded more robust associations with GAD diagnosis and symptoms, despite somewhat lower internal consistency. The current analyses suggest that the association between ERN and anxiety is robust across a range of commonly used methodological choices. The present study is an example of how systematic analyses of analytic strategies on measures of internal consistency and between-subjects variability could help inform individual-differences ERP research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/diagnóstico , Ansiedade/diagnóstico , Potenciais Evocados/fisiologia , Projetos de Pesquisa , Adolescente , Adulto , Ansiedade/fisiopatologia , Transtornos de Ansiedade/fisiopatologia , Criança , Eletroencefalografia/métodos , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Adulto Jovem
8.
Support Care Cancer ; 28(1): 55-64, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30980258

RESUMO

PURPOSE: To facilitate access to and provision of psychosocial care to cancer patients in the community, the Cancer Support Community (CSC) developed CancerSupportSource® (CSS), an evidence-based psychosocial distress screening program. The current study examined the psychometric properties and multi-dimensionality of a revised 25-item version of CSS, and evaluated the scale's ability to identify individuals at risk for clinically significant levels of depression and anxiety. METHODS: CSS development and validation were completed in multiple phases. Exploratory factor analysis was completed with 1436 individuals diagnosed with cancer to examine scale dimensionality, and nonparametric receiver operating characteristic (ROC) curve analyses were used to determine scoring thresholds for depression and anxiety risk scales. Internal consistency reliability and convergent and discriminant validity were also examined. Confirmatory factor analysis and intraclass correlation coefficients were subsequently calculated with a separate sample of 1167 individuals to verify the scale factor structure and examine test-retest reliability. RESULTS: Five factors were identified and confirmed: (1) emotional well-being, (2) symptom burden and impact, (3) body image and healthy lifestyle, (4) health care team communication, and (5) relationships and intimacy. Psychometric evaluation of the total scale and factors revealed strong internal consistency reliability, test-retest reliability, and convergent and divergent validity. Sensitivity of CSS 2-item depression and 2-item anxiety risk scales were .91 and .92, respectively. CONCLUSIONS: Results indicate that CancerSupportSource is a reliable, valid, multi-dimensional distress screening program with the capacity to screen for those at risk for clinically significant levels of depression and anxiety.


Assuntos
Sobreviventes de Câncer/psicologia , Programas de Rastreamento/métodos , Neoplasias/psicologia , Psicometria/métodos , Estresse Psicológico/diagnóstico , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/etiologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/etiologia , Depressão/diagnóstico , Depressão/etiologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/etiologia , Feminino , Humanos , Masculino , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/diagnóstico , Psicometria/normas , Reprodutibilidade dos Testes , Apoio Social
9.
J Stroke Cerebrovasc Dis ; 29(2): 104582, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31859033

RESUMO

BACKGROUND AND PURPOSE: Post-stroke anxiety (PSA) is common and disabling. PSA should be considered as an important outcome in stroke. However, there is a lack of understanding of factors that may be linked to PSA. The purpose of this study was to determine the frequency of PSA and sociodemographic and clinical factors associated with PSA in a cohort of racially and ethnically diverse stroke patients. METHODS: We conducted a retrospective study of ischemic and hemorrhagic stroke patients seen in a stroke outpatient clinic from August 1, 2017 to June 30, 2018. Patients were eligible if a Generalized Anxiety Disorder 7-Item (GAD-7) instrument was available. GAD-7 scores greater than or equal to 10 indicated the presence of moderate to severe PSA. Multivariable logistic regression was used to identify independent sociodemographic and clinical factors associated with PSA. RESULTS: Records from 289 stroke patients with a GAD-7 instrument were analyzed. PSA was common (21%; GAD-7 ≥ 10). Fifty-seven percent of females had a GAD-7 greater than or equal to 10 compared to 41% of females who had a GAD-7 less than 10 (P = .03). Multivariable analysis found that self-reported nonmarried status (odds ratio, 3.27; 95% confidence interval, 1.44-7.44), excessive fatigue (odds ratio, 4.46; 95% confidence interval, 1.87-10.63), and depression (odds ratio, 1.24; 95% confidence interval, 1.16-1.33) were independently associated with PSA. CONCLUSIONS: PSA may occur more frequently in those who report non-married, excessive fatigue, or depression. Trials of PSA interventions should consider the potential impact of social support, depression, and comorbid conditions contributing to post-stroke fatigue, including sleep apnea.


Assuntos
Ansiedade/psicologia , Isquemia Encefálica/psicologia , Hemorragias Intracranianas/complicações , Ataque Isquêmico Transitório/psicologia , Acidente Vascular Cerebral/psicologia , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Comorbidade , Depressão/epidemiologia , Depressão/psicologia , Fadiga/epidemiologia , Fadiga/psicologia , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/psicologia , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/epidemiologia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Pessoa Solteira/psicologia , Isolamento Social , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Texas/epidemiologia
10.
Ideggyogy Sz ; 72(11-12): 397-404, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31834683

RESUMO

Background and purpose: Migraine is one of the most disabling primary headache conditions. We aimed to detect hidden symptoms of anxiety and depression and to survey stress-coping mechanisms and related quality of life in a large migraine population without any known psychiatric comorbidity. Methods: 123 migraine patients (MG) and 66 healthy subjects (HC) completed the Beck Depression Inventory-II (BDI-II), the State and Trait Anxiety Inventory (S-STAI and T-STAI), the Stress and Coping Inventory (SCI) and the 36-Item Short Form Health Survey (SF-36). Results: MG patients reached significantly higher scores on the BDI-II and the T-STAI yielding previously undetected anxiety and depression symptoms. Significant differences were present on the SCI: higher stress scores and lower coping levels suggested impaired stress-coping strategies in migraine. MG patients achieved significantly lower scores on most of SF-36 subscales indicating lower perceived quality of life. Significant correlations were found between BDI-II, T-STAI, SCI scores and subscales of the SF-36. Conclusion: Unrecognized symptoms of anxiety and depression, as well as less effective stress-coping strategies might be related to the lower perceived quality of life in migraine. The screening of these symptoms might lead to more focused and efficient therapeutic strategies. Addressing stress management techniques could improve quality of life on the long-term.


Assuntos
Adaptação Psicológica , Ansiedade/epidemiologia , Depressão/epidemiologia , Transtornos de Enxaqueca/psicologia , Qualidade de Vida/psicologia , Ansiedade/diagnóstico , Ansiedade/psicologia , Comorbidade , Depressão/diagnóstico , Depressão/psicologia , Humanos , Transtornos de Enxaqueca/epidemiologia , Escalas de Graduação Psiquiátrica , Estresse Psicológico
11.
Health Qual Life Outcomes ; 17(1): 172, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718663

RESUMO

BACKGROUND: Early detection of psychosocial problems post-injury may prevent them from becoming chronic. Currently, there is no psychosocial screening instrument that can be used in patients surviving a physical trauma or injury. Therefore, we recently developed a psychosocial screening instrument for adult physical trauma patients, the PSIT. The aim of this study was to finalize and psychometrically examine the PSIT. METHODS: All adult (≥ 18 years) trauma patients admitted to a Dutch level I trauma center from October 2016 through September 2017 without severe cognitive disorders (n = 1448) received the PSIT, Impact of Events Scale-Revised (IES-R), Patient Health Questionnaire-9 (PHQ-9), Rosenberg Self-Esteem Scale (RSES), State-Trait Anxiety Inventory-State (STAI-S), and the World Health Organization Quality of Life-Abbreviated version (WHOQOL-Bref). After 2 weeks, a subgroup of responding participants received the PSIT a second time. The internal structure (principal components analysis, PCA; and confirmatory factor analysis, CFA), internal consistency (Cronbach's alpha, α), test-retest reliability (Intraclass Correlation Coefficient, ICC), construct validity (Spearman's rho correlations), diagnostic accuracy (Area Under the Curve, AUC), and potential cut-off values (sensitivity and specificity) were examined. RESULTS: A total of 364 (25.1%) patients participated, of whom 128 completed the PSIT again after 19.5 ± 6.8 days. Test-retest reliability was good (ICC = 0.86). Based on PCA, five items were removed because of cross-loadings ≥ 0.3. Three subscales were identified: (1) Negative affect (7 items; α = 0.91; AUC = 0.92); (2) Anxiety and Post-Traumatic Stress Symptoms (4 items; α = 0.77; AUC = 0.88); and (3) Social and self-image (4 items; α = 0.79; AUC = 0.92). CFA supported this structure (comparative fit index = 0.96; root mean square error of approximation = 0.06; standardized rood mean square residual = 0.04). Four of the five a priori formulated hypotheses regarding construct validity were confirmed. The following cut-off values represent maximum sensitivity and specificity: 7 on subscale 1 (89.6% and 83.4%), 3 on subscale 2 (94.4% and 90.3%), and 4 on subscale 3 (85.7% and 90.7%). CONCLUSION: The final PSIT has good psychometric properties in adult trauma patients.


Assuntos
Ansiedade/diagnóstico , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Inquéritos e Questionários/normas , Ferimentos e Lesões/psicologia , Adulto , Ansiedade/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/métodos , Qualidade de Vida , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Transtornos de Estresse Pós-Traumáticos/etiologia , Ferimentos e Lesões/complicações , Adulto Jovem
12.
BMC Public Health ; 19(1): 1521, 2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727039

RESUMO

BACKGROUND: Improving the rates of, and instruments used in, screening for perinatal depression and anxiety among Aboriginal and Torres Strait Islander women are important public health priorities. The Kimberley Mum's Mood Scale (KMMS) was developed and later validated as an effective and acceptable perinatal depression and anxiety screening tool for the Kimberley region under research conditions. Other regions have expressed interest in using the KMMS with perinatal Aboriginal and Torres Strait Islander women. It is, however, important to re-evaluate the KMMS in a larger Kimberley sample via a real world implementation study, and to test for applicability in other remote and regional environments before recommendations for wider use can be made. This paper outlines the protocol for evaluating the process of implementation and establishing the 'real world' validity and acceptability of the KMMS in the Kimberley, Pilbara and Far North Queensland in northern Australia. METHODS: The study will use a range of quantitative and qualitative methods across all sites. KMMS validation/revalidation internal consistency of Part 1 will be determined using Cronbach's alpha. Equivalence for identifying risk of depression and anxiety compared to a standard reference assessment will be determined from receiver operating characteristic curves. Sensitivity and specificity will be determined based on these cut-points. Qualitative methods of phenomenology will be used to explore concepts of KMMS user acceptability (women and health professionals). Additional process evaluation methods will collate, assess and report on KMMS quality review data, consultations with health service administrators and management, field notes, and other documentation from the research team. This information will be reported on using the Dynamic Sustainability Framework. DISCUSSION: This project is contributing to the important public health priority of screening Aboriginal and Torres Strait Islander women for perinatal depression and anxiety with tools that are meaningful and responsive to cultural and clinical needs. Identifying and addressing barriers to implementation contributes to our understanding of the complexity of improving routine clinical practie. TRIAL REGISTRATION: The study was registered retrospectively on 15/05/2019 with the Australian and New Zealand Clinical Trial registry (ACTRN12619000580178).


Assuntos
Afeto , Ansiedade/diagnóstico , Depressão/diagnóstico , Programas de Rastreamento/métodos , Saúde Mental/etnologia , Grupo com Ancestrais Oceânicos/psicologia , Assistência Perinatal/métodos , Adolescente , Adulto , Ansiedade/etnologia , Depressão/etnologia , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/etnologia , Feminino , Humanos , Lactente , Recém-Nascido , Ilhas , Programas de Rastreamento/normas , Mães/psicologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etnologia , Gestantes/etnologia , Gestantes/psicologia , Psicometria , Queensland , Projetos de Pesquisa , Estudos Retrospectivos , Adulto Jovem
13.
JAMA ; 322(16): 1561-1569, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31638682

RESUMO

Importance: Selective serotonin receptor inhibitors are prescribed to reduce the severity of core behaviors of autism spectrum disorders, but their efficacy remains uncertain. Objective: To determine the efficacy of fluoxetine for reducing the frequency and severity of obsessive-compulsive behaviors in autism spectrum disorders. Design, Setting, and Participants: Multicenter, randomized, placebo-controlled clinical trial. Participants aged 7.5-18 years with autism spectrum disorders and a total score of 6 or higher on the Children's Yale-Brown Obsessive Compulsive Scale, modified for pervasive developmental disorder (CYBOCS-PDD) were recruited from 3 tertiary health centers across Australia. Enrollment began November 2010 and ended April 2017. Follow-up ended August 2017. Interventions: Participants were randomized to receive fluoxetine (n = 75) or placebo (n = 71). Study medication was commenced at 4 or 8 mg/d for the first week, depending on weight, and then titrated to a maximum dose of 20 or 30 mg/d over 4 weeks. Treatment duration was 16 weeks. Main Outcomes and Measures: The primary outcome was the total score on the CYBOCS-PDD (scores range from 0-20; higher scores indicate higher levels of maladaptive behaviors; minimal clinically important difference, 2 points) at 16 weeks postrandomization, analyzed with a linear regression model adjusted for stratification factors (site, age at baseline, and intellectual disability), with an additional prespecified model that included additional adjustment for baseline score, sex, communication level, and imbalanced baseline and demographic variables. Results: Among the 146 participants who were randomized (85% males; mean age, 11.2 years), 109 completed the trial; 31 in the fluoxetine group and 21 in the placebo group dropped out or did not complete treatment. The mean CYBOCS-PDD score from baseline to 16 weeks decreased in the fluoxetine group from 12.80 to 9.02 points (3.72-point decrease; 95% CI, -4.85 to -2.60) and in the placebo group from 13.13 to 10.89 points (2.53-point decrease; 95% CI, -3.86 to -1.19). The between-group mean difference at 16 weeks was -2.01 (95% CI, -3.77 to -0.25; P = .03) (adjusted for stratification factors), and in the prespecified model with further adjustment, it was -1.17 (95% CI, -3.01 to 0.67; P = .21). Conclusions and Relevance: In this preliminary study of children and adolescents with autism spectrum disorders, treatment with fluoxetine compared with placebo resulted in significantly lower scores for obsessive-compulsive behaviors at 16 weeks. Interpretation is limited by the high dropout rate, null findings of prespecified analyses that accounted for potentially confounding factors and baseline imbalances, and CIs for the treatment effect that included the minimal clinically important difference. Trial Registration: anzctr.org.au Identifier: ACTRN12608000173392.


Assuntos
Transtorno do Espectro Autista/tratamento farmacológico , Fluoxetina/uso terapêutico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Adolescente , Ansiedade/diagnóstico , Transtorno do Espectro Autista/psicologia , Criança , Feminino , Fluoxetina/efeitos adversos , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/classificação , Gravidade do Paciente , Inibidores de Captação de Serotonina/efeitos adversos , Transtorno de Movimento Estereotipado/tratamento farmacológico , Resultado do Tratamento
14.
BMC Infect Dis ; 19(1): 833, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31590634

RESUMO

BACKGROUND: Persistent symptoms attributed to Lyme borreliosis often include self-reported cognitive impairment. However, it remains unclear whether these symptoms can be substantiated by objective cognitive testing. METHODS: For this observational study, cognitive performance was assessed in 280 adults with persistent symptoms attributed to Lyme borreliosis (as part of baseline data collected for the Dutch PLEASE study). Cognitive testing covered the five major domains: episodic memory, working memory / attention, verbal fluency, information-processing speed and executive function. Patients' profiles of test scores were compared to a large age-, education- and sex-adjusted normative sample using multivariate normative comparison. Performance validity was assessed to detect suboptimal effort, and questionnaires were administered to measure self-reported cognitive complaints, fatigue, anxiety, depressive symptoms and several other psychological factors. RESULTS: Of 280 patients, one was excluded as the test battery could not be completed. Of the remaining 279 patients, 239 (85.4%) displayed sufficient performance validity. Patients with insufficient performance validity felt significantly more helpless and physically fatigued, and less orientated. Furthermore, they had a lower education level and less often paid work. Of the total study cohort 5.7% (n = 16) performed in the impaired range. Among the 239 patients who displayed sufficient performance validity, 2.9% (n = 7) were classified as cognitively impaired. No association between subjective cognitive symptoms and objective impairment was found. CONCLUSIONS: Only a small percentage of patients with borreliosis-attributed persistent symptoms have objective cognitive impairment. Performance validity should be taken into account in neuropsychological examinations of these patients. Self-report questionnaires are insufficiently valid to diagnose cognitive impairment. TRIAL REGISTRATION: ClinicalTrials.gov NCT01207739 . Registered 23 September 2010.


Assuntos
Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Doença de Lyme/complicações , Doença de Lyme/psicologia , Adulto , Ansiedade/diagnóstico , Atenção , Estudos de Coortes , Depressão/diagnóstico , Função Executiva , Fadiga/diagnóstico , Feminino , Humanos , Masculino , Memória Episódica , Memória de Curto Prazo , Pessoa de Meia-Idade , Testes Neuropsicológicos , Autorrelato
15.
Tidsskr Nor Laegeforen ; 139(14)2019 Oct 08.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31592606

RESUMO

BACKGROUND: Depression and anxiety are common in patients with cardiac disease and predict a poorer prognosis, increased mortality and reduced compliance with treatment. National and international guidelines recommend procedures for screening, but there is a lack of studies of such practices in Norwegian hospitals. The objective of this study was to implement a simple screening method for symptoms of depression and anxiety in patients with cardiac disease. MATERIAL AND METHOD: Patients in the Department of Cardiology at Diakonhjemmet Hospital who had valvular heart disease, tachyarrhythmia, myocardial infarction or heart failure were screened for symptoms of depression, anxiety and panic attacks with the aid of five questions from the Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder Scale-2 (GAD-2) and Patient Health Questionnaire - Somatic, Anxiety, and Depressive Symptom Scales (PHQ-SADS). The patients were recruited from the outpatient clinic or ward at least one month after acute heart disease. RESULTS: A total of 57 of 232 patients reported symptoms of depression or anxiety when screened. The screening method was easy to implement, but time constraints and uncertainty regarding procedures for follow-up and the effect of following up the patients were reported. INTERPRETATION: Good tools and methods are available for screening for symptoms of depression and anxiety and anxiety in patients with cardiac disease. More studies are needed regarding the benefits of screening, at what stage of the disease it should be performed, and whether it should be performed by the primary and/or the specialist health services.


Assuntos
Ansiedade/diagnóstico , Serviço Hospitalar de Cardiologia , Depressão/diagnóstico , Cardiopatias/psicologia , Assistência ao Convalescente , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/psicologia , Doenças das Valvas Cardíacas/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/psicologia , Noruega , Transtorno de Pânico/diagnóstico , Questionário de Saúde do Paciente , Taquicardia/psicologia
16.
Rev Esp Salud Publica ; 932019 10 03.
Artigo em Espanhol | MEDLINE | ID: mdl-31576814

RESUMO

OBJECTIVE: Ischemic cardiomyopathy is a major public health concern in Spain. Death from ischemic disease accounts for approximately a third of all deaths due to cardiovascular disease, and imposes a serious burden on already overstretched public health system owing to the tendency to chronicity. This study aimed to evaluate the psychometric properties of Templer's Death Anxiety Scale (DAS) in a sample of patients with ischemic cardiomyopathy (acute myocardial infarction and angina pectoris). METHODS: This study applied the Spanish version of Templer's Death Anxiety Scale (DAS). The sample consisted of 141 patients (61% men) with ischemic cardiomyopathy, mean agede 71.57 years (SD=5.76). A descriptive statistical analysis was performed, and factorial analysis of the principal components. RESULTS: The corrected element-total correlation was positive in all items, with values ranging from 0.32 and 0.54. Four factors jointly explained 51.85% of the data variance. The reliability coefficients were high in all of the variables analysed, with a total Cronbach Alpha of 0.77. CONCLUSIONS: The results obtained in this study revealed ischemic cardiomyopathy was susceptible to the process of death anxiety. This underscores the need for educating patients with this pathology to help them adapt to the process of chronicity, and to develop an understanding of the naturalization process of dying bearing in mind each person's multidimensionality.


Assuntos
Ansiedade/diagnóstico , Atitude Frente a Morte , Cardiomiopatias/psicologia , Infarto do Miocárdio/psicologia , Psicometria , Adulto , Idoso , Cardiomiopatias/diagnóstico , Coleta de Dados , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Análise de Componente Principal , Saúde Pública , Reprodutibilidade dos Testes , Espanha
17.
Health Qual Life Outcomes ; 17(1): 158, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651339

RESUMO

BACKGROUND: Unlike active tuberculosis, latent tuberculosis infection (LTBI) is asymptomatic and often considered not to affect the health-related quality of life (HRQoL) of patients. However, being diagnosed with and treated for LTBI can be associated with adverse clinical evens such side effects of treatment as well as psychosocial challenges. Therefore, the aims of this study were to qualitatively explore patients' experiences during diagnosis and treatment of LTBI in Stockholm measure their HRQoL, and contrast and merge the results to better understand how the HRQoL of these patients is affected. METHODS: LTBI patients who were treated in Stockholm during September 2017 and June 2018and who fulfilled the inclusion criteria were invited to fill a survey that included a HRQoL instrument, EQ-5D-3 L, and a mental health screening instrument, RHS-15. After filling the survey, a subset of these patients was asked to participate in an interview with open-ended questions that focused on their experiences during the diagnosis and treatment. RESULTS: In total 108 participants filled that survey and interviews were conducted with 20 patients. Patients scored relatively high on EQ-5D: the scores of utility and VAS scale are similar to those reported by the general population of Stockholm. Very few patients reported problems on the physical health domains of EQ-5D which was supported by the quantitative data that showed no effect on physical health and usual activity. Thirty-eight percent screened positive for RHS-15 and 27.8% reported problems with anxiety/depression domain of EQ-5D which could be related to many stressing factors mentioned in the interviews such as: fear and distress related to lack of clarity about LTBI diagnosis, perceived risk of infecting others and uncertainties about the future. CONCLUSION: The quantified HRQoL of LTBI patients in Stockholm is similar to the general population and there is thus no HRQoL decrements that is detectable with EQ-5D. However, the study reinforces the importance of tackling anxiety and fear and ensuring good health information for persons diagnosed with and treated for LTBI.


Assuntos
Tuberculose Latente/psicologia , Qualidade de Vida , Adulto , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Humanos , Tuberculose Latente/complicações , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Inquéritos e Questionários , Suécia/epidemiologia
18.
Nurs Educ Perspect ; 40(6): 367-369, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644456

RESUMO

Various causes exist for nursing student anxiety in the clinical setting. There is a need for further intervention research that may be effective to reduce student anxiety related to clinical. The purpose of this pilot research study was to measure and manage anxiety for nursing students in the clinical area with the assistance of a smartphone app. The usefulness of the app was evaluated by means of a focus group.


Assuntos
Ansiedade/diagnóstico , Ansiedade/prevenção & controle , Aplicativos Móveis , Smartphone , Estudantes de Enfermagem/psicologia , Bacharelado em Enfermagem , Grupos Focais , Humanos , Projetos Piloto
19.
BMC Musculoskelet Disord ; 20(1): 439, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31597562

RESUMO

BACKGROUND: Chronic low back pain (LBP) is a leading cause of disability worldwide. Biopsychosocial rehabilitation programs have been advocated for its management, especially since the widespread acceptance of the biopsychosocial model of chronic pain. Despite extensive evidence of its short-term benefits, few studies have reported on its long-term effect and more specifically on indirect outcomes such as return to work and quality of life (QoL). The present study evaluated the long-term effect of a multidisciplinary biopsychosocial rehabilitation (MBR) program for patients with chronic LBP, for which short- and intermediate-term efficacy had been established, with an emphasis on recovering work capability. METHODS: This prospective cohort study enrolled 201 patients on a four-week MBR program incorporating physical and occupational therapies and psychological counselling. Assessments occurred at program admission and discharge and at 6 and 18 months. Work capability, Oswestry Disability Index, Tampa Scale for Kinesiophobia, Core Outcome Measures Index (COMI), and Hospital Anxiety and Depression Scale were assessed. Multiple mixed models were used to detect changes in each outcome. Logistic regressions were calculated to identify predictors of recovery of work capability. RESULTS: Of the 201 patients who fulfilled the eligibility criteria, 160 (79.8%) attended the discharge assessment, 127 (63.2%) attended the 6-month follow-up, and 107 (53.3%) continued to the 18-month follow-up. Initially, 128 patients (71.5%) had been on sick leave. At 6 and 18 months, 72 (56.7%) and 84 (78.5%) participants had recovered their work capability, respectively. There were significant improvements in pain, disability, kinesiophobia, and anxiety and depression scores over time. Patients who recovered work capability showed significantly greater improvements in their total COMI score, general QoL, and disability, which were the best three predictors of recovering work capability. CONCLUSIONS: This study extends previous results confirming the program's contribution to recovering work capability among chronic LBP patients.


Assuntos
Ansiedade/reabilitação , Dor Crônica/reabilitação , Depressão/reabilitação , Dor Lombar/reabilitação , Terapia Ocupacional/métodos , Reabilitação Psiquiátrica/métodos , Adulto , Ansiedade/diagnóstico , Ansiedade/etiologia , Dor Crônica/complicações , Dor Crônica/diagnóstico , Dor Crônica/psicologia , Terapia Combinada/métodos , Depressão/diagnóstico , Depressão/etiologia , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Dor Lombar/complicações , Dor Lombar/diagnóstico , Dor Lombar/psicologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Equipe de Assistência ao Paciente , Questionário de Saúde do Paciente , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
20.
Medicine (Baltimore) ; 98(39): e17307, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574859

RESUMO

To investigate the cognitive and psychological outcomes of pediatric allogeneic HSCT survivors in China.A total of 135 3 to 18 years old children and adolescents who underwent allo-HSCT and survived at least 3 months post-HSCT were recruited and completed the assessments. Cognitive and psychological functions were assessed via age-appropriate standardized measures. Clinical information was extracted from the medical records.Forty one 3 to 6 years old children completed Psychological Questionnaires for 3 to 6 years Children. The scores of 21(51.2%) children in cognitive development dimension, 18(43.9%) in motor development dimension, 16(39.0%) in language development and social development dimension, 15(36.6%) in emotion and will dimension and 14(34.1%) in living habits dimension were less than the standard. Fifty six 8 to 16 years old children and adolescents completed the Depression Self-rating Scale for Children and 9 (16.1%) of these met the criteria of depression. Sixty nine 7 to 16 years old children and adolescents completed the screening for Child Anxiety Related Disorders and 7 (10.1%) of these met the criteria of anxiety, especially social phobia and school phobia. Eighty nine 6 to 18 years old children and adolescents completed the Symptom Checklist-90 and 43.8% to 77.5% of these experienced mild symptoms like obsession-compulsion (77.5%), hostility (64%), and interpersonal sensitivity (60.7%). Children treated with total body irradiation (TBI) showed more cognitive impairments like motor deficits than those without TBI. Also older children and adolescents had more symptoms like psychoticism.These findings demonstrated cognitive and psychological late effects of pediatric allo-HSCT survivors in a single center in China and highlighted that the survivors conditioned with TBI had more cognitive impairments and older children and adolescents had more symptoms. Early intervention in these children and adolescents might minimize the cognitive losses and psychological effects.


Assuntos
Ansiedade , Disfunção Cognitiva , Depressão , Transplante de Células-Tronco Hematopoéticas , Complicações Pós-Operatórias , Qualidade de Vida , Adolescente , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/prevenção & controle , Criança , Pré-Escolar , China/epidemiologia , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/prevenção & controle , Depressão/diagnóstico , Depressão/etiologia , Depressão/prevenção & controle , Intervenção Médica Precoce/métodos , Feminino , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Masculino , Destreza Motora , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Técnicas Psicológicas , Sobreviventes/psicologia
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