Psychological issues in the treatment of asthmatic patients

Severity of allergic complaints: the importance of depressed mood

OBJECTIVE

To evaluate the prevalence of depressive symptoms in patients with different kinds of allergic diseases and the connection of depressive symptoms with the severity, type and seasonality of allergic complaints.

METHODS

Data was obtained via a cross-sectional multicenter questionnaire survey of 528 patients aged 16-60 years attending six regional in- and outpatient allergy clinics in Hungary in June to July 1998. Consecutive patients completed a structured, self-administered questionnaire containing questions about their current and past allergic complaints. Depressive symptoms were measured by the Shortened Beck Depression Inventory (BDI).

RESULTS

32.2% of patients scored above the normal level (> or =10) and 12.5% had clinically significant depressive symptomatology (> or =19) by the BDI. These rates were significantly higher than those found in the control group from a national representative population sample (22.4% and 8.3%). Patients with asthma and with perennial symptoms had significantly higher depression scores than patients with other types of allergic diseases. There was a significant association between the severity of depressive symptoms and the severity of allergic complaints independently from age, sex, type and seasonality of the allergic disease, and other current physical illnesses and symptoms tested by the General Linear Model (GLM).

CONCLUSIONS

Our results draw attention that patients even with mild depressive symptoms have significantly more severe allergic complaints and assess general health state as much worse than those without depressive symptoms in any types of allergic diseases. Diagnosis and treatment of depressive symptoms in allergic patients is of great concern from both a clinical and an economical point of view.

Anxiety and depression are related to the outcome of emergency treatment in patients with obstructive pulmonary disease

STUDY OBJECTIVES

To investigate whether psychological factors predict outcome after emergency treatment for obstructive pulmonary disease.

SETTING

Emergency department at a university hospital.

PATIENTS

Forty-three patients presenting with exacerbation of asthma or COPD.

INTERVENTION

The patients received emergency treatment and were followed up for 4 weeks.

MEASUREMENT

Spirometry, blood sampling, pulse oximetry, breathing rate, pulse rate, and dyspnea score was measured before and during emergency treatment. The psychological status was assessed using the hospital anxiety and depression (HAD) scale questionnaire at the end of the follow-up period.

RESULTS

Anxiety and/or depression was found in 17 patients (40%). Of these patients, nine patients (53%) were admitted to hospital or had a relapse within 1 month, compared with five patients (19%) in the group without anxiety and/or depression (p < 0.05). Among patients who relapsed within 1 month (n = 14), the HAD total score was 12.4 +/- 5.9 compared with 8.6 +/- 5.1 (mean +/- SD) among the patients without a relapse (p < 0.05). After making adjustments for age, gender, atopic status, treatment, and pack-years, the significant association between treatment failure and anxiety and/or depression still remained.

CONCLUSION

Our study indicates that anxiety and depression are related to the outcome of emergency treatment in patients with obstructive pulmonary disease. Further studies should be conducted evaluating the effect of treatment of anxiety and depression in patients with recurrent exacerbations of asthma and COPD.

Association between skin test diagnosed atopy and professionally diagnosed depression: a Northern Finland 1966 Birth Cohort study

BACKGROUND

Several studies have suggested an association between IgE-mediated atopic allergies and depression, although thus far no epidemiologic evidence involving a large, unselected, general-population sample and valid methods in diagnosing atopy support this putative association.

METHODS

We used the Northern Finland 1966 Birth Cohort, which was followed prospectively to age 31. Of the total cohort, 5428 individuals underwent skin tests for three of the most common allergens (i.e., cat, birch, and timothy grass) and for dust mites (Dermatophagoides pteronyssinus). Data on doctor-diagnosed lifetime depression were obtained from questionnaires.

RESULTS

After adjusting for social class, mothers' parity, place of residence, and psychiatric morbidity, the logistic regression analysis showed that the risk of developing depression when compared with nonatopic subjects increased up to 1.8-fold in atopic women (adjusted odds ratio 1.8, 95% confidence interval [CI] 1.2-2.6) and, when compared with skin-test-negative female subjects without allergic symptoms, reached 2.7-fold increases (95% CI 1.6-4.6) in those suffering from clinically manifest atopic disorders. Corresponding associations were not found among male subjects.

CONCLUSIONS

Our results indicate that women suffering from atopic diseases may possess an elevated risk for developing depression during early adulthood. Possible background theories (i.e., genetic abnormalities in serotonin metabolism, hypothalamic-pituitary-adrenal axis dysfunction, and histamine theory) are discussed.

Psychiatric issues in pulmonary disease

This article has attempted to provide an overview of the clinical literature regarding the psychological issues facing patients with pulmonary disease, depending on when the illness begins in the life span, because different developmental tasks are disrupted. Patients must contend with side effects of medication that may mimic or exacerbate psychiatric disorders. The main drug interactions for psychiatrists to be aware of in this patient population occur between rifampin, or theophylline and psychotropic medications. In lung transplant recipients on cyclosporine therapy, the antidepressant drug nefazadone may cause increased cyclosporine levels. Psychiatrists must be aware of the risks, benefits, and survival statistics; educate patients; and ascertain whether the patient is competent to make medical decisions regarding treatment procedures.

Prevalence of mood disorders and relationship to asthma severity in patients at an inner-city asthma clinic

BACKGROUND

Depressive symptoms are associated with noncompliance and even sudden death in asthma patients. Some studies suggest that low-income, minority, inner-city asthma patients may be at high risk for asthma-related morbidity and mortality in which depression may be a risk factor. Minimal data are available on the prevalence of depression and other mood disorders in asthma patients.

OBJECTIVE

In this pilot study, we examined the prevalence of depression and the association between depression and measures of asthma severity in patients at an inner-city asthma clinic.

METHODS

Mood disorders were diagnosed using a diagnostic interview given to patients (N = 44) at asthma clinic visits. Inhaled steroid dose, FEV1 percentage, and asthma severity were also obtained.

RESULTS

Eighteen patients (41%) had a lifetime mood disorder but only seven of these patients received pharmacotherapy. Patients with a past mood disorder had significantly higher FEV1 percentage predicted values (P = 0.03) than those without a mood disorder. Trends toward less severe asthma (P = 0.13) and lower inhaled steroid dose (P = 0.13) in patients with a mood disorder history were also found.

CONCLUSIONS

The data suggest that mood disorders are common, but often unrecognized and untreated in asthma patients. The data also suggest that mood disorders are not necessarily associated with more severe asthma, at least in the population studied.