The association between anxiety sensitivity and atopy in adult asthmatics

Association between dimensions of trauma-related psychopathology and asthma in trauma-exposed women

Introduction

Exposure to traumatic events and stressful life experiences are associated with a wide range of adverse mental and physical health outcomes. Studies have found post-traumatic stress disorder (PTSD), depression, and anxiety sensitivity occurrence to be common in addition to inflammatory diseases like asthma, especially in women. Moreover, overlapping neurobiological mechanisms have been linked to both PTSD and asthma.

Methods

In the current study, n = 508 women reported on presence of lifetime asthma diagnosis and symptoms of trauma-related psychopathology including PTSD and depression. A separate group of female participants (n = 64) reported on asthma, PTSD, depression and anxiety sensitivity, and underwent functional MRI scans during a fearful faces task, and their anterior insula responses were analyzed.

Results

Overall, PTSD and depression severity were significantly higher in those with asthma versus those without asthma. There was a positive association between anterior insula response to social threat cues and depression symptoms only among individuals without a lifetime presence of asthma.

Discussion

These findings provide continued evidence on the interactions between stress, neural mechanisms involved in interoception and salience detection, and trauma-related psychopathology.

Type D Personality as a Marker of Poorer Quality of Life and Mood Status Disturbances in Patients with Skin Diseases: A Systematic Review

Type D personality is characterized by social inhibition and negative affectivity. Poorer outcomes and worse quality of life have been linked to type D personality in patients with a variety of non-dermatological diseases. Despite increasing evidence of the importance of type D personality in skin diseases, there are no reviews on this subject. The aim of this review is to summarize the current evidence regarding type D personality and skin diseases. A systematic search was performed using Medline and Web of Science databases from inception to 11 October 2022. Studies addressing the presence of type D personality, its associated factors, its impact on the outcomes of the disease or the quality of life of the patients were included in the systematic review. A total of 20 studies, including 3,124 participants, met the eligibility criteria and were included in the review. Acne, hidradenitis suppurativa, psoriasis, melanoma, atopic dermatitis, chronic spontaneous urticaria and pruritic disorders were the main diseases assessed. Type D personality was more frequent among patients with skin diseases than among controls. Type D personality was found to be associated with poorer quality of life and higher rates of psychological comorbidities in patients with skin diseases. In conclusion, type D personality appears to be a marker of patients with increased risk of poorer quality of life and higher rates of psychological comorbidities. Screening for type D personality in specialized dermatology units might be beneficial to identify patients who are more psychologically vulnerable to the consequences of chronic skin diseases.

Type D Personality Is Associated with Poorer Quality of Life in Patients with Chronic Spontaneous Urticaria: A Cross-sectional Study

Type D personality (TDp) is a stable personality type that has been associated with poor quality of life in the general population and in patients with a variety of diseases, such as cancer, cardiac diseases, and dermatological diseases (e.g. psoriasis). To date, the potential association between chronic spontaneous urticaria and TDp has not been studied. The aim of this study is to analyse the impact of TDp on patients with chronic spontaneous urticaria, regarding mood disturbances, quality of life, sexuality, and sleep disturbances. A cross-sectional study including 75 patients with chronic spontaneous urticaria was performed. Data on socio- demographic variables and disease activity, quality of life, sleep, sexual dysfunction, anxiety, depression and TDp were collected using validated questionnaires. TDp was present in 28% (21/75) of the patients. Although TDp was not related to worse disease control, the presence of anxiety and depression was higher in patients with TDp. Regarding quality of life, TDp was associated with poorer quality of life and higher frequency of sleep disturbances. Prevalence of TDp in patients with chronic spontaneous urticaria is similar to that in the general population. It is associated with mood status disturbances and worse quality of life regardless of disease severity, especially in the emotional and psychological domains. This group of patients could benefit from additional psychological support as a complement to their medical treatment.

Impact of interventions targeting anxiety and depression in adults with asthma

OBJECTIVE

High rates of anxiety and depression exist among asthma patient populations. This scoping review will examine the existing interventional therapies that address depression and anxiety symptoms in patients with asthma.

DATA SOURCES

PubMed, Cochrane, Psychinfo, CINAHL, Google Scholar and EMBASE databases were searched using the following search terms: 'anxiety asthma', 'panic disorder asthma' and 'depression asthma' with a randomized clinical trial filter and additional filters to exclude exclusion criteria.

STUDY SELECTIONS

Study selections included only randomized control trials with anxiety and/or depression and/or panic disorder outcomes as primary or secondary outcomes. Only full-text articles in the English language were included.

RESULTS

This search yielded interventions from pharmacologic (n = 3), psychological (n = 7), lifestyle medicine (n = 10) and complementary and alternative medicine (CAM; n = 1) using a range of outcomes from physiologic to psychologic. While the pharmacologic and CAM studies were inconclusive, psychologic and lifestyle interventions showed improvements in asthma (quality of life, symptoms, asthma attacks) and psychological (anxiety, panic fear, depression) outcomes. Variations in selection methods, outcome measures and diagnostic criteria hindered a direct comparison of the studies. Most studies had small sample sizes, high attrition rates and short study durations.

CONCLUSION

There is limited evidence on best approaches for managing co-morbid anxiety and/or depression in patients with asthma. Psychological and lifestyle medicine interventions are promising with improvements in both asthma and mental health outcomes. Well-designed randomized controlled studies with larger sample sizes, standardized outcomes and longer durations, are needed to better understand the role of depression and anxiety in adults with asthma.

Blunted cortisol response to psychosocial stress in atopic patients is associated with decrease in salivary alpha-amylase and aldosterone: Focus on sex and menstrual cycle phase

A decreased responsiveness of the hypothalamic-pituitary-adrenocortical axis to stress stimuli in patients with atopy is well documented. The aim of this study was to investigate personality traits, salivary alpha-amylase activity and the aldosterone response to psychosocial stress procedure based on public speech in atopic patients with respect to sex and the menstrual cycle (MC) phase. The study was performed in 106 subjects of both sexes, 53 atopic patients suffering from allergic rhinitis, allergic asthma or atopic dermatitis and 53 age-, sex-, the MC phase- and BMI- matched healthy controls. Substantially attenuated activity of alpha-amylase and reduced secretion of aldosterone during the psychosocial stress were observed in the whole sample of patients with atopy. Higher activity of alpha-amylase observed in the follicular compared to the luteal phase in healthy women was not present in atopic patients. In both males and females, atopy was associated with blunted cortisol response but no changes in the heart rate. Psychological characterization revealed a significantly higher trait anxiety and higher preference for avoidance-oriented coping strategy in female but not male atopic patients. These findings provide evidence that patients with atopy exhibit insufficient alpha-amylase and aldosterone responsiveness to psychosocial stress, thus suggesting decreased sympathetic activity. Potential disturbances in sex hormone status during the MC in female patients with atopy have to be considered in future research. Changes in personality traits were demonstrated in female atopic patients, but not in male patients.

Association between patterns of leisure time physical activity and asthma control in adult patients

Background

Physical activity has been shown to have various health benefits in patients with asthma, especially in children. However, there are still limited data on the nature of the association between physical activity and asthma control in adults.

Objective

The objective of the current study was to determine the nature of the association between physical activity and asthma control, with particular emphasis on the intensity of the activity and seasonal variations.

Methods

643 adult patients with objectively confirmed asthma (mean age (SD)=53 (15) years, 60% women) were interviewed by telephone. Patients completed the asthma control questionnaire (ACQ), the asthma quality of life questionnaire, and a 1-year physical activity recall questionnaire to assess leisure time physical activity (LTPA).

Results

Total LTPA was related to control (β (95% CI)=−0.013 (−0.030 to 0.006)), with those doing recommended levels of LTPA being nearly 2.5 times more likely to have good control compared with inactive patients. Analysis of seasonal exercise habits found that winter LTPA (β=−0.027 (−0.048 to −0.006)) was more strongly associated with ACQ scores than summer LTPA (β=−0.019 (−0.037 to −0.001)). Adjustment for age, sex, season of assessment, inhaled corticosteroid (ICS) dose, body mass index, and current smoking status reduced the strength of the relationships.

Conclusions

Data indicate that higher levels of LTPA are associated with better levels of asthma control in adult patients with asthma, and that this seems to be more pronounced among asthmatics who do the recommended levels of exercise.

Negative affectivity, emotion regulation, and coping in migraine and probable migraine: a New Zealand case-control study

BACKGROUND

Migraine is a prevalent and disabling health condition. While there have been some suggestions that personality may be linked to migraine incidence, dose-response links to disability or impact are yet to be conducted and multivariate analyses are uncommon.

PURPOSE

The purposes of this study are to evaluate the personality characteristics differentiating migraine and probable migraine sufferers from matched controls in multivariate models and assess the possibility of a dose-response relationship.

METHODS

Fifty migraine sufferers and 50 age-, sex-, and ethnicity-matched controls in New Zealand completed personality measures including negative affectivity, coping, and monitoring-blunting.

RESULTS

Logistic regressions indicated that migraine status was concurrently predicted by Type D negative affectivity, more frequent venting and planning coping, and lower monitoring. There was little evidence to suggest a consistent dose-response type effect of personality on migraine; lower impact and disability were associated with greater openness to experiences, acceptance, and behavioural disengagement.

CONCLUSIONS

A personality profile characterised by moderate levels of negative emotion and irritability together with failures in inhibitory self-regulation may be associated with an increased risk of strict and probable migraine.

The relationship between allergy and asthma control, quality of life, and emotional status in patients with asthma: a cross-sectional study

Background

Psychiatric comorbidities are prevalent in patients with chronic somatic disorders such as asthma. But, there is no clear evidence regarding the effect of atopic status and the type of sensitized allergen on emotional status. The aim of the present study was to investigate the effects of house dust mites and pollen allergies on emotional status, asthma control and the quality of life in patients with atopic asthma.

Methods

The study included 174 consecutive patients who were diagnosed with asthma accoring to the GINA criteria and who did not receive therapy for their allergy. All patients underwent a skin prick test. The asthma control, quality of life, and emotional status were evaluated using the ACT (asthma control test), AQLQ (asthma-specific quality of life questionnaire), and HAD (hospital anxiety depression questionnaire).

Results

Atopy was detected in 134 (78.7%) patients. Of those patients: 58 (33.3%) had anxiety and 83 (47.7%) had depression. There was no relationship between emotional status, atopic status, and the type of indoor/outdoor allergen. Furthermore, there was no relationship between atopy and asthma severity, asthma control, and the quality of life. The anxiety and depression scores were significantly higher and the quality of life scores lower in the uncontrolled asthma group. The ACT and AQLQ scores were also lower in the anxiety and depression groups.

Conclusions

It was concluded that anxiety and depression are prevalent in patients with uncontrolled asthma, and atopic status did not affect the scores in ACT, AQLQ, and emotional status tests.

The impact of type D personality on health-related quality of life in patients with symptomatic haemorrhoids

Introduction

Haemorrhoids are one of the most common reasons that patients seek consultation from a colon and rectal surgeon. Health-related quality of life (HrQoL) is a significant factor in describing the burden of illness and the impact of treatment in patients with gastrointestinal disease. Type D (distressed) personality is defined as the co-occurrence of negative affect and social inhibition.

Aim

To assess the prevalence of type D personality in patients with haemorrhoids and to investigate whether the presence of a type D personality would affect HrQoL in patients with haemorrhoids.

Material and methods

One hundred and six outpatients with symptomatic haemorrhoids with no psychiatric comorbidity were consecutively enrolled, along with 96 healthy controls. The Type D Scale (DS14) and the General Health Survey Short Form-36 (SF-36) were used in the collection of data.

Results

Of 106 patients evaluated, 29.2% met criteria for type D personality. Patients with haemorrhoids scored lower on bodily pain and vitality dimensions of SF-36 than did healthy subjects (p < 0.001). Patients with a type D personality were found to score lower on bodily pain domain of HrQoL than patients without a type D personality. Linear regression analysis revealed a significant independent association of type D personality with bodily pain dimension of the SF-36 in patients with symptomatic haemorrhoids (r = –0.315, p < 0.01).

Conclusions

Type D personality was associated with increased perceived bodily pain in patients with haemorrhoids. Consideration of type D personality construct personality traits could improve risk stratification in research and clinical practice in this patient group.

Refining the measurement of distress intolerance

Distress intolerance is an important transdiagnostic variable that has long been implicated in the development and maintenance of psychological disorders. Self-report measurement strategies for distress intolerance (DI) have emerged from several different models of psychopathology and these measures have been applied inconsistently in the literature in the absence of a clear gold standard. The absence of a consistent assessment strategy has limited the ability to compare across studies and samples, thus hampering the advancement of this research agenda. This study evaluated the latent factor structure of existing measures of DI to examine the degree to which they are capturing the same construct. Results of confirmatory factor analysis in three samples totaling 400 participants provided support for a single-factor latent structure. Individual items of these four scales were then correlated with this factor to identify those that best capture the core construct. Results provided consistent support for 10 items that demonstrated the strongest concordance with this factor. The use of these 10 items as a unifying measure in the study of DI and future directions for the evaluation of its utility are discussed.

Anxiety sensitivity, asthma control, and quality of life in adults with asthma

OBJECTIVE

The aim of this study was to examine the role of anxiety sensitivity (AS) in terms of asthma control and asthma-related quality of life in a sample of adults with a physician-verified diagnosis of asthma.

METHODS

Self-report measures assessing psychological and asthma symptoms were mailed to 368 asthma patients from a community allergy and asthma office who had been seen for a physician follow-up visit between 1 January 2009 and 1 January 2010. Participants in the current study were 127 asthma patients (74% female; M(age) = 43.4 years, SD = 12.3) who completed and returned the self-report measures.

RESULTS

The results indicated that, after controlling for gender, age, negative affect, and number of comorbid medical problems, the physical concerns factor of AS (AS-Physical Concerns) significantly predicted asthma control and all domains of asthma-related quality of life (symptoms, activity limitations, emotional functioning, and environmental stimuli).

CONCLUSIONS

These findings replicate and extend previous research and indicate that the fear of physical sensations negatively affects both asthma control and quality of life. These findings also suggest that targeting the AS-Physical Concerns may be a novel way to improve asthma control and quality of life.

Association between generalized anxiety disorder and asthma morbidity

BACKGROUND

Generalized anxiety disorder (GAD) is common among people with asthma, but its association with asthma morbidity remains unexplored. This study examined cross-sectional associations between GAD and asthma control, quality of life, and self-efficacy.

METHODS

Seven hundred ninety-four adults with confirmed asthma were recruited from the outpatient clinic of a university hospital. Patients underwent a sociodemographic and medical history interview (to assess health service use and medications), followed by a brief psychiatric interview (Primary Care Evaluation of Mental Disorders) to assess GAD. Patients completed questionnaires assessing asthma control, quality of life, and asthma self-efficacy and underwent spirometry. General linear models and logistic regression were used to assess associations between GAD and asthma morbidity measures, adjusting for covariates.

RESULTS

GAD affected 4% of the sample. The analyses revealed significant associations between GAD and worse overall asthma control (β = 0.62, standard error [SE] = 0.18, p < .001), increased bronchodilator use (β = 10.60, SE = 2.64, p < .001), worse asthma quality of life (β = -0.91, SE = 0.23, p < .001), and worse asthma self-efficacy (β = -59.56, SE = 13.59, p < .001) after the adjustment for covariates. Separate sensitivity analyses including major depressive disorder and asthma self-efficacy as additional covariates rendered many of these associations nonsignificant. There were no associations between GAD and emergency visits or hospitalizations.

CONCLUSIONS

GAD is associated with worse asthma morbidity independent of age, sex, smoking, and asthma severity; however, comorbid major depressive disorder and low asthma self-efficacy may account for many of these associations. Only breathlessness and the frequency of bronchodilator use were uniquely associated with GAD. Future research should examine whether treatment of GAD can affect asthma outcomes.

The role of anxiety sensitivity in terms of asthma control: a pilot test among young adult asthmatics

The aim of the present pilot investigation was to examine the role of specific subfactors of anxiety sensitivity (physical, cognitive, and social concerns) in terms of asthma control among a young adult sample (N = 56; M age = 20.0; SD = 3.9; Range = 18-45 years). Results indicated that, after controlling for gender, cigarette smoking status, and negative affectivity, the physical concerns factor of anxiety sensitivity, relative to cognitive and social concern factors, significantly predicted asthma control. These findings support the theory that fear of physical sensations is associated with poorer asthma control and suggest that targeting the physical concerns facet of anxiety sensitivity may be a novel way to improve asthma control.

A meta-analytic review of the association between anxiety sensitivity and pain

In recent years, anxiety sensitivity (AS) has demonstrated applicability across a wide range of conditions. An area of particular interest has been the association between AS and pain. This study aimed to provide an accounting of the magnitude of this effect across studies of both clinical and nonclinical pain. Forty-one studies (14 clinical and 27 nonclinical pain) were evaluated in this meta-analytic review and represented the study of 5,908 participants (2,093 for clinical and 3,815 for nonclinical pain studies). Results indicate that AS was strongly associated with fearful appraisals of pain, with more modest results for measures of pain tolerance/threshold and pain-related disability. Implications of these results for the treatment of chronic pain are discussed.

Type D personality among noncardiovascular patient populations: a systematic review

OBJECTIVE

This article reviews all available literature concerning the implications of Type D personality (the conjoint effects of negative affectivity and social inhibition) among patients with noncardiovascular conditions.

METHODS

Published papers were included if they studied Type D personality among noncardiovascular patient populations. Twelve articles met our inclusion criteria and were subjected to a methodological quality checklist (e.g., sample size, response rate, Type D measurement).

RESULTS

The methodological quality of the selected studies was quite good. The noncardiovascular patient populations included chronic pain, asthma, tinnitus, sleep apnea, primary care patients, vulvovaginal candidiasis, mild traumatic brain injury, vertigo, melanoma and diabetic foot syndrome. Type D personality was associated with an increased number or severity of reported health complaints, heightened the perception of negative emotions (e.g., depression and anxiety), had an adverse effect on health-related behaviors, was associated with poor adherence to treatment and significantly reduced effort to perform during diagnostic testing.

CONCLUSION

Type D is a vulnerability factor that not only affects people with cardiovascular conditions but also those with other medical conditions. Type D was associated with poor physical and mental health status and poor self-management of the disease. Consequently, including Type D in future studies seems warranted.

Individual-level socioeconomic status is associated with worse asthma morbidity in patients with asthma

BACKGROUND

Low socioeconomic status (SES) has been linked to higher morbidity in patients with chronic diseases, but may be particularly relevant to asthma, as asthmatics of lower SES may have higher exposures to indoor (e.g., cockroaches, tobacco smoke) and outdoor (e.g., urban pollution) allergens, thus increasing risk for exacerbations.

METHODS

This study assessed associations between adult SES (measured according to educational level) and asthma morbidity, including asthma control; asthma-related emergency health service use; asthma self-efficacy, and asthma-related quality of life, in a Canadian cohort of 781 adult asthmatics. All patients underwent a sociodemographic and medical history interview and pulmonary function testing on the day of their asthma clinic visit, and completed a battery of questionnaires (Asthma Control Questionnaire, Asthma Quality of Life Questionnaire, and Asthma Self-Efficacy Scale). General Linear Models assessed associations between SES and each morbidity measure.

RESULTS

Lower SES was associated with worse asthma control (F = 11.63, p < .001), greater emergency health service use (F = 5.09, p = .024), and worse asthma self-efficacy (F = 12.04, p < .01), independent of covariates. Logistic regression analyses revealed that patients with <12 years of education were 55% more likely to report an asthma-related emergency health service visit in the last year (OR = 1.55, 95%CI = 1.05-2.27). Lower SES was not related to worse asthma-related quality of life.

CONCLUSIONS

Results suggest that lower SES (measured according to education level), is associated with several indices of worse asthma morbidity, particularly worse asthma control, in adult asthmatics independent of disease severity. Results are consistent with previous studies linking lower SES to worse asthma in children, and add asthma to the list of chronic diseases affected by individual-level SES.

Allergic rhinitis induces anxiety-like behavior and altered social interaction in rodents

Epidemiological and clinical studies report higher incidences of anxiety and increased emotional reactivity in individuals suffering from respiratory allergies. To evaluate if respiratory allergies are capable of promoting anxiety-like behavior in rodents, we used models of allergic rhinitis and behavioral evaluations followed by assessment of mRNA for cytokines in relevant brain regions. Mice and rats were sensitized to ovoalbumin or pollen, respectively, following standard sensitization and challenge protocols. After challenge, the animals were evaluated in the open field, elevated plus-maze and resident-intruder tests. Cytokines and corticotropin-releasing factor expression were assessed in several brain regions by real-time RT-PCR and plasma corticosterone concentrations by radioimmunoassay. Mice and rats sensitized and exposed to allergen showed increased anxiety-like behavior and reduced social interaction without any overt behavioral signs of sickness. T-helper type 2 (T(H)2) cytokines were induced in both rats and mice in the olfactory bulbs and prefrontal cortex and remained unchanged in the temporal cortex and hypothalamus. The same results were found for CRF mRNA expression. No differences were observed in corticosterone concentrations 1h after the last behavioral test. These results show that sensitization and challenge with allergens induce anxiety across rodent species and that these effects were paralleled by an increased expression of T(H)2 cytokines and CRF in the prefrontal cortex. These studies provide experimental evidence that sensitized rodents experience neuroimmune-mediated anxiety and reduced social interaction associated with allergic rhinitis.