Preattentive processing of heart cues and the perception of heart symptoms in congenital heart disease

Illness perceptions of adults with congenital heart disease and their predictive value for quality of life two years later

BACKGROUND

To improve patients' quality of life (QoL) we need to identify modifiable determinants, such as illness perceptions. Patients' illness perceptions are known to regulate emotional responses and health-behaviour. Illness perceptions comprise several components: consequences, control, coherence, changeability and emotional representations.

AIMS

To examine (a) the relation between patient characteristics and illness perceptions, and (b) the independent predictive value of illness perceptions for future QoL.

METHODS

A longitudinal study in 845 patients with congenital heart disease was conducted. Patients completed three questionnaires: the IPQ-R (illness perceptions) and two years later the SF-36 and TAAQOL-CHD (QoL). Linear regression analyses were performed relating illness perceptions to patient characteristics (sex, age, disease complexity and functional status) and QoL.

RESULTS

Patients with a complex defect or poor functional status reported poor illness perceptions. Independent of patient characteristics, poor illness perceptions (i.e. a strong belief that the illness has severe consequences; a weak belief that you have a coherent illness understanding and that the illness can be controlled by treatment; and a strong belief that the illness is changeable and causes negative emotions) were predictive of future QoL.

CONCLUSION

Illness perceptions independently predict QoL, suggesting that QoL may be improved by altering patients' beliefs about their illness. For example, increasing patients' knowledge regarding their disease and informing them about treatment opportunities may enhance their QoL.

Valid Cues for Auditory or Somatosensory Targets Affect Their Perception: A Signal Detection Approach

We investigated the effects of focusing attention towards auditory or somatosensory stimuli on perceptual sensitivity and response bias using a signal detection task. Participants ( N = 44) performed an unspeeded detection task in which weak (individually calibrated) somatosensory or auditory stimuli were delivered. The focus of attention was manipulated by the presentation of a visual cue at the start of each trial. The visual cue consisted of the word “warmth” or the word “tone”. This word cue was predictive of the corresponding target on two-thirds of the trials. As hypothesised, the results showed that cueing attention to a specific sensory modality resulted in a higher perceptual sensitivity for validly cued targets than for invalidly cued targets, as well as in a more liberal response criterion for reporting stimuli in the valid modality than in the invalid modality. The value of this experimental paradigm for investigating excessive attentional focus or hypervigilance in various non-clinical and clinical populations is discussed.

Assessment and treatment of psychological factors in pediatric chest pain

Chest pain is regularly encountered in pediatric medical settings and may be associated with many organic diagnoses that vary widely in morbidity and mortality. Patients with chest pain with and without organic disease may also suffer from comorbid, exacerbating, or causal psychopathology. This article provides practical general guidelines for psychological diagnosis and alleviation of emotional and behavioral difficulties. Specific medical conditions that may benefit from psychological consultation are highlighted. Pediatric chest pain, including an analysis of medically unexplained chest pain, is examined from a psychological perspective that includes a critical review of relevant literature and suggestions for the clinical management of this condition.

False heart rate feedback and the perception of heart symptoms in patients with congenital heart disease and anxiety

Background

Little is known about the mechanisms explaining an increased perception of heart symptoms in congenital heart disease (ConHD). In the present study, it was suggested that a combination of high trait anxiety and disease history increases the perception of heart symptoms.

Purpose

It was tested whether false heart cues will result in an increased perception of heart symptoms in patients with ConHD and anxiety.

Method

Thirty-six patients with ConHD and 44 healthy controls performed two exercise tasks. During one of the exercise tasks, participants were exposed to a false heart cue consisting of false heart rate feedback (regular or irregular). Perceived heart symptoms were assessed and heart rate, arterial partial pressure of CO₂, and respirator rate were monitored continuously.

Results

In line with the predictions, false heart rate feedback resulted in an increased perception of heart symptoms in high trait anxious patients with ConHD that could not be explained by acute heart dysfunction. However, unexpectedly, this effect was not observed immediately after the false heart rate feedback task but after a second exercise task without false feedback.

Conclusion

The results suggest that not the sole presence of ConHD but ConHD in combination with high trait anxiety results in a vulnerability to overperceive heart symptoms.

High symptom reporters are less interoceptively accurate in a symptom-related context

OBJECTIVE

We investigated the role of a symptom interpretation frame on the accuracy of interoception and on retrospective symptom reporting in nonclinical high and low reporters of medically unexplained symptoms.

METHODS

All participants (N=74) went through two subsequent trials of the Rebreathing Test, inducing altered respiration and other physical sensations as a result of a gradually increasing pCO(2) level in the blood. Each trial consisted of a baseline (60 s), a rebreathing phase (150 s), and a recovery phase (150 s). In one trial, the sensations were framed in a neutral way ("the gas mixture might alter breathing behavior and induce respiratory sensations"). In the other trial, a symptom frame was induced ("the gas mixture might alter breathing behavior and induce respiratory symptoms"). Breathing behavior was continuously monitored, subjective sensations were rated every 10 s, and after each trial, participants filled out a symptom checklist. Within-subject correlations between the subjective rating and its physiological referent were calculated for the rebreathing phase and recovery phase of each trial separately.

RESULTS

High symptom reporters had more (retrospective) complaints than low symptom reporters, especially in the symptom trial. Only in the symptom frame were high symptom reporters less accurate than low symptom reporters. The reduction in interoceptive accuracy (IA) in high symptom reporters was most striking in the recovery phase of the symptom frame trial.

CONCLUSION

A contextual cue, such as a reference to symptoms, reduced IA in high symptom reporters and this was more so during recovery from the symptom induction.