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de Filippis R, Mercurio M, Segura-Garcia C, De Fazio P, Gasparini G, Galasso O. Defining the minimum clinically important difference (MCID) in the hospital anxiety and depression scale (HADS) in patients undergoing total hip and knee arthroplasty. Orthop Traumatol Surg Res 2024; 110:103689. [PMID: 37741440 DOI: 10.1016/j.otsr.2023.103689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/02/2023] [Accepted: 08/30/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION Total hip (THA) and knee (TKA) arthroplasty are effective procedures, but whose success depends on various factors, including patients' genetics, sociocultural environments, and psychological factors. Patient-reported outcome measures (PROMs) provide objective health status outcomes measurements, whose lowest significant variation is detected by the minimum clinically important difference (MCID). HYPOTHESIS We aimed to find the MCID scores for the Hospital Anxiety and Depression Scale (HADS), HADS-A, and HADS-D in a cohort of individuals undergoing THA or TKA. PATIENTS AND METHODS We enrolled 88 patients suffering from osteoarthritis (43 undergoing THA, and 45 TKA) by administering HADS, SF-12 and WOMAC at baseline and then with a 12-month prospective follow-up. The MCID for HADS, HADS-A, and HADS-D was calculated using the distribution-based approach, according to various techniques (0.5 standard deviation [0.5 SD]), the standard error of measurement (SEM), the effect size (ES), and the minimum detectable change (MDC). RESULTS The analysis of HADS, HADS-A, and HADS-D scores revealed clinically significant improvements in symptoms in patients who underwent THA and TKA. The MCID range values were determined to be between 2.7-8.5 for the HADS, 1.4-4.4 for the HADS-A, and 1.5-4.8 for the HADS-D in the group of patients undergoing THA, and 2.1-6.7 for the HADS, 1.2-3.8 for the HADS-A, and 1.1-3.6 for the HADS-D in the TKA group. DISCUSSION The study determined significant improvement in all scores applying MCID analysis, which can aid physicians in interpreting anxiety and depression scores and developing both preoperative and postoperative procedures to enhance outcomes for patients undergoing THA and TKA. LEVEL OF EVIDENCE I; well-designed cohort study.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V. le Europa, 88100 Catanzaro, Italy.
| | - Cristina Segura-Garcia
- Psychiatry Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V. le Europa, 88100 Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V. le Europa, 88100 Catanzaro, Italy
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Ge BH, Yang F. Transcending the self to transcend suffering. Front Psychol 2023; 14:1113965. [PMID: 37484086 PMCID: PMC10361767 DOI: 10.3389/fpsyg.2023.1113965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/02/2023] [Indexed: 07/25/2023] Open
Abstract
Suffering is inevitable in human life. Our perspective paper theorizes on precise mechanisms for how self-transcendence-the state in which an individual looks beyond the self and adopts a larger perspective including concern for others and the world-may help people endure the experience of suffering. From an examination of empirical literature ranging from social psychology to clinical research, we propose that self-transcendence may aid the endurance of suffering along three psychological levels: (1) On the level of affect, the unique profundity and positivity of self-transcendent experiences (e.g., awe, flow, compassion) may supersede and reduce the salience of negative affect arising from suffering (e.g., fear, despair, depressive mood). (2) On the level of cognition, the larger frame of reference provided by self-transcendent thinking may contextualize one's suffering as something comprehendible, thereby helping to resolve the challenges of making meaning from suffering (e.g., that one's existing meaning systems are unable to explain the suffering event). (3) On the level of motivation, the drive to fulfill one's need for self-transcendence may counterbalance the more hedonically-oriented motivations that can promote negative coping strategies in response to suffering (e.g., avoidance, substance abuse). All three mechanisms may also provoke downstream prosocial behaviors that help embed the individual into networks of social support. Altogether, by synthesizing specific mechanisms from affective, cognitive, and motivational self-transcendent processes, our paper establishes a theoretical framework for how self-transcendence may help people endure and transcend suffering, thereby elevating the conditions and experiences of our existence.
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The Impact of Affective Temperaments on Suicidal Ideation and Behaviors: Results from an Observational Multicentric Study on Patients with Mood Disorders. Brain Sci 2023; 13:brainsci13010117. [PMID: 36672098 PMCID: PMC9856472 DOI: 10.3390/brainsci13010117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Suicide ideation and behaviors are major health issues in the field of mental health. Several psychological and psychosocial factors have been taken into account as possible predictors of suicidality. Only recently affective temperaments have been considered as possible factors linked to suicide. This study aims to investigate the relationship between affective temperaments and suicidality, including the lifetime onset of suicide ideation, lifetime presence of suicide attempts and the total number of lifetime suicide attempts. This is a naturalistic multicentric observational study, involving outpatient units of seven University sites in Italy. Patients were administered with the short version of TEMPS-M and the Columbia Suicide Severity Rating Scale. A total of 653 participants were recruited, with a diagnosis of bipolar (55.7%), unipolar (35.8%) and cyclothymic disorder (8.4%). Regression models showed that the presence of lifetime suicide behaviors was increased in patients presenting trait related impulsivity (p < 0.0001), poor free-interval functioning (p < 0.05), higher number of affective episodes (p < 0.01), higher number of hospitalizations (p < 0.0001), cyclothymic and irritable affective temperaments (p < 0.05 and p < 0.05, respectively). Conversely, the presence of hyperthymic affective disposition reduced the likelihood of having suicidal behaviors (p < 0.01). Lifetime suicidal ideation was associated with trait-related impulsivity (p < 0.001), poor free-interval functioning (p < 0.05), higher number of affective episodes (p < 0.001) and of hospitalizations (p < 0.001). Depressive temperaments increased the likelihood of presenting suicidal ideation (p < 0.05), along with irritable temperaments (p < 0.01), contrary to hyperthymic affective (p < 0.05). Results of the present study confirm that affective disposition has a significant impact on the onset of suicidal ideation and behaviors, and that affective dispositions should be assessed in clinical settings to identify people at risk of suicide. Moreover, a wider clinical evaluation, including different clinical psychopathological dimensions, should be taken into consideration to develop effective preventive interventions.
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Favaretto E, Gögele M, Bedani F, Hicks AA, Erfurth A, Perugi G, Pramstaller PP, Melotti R. Pain sensitivity is modulated by affective temperament: Results from the population-based CHRIS Affective Disorder (CHRIS-AD) study. J Affect Disord 2022; 316:209-216. [PMID: 35952933 DOI: 10.1016/j.jad.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/06/2022] [Accepted: 08/06/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Nociceptive pain modulation is related to psychological and psychiatric conditions. Evidence from clinical studies backs innate temperaments as potential precursors of mood symptoms and disorders, and pain sensitivity. Our study examines the modulation effect of affective temperaments on pain sensitivity in a general population adult sample, accounting for possible intervening mood symptoms, lifetime anxiety and depression, and pain treatments. METHODS The sample is part of the CHRIS-AD study, Italy. Primary outcomes were the pain sensitivity questionnaire PSQ-total intensity score and the experimental pressure pain threshold (PPT). Affective temperaments were evaluated with the TEMPS-M. Lifetime depression, anxiety, current mood disorders, and treatments were self-reported via rating-scales. Directed acyclic graphs theory guided linear and mixed linear regression model analyses. RESULTS Among 3804 participants (aged 18-65; response rate 78.4 %, females 53.3 %, mean age 38.4 years) for any given temperament, both the PSQ-total and the PPT were associated with temperament. The TEMPS-M four cyclothymic-related temperaments aligned on the pain-sensitive pole and the hyperthymic on the pain-resilient pole. The inclusion of current or lifetime mood symptoms, or pain drug use, as possible intervening pathways only partly diluted these associations, with stronger evidence for an effect of trait anxiety. LIMITATIONS The main limitations were the lack of experimental measures of suprathreshold pain intensity perception, and detailed information on affective disorders in the study population. CONCLUSIONS These findings support the hypothesis of a biological dichotomous diathesis of affective temperaments towards pain sensitivity; hyperthymic suggesting protection, whereas cyclothymic suggesting predisposition.
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Affiliation(s)
| | - Martin Gögele
- Institute for Biomedicine (affiliated to the University of Lübeck, Lübeck, Germany), Eurac Research, Bolzano, Italy
| | - Fulvio Bedani
- Department of Psychiatry, General Hospital, Bressanone, Italy
| | - Andrew A Hicks
- Institute for Biomedicine (affiliated to the University of Lübeck, Lübeck, Germany), Eurac Research, Bolzano, Italy
| | - Andreas Erfurth
- Klinik Hietzing, Department of Psychiatry and Psychotherapeutic Medicine, Vienna, Austria
| | - Giulio Perugi
- Section of Psychiatry, Department of Experimental and Clinic Medicine, University of Pisa, Pisa, Italy
| | - Peter P Pramstaller
- Institute for Biomedicine (affiliated to the University of Lübeck, Lübeck, Germany), Eurac Research, Bolzano, Italy; Department of Neurology, General Central Hospital, Bolzano, Italy
| | - Roberto Melotti
- Institute for Biomedicine (affiliated to the University of Lübeck, Lübeck, Germany), Eurac Research, Bolzano, Italy
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Roy R, Sommer JL, Bolton JM, El-Gabalawy R. Understanding correlates of suicidality among those with usual pain and discomfort: A Canadian nationally representative study. J Psychosom Res 2021; 151:110651. [PMID: 34673350 DOI: 10.1016/j.jpsychores.2021.110651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/10/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Suicidality (ideation, plans, attempts) is elevated among those with chronic pain. However, population-based research is limited and studies primarily focus on mechanisms associated with increasing rather than decreasing risk. This study aimed to identify correlates associated with increased and decreased odds of suicidality among Canadians with usual pain/discomfort in a nationally representative sample. METHODS Cross-sectional data from the 2012 Canadian Community Health Survey-Mental Health supplement (CCHS-MH; N = 25,113) identified individuals with usual pain/discomfort (i.e., chronic pain; n = 5891). Multiple logistic regressions examined correlates that may increase (disability, activity limitations) and decrease (social support, positive mental health, spirituality) odds of suicidality among individuals endorsing usual pain/discomfort. RESULTS Among those endorsing usual pain/discomfort, between 7.1% (suicide attempt) to 21.0% (suicide ideation) endorsed suicidality, notably higher than those without (2.0% vs 9.6% for suicide attempt and ideation, respectively). Both greater social support and positive mental health were associated with decreased odds of suicide ideation and attempts (adjusted odds ratio (AOR) range = 0.94-0.97). Those whose pain prevented most activities had increased odds of suicide plans and attempts (AOR range = 1.72-1.94). Additionally, greater disability was associated with increased odds of suicide ideation (AOR = 1.01, 95% CI[1.01-1.02], p < .001). A multivariable model including all risk and protective correlates found only positive mental health as significantly associated with decreased odds of suicide ideation and attempts. CONCLUSIONS These findings may inform targeted screening, prevention, and intervention strategies to promote resilience and mitigate risk, among those with usual pain/discomfort.
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Affiliation(s)
- Rachel Roy
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada
| | - Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, MB, Canada; Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba, Winnipeg, MB, Canada.
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Hung CI, Liu CY, Yang CH, Wang SJ. Migraine with active headache was associated with other painful physical symptoms at two-year follow-up among patients with major depressive disorder. PLoS One 2019; 14:e0216108. [PMID: 31039196 PMCID: PMC6490935 DOI: 10.1371/journal.pone.0216108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Few studies have investigated the associations of comorbid migraine with other painful physical symptoms (PPS) in patients with major depressive disorder (MDD) at the two-year follow-up point. This study aimed to investigate this issue. METHODS At baseline, 155 outpatients with MDD were enrolled. Migraine was diagnosed at baseline according to the International Classification of Headache Disorders. At follow-up, data of 101 subjects were analyzed. The average intensities of head, bone and/or joints, back, chest, abdomen, neck and/or shoulder, general muscle, and limb pain in the past week were evaluated using a visual analog scale (VAS). At follow-up, active headache was defined as a score on the VAS > 3. Multiple linear regressions were used to investigate the associations of migraine at baseline with other PPS at follow-up. RESULTS Compared with the migraine with inactive headache group and the non-migraine group, patients with migraine with active headache had significantly higher intensities of other PPS and a lower remission rate of depression. There were no significant differences in the pain intensities of the other seven PPS between the migraine with inactive headache group and the non-migraine group. Headache intensity was significantly correlated with the intensities of other PPS at baseline and follow-up. Migraine with active headache independently predicted other PPS after controlling for depression and anxiety at baseline. CONCLUSIONS Migraine with active headache among MDD patients could predict other PPS. Prevention and treatment of headache might help to decrease other PPS and improve the prognosis of depression. Integration of treatment for depression and headache is indicated.
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Affiliation(s)
- Ching-I Hung
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chia-Yih Liu
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Ching-Hui Yang
- Department of Nursing, Mackay Medical College, New Taipei, Taiwan
| | - Shuu-Jiun Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail:
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Elkana O, Conti Y, Heyman O, Hamdan S, Franko M, Vatine JJ. The associations between executive functions and different aspects of perceived pain, beyond the influence of depression, in rehabilitation setting. Neuropsychol Rehabil 2019; 30:1303-1317. [DOI: 10.1080/09602011.2019.1574590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Odelia Elkana
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo, Israel
| | - Yael Conti
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo, Israel
| | - Ofir Heyman
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo, Israel
| | - Sami Hamdan
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo, Israel
| | - Motty Franko
- Behavioral Sciences, Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo, Israel
| | - Jean-Jacques Vatine
- Reuth Rehabilitation Hospital, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Velly AM, Mohit S. Epidemiology of pain and relation to psychiatric disorders. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:159-167. [PMID: 28522289 DOI: 10.1016/j.pnpbp.2017.05.012] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/10/2017] [Accepted: 05/14/2017] [Indexed: 12/11/2022]
Abstract
Chronic pain is a common pain condition. Some psychiatric disorders, such as anxiety and depression, are also common in the general population. Epidemiological studies found that some psychiatric disorders are more commonly found among persons with chronic pain (e.g., headache, back pain) than those without chronic pain. Why those psychiatric disorders co-occur with chronic pain, however, is not well understood. Further, studies demonstrated that some psychiatric disorders, such as depression, increase the risk of chronic pain as well as its persistence. It is also recognized that chronic pain has a negative impact on the persistence of psychiatric disorders. The observations from clinical studies suggest that chronic pain is not a common comorbidity among individuals with other psychiatric disorders, such as dementia and schizophrenia. It is not clear if this is a consequence of any specific biological mechanism, or methodology problems in the studies. This paper provides an overview on the distribution of chronic pain and psychiatric disorders, followed by a review of studies that have demonstrated the association between psychiatric disorders and chronic pain.
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Affiliation(s)
- Ana Miriam Velly
- Faculty of Dentistry, McGill University, Montreal, Canada; Centre for Clinical Epidemiology, Canada; Department of Dentistry, Jewish General Hospital, 3755, Chemin de la Côte Ste-Catherine, Suite A-017, H3T 1E2 Montréal, Québec, Canada.
| | - Shrisha Mohit
- Department of Dentistry, Jewish General Hospital, 3755, Chemin de la Côte Ste-Catherine, Suite A-017, H3T 1E2 Montréal, Québec, Canada.
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Fond G, Boyer L, Andrianarisoa M, Godin O, Bulzacka E, Berna F, Brunel L, Coulon N, Aouizerate B, Capdevielle D, Chereau I, D'amato T, Denizot H, Dubertret C, Dubreucq J, Faget C, Leignier S, Mallet J, Misdrahi D, Rey R, Lancon C, Passerieux C, Schandrin A, Urbach M, Vidailhet P, Leboyer M, Schurhoff F, Llorca PM. Self-reported pain in patients with schizophrenia. Results from the national first-step FACE-SZ cohort. Prog Neuropsychopharmacol Biol Psychiatry 2018; 85:62-68. [PMID: 29678770 DOI: 10.1016/j.pnpbp.2018.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/11/2018] [Accepted: 04/15/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Little is known about perception of physical pain in schizophrenia (SZ). Some studies have suggested that patients with SZ may have an increased pain threshold, while others have suggested that patients with SZ may suffer from undetected and untreated high physical pain levels. The objectives of this study were (i) to investigate the prevalence of self-reported physical pain in stabilized SZ subjects, and (ii) to determine whether physical pain was associated with psychiatric characteristics and somatic comorbidities (iii) to determine whether antidepressants and benzodiazepine administration were associated with lower self-reported pain. METHOD 468 community-dwelling stable SZ subjects (73% men, mean aged 32 years) were recruited in the Schizophrenia Expert Center national network. Patients with moderate to extreme pain, assessed with the EQ5D-5L questionnaire, were classified as belonging to the "pain group". RESULTS 104 (22.2%) reported moderate to extreme pain levels. In multivariate analysis, pain has been associated with headache (OR = 2.63 [1.04-6.63], p = 0.04), higher anxiety (OR = 1.61 [1.18-2.21], p = 0.003), higher current depressive symptoms (OR = 1.09 [1.01-1.17], p = 0.03), history of childhood trauma (1.03 [1.01-1.06], p = 0.01) and older age (OR = 1.04 [1.01-1.07], p = 0.03), independently of current psychotic severity, sociodemographic variables, antipsychotic, antidepressant and benzodiazepine treatments. No association with addictive behaviors or illness characteristics has been found. CONCLUSION The present findings suggest that community-dwelling SZ outpatients report a high rate of self-reported physical pain, associated with headache, depression and anxiety and history of childhood trauma. Physical pain should be systematically assessed and specifically treated, when needed, in patients with SZ.
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Affiliation(s)
- Guillaume Fond
- Fondation FondaMental, Créteil, France; Aix-Marseille Univ, School of MEDICINE - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France.
| | - Laurent Boyer
- Fondation FondaMental, Créteil, France; Aix-Marseille Univ, School of MEDICINE - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Meja Andrianarisoa
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, Créteil, France; Paris Est University, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - Ophelia Godin
- Fondation FondaMental, Créteil, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France
| | - Ewa Bulzacka
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, Créteil, France; Paris Est University, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - Fabrice Berna
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Lore Brunel
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, Créteil, France; Paris Est University, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - Nathalie Coulon
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, Créteil, France; Paris Est University, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, F-33076 Bordeaux, France; Inserm, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, U862, F-33000 Bordeaux, France
| | - Delphine Capdevielle
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - Isabelle Chereau
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - Thierry D'amato
- Fondation FondaMental, Créteil, France; Université Claude Bernard Lyon 1, Centre Hospitalier Le Vinatier, Pole Est, BP 300 39-95 bd Pinel, 69678 Bron Cedex, France
| | - Hélène Denizot
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Inserm U894, Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - Julien Dubreucq
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - Catherine Faget
- Fondation FondaMental, Créteil, France; Assistance Publique des Hôpitaux de Marseille (AP-HM), pôle universitaire de psychiatrie, Marseille, France
| | - Sylvain Leignier
- Fondation FondaMental, Créteil, France; Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - Jasmina Mallet
- Fondation FondaMental, Créteil, France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Inserm U894, Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France
| | - David Misdrahi
- Fondation FondaMental, Créteil, France; Centre Hospitalier Charles Perrens, Université de Bordeaux, F-33076 Bordeaux, France; CNRS UMR 5287-INCIA, France
| | - Romain Rey
- Fondation FondaMental, Créteil, France; Université Claude Bernard Lyon 1, Centre Hospitalier Le Vinatier, Pole Est, BP 300 39-95 bd Pinel, 69678 Bron Cedex, France
| | - Christophe Lancon
- Fondation FondaMental, Créteil, France; Assistance Publique des Hôpitaux de Marseille (AP-HM), pôle universitaire de psychiatrie, Marseille, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - Aurélie Schandrin
- Fondation FondaMental, Créteil, France; Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - Mathieu Urbach
- Fondation FondaMental, Créteil, France; Service de psychiatrie d'adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France
| | - Pierre Vidailhet
- Fondation FondaMental, Créteil, France; Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, Créteil, France; Paris Est University, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - Franck Schurhoff
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry Team, Créteil, France; Paris Est University, DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Créteil, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France; CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
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10
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Wang X, Chen C, Liu P, Li W, Wang L, Liu Y. The morbidity of sexual dysfunction of 125 Chinese women following different types of radical hysterectomy for gynaecological malignancies. Arch Gynecol Obstet 2017; 297:459-466. [PMID: 29282516 DOI: 10.1007/s00404-017-4625-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 12/11/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE Due to early detection and effective treatment, quality of sexual life of patients with gynaecological malignancies has become an important issue. However, the morbidity of sexual dysfunction and the proportion of different kinds of sexual dysfunction after radical hysterectomy are unclear. The aim of the current study was to assess the morbidity of sexual dysfunction and to conduct multivariate logistic regression analysis of patients' sexual dysfunction. METHODS Between July 2007 and December 2012, 125 women underwent radical hysterectomy, modified radical hysterectomy, and nerve-sparing radical hysterectomy were administered a self-reported sexual function questionnaire. RESULTS The preoperative, and 1- and 2-year postoperative sexual dysfunction rates were 50.5% (50/99), 86.9% (93/107), and 92.3% (72/78), respectively. The incidence rates of sexual desire disorders before operation, at postoperative year 1, and at postoperative year 2 were 14.7% (14/95), 42.1% (45/107), and 51.9% (40/77), respectively. The preoperative incidence rates of sexual arousal disorders, orgasmic disorders, and sexual pain disorders were 18.4% (18/98), 51.1% (48/94), and 10.9% (11/101), respectively. At postoperative years 1 and 2, these were 38.8% (31/80), 81.0% (64/79), and 24.4% (20/82), and 49.1% (26/53), 84.6% (44/52), and 30.2% (16/53), respectively. Multivariable regression analysis revealed that age, preserved ovary, preserved posterior vaginal wall length, preoperative stage, radiotherapy, and education background were risk factors associated with sexual dysfunction. CONCLUSION The patients following radical hysterectomy had a high incidence of sexual dysfunction, which plateaued in postoperative years 1 and 2.
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Affiliation(s)
- Xueqin Wang
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, People's Republic of China
- Department of Obstetrics and Gynecology, The Fifth Affiliated Hospital of Southern Medical University, No. 566, CongCheng Road, Conghua District, Guangzhou, 510900, People's Republic of China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, People's Republic of China.
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, People's Republic of China
| | - Weili Li
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, People's Republic of China
| | - Liling Wang
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, People's Republic of China
| | - Yunlu Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital of Southern Medical University, No. 1838, Guangzhou Avenue, Guangzhou, 510515, People's Republic of China
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11
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Paquet A, Plansont B, Labrunie A, Malauzat D, Girard M. Past Pain Experience and Experimentally induced Pain Perception. Issues Ment Health Nurs 2017; 38:1013-1021. [PMID: 28766994 DOI: 10.1080/01612840.2017.1354103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
UNLABELLED Many intercurrent factors may be involved in the modulation of the pain message and its expression, such as the previous experience of pain built along the life. In this study, we aimed to determine whether susceptibility to experimentally induced pain is differentially influenced by the individual previous painful experience in subjects with schizophrenia (SC) major depression (MD), and controls (C). METHODS The SC (30), MD (32) and C (30) groups participated in experimental pain tests (application of pressure and induction of ischemia) after a semi-structured interview to make an inventory of the previous painful experiences, and the evaluation of anxiety either with autonomic (heart rate, blood pressure) or psychological (Hospital Anxiety Depression scale HAD) measures, and catastrophism. RESULTS The reported pain intensities, severities, duration, of the previous pain events, and the number of previous painful events were equivalent in the three groups, except for the number of painful events experimented before the last six months which was lower in the MD group. Experimental pain sensitivity was influenced by the diagnosis, the HAD scores or the number and intensities of previous lived painful events. CONCLUSION The lack of a past experience of pain was comparable for the different groups, suggesting that psychiatric disorders do not affect the experience of pain associated with daily life or past events. For each subject, the reported previous experience of pain influences the present feeling of pain.
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Affiliation(s)
- Aude Paquet
- a Unité de recherche et de neurostimulation , Centre Hospitalier Esquirol , Limoges , France
| | - Brigitte Plansont
- a Unité de recherche et de neurostimulation , Centre Hospitalier Esquirol , Limoges , France
| | - Anaïs Labrunie
- b INSERM, U1094 , Neuroépidémiologie Tropicale , Limoges , France ; CHU Limoges , Centre d'Epidémiologie, de Biostatistique et de Méthodologie de la Recherche , Limoges , France
| | - Dominique Malauzat
- a Unité de recherche et de neurostimulation , Centre Hospitalier Esquirol , Limoges , France
| | - Murielle Girard
- a Unité de recherche et de neurostimulation , Centre Hospitalier Esquirol , Limoges , France
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12
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Jeon HJ, Woo JM, Kim HJ, Fava M, Mischoulon D, Cho SJ, Chang SM, Park DH, Kim JW, Yoo I, Heo JY, Hong JP. Gender Differences in Somatic Symptoms and Current Suicidal Risk in Outpatients with Major Depressive Disorder. Psychiatry Investig 2016; 13:609-615. [PMID: 27909451 PMCID: PMC5128348 DOI: 10.4306/pi.2016.13.6.609] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 11/10/2015] [Accepted: 11/22/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Although somatic symptoms are common complaints of patients with major depressive disorder (MDD), their associations with suicide are still unclear. METHODS A total of 811 MDD outpatients of aged between 18 to 64 years were enrolled nationwide in Korea with the suicidality module of the Mini-International Neuropsychiatric Interview (MINI) and the Depression and Somatic Symptom Scale (DSSS). RESULTS On stepwise regression analysis, current suicidality scores were most strongly associated with chest pain in men, and neck or shoulder pain in women. Severe chest pain was associated with higher current suicidality scores in men than in women, whereas severe neck or shoulder pain showed no significant differences between the genders. In conclusion, MDD patients of both sexes with suicidal ideation showed significantly more frequent and severe somatic symptoms than those without. Current suicidal risk was associated with chest pain in men, and neck or shoulder pain in women. CONCLUSION We suggest that clinicians pay attention to patients' somatic symptoms in real world practice.
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Affiliation(s)
- Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jong-Min Woo
- Department of Psychiatry, Seoul Paik Hospital, Inje University School of Medicine, Seoul, Republic of Korea
- Stress Research Institute, Inje University, Seoul, Republic of Korea
| | - Hyo-Jin Kim
- OR/RWD Team, Corporate Affairs·Health & Value Division, Pfizer Korea, Seoul, Republic of Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Seong Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon Medical School, Incheon, Republic of Korea
| | - Sung Man Chang
- Department of Psychiatry, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Doo-Heum Park
- Department of Psychiatry, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jong Woo Kim
- Department of Psychiatry, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ikki Yoo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung-Yoon Heo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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13
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Raji SO, Lawani AO, James BO. Prevalence and correlates of major depression among Nigerian adults with sickle cell disease. Int J Psychiatry Med 2016. [PMID: 28629283 DOI: 10.1177/0091217416680839] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To ascertain the current and lifetime prevalence of depression among adults with sickle cell disease and identify relevant socio-demographic and clinical correlates. Method A cross-sectional study of 205 stable adult out-patient attendees at a treatment center in southern Nigeria between April and September, 2014. A socio-demographic questionnaire, the depression module of Mini International Neuropsychiatric Interview, and the eight-item Morisky Medication Adherence Scale were administered. Categorical and continuous variables associated with a diagnosis of depression were tested using chi-squared and t-tests respectively. Level of significance was set a priori at P < 0.05. Results Prevalence of current depression was 16.6%, while lifetime prevalence was 29.8%. Current depression was significantly associated with frequent analgesic use ( P < 0.03), unemployment ( P = 0.04), low income ( P < .04), low educational status ( P < 0.01), and subjective pain ( P < 0.001). Subjective pain was nearly twice as likely to predict a current depressive episode (AOR: 1.81, 95%CI: 1.42-2.02, P < 0.03). Conclusions Depression is common among adults with sickle cell disease and is significantly associated with severity of subjective pain.
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Affiliation(s)
- Saheed O Raji
- 1 Department of Clinical Services, Federal Neuro-Psychiatric Hospital, Benin City, Edo State, Nigeria
| | - Ambrose O Lawani
- 1 Department of Clinical Services, Federal Neuro-Psychiatric Hospital, Benin City, Edo State, Nigeria
| | - Bawo O James
- 1 Department of Clinical Services, Federal Neuro-Psychiatric Hospital, Benin City, Edo State, Nigeria
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14
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Sohn HS, Lee DH, Lee KJ, Noh EC, Choi SH, Jang JH, Kim YC, Kang DH. Impaired Empathic Abilities among Patients with Complex Regional Pain Syndrome (Type I). Psychiatry Investig 2016; 13:34-42. [PMID: 26766944 PMCID: PMC4701683 DOI: 10.4306/pi.2016.13.1.34] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aims of this study were to evaluate differences in empathic abilities between patients with complex regional pain syndrome (CRPS) Type I and healthy control subjects (HCs) and to assess correlations between empathic abilities and multidimensional aspects of pain. METHODS Empathic ability was measured in 32 patients with CRPS Type I and in 36 HCs using the Interpersonal Reactivity Index (IRI). A comprehensive assessment of pain was conducted in the patient group using the West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Psychiatric symptoms were assessed using the Beck Depression and Anxiety Inventories (BDI and BAI), and quality of life was evaluated using the WHO Quality of Life (WHOQOL-BREF) questionnaire. RESULTS Patients with CRPS showed impaired cognitive and emotional empathic abilities compared with HCs. Significantly lower levels of perspective taking and empathic concern and higher levels of personal distress on the IRI were exhibited by the patient group. Perspective taking and personal distress were associated with affective distress and poor quality of life in social contexts (BDI, BAI, and WHOQOL). However, empathic concern was positively correlated with pain severity and social support from others (WHYMPI). CONCLUSION A tendency toward self-oriented distress in social cognition was exhibited among patients with CRPS Type I. Impaired empathic ability was shown to have potentially negative effects on subjective emotional outcomes and social performance in the lives of patients. Interventions to improve emotional awareness and theory of mind would be beneficial for enhancing social functioning in patients with CRPS Type I.
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Affiliation(s)
- Hong-Suk Sohn
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do-Hyeong Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Jun Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Chung Noh
- Interdisciplinary Program of Neuroscience, Seoul National University, Seoul, Republic of Korea
| | - Soo-Hee Choi
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joon Hwan Jang
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong Chul Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do-Hyung Kang
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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15
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Hoffelt C, Zwack A. Assessment and management of chronic pain in patients with depression and anxiety. Ment Health Clin 2014. [DOI: 10.9740/mhc.n198935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article will review the role of the pharmacist in the management of chronic pain in patients with comorbid mood disorders.
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16
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Fornaro M, De Berardis D, Iasevoli F, Pistorio ML, D'Angelo E, Mungo S, Martino M, Ventriglio A, Cattaneo CI, Favaretto E, Del Debbio A, Romano A, Ciampa G, Elassy M, Perugi G, De Pasquale C. Treatment adherence towards prescribed medications in bipolar-II acute depressed patients: relationship with cyclothymic temperament and "therapeutic sensation seeking" in response towards subjective intolerance to pain. J Affect Disord 2013; 151:596-604. [PMID: 23906864 DOI: 10.1016/j.jad.2013.07.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 07/04/2013] [Accepted: 07/06/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Treatment adherence (TA) is crucial during almost any phase of bipolar disorder (BD), including type-II (BD-II) acute depression. While a number of issues have been traditionally accounted on the matter, additional factors should be likewise involved, including affective temperaments and some clinically suggestive psychopathological traits whose systematic assessment represents the aim of this study. METHODS Two hundred and twenty BD-II acute depressed outpatients were consecutively evaluated using the Structured Clinical Interviews for Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition Axis-I and II Disorders, Hamilton scales for Depression and Anxiety, Temperament Evaluation of the Memphis Pisa Paris San Diego-Auto-questionnaire-110-item, Visual Analogue Scale (VAS), Zuckerman's Sensation-Seeking Scale-Form-V (SSS-V), Barratt's Impulsivity Scale-11-item, State-Trait Anxiety Inventory modules, Severity module of the Clinical Global Impression Scale for BD, Morisky 8-Item Medication Adherence Scale (MMAS-8) and the Clinician Rating Scale (CRS). Patients were divided into non-adherent vs. treatment-adherent cases depending on MMAS-8+CRS scores. RESULTS In the TA(-) group, higher VAS and cyclothymic temperament scores were highly correlated (r=.699; p≤.001). Those latter scores, along with SSS-V scores and the occurrence of lifetime addiction to painkiller and/or homeopathic medications available over the counter defined a "therapeutic sensation seeking" pattern allowing to correctly classify as much as 93.9% [Exp(B)=3.490; p≤.001] of TA(-) cases (49/220). LIMITS Lack of objective TA measures and systematic pharmacological record; recall bias on some diagnoses; and relatively small sample size. CONCLUSIONS Stating the burden of TA in BD, additional studies on this regard are aimed, ideally contributing to enhance the management of BD itself.
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Affiliation(s)
- Michele Fornaro
- Department of Educational Sciences, University of Catania, via Ofelia n.1, Zip 95125, Catania, Italy.
| | - Domenico De Berardis
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, "ASL 4", Teramo, Italy.
| | - Felice Iasevoli
- Laboratory of Molecular Psychiatry and Psychopharmacotherapeutics, Section of Psychiatry, Department of Neuroscience, University School of Medicine Federico II, Naples, Italy.
| | - Maria Luisa Pistorio
- Department of Educational Sciences, University of Catania, via Ofelia n.1, Zip 95125, Catania, Italy.
| | | | | | - Matteo Martino
- Department of Psychiatry, University of Genova, Genoa, Italy.
| | | | | | | | | | - Anna Romano
- Department of Psychiatry, University of Pisa, Pisa, Italy.
| | | | - Mai Elassy
- Department of Psychiatry, Mansoura University, Egypt.
| | - Giulio Perugi
- Department of Psychiatry, University of Pisa, Pisa, Italy.
| | - Concetta De Pasquale
- Department of Educational Sciences, University of Catania, via Ofelia n.1, Zip 95125, Catania, Italy.
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