Somatic disease and psychological disorder

Out-of-Hospital Cardiac Arrest in Patients With and Without Psychiatric Disorders: Differences in Use of Coronary Angiography, Coronary Revascularization, and Implantable Cardioverter-Defibrillator and Survival

Background

Healthcare disparities for psychiatric patients are common. Whether these inequalities apply to postresuscitation management in out‐of‐hospital cardiac arrest (OHCA) is unknown. We investigated differences in in‐hospital cardiovascular procedures following OHCA between patients with and without psychiatric disorders.

Methods and Results

Using the Danish nationwide registries, we identified patients admitted to the hospital following OHCA of presumed cardiac cause (2001‐2015). Psychiatric disorders were identified using hospital diagnoses or redeemed prescriptions for psychotropic drugs. We calculated age‐ and sex‐standardized incidence rates and incidence rate ratios (IRRs) of cardiovascular procedures during post‐OHCA admission in patients with and without psychiatric disorders. Differences in 30‐day and 1‐year survival were assessed by multivariable logistic regression in the overall population and among 2‐day survivors who received acute coronary angiography (CAG). We included 7288 hospitalized patients who had experienced an OHCA: 1661 (22.8%) had a psychiatric disorder. Compared with patients without psychiatric disorders, patients with psychiatric disorders had lower standardized incidence rates for acute CAG (≤1 day post‐OHCA) (IRR, 0.51; 95% CI, 0.45–0.57), subacute CAG (2–30 days post‐OHCA) (IRR, 0.40; 95% CI, 0.30–0.52), and implantable cardioverter‐defibrillator implantation (IRR, 0.67; 95% CI, 0.48–0.95). Conversely, we did not detect differences in coronary revascularization among patients undergoing CAG (IRR, 1.11; 95% CI, 0.94–1.30). Patients with psychiatric disorders had lower survival even among 2‐day survivors who received acute CAG: (odds ratio of 30‐day survival, 0.68; 95% CI, 0.52–0.91; and 1‐year survival, 0.66; 95% CI, 0.50–0.88).

Conclusions

Psychiatric patients had a lower probability of receiving post‐OHCA CAG and implantable cardioverter‐defibrillator implantation compared with nonpsychiatric patients but the same probability of coronary revascularization among patients undergoing CAG. However, their survival was lower irrespective of angiographic procedures.

Most common problems across health conditions as described by the International Classification of Functioning, Disability, and Health

Health conditions are associated with a variety of functional outcomes. Even though functional outcomes are diverse for different health conditions, they can have important commonalities. The aim of this study was to identify the most common problems in functioning across the wide range of health conditions using the International Classification of Functioning (ICF). Existing databases created for the 21 ICF Core Sets studies were descriptively analyzed. These included data collected in 44 countries on 9978 patients with one of 21 health conditions as the main diagnosis. A frequency cutoff of 50% was used to identify the most common problems in functioning when looking at single health conditions and across them. No category was identified as common to all health conditions included in the study. Fifteen most frequent categories were common in 10 to 13 health conditions out of 21. Eleven categories correspond to the list of activities and participation, and four to the list of body functions. These are related to mobility, daily routine, mental functions, intimate relations, employment, and leisure. Some health conditions have more commonalities between each other. The most common problems across health conditions are therefore related to mental functions, mobility, daily life, intimate relations, employment, and leisure. The results contribute toward the identification of the universal set of ICF categories that can be used in clinical practice for the general assessment of functioning.

Epidemiological and genome-wide association study of gastritis or gastric ulcer in korean populations

Gastritis is a major disease that has the potential to grow as gastric cancer. Gastric cancer is a very common cancer, and it is related to a very high mortality rate in Korea. This disease is known to have various reasons, including infection with Helicobacter pylori, dietary habits, tobacco, and alcohol. The incidence rate of gastritis has reported to differ between age, population, and gender. However, unlike other factors, there has been no analysis based on gender. So, we examined the high risk factors of gastritis in each gender in the Korean population by focusing on sex. We performed an analysis of 120 clinical characteristics and genome-wide association studies (GWAS) using 349,184 single-nucleotide polymorphisms from the results of Anseong and Ansan cohort study in the Korea Association Resource (KARE) project. As the result, we could not prove a strong relation with these factors and gastritis or gastric ulcer in the GWAS. However, we confirmed several already-known risk factors and also found some differences of clinical characteristics in each gender using logistic regression. As a result of the logistic regression, a relation with hyperlipidemia, coronary artery disease, myocardial infarction, hyperlipidemia therapy, hypotensive or antihypotensive drug, diastolic blood pressure, and gastritis was seen in males; the results of this study suggest that vascular disease has a potential association with gastritis in males.

Catecholamine-Induced β2-adrenergic receptor activation mediates desensitization of gastric cancer cells to trastuzumab by upregulating MUC4 expression

Trastuzumab is currently used for patients with Her2(+) advanced gastric cancer. However, the response rate to trastuzumab among the patients is low. The molecular mechanisms underlying trastuzumab resistance in gastric cancer are unknown. Our in vitro data show that activation of β2-adrenergic receptor (β2-AR) triggered by catecholamine caused "targeting failure" of trastuzumab in gastric cancer cells. The antitumor activities of trastuzumab were significantly impeded by chronic catecholamine stimulation in gastric cancer cells and in the mice bearing human gastric cancer xenografts. Mechanistically, catecholamine induced upregulation of the MUC4 expression at both transcription and protein levels via activating STAT3 and ERK. The effects of catecholamine could be effectively blocked by β2-AR antagonist ICI-118,551, indicating that β2-AR-mediated signaling pathway plays a key role in upregulation of MUC4, which was previously demonstrated to interfere with the recognition and physical binding of trastuzumab to Her2 molecules. Moreover, a significant elevation of the MUC4 level was observed in the xenograft tissues in nude mice chronically treated with isoproterenol. Knockdown of MUC4 restored the binding activities of trastuzumab to Her2-overexpressing gastric cancer cells. In addition, coexpression of β2-AR and MUC4 were observed in gastric cancer tissues. Our data indicated a novel trastuzumab resistance mechanism, by which catecholamine-induced β2-AR activation mediates desensitization of gastric cancer cells to trastuzumab through upregulating the MUC4 expression.

The buffering effect of relationship satisfaction on emotional distress in couples

Background

Marital distress and depression frequently co-occur, and partnership quality is associated with depressive symptoms and mental disorders in both men and women. One aim of this study was to investigate the contribution of a set of risk factors for emotional distress among men and women in couples, with a special focus on satisfaction with partner relationship. The most important aim was to investigate the extent to which high relationship satisfaction in couples acts as a buffer against stressful events.

Methods

Pregnant women and their husbands (n = 62,956 couples) enrolled in the Norwegian Mother and Child Cohort Study completed a questionnaire with questions about emotional distress, relationship satisfaction, and other risk factors. Twelve potential risk factors were included in the analyses, including relationship satisfaction, demographic characteristics, and somatic diseases in men and women. Associations between the predictor variables and emotional distress were estimated by multiple linear regression analysis. Cross-spousal effects, in which data reported by one of the spouses predicted emotional distress in the other, were also investigated. Possible interaction effects between certain risk factors and self-reported and partner's relationship satisfaction were tested and further explored with regression analyses in subsamples stratified by relationship satisfaction scores.

Results

The unique effects of relationship satisfaction were of similar sizes for both men and women: substantial for self-reported (β = -0.23 and β = -0.28, respectively) and weak for partner-reported satisfaction (β = -0.04 and β = -0.02, respectively). Other relatively strong risk factors were somatic disease, first-time motherhood, and unemployment. Self-reported as well as partner-reported relationship satisfaction appeared to strongly buffer the effects of a number of stressors.

Conclusions

Partner relationship dissatisfaction is strongly associated with emotional distress in men and women. Good partner relationship, both as perceived by the individual him(her)self and by the spouse, quite strongly moderates adverse effects of various types of emotional strain.

Catecholamine up-regulates MMP-7 expression by activating AP-1 and STAT3 in gastric cancer

BACKGROUND

Stress, anxiety and depression can cause complex physiological and neuroendocrine changes, resulting in increased level of stress related hormone catecholamine, which may constitute a primary mechanism by which physiological factors impact gene expression in tumors. In the present study, we investigated the effects of catecholamine stimulation on MMP-7 expression in gastric cancer cells and elucidated the molecular mechanisms of the up-regulation of MMP-7 level by catecholamine through an adrenergic signaling pathway.

RESULTS

Increased MMP-7 expression was identified at both mRNA and protein levels in the gastric cancer cells in response to isoproterenol stimulation. β2-AR antigonist effectively abrogated isoproterenol-induced MMP-7 expression. The activation of STAT3 and AP-1 was prominently induced by isoproterenol stimulation and AP-1 displayed a greater efficacy than STAT3 in isoproterenol-induced MMP-7 expression. Mutagenesis of three STAT3 binding sites in MMP-7 promoter failed to repress the transactivation of MMP-7 promoter and silencing STAT3 expression was not effective in preventing isoproterenol-induced MMP-7 expression. However, isoproterenol-induced MMP-7 promoter activities were completely disappeared when the AP-1 site was mutated. STAT3 and c-Jun could physically interact and bind to the AP-1 site, implicating that the interplay of both transcriptional factors on the AP-1 site is responsible for isoproterenol-stimulated MMP-7 expression in gastric cancer cells. The expression of MMP-7 in gastric cancer tissues was found to be at the site where β2-AR was overexpressed and the levels of MMP-7 and β2-AR were the highest in the metastatic locus of gastric cancer.

CONCLUSIONS

Up-regulation of MMP-7 expression through β2-AR-mediated signaling pathway is involved in invasion and metastasis of gastric cancer.

Mental health problems in children of somatically ill parents, e.g. multiple sclerosis

OBJECTIVES

Based on the investigation of 144 families (144 patients affected by Multiple Sclerosis (MS), 109 partners, and 192 children) examined in three different European child and adolescent psychiatric University centres by means of questionnaires, we evaluated the prevalence of psychological symptoms in the offspring and associated risk factors such as duration and severity of the disease as well as depression of the ill and the healthy parent.

RESULTS

Indicate that the severe disease of MS is associated with depression of the ill and healthy parent. Ill parents, especially ill mothers, as well as depressed ill, or depressed healthy parents evaluate their children's mental health problems with a higher prevalence within the internalizing spectrum. Healthy parents report normal psychological adjustment of their children. If two parents present a depressive state, the prevalence of relevant psychological internalizing symptoms is twice or three times as high as the age norms.

CONCLUSION

Children in families with a parent affected by MS and associated depression of the parental couple are at high risk of mental health problems, especially internalizing disorders. In focusing on the mental health of children one must also be aware of the potential opportunities to address the parents' own psychological needs.

Associations between fatigue attributions and fatigue, health, and psychosocial work characteristics: a study among employees visiting a physician with fatigue

AIMS

To study associations between characteristics of employees active at work and making a fatigue related visit to the general practitioner (GP) or occupational physician (OP) in terms of fatigue, physical health problems, mental health problems, psychosocial work characteristics, and attributions of their fatigue complaints.

METHODS

Self report questionnaires from the Maastricht Cohort Study Fatigue at Work were used to measure fatigue (Checklist Individual Strength, Maslach Burnout Inventory-General Survey), physical health problems (chronic illness), mental health problems (Hospital Anxiety and Depression Scale), psychosocial work characteristics (Job Content Questionnaire), and fatigue attributions (somatic, psychological, none) in employees who made a fatigue related visit to the GP or OP over a six month period.

RESULTS

In employees visiting only the GP, fatigue was an important reason to visit in one of seven (13.9%) employees. These fatigue related visits were in particular associated with high fatigue levels and mental health problems. A psychological fatigue attribution was reported by 41.8%, a somatic fatigue attribution by 44.0%. On a multivariate level, mental health problems showed the strongest association with psychological fatigue attributions, over and beyond fatigue itself. No associations were found between fatigue attributions and psychosocial work characteristics. Attributional patterns appeared to be different between visitors of the GP and the OP.

CONCLUSIONS

Fatigue is a common reason among employees to consult a GP. Asking employees for their own fatigue attributions in terms of somatic or psychological causes may be useful for the GP-and possibly also the OP-to gather information about underlying health problems in employees active at work and making a fatigue related visit.

The association between chronic diseases and fatigue in the working population

OBJECTIVE

The aims of this study were to examine (a) whether employees with a chronic disease report more fatigue than employees without a chronic disease, (b) whether number or type of chronic disease is related to fatigue, and (c) whether differences in fatigue level in various types of chronic diseases are related to psychological distress.

METHODS

Data were taken from 12,137 employees. Fatigue was measured with the Checklist Individual Strength (CIS).

RESULTS

Employees with a chronic disease reported more fatigue (OR=2.9, 95% CI=2.7-3.2). Small differences were observed in the level of fatigue in various types of diseases. A strong linear association between the number of chronic diseases and fatigue was found. Psychological distress explained the higher level of fatigue in some chronic diseases (gastrointestinal diseases and migraine).

CONCLUSIONS

Fatigue is more common in employees with a chronic disease. A strong association between number of chronic diseases and fatigue exists. Fatigue in employees with a chronic disease can partly be explained by psychological distress. Some chronic diseases show a stronger association between psychological distress and fatigue.

Recurrent symptoms: well-being and management

Although most older adults report one or more symptoms of a chronic health problem, little attention has been paid to the report of these symptoms over time and whether different symptom patterns affect well-being and symptom management in community-dwelling elders. Therefore, this study examined whether community-dwelling older adults in Ohio, U.S.A. who experience consistently recurring (a) arthritis or (b) cardiopulmonary symptoms report more depression and worse self-assessed health and show more symptom management than those who report inconsistent symptoms and if there are differences in well-being and symptom management over time. This secondary analysis used longitudinal data collected from a random sample of 387 older adults who reported their health complaints in four interviews over 27 months time. Subjects were included in this analysis if they reported either arthritis (n = 321) or cardiopulmonary (n = 232) symptoms at one or more times during 27 months, and then were classified as having either consistent (occurring at all four time points) or intermittent/inconsistent (occurring at three or fewer time points) symptoms. Data analysis included t-tests, chi-square tests, and Repeated Measures ANOVA. Results indicate that those with consistent symptoms reported greater depression and worse self-assessed health than those with less consistent symptoms. Specifically, those with consistent cardiopulmonary symptoms became more depressed over time. Those with consistent cardiopulmonary complaints were more likely than those with an inconsistent pattern to use an illness label to describe their symptoms. Those with consistent arthritis symptoms tended to use more self-care at all time points, to label their symptoms as an illness, and were more likely to consult a physician as their symptoms persisted. The implications of symptom recurrence on well-being, symptom management and the concept chronicity are discussed.

Mental disorders and medical conditions. A community study in a small island in Spain

OBJECTIVES

This study focuses on the comorbidity between medical and psychiatric illnesses in a sample taken from the general population.

METHODS

We design a two-stage epidemiological community study in the island of Formentera (Spain), using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). In the first stage, the sample (N=697) was screened using the General Health Questionnaire (GHQ-28). In the second stage, the SCAN, subjects' clinical histories and General Practitioners' diagnosis were used to evaluate psychiatric disorders and medical illnesses. The final sample comprised 242 subjects.

RESULTS

Subjects with diagnosed ICD-10 mental disorders presented higher comorbidity with medical pathologies than the group of respondents without psychiatric diagnosis, although the differences were not statistically significant. Of the psychiatric conditions, mood disorders (in which differences were significant) and neurotic disorders were the ones that most frequently presented comorbidity, followed by sleep disorders. Mean scores on the GHQ-28 used at the screening stage, and mean scores on neurotic, depressive and somatic symptoms on the SCAN, were significantly higher in the comorbid group. Comorbidity was more frequent in females.

CONCLUSION

More studies on comorbidity in general population are required, with diagnostic instruments that cover the whole of the psychiatric spectrum and correct assessment systems for medical diagnosis.

Sleep and hypnotic use in relation to perceived somatic and mental health among the elderly

The aim of this study was to evaluate the influence of somatic health, mental health and age on sleep and the use of sleep medication in a group of elderly men and women. Questionnaires were distributed to 9417 persons, and the response rate was 69%. The mean ages (s.d.) of the male and female participants were 73.9 (6.3) and 74.5 (6.8) years, respectively. Sleep disturbances were more common in women than in men at all ages and increased with age in both sexes. A stepwise regression analysis showed that in men, more severely sleep disturbances were associated with poorer somatic health (R(2)=0.089; P<0.0001), poorer mental health (R(2)=0.106; P<0.0001) and increasing age (R(2)=0.109; P<0.0001) and in the women worse somatic health (R(2)=0.087; P<0.0001), worse mental health (R(2)=0.104; P<0.0001) but no further deterioration of sleep with age. Sleep medication was more common in women than in men at all ages and increased with age in both sexes. The use of sleep medication was more strongly related to somatic health than to mental health and age in both sexes. In conclusion, both sleep complaints and sleep medication showed a stronger relation to somatic health than to mental health and age in this group of elderly men and women.