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Abed MA, Khalil AA, Moser DK. Patient Denial of Myocardial Infarction in the Prehospital Phase: Prevalence and Correlates. J Cardiovasc Nurs 2024; 39:456-464. [PMID: 37738318 DOI: 10.1097/jcn.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
BACKGROUND Limited knowledge exists regarding patients' denial of myocardial infarction (MI) before hospitalization for an MI. OBJECTIVE The aim of this study was to determine the prevalence and correlates of denial of MI in the prehospital phase of a confirmed MI. METHODS This secondary analysis included 166 hospitalized patients (mean [SD] age, 54.1 [10.5] years) who developed MI outside a healthcare facility and had high congruence between their experienced and expected symptoms. Measurements included the Denial subscale of the Brief COPE Inventory, the modified Response to Symptoms Questionnaire, and a Likert scale measuring perceived risk for MI. Patients who arrived at a hospital at least 1 hour after the onset of their symptoms were considered to have prolonged prehospital delay. RESULTS Despite their high symptom congruence, 77% of patients denied the possibility of having an MI before hospitalization. The lower denial group was characterized by cardiac history, whereas the higher denial group was distinguished by nonsmoking, a lower perceived risk of MI, less anxiety at symptom onset, and more concerns about seeking medical help. Compared with the lower denial group, patients in the higher denial group were more likely to underestimate the seriousness of their symptoms and delay seeking medical help. The higher denial group responded to symptoms in a more passive manner (eg, waiting), whereas the lower denial group showed a more problem-solving approach (eg, contacting emergency services). CONCLUSIONS Denial of MI is highly prevalent in the prehospital phase and is negatively linked with cognitive, emotional, and behavioral responses to MI symptoms.
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Wise TN. Illness Denial in Medical Conditions: The Time Has Come to Include It in DSM Iterations. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:292-294. [PMID: 37669633 PMCID: PMC10716871 DOI: 10.1159/000533287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Thomas N Wise
- Beavioral Services, Inova Health System, Falls Church, Virginia, USA
- Department of Psychiatry, Johns Hopkins School of Medicine George Washington School of Medicine, Baltimore, Maryland, USA
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Fricchione GL. Clinical Implications of Illness Denial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:208-210. [PMID: 37634501 DOI: 10.1159/000533124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Gregory L Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Patierno C, Fava GA, Carrozzino D. Illness Denial in Medical Disorders: A Systematic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:211-226. [PMID: 37429268 DOI: 10.1159/000531260] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/23/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Illness denial pertains to medical patients who do not acknowledge the presence or severity of their disease or the need of treatment. OBJECTIVE This systematic review was performed to clarify the clinical role and manifestations of illness denial, its impact on health attitudes and behavior, as well as on short- and long-term outcomes in patients with medical disorders. METHODS The systematic search according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines was conducted on PubMed, Scopus, and Web of Science. RESULTS The initial search yielded a total of 14,098 articles; 176 studies met the criteria for inclusion. Illness denial appeared to be a relatively common condition affecting a wide spectrum of health attitudes and behavior. In some cases, it may help a person cope with various stages of illness and treatment. In other situations, it may determine delay in seeking treatment, impaired adherence, and reduced self-management, leading to adverse outcomes. The Diagnostic Criteria for Psychosomatic Research (DCPR) were found to set a useful severity threshold for the condition. An important clinical distinction can also be made based on the DCPR for illness denial, which require the assessment of whether the patient has been provided with an adequate appraisal of the medical situation. CONCLUSIONS This systematic review indicates that patients with medical disorders experience and express illness denial in many forms and with varying degrees of severity. The findings suggest the need for a multidimensional assessment and provide challenging insights into the management of medical disorders.
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Affiliation(s)
- Chiara Patierno
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Danilo Carrozzino
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
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Chu RYK, Dong D, Wong SYS, Lee EKP. Barriers and Determinants to the Underutilized Hypertension Screening in Primary Care Patients in Hong Kong: A Mixed-Method Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:985. [PMID: 36673741 PMCID: PMC9859345 DOI: 10.3390/ijerph20020985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
(1) Background: Hypertension (HT) is the most common chronic condition, affecting approximately 1.13 billion people worldwide. Despite freely available blood pressure (BP) devices in primary care (PC) clinics, many patients do not regularly screen for HT and are untreated. (2) Methods: This study investigated the proportion of PC patients who did not screen for HT and the underlying reasons in Hong Kong. An explanatory mixed-method cross-sectional study was conducted in 2020, which included a questionnaire survey, office BP measurements, and subsequent semi-structured interviews. Adult patients who had no diagnosis of HT were recruited in a large PC clinic by convenience sampling. The relationships between not having HT screening and sociodemographic data were investigated by logistic regression. Twenty-four patients were purposefully sampled (based on demographics) and were interviewed until data saturation. (3) Results: Among 428 participants, 190 (44.4%) had not had HT screening in the last two years, but 197 (46.0%) had HT. No HT screening in the last two years or ever was associated with being male, being single, being of younger age, having no family history of HT, having no clinic visits in the last two years, employment status, and self-perceived HT condition. Most participants (77.8%) misinterpreted their BP readings. Individual, social, and healthcare service barriers were identified in patients' interviews. Many PC patients had no regular HT screening but around half had elevated BP. (4) Conclusion: The study results indicate that the barriers to HT screening were multifactorial. HT screening in PC is urgently needed.
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Affiliation(s)
- Rachel Yui-Ki Chu
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dong Dong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518000, China
| | - Samuel Yeung-Shan Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eric Kam-Pui Lee
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Livneh H. Psychosocial Adaptation to Chronic Illness and Disability: An Updated and Expanded Conceptual Framework. REHABILITATION COUNSELING BULLETIN 2021. [DOI: 10.1177/00343552211034819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The article revisits and updates an earlier model (Livneh, 2001) that examined the building blocks that constitute the dynamics of psychosocial adaptation to chronic illness and disability (CID). In the revised tripartite model, the author reconstructs and refines the earlier model based on recent theoretical formulations, clinical reviews and research findings. In the revised model, the author discusses three overarching components, namely, antecedents (causes of medical conditions, background variables), processes (the dynamically unfolding course of post-CID events), and outcomes (anticipated exit indicators that serve, as snapshot end products, to assess the individual’s experienced and reported quality of life following onset of CID). The article concludes with a brief review of the model’s practical and research implications.
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Petralia A, Bisso E, Concas I, Maglitto A, Bucolo N, Alaimo S, Di Cataldo A, Signorelli MS, Pulvirenti A, Aguglia E. Psychopathological outcomes and defence mechanisms in clinically healed adults with a paediatric cancer history: an exploratory study. Gen Psychiatr 2021; 34:e100307. [PMID: 34308150 PMCID: PMC8256730 DOI: 10.1136/gpsych-2020-100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 05/20/2021] [Indexed: 11/14/2022] Open
Abstract
Background The incidence of paediatric cancers has increased in recent years; however, with advances in the treatment of paediatric cancer, almost 80% of children and adolescents who receive a diagnosis of cancer become long-term survivors. Given the high stress levels associated with cancer, it becomes important to ascertain the risk and likelihood of psychiatric disorders in adult paediatric cancer survivors. Aims This study aims to investigate the relationship between defence styles and predisposition to psychiatric diseases in adults with a history of paediatric cancer. Methods We performed an explorative study on a sample of 66 clinically healed adults with a history of paediatric cancer (survivors) during follow-up visits at the University Hospital ‘Policlinico G Rodolico’ of Catania (Italy) and 98 healthy controls among medicine students. We administered the Defence Mechanism Inventory (DMI) to assess defence styles. The Symptom Checklist-90-Revised (SCL-90-R) and the Davidson Trauma Scale (DTS) were administered to assess psychopathological indices. We conducted comprehensive statistical analysis based on correlation analysis and mediation analysis to investigate the relationship between defence styles and psychopathological outcomes in survivors compared with controls. Results The survivors obtained statistically significant lower values in TAO, PRO and TAS defence styles and a higher value in REV. Both groups showed non-pathlogical mean scores in DTS and SCL-90-R (with an exception of the obsessive-compulsive subscale), with lower mean values among survivors. The results of mediation analysis showed that TAS had mediation effects on interpersonal sensitivity, anxiety, PSDI, GSI and avoidance, while TAO had mediation effects on DTS total score and intrusivity. Thus, for these psychopathological indices, the effect of the oncological pathology was indirect and mediated by TAO or TAS. Our analysis exlcluded mediation effects between the remaining variables and defence styles. Conclusion Integrating data from mediation and correlation analysis, we found how the decreasing of TAS utilization in survivors as the consequence of cancer history, has decreased interpersonal sensitivity, anxiety and GSI score in these subjects compared with controls. Similary, the decrease of TAO utilization played a role in lower values of DTS total score and intrusivity subscale. Unexpectedly, our analysis excluded relationships between cancer history, other defence styles and psycopathological scores as we initially assumed.
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Affiliation(s)
- Antonino Petralia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, School of Medicine, Catania, Italy
| | - Emanuele Bisso
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, School of Medicine, Catania, Italy
| | - Ilaria Concas
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, School of Medicine, Catania, Italy
| | - Antonino Maglitto
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, School of Medicine, Catania, Italy
| | - Nunzio Bucolo
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, School of Medicine, Catania, Italy
| | - Salvatore Alaimo
- Department of Mathematics and Computer Science, University of Catania, Catania, Italy
| | - Andrea Di Cataldo
- Department of Clinical and Experimental Medicine, Pediatric Hemato-Oncology Unit, University of Catania, School of Medicine, Catania, Italy
| | - Maria Salvina Signorelli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, School of Medicine, Catania, Italy
| | - Alfredo Pulvirenti
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, School of Medicine, Catania, Italy.,Department of Mathematics and Computer Science, University of Catania, Catania, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, School of Medicine, Catania, Italy
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Lee CW, Lee J, Jun JY, Lee SH, Yu SY, Park J, Kim SJ. Associations between defense mechanisms and life satisfaction among North Korean refugees. Ann Gen Psychiatry 2021; 20:18. [PMID: 33750410 PMCID: PMC7941897 DOI: 10.1186/s12991-021-00339-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 03/01/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The present study investigated associations between defense mechanisms and life satisfaction among North Korean refugees living in South Korea. METHODS A total of 178 North Korean refugees completed the Korean version of the Defense Style Questionnaire, a revised version of the Ways of Thinking of North Korean Defectors scale, the Center for Epidemiologic Studies-Depression Scale, and the State-Trait Anxiety Inventory. Multiple stepwise regression analysis was performed to investigate the defense mechanisms associated with North Korean refugees' life satisfaction in South Korea. RESULTS Among defense mechanisms, denial most strongly predicted higher overall and economic satisfaction among North Korean refugees living in South Korea (β = 0.145, p < 0.01; β = 0.137, p = 0.03, respectively) after controlling for age, gender, anxiety, depression, and number of traumatic events experienced. Furthermore, resignation predicted lower overall (β = -0.206, p < 0.001) and economic satisfaction (β = -0.134, p = 0.02). However, the association between resignation and life satisfaction was not significant after controlling for depression, anxiety, and number of traumatic events experienced. CONCLUSIONS Specific defense mechanisms such as high denial and low resignation were associated with life satisfaction in South Korea among North Korean refugees. Our findings suggest that refugees' psychological defense mechanisms may affect their satisfactory resettlement.
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Affiliation(s)
- Chang Woo Lee
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81 Ilwon-ro, Kangnam-gu, Seoul, 06351, Korea
| | - Jooyoung Lee
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81 Ilwon-ro, Kangnam-gu, Seoul, 06351, Korea
| | - Jin Yong Jun
- Department of Research Planning, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - So Young Yu
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
| | - Juhyun Park
- Department of Psychology, University At Buffalo, Buffalo, NY, USA
| | - Seog Ju Kim
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81 Ilwon-ro, Kangnam-gu, Seoul, 06351, Korea.
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Fipps DC, Rainey E. COVID-19 and the Doctor-Patient Relationship. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:59-60. [PMID: 34483769 DOI: 10.1176/appi.focus.20200033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
During a pandemic, physicians can become so inundated with combating the disease that they may forget the individual patient's experience. In this perspective, the authors describe a case of COVID-19 from the point of view of the grief stages (or categories) described by Elizabeth Kübler-Ross, with an emphasis on utilizing skills to enhance the doctor-patient relationship even in this time of crisis.
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Affiliation(s)
- David C Fipps
- Mayo Clinic, Rochester, Minnesota (Fipps); Prima Health-Upstate, University of South Carolina, Greenville (Rainey)
| | - Elisabet Rainey
- Mayo Clinic, Rochester, Minnesota (Fipps); Prima Health-Upstate, University of South Carolina, Greenville (Rainey)
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Cluster-randomized controlled trial for the early promotion of clinic visits for untreated hypertension. Hypertens Res 2020; 44:355-362. [PMID: 33057184 DOI: 10.1038/s41440-020-00559-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/22/2020] [Accepted: 08/28/2020] [Indexed: 11/08/2022]
Abstract
Despite clear evidence of the benefits of lowering blood pressure among patients with hypertension, the treatment rate remains <40% worldwide. In the present trial, we aimed to investigate the effects of the early promotion of clinic visits among patients with untreated hypertension detected during annual health checkups. This was a worksite-based, parallel group, cluster-randomized trial with blinded outcome assessment. Employees of 152 Japanese supermarket stores found to have untreated hypertension (blood pressure levels ≥ 160/100 mmHg) during health checkups were assigned to an early promotion group (encouraged to visit a clinic in face-to-face interviews and provided with a referral letter to a physician as well as a leaflet) or a control group (received usual care), according to random assignment. The primary outcome was the completion of a clinic visit within 6 months. Odds ratios with 95% confidence intervals for the early promotion group versus the control group were estimated using multilevel logistic regression with random effects of clusters. A total of 273 participants (mean age 50.3 years, 55% women) from 107 stores were assigned to the early promotion group (138 from 55 stores) or control group (135 from 52 stores). During the 6-month follow-up, 47 (34.1%) participants in the early promotion group visited a clinic, as did 26 (19.3%) in the control group (odds ratio 2.33, 95% confidence interval 1.12-4.84, P = 0.024). Early promotion using a referral letter during health checkups significantly increased the number of clinic visits within 6 months completed by participants with untreated hypertension (UMIN000025411).
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11
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Langer KG, Bogousslavsky J. The Merging Tracks of Anosognosia and Neglect. Eur Neurol 2020; 83:438-446. [PMID: 32927461 DOI: 10.1159/000510397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/23/2020] [Indexed: 11/19/2022]
Abstract
Anosognosia and hemineglect are among the most startling neurological phenomena identified during the 20th century. Though both are associated with right hemisphere cerebral dysfunction, notably stroke, each disorder had its own distinct literature. Anosognosia, as coined by Babinski in 1914, describes patients who seem to have no idea of their paralysis, despite general cognitive preservation. Certain patients seem more than unaware, with apparent resistance to awareness. More extreme, and qualitatively distinct, is denial of hemiplegia. Various interpretations of pathogenesis are still deliberated. As accounts of its captivating manifestations grew, anosognosia was established as a prominent symbol of neurological and psychic disturbance accompanying (right-hemisphere) stroke. Although reports of specific neglect-related symptomatology appeared earlier, not until nearly 2 decades after anosognosia's inaugural definition was neglect formally defined by Brain, paving a path spanning some years, to depict a class of disorder with heterogeneous variants. Disordered awareness of body and extrapersonal space with right parietal lesions, and other symptom variations, were gathered under the canopy of neglect. Viewed as a disorder of corporeal awareness, explanatory interpretations involve mechanisms of extinction and perceptual processing, disturbance of spatial attention, and others. Odd alterations involving apparent concern, attitudes, or belief characterize many right hemisphere conditions. Anosognosia and neglect are re-examined, from the perspective of unawareness, the nature of belief, and its baffling distortions. Conceptual parallels between these 2 distinct disorders emerge, as the major role of the right hemisphere in mental representation of self is highlighted by its most fascinating syndromes of altered awareness.
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Affiliation(s)
- Karen G Langer
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA,
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12
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Gillanders SL, McHugh A, Hintze J, Donnelly MJ. Erosive rodent ulcer of the ear secondary to neglect. BMJ Case Rep 2020; 13:13/8/e234456. [PMID: 32847871 DOI: 10.1136/bcr-2020-234456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Basal cell carcinomas (BCCs) are slow-growing, locally invasive lesions that rarely metastasise, however, if left untreated can progress to extensive destruction of local structures giving rise to the alternative name 'the rodent ulcer'. Here we present a case of BCC of the ear progressing to destruction of the pinna and mastoid, involving the facial nerve and breaching dura. This case presentation shows not only the seldom-seen natural progression of the rodent ulcer with impressive imaging and clinical photographs but also highlights a broader topic of capacity and consent in patients displaying maladaptive denial or abnormal illness behaviour, how this can affect patient outcomes and what we as clinicians can do to ensure the best care for our patients.
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Affiliation(s)
- Sarah Louise Gillanders
- ENT, Royal College of Surgeons in Ireland, Dublin, Ireland .,ENT, Waterford University Hospital, Waterford, Ireland
| | - Alison McHugh
- ENT, Waterford University Hospital, Waterford, Ireland
| | - Justin Hintze
- ENT, Royal College of Surgeons in Ireland, Dublin, Ireland
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Eni EN, Edet BE, Ibanga AA, Duke RE. <p>Cross-Sectional Study on the Coping Strategies Among Glaucoma Patients Attending a Secondary Eye Clinic in Calabar, Nigeria</p>. Clin Ophthalmol 2020; 14:1307-1313. [PMID: 32494121 PMCID: PMC7231764 DOI: 10.2147/opth.s242443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/09/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The major objective of this cross-sectional study was to examine the coping strategies of glaucoma patients at a secondary eye care unit with a view to deciding whether an intervention programme would be justified. Patients and Methods The coping styles of 130 consenting adult glaucoma patients aged 18 years and above who were being treated for glaucoma in the Cross River State Eye Care Programme clinic in Calabar, Nigeria, were investigated by means of the 28-item Brief-COPE inventory in this descriptive cross-sectional study. Results The mean age of the participants was 54.2 years (±14.3) while almost three quarters (73.8%) of them were married. About four out of every five persons examined (81.5%) had a minimum of primary education. “Substance (alcohol and other drug) use”, “self-blame” and “behavioural disengagement” are coping styles that were reported by 33%, 42% and 42% of the participants, respectively. This group of patients should be identified in the clinic for appropriate psychological intervention. Conclusion The present study confirms previous findings and contributes additional evidence that suggests that coping strategies should be considered in the holistic management of glaucoma patients. The information from the current study can be used to develop targeted interventions aimed at improving the coping styles of glaucoma patients.
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Affiliation(s)
- Egbula Nkanu Eni
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Nigeria
- Correspondence: Egbula Nkanu Eni Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, NigeriaTel +234 7035252071 Email
| | | | | | - Roseline Ekanem Duke
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Nigeria
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14
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Koh Boon Yau E, Pang Tze Ping N, Shoesmith WD, James S, Nor Hadi NM, Loo JL. The Behaviour Changes in Response to COVID-19 Pandemic within Malaysia. Malays J Med Sci 2020; 27:45-50. [PMID: 32788840 PMCID: PMC7409570 DOI: 10.21315/mjms2020.27.2.5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 11/05/2022] Open
Abstract
The novel coronavirus infection, COVID-19, is a pandemic that currently affects the whole world. During this period, Malaysians displayed a variety of behaviour changes as a response to COVID-19, including panic buying, mass travelling during movement restriction and even absconding from treatment facilities. This article attempts to explore some of these behaviour changes from a behaviourist perspective in order to get a better understanding of the rationale behind the changes.
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Affiliation(s)
- Eugene Koh Boon Yau
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | | | | | - Sandi James
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Sabah, Malaysia.,Department of Social Work and Social Policy, School of Science, Health and Engineering, La Trobe University, Australia
| | - Noor Melissa Nor Hadi
- Department of Psychiatry and Mental Health, Hospital Tuanku Fauziah, Perlis, Malaysia
| | - Jiann Lin Loo
- Queensway Clinic, Central and North West London NHS Foundation Trust, Milton Keynes, United Kingdom
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15
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Rossi Ferrario S, Panzeri A. Exploring illness denial of LVAD patients in cardiac rehabilitation and their caregivers: A preliminary study. Artif Organs 2020; 44:655-660. [PMID: 31904106 DOI: 10.1111/aor.13630] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/16/2019] [Accepted: 12/30/2019] [Indexed: 12/20/2022]
Abstract
Implantable left ventricular assist devices (LVADs) are increasingly used for patients with heart failure. Despite this evidence, the psychological processes affecting implanted patients and their caregivers are only marginally studied. While common emotional reactions, such as anxiety and depression already receive attention, very little is known about the course of caregiver strain, illness denial, and their reciprocal relation. This preliminary study aims at exploring these critical topics in a cardiac rehabilitation setting, besides offering indications for future research. A total of 44 LVAD patients and caregivers were administered specific questionnaires at admission and discharge from cardiac rehabilitation. Overall, questionnaires completed at discharge showed a positive improvement in the emotional measures used. However, they also showed a worsening in the illness denial measure. We suggest that the denial process may prepare patients and caregivers in returning home. Moreover, we conclude that studying only the common emotional reactions may limit the understanding of the psychological process adaptation to severe illness.
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Affiliation(s)
- Silvia Rossi Ferrario
- Psychology and Neuropsychology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Veruno, Italy
| | - Anna Panzeri
- Psychology and Neuropsychology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Veruno, Italy
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16
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Goreis A, Asbrock F, Nater UM, Mewes R. What Mediates the Relationship Between Ethnic Discrimination and Stress? Coping Strategies and Perceived Social Support of Russian Immigrants in Germany. Front Psychiatry 2020; 11:557148. [PMID: 33192672 PMCID: PMC7533615 DOI: 10.3389/fpsyt.2020.557148] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/13/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Experiences of ethnic discrimination may constitute major stressors for ethnic minority groups. This study examined the associations between different forms of ethnic discrimination and levels of perceived stress in Russian immigrants living in Germany, taking into account potential moderating (in-group identification) and mediating (coping and social support) factors. METHODS Russian immigrants (N = 308) were assessed using online questionnaires (e.g., perceived stress scale, behaviors from intergroup affect and stereotype treatment scale, and brief COPE). Three forms of ethnic discrimination were examined: active harm (e.g., open aggression), passive harm (e.g., paternalistic behavior), and everyday discrimination (e.g., receiving poor service). Moderation by in-group identification and mediation via coping and social support were tested. RESULTS Passive harm was more prevalent than everyday discrimination and active harm. Passive harm and everyday discrimination were associated with higher perceived stress (rs = .22 and .18, ps <.01), and in-group identification did not moderate these associations (ps >.27). The coping strategy self-blame mediated the association between active harm and stress. Substance use and self-blame mediated the association between passive harm and stress, whereas venting, behavioral disengagement, denial, self-blame, and social support mediated the association between everyday discrimination and stress. A direct effect remained for passive harm and everyday discrimination. CONCLUSION The present study revealed that Russian immigrants encounter different forms of ethnic discrimination, and that this is associated with higher levels of stress. This association was partly explained by coping and social support, illustrating possibilities for interventions aimed at improving the use of adaptive coping strategies and promoting social support-seeking for Russian immigrants.
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Affiliation(s)
- Andreas Goreis
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria.,Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Frank Asbrock
- Department of Psychology, Chemnitz University of Technology, Chemnitz, Germany
| | - Urs M Nater
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Ricarda Mewes
- Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Vienna, Austria
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Di Giuseppe M, Ciacchini R, Micheloni T, Bertolucci I, Marchi L, Conversano C. Defense mechanisms in cancer patients: a systematic review. J Psychosom Res 2018; 115:76-86. [PMID: 30470322 DOI: 10.1016/j.jpsychores.2018.10.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/26/2018] [Accepted: 10/27/2018] [Indexed: 10/28/2022]
Abstract
The importance of defense mechanisms in cancer progression and adaptation have been largely observed. However, few studies referred to the generally accepted hierarchical organization of defenses and used validated measurements for defensive assessment. In this systematic review, we investigated the whole hierarchy of defense mechanisms and how they associate with various psychological aspects in cancer patients. A literature search was conducted using electronic databases. Among 1570 records published from 1990 to date, only 15 articles met inclusion criteria. Findings related to cancer patients' defensive functioning and its relations with other physical and psychological variables were extracted. A general consistency emerges on the role of defense mechanisms in cancer progression and recovery. Following the hierarchical organization of defenses, higher physical and emotional functioning emerged as being associated with High-adaptive defenses, while Mental Inhibition defenses, in particular repression, promote psychosomatic symptoms, passive decisional preferences and worse physical and emotional health. Disavowal defenses foster lower anxiety and higher emotional functioning by denying anxiety about death. Image distortion defenses, including both Minor and Major image-distorting defenses, were more frequent in cancer patients than in control groups and finally, Action defenses predicted sleep disturbance and lower survival probability. The early detection of maladaptive defensive functioning may foster appropriate psychotherapeutic intervention and prevent worsening of the illness. Further investigations are required to replicate these findings and highlight associations between defense mechanisms and various aspects of mental functioning in cancer patients.
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Affiliation(s)
- Mariagrazia Di Giuseppe
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy.
| | - Rebecca Ciacchini
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Tommaso Micheloni
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Ilaria Bertolucci
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Laura Marchi
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
| | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
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Rossi Ferrario S, Giorgi I, Baiardi P, Giuntoli L, Balestroni G, Cerutti P, Manera M, Gabanelli P, Solara V, Fornara R, Luisetti M, Omarini P, Omarini G, Vidotto G. Illness denial questionnaire for patients and caregivers. Neuropsychiatr Dis Treat 2017; 13:909-916. [PMID: 28356745 PMCID: PMC5367559 DOI: 10.2147/ndt.s128622] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Interest in assessing denial is still present, despite the criticisms concerning its definition and measurement. We tried to develop a questionnaire (Illness Denial Questionnaire, IDQ) assessing patients' and caregivers' denial in relation to their illness/disturbance. PATIENTS AND METHODS After a preliminary study, a final version of 24 dichotomous items (true/false) was selected. We hypothesized a theoretical model with three dimensions: denial of negative emotions, resistance to change, and conscious avoidance, the first two composing the actual Denial and the last representing an independent component of the illness denial behavior. The IDQ was administered to 400 subjects (219 patients and 181 caregivers) together with the Anxiety-Depression Questionnaire - Reduced form (AD-R), in order to assess concurrent validity. Confirmatory factor analysis (CFA), internal consistency indices (Cronbach's α and McDonald's ω), and test-retest analysis were performed. RESULTS CFA and internal consistency indices (Cronbach's α: 0.87-0.96) indicated a clear and meaningful three-factor structure of IDQ, for both patients and caregivers. Further analyses showed good concurrent validity, with Denial and its subscale negatively associated with anxiety and depression and avoidance positively associated with anxiety and depression. The IDQ also showed a good stability (r from 0.71 to 0.87). CONCLUSION The IDQ demonstrated good psychometric properties. Denial of negative emotions and resistance to change seem to contribute to a real expression of denial, and conscious avoidance seems to constitute a further step in the process of cognitive-affective elaboration of the illness.
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Affiliation(s)
| | | | - Paola Baiardi
- Scientific Direction, Istituti Clinici Scientifici Maugeri SpA SB, Pavia, Italy
| | - Laura Giuntoli
- Department of General Psychology, University of Padova, Padova, Italy
| | | | - Paola Cerutti
- Psychology Unit, Istituti Clinici Scientifici Maugeri SpA SB, Veruno, NO, Italy
| | | | | | - Valentina Solara
- Department of Neurology, ALS Centre, "Maggiore della Carità" University Hospital, Novara, Italy
| | - Roberta Fornara
- Psychology Unit, SS Trinità Hospital, Borgomanero, NO, Italy
| | - Michela Luisetti
- Psychology Unit, Istituti Clinici Scientifici Maugeri SpA SB, Veruno, NO, Italy
| | - Pierangela Omarini
- Psychology Unit, Istituti Clinici Scientifici Maugeri SpA SB, Veruno, NO, Italy
| | - Giovanna Omarini
- Psychology Unit, Istituti Clinici Scientifici Maugeri SpA SB, Veruno, NO, Italy
| | - Giulio Vidotto
- Department of General Psychology, University of Padova, Padova, Italy
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Fang XY, Albarqouni L, von Eisenhart Rothe AF, Hoschar S, Ronel J, Ladwig KH. Is denial a maladaptive coping mechanism which prolongs pre-hospital delay in patients with ST-segment elevation myocardial infarction? J Psychosom Res 2016; 91:68-74. [PMID: 27894465 DOI: 10.1016/j.jpsychores.2016.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/19/2016] [Accepted: 10/20/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE During an acute myocardial infarction, patients often use denial as a coping mechanism which may provide positive mood regulating effects but may also prolong prehospital delay time (PHD). However, empirical evidences are still sparse. METHODS This cross-sectional study included 533 ST-elevated myocardial infarction (STEMI) patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Data on sociodemographic, clinical and psycho-behavioral characteristics were collected at bedside. The outcome was assessed using the Cardiac Denial of Impact Scale (CDIS) with the median split as cutoff point. A total of 206 (41.8%) STEMI patients were thus classified as deniers. RESULTS Deniers were less likely to suffer from major depression (p=0.04), anxiety (p=0.01) and suboptimal well-being (p=0.01) compared to non-deniers during the last six months prior to STEMI. During STEMI, they were less likely to perceive severe pain strength (p=0.04) and racing heart (p=0.02). Male deniers were also less likely to perceive shortness of breath (p=0.03) and vomiting (p=0.01). Denial was not associated with overall delay time. However, in the time window of 3 to 24h, denial accounted for roughly 40min extra delay (356 vs. 316.5min p=0.02 n=196). CONCLUSIONS Denial not only contributes to less suffering from acute heart related symptoms and negative affectivity but also leads to a clinically significant delay in the prevalent group.
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Affiliation(s)
- X Y Fang
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - L Albarqouni
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - A F von Eisenhart Rothe
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - S Hoschar
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - J Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - K-H Ladwig
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Germany.
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The clinical inadequacy of the DSM-5 classification of somatic symptom and related disorders: an alternative trans-diagnostic model. CNS Spectr 2016; 21:310-7. [PMID: 26707822 DOI: 10.1017/s1092852915000760] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The Diagnostic and Statistical of Mental Disorders, Fifth Edition (DSM-5) somatic symptom and related disorders chapter has a limited clinical utility. In addition to the problems that the single diagnostic rubrics and the deletion of the diagnosis of hypochondriasis entail, there are 2 major ambiguities: (1) the use of the term "somatic symptoms" reflects an ill-defined concept of somatization and (2) abnormal illness behavior is included in all diagnostic rubrics, but it is never conceptually defined. In the present review of the literature, we will attempt to approach the clinical issue from a different angle, by introducing the trans-diagnostic viewpoint of illness behavior and propose an alternative clinimetric classification system, based on the Diagnostic Criteria for Psychosomatic Research.
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21
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Freeman EE, Lesk MR, Harasymowycz P, Desjardins D, Flores V, Kamga H, Li G. Maladaptive coping strategies and glaucoma progression. Medicine (Baltimore) 2016; 95:e4761. [PMID: 27583929 PMCID: PMC5008613 DOI: 10.1097/md.0000000000004761] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The identification of modifiable risk factors for glaucoma progression is needed. Our objective was to determine whether maladaptive coping styles are associated with recent glaucoma progression or worse visual field mean deviation.A hospital-based case-control study was conducted in the Glaucoma Service of Maisonneuve-Rosemont Hospital in Montreal, Canada. Patients with primary open angle glaucoma or normal tension glaucoma with ≥4 years of follow-up and ≥5 Humphrey visual fields were included. Cases had recent visual field progression as defined according to the Early Manifest Glaucoma Trial pattern change probability maps. Controls had stable visual fields. The Brief Cope questionnaire, a 28-item questionnaire about 14 different ways of coping with the stress of a chronic disease, was asked. Questions were also asked about demographic and medical factors, and the medical chart was examined. Outcomes included glaucoma progression (yes, no) and visual field mean deviation. Logistic and linear regressions were used.A total of 180 patients were included (82 progressors and 98 nonprogressors). Although none of the 14 coping scales were associated with glaucoma progression (P > 0.05), higher denial was correlated with worse visual field mean deviation (r = -0.173, P = 0.024). In a linear regression model including age, sex, education, depression, intraocular pressure, and family history of glaucoma, greater levels of denial (β = -1.37, 95% confidence interval [CI] -2.32, -0.41), Haitian ethnicity (β = -7.78, 95% CI -12.52, -3.04), and the number of glaucoma medications (β = -1.20, 95% CI -2.00, -0.38) were statistically significantly associated with visual field mean deviation.The maladaptive coping mechanism of denial was a risk factor for worse visual field mean deviation. Further prospective research will be required to verify the pathways by which denial may exert an effect on glaucomatous visual field loss.
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Affiliation(s)
- Ellen E. Freeman
- Research Centre, Hôpital Maisonneuve-Rosemont
- Department of Ophthalmology, Université de Montréal, Montreal, Canada
- Correspondence: Ellen E. Freeman, Recherche Ophtalmologie, Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l’Assomption, Montreal, QC, H1T 2M4, Canada (e-mail: )
| | - Mark R. Lesk
- Research Centre, Hôpital Maisonneuve-Rosemont
- Department of Ophthalmology, Université de Montréal, Montreal, Canada
| | - Paul Harasymowycz
- Research Centre, Hôpital Maisonneuve-Rosemont
- Department of Ophthalmology, Université de Montréal, Montreal, Canada
| | - Daniel Desjardins
- Research Centre, Hôpital Maisonneuve-Rosemont
- Department of Ophthalmology, Université de Montréal, Montreal, Canada
| | | | | | - Gisèle Li
- Research Centre, Hôpital Maisonneuve-Rosemont
- Department of Ophthalmology, Université de Montréal, Montreal, Canada
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Abstract
The processes through which people learn to live with CFS/ME are poorly understood and have not been rigorously explored within the literature. Semi-structured interviews were conducted with eight women and analysed using interpretative phenomenological analysis. Participants initially described being ‘overwhelmed’ by CFS/ME. Attempts at seeking help were unsatisfactory and participants described feeling let down and disbelieved. Participants reacted to this by identifying types of ‘self-help’ and assertively taking more responsibility for their illness and its treatment. Acquiring social support and greater knowledge were key mediating factors in the emergence of control and acceptance. The relevance of the themes to existing research and the implications for clinical practice are considered.
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Schur HV, Gamsu DS, Barley VM. The Young Person's Perspective on Living and Coping with Diabetes. J Health Psychol 2016; 4:223-36. [DOI: 10.1177/135910539900400215] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Adolescence and young adulthood is a time of significant psychological and psychosocial development, and for young people with Type 1 diabetes mellitus it is a time when self-care and metabolic control of diabetes may become compromised. In order to enhance services’ efforts to meet the complex needs of young people with diabetes, a qualitative interview study with eight young people (aged 16–22 years) was carried out. Young people identified an inherent vulnerability associated with having diabetes and feared that diabetes would take control and overwhelm them. Through learning to live with diabetes, and learning to manage a relationship with diabetes, the young people had developed sophisticated, interrelated self-protective strategies to manage intrapersonal and interpersonal threats from diabetes.
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Affiliation(s)
| | - D. S. Gamsu
- Diabetes Centre, Northern General Hospital, Sheffield, UK
| | - Valerie M. Barley
- Oakwood Young People's Centre, Northern General Hospital, Sheffield, UK
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Gamba A, Stefana A. "Sono innamor(a)to della terra". Note su gioco, disegno, sogno e terapie diversionali nella cura di bambini con gravi patologie fisiche. PSICOTERAPIA E SCIENZE UMANE 2016. [DOI: 10.3280/pu2016-002003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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25
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Self-deception as affective coping. An empirical perspective on philosophical issues. Conscious Cogn 2016; 41:119-34. [DOI: 10.1016/j.concog.2016.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/22/2015] [Accepted: 02/06/2016] [Indexed: 11/22/2022]
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Stoewen DL, Coe JB, MacMartin C, Stone EA, Dewey CE. Qualitative study of the information expectations of clients accessing oncology care at a tertiary referral center for dogs with life-limiting cancer. J Am Vet Med Assoc 2014; 245:773-83. [DOI: 10.2460/javma.245.7.773] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hoang-Kim A, Schemitsch E, Sale JEM, Beaton D, Warmington K, Kulkarni AV, Reeves S. Understanding osteoporosis and fractures: an introduction to the use of qualitative research. Arch Orthop Trauma Surg 2014; 134:207-17. [PMID: 23860671 DOI: 10.1007/s00402-013-1799-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Qualitative research has been recognized in recent years as a field of inquiry used to understand people's beliefs, attitudes, behaviors, culture or lifestyle. While quantitative results are challenging to apply in everyday practice, the qualitative paradigm can be useful to fill in a research context that is poorly understood or ill-defined. It can provide an in-depth study of interactions, a way to incorporate context, and a means to hear the voices of participants. Understanding experiences, motivation, and beliefs can have a profound effect on the interpretation of quantitative research and generating hypotheses. In this paper, we will review different qualitative approaches that healthcare providers and researchers may find useful to implement in future study designs, specifically in the context of osteoporosis and fracture. METHODS We will provide insight into the qualitative paradigm gained from the osteoporosis literature on fractures using examples from the database Scopus. Five prominent qualitative techniques (narratives, phenomenology, grounded theory, ethnography, and case study) can be used to generate meanings of the social and clinical world. DISCUSSION AND CONCLUSION We have highlighted how these strategies are implemented in qualitative research on osteoporosis and fractures and are anchored to specific methodological practices. We focus on studies that explore patient psychosocial experiences of diagnosis and treatment, cultural boundaries, and interprofessional communication. After reviewing the research, we believe that action research, that is not frequently used, could also effectively be used by many professions to improve programs and policies affecting those dealing with osteoporosis issues.
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Affiliation(s)
- A Hoang-Kim
- Institute of Medical Science, St. Michael's Hospital, University of Toronto, 30 Bond, Street (193 Yonge Street, 6th Floor), Toronto, ON, M5B 1W8, Canada,
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Insight in stable schizophrenia: relations with psychopathology and cognition. Compr Psychiatry 2013; 54:484-92. [PMID: 23332554 DOI: 10.1016/j.comppsych.2012.12.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 12/04/2012] [Accepted: 12/06/2012] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE This study evaluated the relationship among insight, sociodemographic and clinical variables, symptoms and cognitive functions in a population of outpatients with stable schizophrenia, in order to identify possible contributing factors to awareness. METHOD Two-hundred and seventy-six consecutive outpatients with stable schizophrenia were enrolled in a cross-sectional study. All subjects were assessed by psychiatric scales and interview, and a wide neuropsychological battery. A factor analysis was performed to identify cognitive factors and multiple regression analyses were executed to test the contribution of variables considered to insight. RESULTS Our results showed that positive and negative symptoms, executive functions, verbal memory-learning were contributors of awareness of mental illness; positive and negative symptoms explained variability in awareness of the need for treatment; positive symptoms and executive functions contributed to awareness of the social consequences of disorder. CONCLUSIONS These results suggested that insight was partially influenced by positive and negative symptoms and by cognitive functions. A complex system of overlapping variables may underlie impaired insight, contributing to a different extent to specific dimensions of poor insight in patients with stable schizophrenia.
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Dubler NN. Commentary on Bergman: “Yes … But”. THE JOURNAL OF CLINICAL ETHICS 2013. [DOI: 10.1086/jce201324103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Guidi J, Rafanelli C, Roncuzzi R, Sirri L, Fava GA. Assessing psychological factors affecting medical conditions: comparison between different proposals. Gen Hosp Psychiatry 2013; 35:141-6. [PMID: 23122485 DOI: 10.1016/j.genhosppsych.2012.09.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/25/2012] [Accepted: 09/25/2012] [Indexed: 01/10/2023]
Abstract
OBJECTIVE We compared the provisional Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for Somatic Symptom Disorders (SSD) and an alternative classification based on the Diagnostic Criteria for Psychosomatic Research (DCPR) as to prevalence and associations with dimensional measures of psychological distress and functioning in a population of medical patients. METHOD Seventy consecutive outpatients with congestive heart failure were administered an ad hoc structured clinical interview for the identification of DSM-5 SSD, the section concerning hypochondriasis of the Structured Clinical Interview for DSM-IV, the Structured Interview for DCPR and Paykel's Clinical Interview for Depression. Subjects also completed the Symptom Questionnaire and the Psychosocial Index. Global assessment of functioning was performed with the DSM-IV Axis V. RESULTS A diagnosis within DSM-5 SSD was found in 13 patients (18.5%): 61.5% of them were diagnosed with the Psychological Factors Affecting Medical Condition category. Twenty-nine patients (41.4%) were classified according to the DCPR-based proposal: illness denial, demoralization and irritable mood were the most frequent specifiers. The DCPR-based classification showed a greater number of significant associations with dimensional measures of psychological distress, global functioning and stress. CONCLUSION Compared to DSM-5 SSD, the DCPR-based proposal was more sensitive in detecting psychological factors relevant to illness course and provided a better characterization of such factors. The DCPR-based proposal was also superior in identifying patients with increased psychological distress and poor psychosocial functioning.
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Affiliation(s)
- Jenny Guidi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Italy.
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Abstract
The Diagnostic Criteria for Psychosomatic Research (DCPR) were introduced in 1995 by an international group of investigators to expand the traditional domains of the disease model. The DCPR are a set of 12 'psychosomatic syndromes' which provide operational tools for psychosocial variables with prognostic and therapeutic implications in clinical settings. Eight syndromes concern the main manifestations of abnormal illness behaviour: somatization, hypochondriacal fears and beliefs, and illness denial. The other four syndromes (alexithymia, type A behaviour, demoralization and irritable mood) refer to the domain of psychological factors affecting medical conditions. This review describes the conceptual bases of the DCPR and the main findings concerning their application, with particular reference to the incremental information they added to the customary psychiatric classification. The DCPR were also compared with the provisional DSM-5 somatic symptom disorders. The DCPR were found to be more sensitive than DSM-IV in identifying subthreshold psychological distress and characterizing patients' psychological response to medical illness. DSM-5 somatic symptom disorders seem to neglect important clinical phenomena, such as illness denial, resulting in a narrow view of patients' functioning. The additional information provided by the DCPR may enhance the decision-making process.
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Affiliation(s)
- Laura Sirri
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
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Le Grande MR, Elliott PC, Worcester MU, Murphy BM, Goble AJ, Kugathasan V, Sinha K. Identifying illness perception schemata and their association with depression and quality of life in cardiac patients. PSYCHOL HEALTH MED 2012; 17:709-22. [DOI: 10.1080/13548506.2012.661865] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
AbstractObjective:The purpose of this study was to explore the impact of advanced cancer patients' denial on their family caregivers and how they cope, in order to enable clinicians to better support them and their caregiving.Method:As the objective was to obtain clinically useful findings, an interpretive descriptive design was used. Data consisted of prospective semi-structured interviews with 16 family caregivers of advanced cancer patients in denial, field notes, reflexive journals, and memos during the analysis.Results:Caregivers experienced extra burdens with the patient's denial. Feeling bound to preserve the denial, which they perceived as immutable, they were prevented from seeking information to manage the patient's care. Additionally, those caring for noncompliant patients felt disenfranchised from their role, resulting in feelings of powerlessness and guilt, and felt burdened by managing medical situations that arose from noncompliance. Caregivers described the ambivalence of feeling frustrated and burdened by the denial while recognizing it as a long-standing coping pattern for the patient. The denial prevented them from acknowledging their own needs to the patients or seeking informal support. They therefore developed solitary coping strategies, sought professional psychosocial support, and/or employed denial themselves.Significance of results:Caregivers of patients in denial experience added burdens, which they must bear without most of the usual sources of support. The burden is accentuated when patients are noncompliant with care, placing themselves in dangerous situations. Healthcare providers should identify patients in denial and support their caregivers in meeting both their caregiving and their own needs. Evidence-based strategies to accomplish this should be developed and implemented.
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Abstract
Nearly 50% of adults have one or more chronic illnesses. Self-care is considered essential in the management of chronic illness, but the elements of self-care in this context have not been specified in a middle-range theory. This article describes a middle-range theory of self-care that addresses the process of maintaining health with health promoting practices within the context of the management required of a chronic illness. The key concepts include self-care maintenance, self-care monitoring, and self-care management. Assumptions and propositions of the theory are specified. Factors influencing self-care including experience, skill, motivation, culture, confidence, habits, function, cognition, support from others, and access to care are described.
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Lockeridge S, Simpson J. The experience of caring for a partner with young onset dementia: how younger carers cope. DEMENTIA 2012; 12:635-51. [PMID: 24337334 DOI: 10.1177/1471301212440873] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A growing body of literature suggests that the social context of experiencing dementia at a younger age may influence carers' and particularly partners' subjective experience and coping strategies. The current paper aims to explore the coping strategies adopted by six carers in order to adapt to changes in their relationship with their partner with young onset dementia. All were recruited from the north west of England and interpretative phenomenological analysis was used to analyse the data. Four major themes were evident: (1) 'this is not happening': the use of denial as a coping strategy; (2) 'let's not have anymore of this demeaning [treatment]': stigma in young onset dementia; (3) 'I've had to fight every inch': struggling to maintain control of events and emotions; (4) 'what will become of me?': carers' adaptation to loss. Comparisons with existing literature are made and implications for clinical practice are considered.
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Snowden A, Marland G, Murray E, McCaig M. Denial of heart disease, delays seeking help and lifestyle changes. ACTA ACUST UNITED AC 2012. [DOI: 10.12968/bjca.2012.7.3.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Austyn Snowden
- University Campus Paisley, University of the West of Scotland
| | - Glenn Marland
- University Campus Dumfries, University of the West of Scotland, DG1 4ZN
| | | | - Marie McCaig
- Mental Health Nursing, University Campus Dumfries, University of the West of Scotland
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Fava GA, Guidi J, Porcelli P, Rafanelli C, Bellomo A, Grandi S, Grassi L, Mangelli L, Pasquini P, Picardi A, Quartesan R, Rigatelli M, Sonino N. A cluster analysis-derived classification of psychological distress and illness behavior in the medically ill. Psychol Med 2012; 42:401-407. [PMID: 24438853 DOI: 10.1017/s0033291711001231] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The classification of psychological distress and illness behavior in the setting of medical disease is still controversial. Current psychiatric nosology does not seem to cover the spectrum of disturbances. The aim of this investigation was to assess whether the joint use of DSM-IV categories and the Diagnostic Criteria for Psychosomatic Research (DCPR), that provide identification of syndromes related to somatization, abnormal illness behavior, irritable mood, type A behavior, demoralization and alexithymia, could yield subtyping of psychosocial variables in the medically ill. METHOD A cross-sectional assessment using both DSM-IV and the DCPR was conducted in eight medical centers in the Italian Health System. Data were submitted to cluster analysis. Participants were consecutive medical out-patients and in-patients for whom a psychiatric consultation was requested. A total of 1700 subjects met eligibility criteria and 1560 agreed to participate. RESULTS Three clusters were identified: non-specific psychological distress, irritability and affective disturbances with somatization. CONCLUSIONS Two-step cluster analysis revealed clusters that were found to occur across clinical settings. The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of somatization, illness behavior and subclinical distress encompassed by the DCPR.
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Affiliation(s)
- G A Fava
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - J Guidi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - P Porcelli
- Psychosomatic Unit, IRCCS De Bellis Hospital, Castellana Grotte, Bari, Italy
| | - C Rafanelli
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - A Bellomo
- Section of Psychiatry and Clinical Psychology, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - S Grandi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - L Grassi
- Section of Psychiatry, Department of Medical Sciences of Communication and Behavior, University of Ferrara, Ferrara, Italy
| | - L Mangelli
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - P Pasquini
- Clinical Epidemiology Unit, Istituto Dermapatico dell'Immacolata (IDI-IRCCS), Roma, Italy
| | - A Picardi
- Mental Health Unit, Italian National Institute of Health Center of Epidemiology, Surveillance and Health Promotion, Roma, Italy
| | - R Quartesan
- Section of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy
| | - M Rigatelli
- Department of Neuroscience, University of Modena and Reggio Emilia, Modena, Italy
| | - N Sonino
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA
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Riegel B, Elmi A, Moser DK, McKinley S, Meischke H, Doering LV, Davidson P, Pelter M, Baker H, Dracup K. Who listens to our advice? A secondary analysis of data from a clinical trial testing an intervention designed to decrease delay in seeking treatment for acute coronary syndrome. PATIENT EDUCATION AND COUNSELING 2011; 85:e33-e38. [PMID: 21300515 PMCID: PMC3097294 DOI: 10.1016/j.pec.2011.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 01/06/2011] [Accepted: 01/07/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Prolonged prehospital delay in persons experiencing acute coronary syndrome (ACS) remains a problem. Understanding which patients respond best to particular interventions designed to decrease delay time would provide mechanistic insights into the process by which interventions work. METHODS In the PROMOTION trial, 3522 at-risk patients were enrolled from 5 sites in the United States (56.4%), Australia and New Zealand; 490 (N=272 intervention, N=218 control) had an acute event within 2 years. Focusing on these 490, we (1) identified predictors of a rapid response to symptoms, (2) identified intervention group subjects with a change in these predictors over 3 months of follow-up, and (3) compared intervention group participants with and without the favorable response pattern. Hypothesized predictors of rapid response were increased perceived control and decreased anxiety. Knowledge, attitudes, and beliefs were hypothesized to differ between responders and non-responders. RESULTS Contrary to hypothesis, responders had low anxiety and low perceived control. Only 73 (26.8%) subjects showed this pattern 3 months following the intervention. No differences in ACS knowledge, attitudes, or beliefs were found. CONCLUSION The results of this study challenge existing beliefs. PRACTICE IMPLICATIONS New intervention approaches that focus on a realistic decrease in anxiety and perceived control are needed.
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Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-4217, USA.
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Pijnenborg GHM, Van der Gaag M, Bockting CLH, Van der Meer L, Aleman A. REFLEX, a social-cognitive group treatment to improve insight in schizophrenia: study protocol of a multi-center RCT. BMC Psychiatry 2011; 11:161. [PMID: 21975132 PMCID: PMC3222612 DOI: 10.1186/1471-244x-11-161] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 10/05/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Insight is impaired in a majority of people with schizophrenia. Impaired insight is associated with poorer outcomes of the disorder. Based on existing literature, we developed a model that explains which processes may possibly play a role in impaired insight. This model was the starting point of the development of REFLEX: a brief psychosocial intervention to improve insight in schizophrenia. REFLEX is a 12-sessions group training, consisting of three modules of four sessions each. Modules in this intervention are: "coping with stigma", "you and your personal narrative", and "you in the present". METHODS/DESIGN REFLEX is currently evaluated in a multicenter randomized controlled trial. Eight mental health institutions in the Netherlands participate in this evaluation. Patients are randomly assigned to either REFLEX or an active control condition, existing of cognitive remediation exercises in a group. In a subgroup of patients, fMRI scans are made before and after training in order to assess potential haemodynamic changes associated with the effects of the training. DISCUSSION REFLEX is one of the few interventions aiming specifically to improving insight in schizophrenia and has potential value for improving insight. Targeting insight in schizophrenia is a complex task, that comes with several methodological issues. These issues are addressed in the discussion of this paper. TRIAL REGISTRATION Current Controlled Trials: ISRCTN50247539.
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Affiliation(s)
- GHM Pijnenborg
- Dept. of Psychotic Disorders, GGZ-Drenthe, Dennenweg 9, 9404 LA, Assen, the Netherlands
- Dept. of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
- Neuroimaging Center, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, Groningen, the Netherlands
| | - Mark Van der Gaag
- VU University and EMGO+ Institute of Health and Care Research, Dept. of Clinical Psychology, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands
- Parnassia Psychiatric Institute, Prinsegracht 63, 2512 EX The Hague, the Netherlands
| | - Claudi LH Bockting
- Dept. of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
| | - Lisette Van der Meer
- Lentis, Center for Mental Healthcare, Department of Longterm Rehabilitation, Zuidlaren, the Netherlands
- Neuroimaging Center, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, Groningen, the Netherlands
| | - André Aleman
- Dept. of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
- Neuroimaging Center, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, Groningen, the Netherlands
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Abstract
Palliative care is not just vital in controlling symptoms of the patient’s disease condition, but also aims to extend the patient’s life, giving it a better quality. However, several times in the course of management, the psychosocial impact of cancer, HIV/AIDS, and other life-limiting disease conditions may not be noticed and dealt with during the admission period, thereby giving rise to a more complex situation than the disease condition itself. This article aims to review some psychosocial issues and measures that can be taken to address them. It highlights the various roles and the importance of the clinician, nurse, social worker, and other members of the multidisciplinary team in tackling these issues and will help healthcare professionals in this field achieve better practice in the future.
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Affiliation(s)
- Tonia C Onyeka
- Department of Anesthesia, Pain and Palliative Care Unit, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, PMB 01129, Nigeria
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Kaltsouda A, Skapinakis P, Damigos D, Ikonomou M, Kalaitzidis R, Mavreas V, Siamopoulos KC. Defensive coping and health-related quality of life in chronic kidney disease: a cross-sectional study. BMC Nephrol 2011; 12:28. [PMID: 21689443 PMCID: PMC3141643 DOI: 10.1186/1471-2369-12-28] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Accepted: 06/20/2011] [Indexed: 11/28/2022] Open
Abstract
Background Coping with the stresses of chronic disease is considered as a key factor in the perceived impairment of health related quality of life (HRQL). Little is known though about these associations in chronic kidney disease (CKD). The present study aimed to investigate the relationship of defensive coping and HRQL among patients in different CKD stages, after adjusting for psychological distress, sociodemographic and disease-related variables. Methods The sample consisted of 98 CKD patients, attending a university nephrology department. Seventy-nine (79) pre-dialysis patients of disease stages 3 to 4 and 19 dialysis patients were included. HRQL was assessed by the 36-item Short-Form health survey (SF-36), defensive coping by the Rationality/Emotional Defensiveness (R/ED) scale of the Lifestyle Defense Mechanism Inventory (LDMI) and psychological distress by the depression and anxiety scales of the revised Hopkins Symptom CheckList (SCL-90-R). Regression analyses were carried out to examine the association between SF-36 dimensions and defensive coping style. Results Patients on dialysis had worse scores on SF-36 scales measuring physical aspects of HRQL. In the fully adjusted analysis, a higher defensive coping score was significantly associated with a lower score on the mental component summary (MCS) scale of the SF-36 (worse mental health). In contrast, a higher defensive score showed a small positive association with the physical component summary (PCS) scale of the SF-36 (better health), but this was marginally significant. Conclusions The results provided evidence that emotional defensiveness as a coping style tends to differentially affect the mental and the physical component of HRQL in CKD. Clinicians should be aware of the effects of long-term denial and could examine the possibility of screening for defensive coping and depression in recently diagnosed CKD patients with the aim to improve both physical and mental health.
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Affiliation(s)
- Anna Kaltsouda
- Department of Psychiatry, School of Medicine, University of Ioannina, Ioannina 45110, Greece.
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42
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Sirri L, Fava GA, Wise TN. Psychiatric classification in the setting of medical disease: comparing the clinical value of different proposals. J Psychosom Res 2011; 70:493-5. [PMID: 21624570 DOI: 10.1016/j.jpsychores.2010.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 10/12/2010] [Accepted: 10/21/2010] [Indexed: 11/16/2022]
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43
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Travis AC, Pawa S, LeBlanc JK, Rogers AI. Denial: what is it, how do we recognize it, and what should we do about it? Am J Gastroenterol 2011; 106:1028-30. [PMID: 21637266 DOI: 10.1038/ajg.2010.466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Anne C Travis
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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44
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Vos MS, Putter H, van Houwelingen HC, de Haes HC. Denial and social and emotional outcomes in lung cancer patients: The protective effect of denial. Lung Cancer 2011; 72:119-24. [DOI: 10.1016/j.lungcan.2010.07.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 07/10/2010] [Accepted: 07/14/2010] [Indexed: 11/25/2022]
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45
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Albuquerque SC, Carvalho ER, Lopes RS, Marques HS, Macêdo DS, Pereira ED, Hyphantis TN, Carvalho AF. Ego defense mechanisms in COPD: impact on health-related quality of life and dyspnoea severity. Qual Life Res 2011; 20:1401-10. [DOI: 10.1007/s11136-011-9884-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2011] [Indexed: 11/28/2022]
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O'Callaghan C, Powell T, Oyebode J. An exploration of the experience of gaining awareness of deficit in people who have suffered a traumatic brain injury. Neuropsychol Rehabil 2011; 16:579-93. [PMID: 16952894 DOI: 10.1080/09602010500368834] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Gaining awareness of deficits was explored in 10 people with moderate to severe traumatic brain injury (TBI) using a semi-structured interview and interpretative phenomenological analysis. Eight master themes emerged from the transcripts. Knowledge of deficits was acquired through personal discovery and the reactions of others, often outside the rehabilitation environment. Rehabilitation provided explanations and a normalising and supportive environment that facilitated people in acknowledging their deficits. Most participants spontaneously referred to denial and saw this as an active cognitive and behavioural process that both helped and hindered recovery. The emotional reaction to learning about deficits was described largely in terms of fear and loss and resonates with psychological models of grief.
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Affiliation(s)
- Catherine O'Callaghan
- Department of Clinical Psychology, University of Birmingham, Edgbaston, Birmingham, UK
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Sale JEM, Beaton DE, Bogoch ER, Elliot-Gibson V, Frankel L. The BMD muddle: the disconnect between bone densitometry results and perception of bone health. J Clin Densitom 2010; 13:370-8. [PMID: 21029973 DOI: 10.1016/j.jocd.2010.07.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 06/28/2010] [Accepted: 07/23/2010] [Indexed: 10/18/2022]
Abstract
We conducted a phenomenological qualitative study to examine fracture patients' interpretations of their most recent bone densitometry results and perceptions of their current bone health. English-speaking outpatients who had sustained a fragility fracture in the previous 18-24 mo and reported having at least 1 previous bone mineral density (BMD) test were eligible. Data were collected through semistructured interviews in patients' homes. Patients were asked to describe their most recent BMD test results and perception of their bone health status based on these results. Eighteen patients (14 women and 4 men) aged 49-82 yr were recruited. BMD results showed bone density in patients to be normal (n=4), osteopenic (n=9), and osteoporotic (n=5). A correct diagnosis was recalled by 6 patients. Two common interpretations of BMD test results emerged: (1) no news was considered to be good news (n=9) and (2) evidence of compromised bone health was not considered to be serious or accurate (n=6). Medication adherence did not appear to be associated with perception of bone health or actual BMD results. Patients' perceptions of their current bone health did not correspond to the results of their most recent BMD test. Standardized bone densitometry reporting may improve patients' understanding of their bone health.
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Affiliation(s)
- Joanna E M Sale
- Mobility Program Clinical Research Unit, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
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Rocca P, Castagna F, Mongini T, Montemagni C, Bogetto F. Relative contributions of psychotic symptoms and insight to quality of life in stable schizophrenia. Psychiatry Res 2010; 177:71-6. [PMID: 20381879 DOI: 10.1016/j.psychres.2009.01.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 01/22/2009] [Accepted: 01/28/2009] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to examine the relative contributions of psychotic symptomatology such as delusions and hallucinations, and insight to quality of life (QOL) in a sample of outpatients with stable schizophrenia. Eighty-three consecutive outpatients with stable schizophrenia were enrolled in a cross-sectional study. We performed a path analysis using a multiple regression technique to assess the specific effect of psychotic symptomatology on QOL and the possible mediating role of insight. Our findings suggested that (i) psychotic symptomatology was negatively correlated to both QOL and the two dimensions of insight we considered (awareness of symptoms and attribution of symptoms); (ii) the impact of insight on QOL was not uniform as attribution of symptoms positively predicted QOL, while the effect of symptom awareness was negative; (iii) when the mediation effect of insight was taken into account, psychotic symptomatology was no longer a significant predictor of QOL on its own. These results suggested a complex pattern of relationships between different dimensions of insight, QOL and psychotic symptomatology. Different dimensions of insight could be related to different aspects of outcome, and this would need to be reflected in rehabilitation programs.
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Affiliation(s)
- Paola Rocca
- Department of Neuroscience, Psychiatric Section, University of Turin, Turin, Italy.
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Shaw RJ, Harvey JE, Bernard R, Gunary R, Tiley M, Steiner H. Comparison of Short-Term Psychological Outcomes of Respiratory Failure Treated by Either Invasive or Non-Invasive Ventilation. PSYCHOSOMATICS 2009. [DOI: 10.1016/s0033-3182(09)70860-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Livneh H. Denial of Chronic Illness and Disability: Part II. Research Findings, Measurement Considerations, and Clinical Aspects. REHABILITATION COUNSELING BULLETIN 2009. [DOI: 10.1177/0034355209346013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The concept of denial has been an integral part of the psychological and disability studies bodies of literature for over 100 years.Yet, denial is a highly elusive concept and has been associated with mixed, indeed conflicting theoretical perspectives, clinical strategies, and empirical findings. In part II the author reviews empirical findings, measurement strategies, and clinical approaches associated with denial, with particular emphasis on rehabilitation-specific findings and implications. It focuses on empirical findings linking the use of denial to a number of psychosocial outcomes, measures that have been employed in the assessment of denial and, intervention strategies to manage denial. Part II concludes with a brief discussion of the implications generated by the current understanding of denial to rehabilitation practitioners and researchers.
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