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Lešin Gaćina D, Marčinko D, Kuzman T, Škegro I, Vidas Pauk S, Škegro B, Tomić M, Bulum T, Jandroković S. Personality dimensions and treatment adherence among glaucoma patients: the role of self-transcendence. Curr Med Res Opin 2024; 40:583-590. [PMID: 38404158 DOI: 10.1080/03007995.2024.2323644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Cloninger's psychobiosocial model of personality proposes that consistent patterns of health behavior are determined by the complex interaction of different neurobiological processes of the patient's temperament and character dimensions. Poor medication adherence is a pervasive problem among glaucoma patients and can lead to increased morbidity and disability. The objective of the present study was to investigate the association between Cloninger's personality dimensions and medication adherence among glaucoma patients. METHODS The cross-sectional study was conducted among 113 primary open-angle glaucoma (POAG) patients. The treatment adherence was assessed through a valid and reliable self-administered questionnaire, the Culig Adherence Scale (CAS). Personality dimensions were evaluated using the abbreviated version of the Temperament and Character Inventory-Revised (TCI-140). Statistical analyses were performed using TIBCO Statistica 14.0.1. The study protocol was registered in the DRKS - German Clinical Trials Register; (DRKS-ID: DRKS00022081). RESULTS According to CAS, only 39.8% of patients were adherent to glaucoma treatment. Adherence was significantly negatively related only to the character dimension of Self-Transcendence (p < 0.05). No other TCI-140 dimension was significantly associated with medication adherence (p > 0.05). CONCLUSIONS The results suggest that POAG patients with higher scores on the Self-Transcendent personality dimension are more likely to experience difficulties adhering to medication regimen. The study highlights the importance of a holistic approach to glaucoma treatment, which takes into account not only the biological aspects of disease but also the psychosocial factors that influence patient behavior. Healthcare providers may need to consider glaucoma patients' personality dimensions, beliefs and values when developing treatment plans and strategies to improve medication adherence.
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Affiliation(s)
- Dina Lešin Gaćina
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | - Darko Marčinko
- Department of Psychiatry and Psychological Medicine, Zagreb University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Tomislav Kuzman
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivan Škegro
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Sania Vidas Pauk
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
| | | | - Martina Tomić
- Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| | - Tomislav Bulum
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Ophthalmology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
| | - Sonja Jandroković
- Department of Ophthalmology, Zagreb University Hospital Centre, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Abu EK, Antiri EO, Ocansey S, Ntodie M, Abokyi S, Abraham CH. Associations between personality traits and adherence to treatment in patients with primary open–angle glaucoma in an African population. Clin Exp Optom 2022:1-7. [DOI: 10.1080/08164622.2022.2075253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Emmanuel K Abu
- Department of Optometry and Vision Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer O Antiri
- Department of Optometry and Vision Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Stephen Ocansey
- Department of Optometry and Vision Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Michael Ntodie
- Department of Optometry and Vision Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Abokyi
- Department of Optometry and Vision Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Carl Halladay Abraham
- Department of Optometry and Vision Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana
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Tan Z, Tung TH, Xu SQ, Chen PE, Chien CW, Jiang B. Personality types of patients with glaucoma: A systematic review of observational studies. Medicine (Baltimore) 2021; 100:e25914. [PMID: 34114987 PMCID: PMC8202580 DOI: 10.1097/md.0000000000025914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 04/21/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To synthesize recent empirical research on the association between personality and glaucoma among this sub-population. METHODS PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Scopus and ScienceDirect databases were searched to identify eligible studies published between January 1950 and March 2019 in any language. The quality of included observational studies was assessed using an 11-item checklist which was recommended by Agency for Healthcare Research and Quality (AHRQ). After using the checklist, 12 papers are included into the systematic review. RESULTS There are some differences on the studies about the negative personality of glaucoma patients. In spite of these differences, most included studies significantly showed that glaucoma patients tend to or do have some specific personality. CONCLUSION The extant research could demonstrate that glaucoma patients tend to have some negative personality in some extent. Future studies are needed to provide more convincing support to personality of glaucoma patients.
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Affiliation(s)
- Zhenyan Tan
- Institute for Hospital Management, Tsinghua University, Shenzhen Campus
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, Zhejiang
| | - Shi-Qing Xu
- Institute for Hospital Management, Tsinghua University, Shenzhen Campus
| | - Pei-En Chen
- Taiwan Association of Health Industry Management and Development
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsinghua University, Shenzhen Campus
| | - Bo Jiang
- Department of Ophthalmology, Maoming People's Hospital, Maoming, Guangdong Province, China
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Abstract
The prognosis of going blind is very stressful for patients diagnosed with "glaucoma". Worries and fear of losing independence is a constant mental burden, with secondary risks of depression and social isolation. But stress is not only a result of glaucoma but also a possible cause (risk factor). This should not be surprising, given that chronic stress can trigger "psychosomatic" organ dysfunctions anywhere in the body. Why should the organ "eye" be an exception? Indeed, glaucoma patients often suspect that severe emotional stress caused their visual field loss or "foggy vision". The hypothesis that stress is a possible cause of glaucoma is supported by different observations: (i) acute and chronic stress increases intraocular pressure and (ii) long-term stress can lead to vascular dysregulation of the microcirculation in the eye and brain ("Flammer's syndrome"), leading to partial hypoxia and hypoglycaemia (hypo-metabolism). Even if nerve cells do not die, they may then become inactive ("silent" neurons). (iii) Degenerative changes have been reported in the brain of glaucoma patients, affecting not only anterograde or transsynaptic areas of the central visual pathway, but degeneration is also found (iv) in brain areas involved in emotional appraisal and the physiological regulation of stress hormones. There are also psychological hints indicating that stress is a cause of glaucoma: (v) Glaucoma patients with Flammer's syndrome show typical personality traits that are associated with low stress resilience: they often have cold hands or feet, are ambitious (professionally successful), perfectionistic, obsessive, brooding and worrying a lot. (vi) If stress hormone levels and inflammation parameters are reduced in glaucoma patients by relaxation with meditation, this correlates with normalisation of intraocular pressure, and yet another clue is that (vii) visual field improvements after non-invasive current stimulation therapy, that are known to improve circulation and neuronal synchronisation, are much most effective in patients with stress resilient personalities. An appreciation of stress as a "cause" of glaucoma suggests that in addition to standard therapy (i) stress reduction through relaxation techniques should be recommended (e.g. meditation), and (ii) self-medication compliance should not be induced by kindling anxiety and worries with negative communication ("You will go blind!"), but communication should be positive ("The prognosis is optimistic").
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Affiliation(s)
- Bernhard A Sabel
- Otto-von-Guericke Universität Magdeburg, Institut für Medizinische Psychologie, Deutschland
| | - Luisa Lehnigk
- Otto-von-Guericke Universität Magdeburg, Institut für Medizinische Psychologie, Deutschland
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The Eysenck Personality Profile in Selected Groups of Ophthalmological Patients. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2019; 40:41-49. [PMID: 31605595 DOI: 10.2478/prilozi-2019-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Personality correlates in patients with eye diseases have bidirectional influence. It is possible that personality variables lead to behaviours that may influence the cause of eye problems, but the opposite is also possible, that eye problems could have a direct effect on personality. The aim of this study was to evaluate personality traits in patients with glaucoma, diabetic retinopathy and cataract using the Eysenck Personality Questionnaire. Obtained results showed similar personality profiles in patients with glaucoma, diabetic retinopathy and cataract. However, extraversion and neuroticism were higher in patients with diabetes, while the psychopathic traits are the highest in the group of cataract. Age and gender of patients do not influence the scores obtained on the questionnaire confirmed with one way ANOVA. Not significant difference in parameters (tested with Student t-test) was obtained between groups. It is proposed psychological evaluation to be included in the assessment of more serious eye diseases for helping patients to adjust and adapt to the condition and treatment.
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Psychodynamic Features Associated With Orthognathic Surgery: A Comparison Between Conventional Orthognathic Treatment and “Surgery-First” Approach. J Oral Maxillofac Surg 2019; 77:157-163. [DOI: 10.1016/j.joms.2018.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 11/19/2022]
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Zhu MM, Lai JSM, Choy BNK, Shum JWH, Lo ACY, Ng ALK, Chan JCH, So KF. Physical exercise and glaucoma: a review on the roles of physical exercise on intraocular pressure control, ocular blood flow regulation, neuroprotection and glaucoma-related mental health. Acta Ophthalmol 2018; 96:e676-e691. [PMID: 29338126 DOI: 10.1111/aos.13661] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 11/06/2017] [Indexed: 12/13/2022]
Abstract
The benefits of physical exercise on health and well-being have been studied in a wide range of systemic and ocular diseases, including glaucoma, a progressive optic neuropathy characterized by accelerated apoptosis of retinal ganglion cells (RGCs). Elevated intraocular pressure (IOP) and insufficient ocular perfusion have been postulated to be the two main theories in glaucoma development and progression. The effects of exercise in these two aspects have been demonstrated by numerous researches. A review in 2009 focusing on these two theories concluded that exercise results in transient IOP reduction but an inconsistent elevation in ocular perfusion. However, the majority of the studies had been conducted in healthy subjects. Over the past decade, technological advancement has brought forth new and more detailed evidence regarding the effects of exercise. Moreover, the neuroprotective effect of exercise by upregulation of neurotrophin and enhancement of mitochondrial function has been a focus of interest. Apart from visual impairment, the mental health issues in patients with glaucoma, which include anxiety and depression, should also be addressed. In this review, we mainly focus on publications from the recent years, so as to provide a comprehensive review on the impact of physical exercise on IOP, ocular perfusion, neuroprotection and mental health in patients with glaucoma.
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Affiliation(s)
- Ming Ming Zhu
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Jimmy Shiu Ming Lai
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Bonnie Nga Kwan Choy
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Jennifer Wei Huen Shum
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Amy Cheuk Yin Lo
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Alex Lap Ki Ng
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Jonathan Cheuk Hung Chan
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
| | - Kwok Fai So
- Department of Ophthalmology; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
- School of Biomedical Sciences; LKS Faculty of Medicine; The University of Hong Kong; Hong Kong SAR China
- State Key Laboratory of Brain and Cognitive Sciences; The University of Hong Kong; Hong Kong SAR China
- GHM Institute of CNS Regeneration; Ministry of Education CNS Regeneration Collaborative Joint Laboratory; Jinan University; Guangzhou China
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Sabel BA, Wang J, Cárdenas-Morales L, Faiq M, Heim C. Mental stress as consequence and cause of vision loss: the dawn of psychosomatic ophthalmology for preventive and personalized medicine. EPMA J 2018; 9:133-160. [PMID: 29896314 PMCID: PMC5972137 DOI: 10.1007/s13167-018-0136-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/18/2018] [Indexed: 12/14/2022]
Abstract
The loss of vision after damage to the retina, optic nerve, or brain has often grave consequences in everyday life such as problems with recognizing faces, reading, or mobility. Because vision loss is considered to be irreversible and often progressive, patients experience continuous mental stress due to worries, anxiety, or fear with secondary consequences such as depression and social isolation. While prolonged mental stress is clearly a consequence of vision loss, it may also aggravate the situation. In fact, continuous stress and elevated cortisol levels negatively impact the eye and brain due to autonomous nervous system (sympathetic) imbalance and vascular dysregulation; hence stress may also be one of the major causes of visual system diseases such as glaucoma and optic neuropathy. Although stress is a known risk factor, its causal role in the development or progression of certain visual system disorders is not widely appreciated. This review of the literature discusses the relationship of stress and ophthalmological diseases. We conclude that stress is both consequence and cause of vision loss. This creates a vicious cycle of a downward spiral, in which initial vision loss creates stress which further accelerates vision loss, creating even more stress and so forth. This new psychosomatic perspective has several implications for clinical practice. Firstly, stress reduction and relaxation techniques (e.g., meditation, autogenic training, stress management training, and psychotherapy to learn to cope) should be recommended not only as complementary to traditional treatments of vision loss but possibly as preventive means to reduce progression of vision loss. Secondly, doctors should try their best to inculcate positivity and optimism in their patients while giving them the information the patients are entitled to, especially regarding the important value of stress reduction. In this way, the vicious cycle could be interrupted. More clinical studies are now needed to confirm the causal role of stress in different low vision diseases to evaluate the efficacy of different anti-stress therapies for preventing progression and improving vision recovery and restoration in randomized trials as a foundation of psychosomatic ophthalmology.
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Affiliation(s)
- Bernhard A. Sabel
- Institute of Medical Psychology, Medical Faculty, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Jiaqi Wang
- Institute of Medical Psychology, Medical Faculty, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Lizbeth Cárdenas-Morales
- Institute of Medical Psychology, Medical Faculty, Otto von Guericke University of Magdeburg, Magdeburg, Germany
| | - Muneeb Faiq
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029 India
- Department of Ophthalmology, NYU Langone Health, New York University School of Medicine, New York, NY USA
| | - Christine Heim
- Berlin Institute of Health (BIH), Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA USA
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