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Park H, Lee CH. The Impact of Pulmonary Disorders on Neurological Health (Lung-Brain Axis). Immune Netw 2024; 24:e20. [PMID: 38974208 PMCID: PMC11224666 DOI: 10.4110/in.2024.24.e20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/30/2024] [Accepted: 05/23/2024] [Indexed: 07/09/2024] Open
Abstract
The brain and lungs, vital organs in the body, play essential roles in maintaining overall well-being and survival. These organs interact through complex and sophisticated bi-directional pathways known as the 'lung-brain axis', facilitated by their close proximity and neural connections. Numerous studies have underscored the mediation of the lung-brain axis by inflammatory responses and hypoxia-induced damage, which are pivotal to the progression of both pulmonary and neurological diseases. This review aims to delve into how pulmonary diseases, including acute/chronic airway diseases and pulmonary conditions, can instigate neurological disorders such as stroke, Alzheimer's disease, and Parkinson's disease. Additionally, we highlight the emerging research on the lung microbiome which, drawing parallels between the gut and lungs in terms of microbiome contents, may play a significant role in modulating brain health. Ultimately, this review paves the way for exciting avenues of future research and therapeutics in addressing respiratory and neurological diseases.
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Affiliation(s)
- Hongryeol Park
- Department of Tissue Morphogenesis, Max-Planck Institute for Molecular Biomedicine, Muenster 48149, Germany
| | - Chan Hee Lee
- Department of Biomedical Science, Hallym University, Chuncheon 24252, Korea
- Program of Material Science for Medicine and Pharmaceutics, Hallym University, Chuncheon 24252, Korea
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2
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Morales-Demori R, Coleman R, Mallory GB. Pediatric Pulmonary Hypertension. Pediatr Rev 2024; 45:251-259. [PMID: 38689108 DOI: 10.1542/pir.2023-006010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
| | | | - George B Mallory
- Section of Pulmonology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
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3
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Zhang Z, Wang P, Gu J, Zhang Q, Sun C, Wang P. Effect of metacognitive therapy on depression in patients with chronic disease: a protocol for a systematic review and meta-analysis. BMJ Open 2024; 14:e075959. [PMID: 38631830 PMCID: PMC11029478 DOI: 10.1136/bmjopen-2023-075959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Chronic diseases have a high prevalence worldwide, and patients with chronic diseases often suffer from depression, leading to a poor prognosis and a low quality of life. Metacognitive therapy is a transdiagnostic psychotherapy intervention focused on thinking patterns, with the advantages of reliable implementation effect, short intervention period and low cost. It can help patients change negative metacognition, alleviate depression symptoms, and has a higher implementation value compared with other cognitive interventions. Therefore, metacognitive therapy may be an effective way to improve the mental health of patients with chronic diseases. METHODS AND ANALYSIS CNKI, Wanfang Database, VIP Database for Chinese Technical Periodicals, Sinomed, PubMed, SCOPUS, Embase, The Cochrane Library, Web of Science and PsycINFO will be used to select the eligible studies. As a supplement, websites (eg, the Chinese Clinical Registry, ClinicalTrials.gov) will be searched and grey literature will be included. The heterogeneity and methodological quality of the eligible studies will be independently screened and extracted by two experienced reviewers. All the data synthesis and analysis (drawing forest plots, subgroup analysis and sensitive analysis) will be conducted using RevMan 5.4.1. ETHICS AND DISSEMINATION This article is a literature review that does not include patients' identifiable information. Therefore, ethical approval is not required in this protocol. The findings of this systematic review and meta-analysis will be published in a peer-reviewed journal as well as presentations at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42023411105.
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Affiliation(s)
- Zirui Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Peng Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jinjin Gu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Qiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Changqing Sun
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Panpan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
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Schuchman M, Brady TM, Glenn DA, Tuttle KR, Cara-Fuentes G, Levy RV, Gonzalez-Vicente A, Alakwaa FM, Srivastava T, Sethna CB. Association of mental health-related patient reported outcomes with blood pressure in adults and children with primary proteinuric glomerulopathies. J Nephrol 2024; 37:647-660. [PMID: 38512380 DOI: 10.1007/s40620-024-01919-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/01/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION The prevalence of mental health disorders including anxiety and depression is increasing and is linked to hypertension in healthy individuals. However, the relationship of psychosocial patient-reported outcomes on blood pressure (BP) in primary proteinuric glomerulopathies is not well characterized. This study explored longitudinal relationships between psychosocial patient-reported outcomes and BP status among individuals with proteinuric glomerulopathies. METHODS An observational cohort study was performed using data from 745 adults and children enrolled in the Nephrotic Syndrome Study Network (NEPTUNE). General Estimating Equations for linear regression and binary logistic analysis for odds ratios were performed to analyze relationships between the exposures, longitudinal Patient-Reported Outcome Measurement Information System (PROMIS) measures and BP and hypertension status as outcomes. RESULTS In adults, more anxiety was longitudinally associated with higher systolic and hypertensive BP. In children, fatigue was longitudinally associated with increased odds of hypertensive BP regardless of the PROMIS report method. More stress, anxiety, and depression were longitudinally associated with higher systolic BP index, higher diastolic BP index, and increased odds of hypertensive BP index in children with parent-proxy patient-reported outcomes. DISCUSSION/CONCLUSION Chronically poor psychosocial patient-reported outcomes may be significantly associated with higher BP and hypertension in adults and children with primary proteinuric glomerulopathies. This interaction appears strong in children but should be interpreted with caution, as multiple confounders related to glomerular disease may influence both mental health and BP independently. That said, access to mental health resources may help control BP, and proper disease and BP management may improve overall mental health.
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Affiliation(s)
- Matthew Schuchman
- Northwell, Cohen Children's Medical Center, Division of Pediatric Nephrology, New Hyde Park, NY, USA
| | - Tammy M Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorey A Glenn
- Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine R Tuttle
- Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA, USA
- Division of Nephrology, University of Washington School of Medicine, Spokane, WA, USA
| | - Gabriel Cara-Fuentes
- Section of Pediatric Nephrology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Rebecca V Levy
- Division of Nephrology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
- Division of Pediatric Nephrology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Agustin Gonzalez-Vicente
- Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Fadhl M Alakwaa
- Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI, USA
| | - Tarak Srivastava
- Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Christine B Sethna
- Northwell, Cohen Children's Medical Center, Division of Pediatric Nephrology, New Hyde Park, NY, USA.
- Feinstein Institutes for Medical Research, Manhasset, NY, USA.
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Liu A, Price LC, Sharma R, Wells AU, Kouranos V. Sarcoidosis Associated Pulmonary Hypertension. Biomedicines 2024; 12:177. [PMID: 38255282 PMCID: PMC10813665 DOI: 10.3390/biomedicines12010177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
In patients with sarcoidosis, the development of pulmonary hypertension is associated with significant morbidity and mortality. The global prevalence of sarcoidosis-associated pulmonary hypertension (SAPH) reportedly ranges between 2.9% and 20% of sarcoidosis patients. Multiple factors may contribute to the development of SAPH, including advanced parenchymal lung disease, severe systolic and/or diastolic left ventricular dysfunction, veno-occlusive or thromboembolic disease, as well as extrinsic factors such as pulmonary vascular compression from enlarged lymph nodes, anemia, and liver disease. Early diagnosis of SAPH is important but rarely achieved primarily due to insufficiently accurate screening strategies, which rely entirely on non-invasive tests and clinical assessment. The definitive diagnosis of SAPH requires right heart catheterization (RHC), with transthoracic echocardiography as the recommended gatekeeper to RHC according to current guidelines. A 6-min walk test (6MWT) had the greatest prognostic value in SAPH patients based on recent registry outcomes, while advanced lung disease determined using a reduced DLCO (<35% predicted) was associated with reduced transplant-free survival in pre-capillary SAPH. Clinical management involves the identification and treatment of the underlying mechanism. Pulmonary vasodilators are useful in several scenarios, especially when a pulmonary vascular phenotype predominates. End-stage SAPH may warrant consideration for lung transplantation, which remains a high-risk option. Multi-centered randomized controlled trials are required to develop existing therapies further and improve the prognosis of SAPH patients.
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Affiliation(s)
| | | | | | | | - Vasileios Kouranos
- Royal Brompton Hospital, Part of Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 6NP, UK; (A.L.); (L.C.P.); (R.S.); (A.U.W.)
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Weatherald J, Varughese RA, Liu J, Humbert M. Management of Pulmonary Arterial Hypertension. Semin Respir Crit Care Med 2023; 44:746-761. [PMID: 37369218 DOI: 10.1055/s-0043-1770118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a rare pulmonary vascular disease characterized by progressive pulmonary arterial remodeling, increased pulmonary vascular resistance, right ventricular dysfunction, and reduced survival. Effective therapies have been developed that target three pathobiologic pathways in PAH: nitric oxide, endothelin-1, and prostacyclin. Approved therapies for PAH include phosphodiesterase type-5 inhibitors, soluble guanylate cyclase stimulators, endothelin receptor antagonists, prostacyclin analogs, and prostacyclin receptor agonists. Management of PAH in the modern era incorporates multidimensional risk assessment to guide the use of these medications. For patients with PAH and without significant comorbidities, current guidelines recommend two oral medications (phosphodiesterase type-5 inhibitor and endothelin receptor antagonist) for low- and intermediate-risk patients, with triple therapy including a parenteral prostacyclin to be considered in those at high or intermediate-high risk. Combination therapy may be poorly tolerated and less effective in patients with PAH and cardiopulmonary comorbidities. Thus, a single-agent approach with individualized decisions to add-on other PAH therapies is recommended in older patients and those with significant comorbid conditions. Management of PAH is best performed in multidisciplinary teams located in experienced centers. Other core pillars of PAH management include supportive and adjunctive treatments including oxygen, diuretics, rehabilitation, and anticoagulation in certain patients. Patients with PAH who progress despite optimal treatment or who are refractory to best medical care should be referred for lung transplantation, if eligible. Despite considerable progress, PAH is often fatal and new therapies that reverse the disease and improve outcomes are desperately needed.
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Affiliation(s)
- Jason Weatherald
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Rhea A Varughese
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Jonathan Liu
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, Canada
| | - Marc Humbert
- Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Service de Pneumologie et Soins Intensifs Respiratoires, Assistance Publique Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Hôpital Marie Lannelongue, Le Plessis Robinson, INSERM UMR_S 999, France
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Rawlings GH, Novakova B, Armstrong I, Thompson AR. A systematic review of psychological interventions in adults with pulmonary hypertension: Is the evidence-base disproportionate to the problem? THE CLINICAL RESPIRATORY JOURNAL 2023; 17:966-972. [PMID: 37581272 PMCID: PMC10500323 DOI: 10.1111/crj.13685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/16/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Our understanding of the psychological impact of living with pulmonary hypertension (PH) is growing, particularly for how anxiety and depression present in this group. There is evidence for the use of psychological interventions in other chronic lung conditions; however, trials focusing on adults with PH have yet to be subject to a systematic review. METHODS We systematically searched four databases for evidence examining the effectiveness of psychological interventions for adults with PH. A narrative approach has been used to present findings. RESULTS Overall, 186 unique articles were identified of which four were suitable. Data was gathered from 143 individuals. Cognitive behavioural therapy (CBT), metacognitive therapy (MCT) or counselling were investigated. All three studies reported a significant reduction in anxiety and depression, and some secondary outcomes were also associated with change. DISCUSSION The evidence supporting the use of psychological therapies for adults with PH is promising, although limited. There is an urgent need for more research in this area to better understand how we can support this clinical group.
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Affiliation(s)
| | - Barbora Novakova
- Health and Wellbeing ServiceSheffield IAPT, Sheffield Health and Social Care NHS Foundation TrustSheffieldUK
| | - Iain Armstrong
- Sheffield Pulmonary Vascular Disease UnitRoyal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Andrew R. Thompson
- South Wales Clinical Psychology Training ProgrammeCardiff and Vale University Health Board and Cardiff UniversityCardiffUK
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Fernández Macedo SA, Agüero JJ, Salas GB, Fernandez Tapia SB, Rossel EC. Semiologic differences and primary dysmenorrhea. Heliyon 2023; 9:e19489. [PMID: 37810005 PMCID: PMC10558588 DOI: 10.1016/j.heliyon.2023.e19489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/10/2023] Open
Abstract
Dysmenorrhea is a condition that manifests itself in women before, during, and after menstruation, and it is accompanied by very intense pelvic pain. Moreover, women experience moderate to intense menstrual cramps year after year, decreasing their quality of life. The purpose of the study was to establish semiological differences associated with primary dysmenorrhea. Women who start their menstrual cycles with this symptomatology assume that it is normal and that they do not need specialized medical assistance. Medical professionals have established general practice guidelines on clinical disorders. However, there are no specific recommendations for the menstrual cycle that can effectively support the prompt diagnosis and treatment of primary dysmenorrhea, particularly at 3870 msnm. The uniqueness of our research is that semiological distinctions can change depending on height.
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Affiliation(s)
| | - Julio Jimenez Agüero
- Santa Rose Hospital. Lime, teacher of the school of obstetrics. Andean University Néstor Cáceres Velásquez. Juliaca-Peru
| | - Graciela Bernal Salas
- Hospital Carlos Monge Medrano, teacher of the school of obstetrics. Andean University Néstor Cáceres Velásquez. Juliaca-Peru
| | | | - Esperanza Cueva Rossel
- Hospital Regional Manuel Nuñez Butron. Puno, Andean University Nestor Caceres Velasquez. Juliaca-Peru
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Kozlakidis Z, Shi P, Abarbanel G, Klein C, Sfera A. Recent Developments in Protein Lactylation in PTSD and CVD: Novel Strategies and Targets. BIOTECH 2023; 12:38. [PMID: 37218755 PMCID: PMC10204439 DOI: 10.3390/biotech12020038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 05/24/2023] Open
Abstract
In 1938, Corneille Heymans received the Nobel Prize in physiology for discovering that oxygen sensing in the aortic arch and carotid sinus was mediated by the nervous system. The genetics of this process remained unclear until 1991 when Gregg Semenza while studying erythropoietin, came upon hypoxia-inducible factor 1, for which he obtained the Nobel Prize in 2019. The same year, Yingming Zhao found protein lactylation, a posttranslational modification that can alter the function of hypoxia-inducible factor 1, the master regulator of cellular senescence, a pathology implicated in both post-traumatic stress disorder (PTSD) and cardiovascular disease (CVD). The genetic correlation between PTSD and CVD has been demonstrated by many studies, of which the most recent one utilizes large-scale genetics to estimate the risk factors for these conditions. This study focuses on the role of hypertension and dysfunctional interleukin 7 in PTSD and CVD, the former caused by stress-induced sympathetic arousal and elevated angiotensin II, while the latter links stress to premature endothelial cell senescence and early vascular aging. This review summarizes the recent developments and highlights several novel PTSD and CVD pharmacological targets. They include lactylation of histone and non-histone proteins, along with the related biomolecular actors such as hypoxia-inducible factor 1α, erythropoietin, acid-sensing ion channels, basigin, and Interleukin 7, as well as strategies to delay premature cellular senescence by telomere lengthening and resetting the epigenetic clock.
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Affiliation(s)
- Zisis Kozlakidis
- International Agency for Research on Cancer, World Health Organization (IARC/WHO), 69372 Lyon, France
| | - Patricia Shi
- Department of Psychiatry, Loma Linda University, Loma Linda, CA 92350, USA
| | - Ganna Abarbanel
- Patton State Hospital, University of California, Riverside, CA 92521, USA
| | | | - Adonis Sfera
- Patton State Hospital, University of California, Riverside, CA 92521, USA
- Department of Psychiatry, University of California, Riverside, CA 92521, USA
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Braley K, Richardson K, Whitley L, Werner K, Appleby L. Patient perspectives on pulmonary hypertension in the United States: Burdens, expectations, and goals. Pulm Circ 2023; 13:e12247. [PMID: 37346966 PMCID: PMC10279947 DOI: 10.1002/pul2.12247] [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: 08/24/2022] [Revised: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023] Open
Abstract
Pulmonary hypertension (PH) is a life-threatening, debilitating disease caused by increased blood pressure in the pulmonary arteries. As patients living in the United States, we have unique insights into the journey from diagnosis and treatment within the US healthcare system and the significant impact that PH has on our quality of life. While there have recently been advances in PH management, there are several areas of PH care which we feel should be reassessed and improved. Commonly, diagnosis is lengthy and convoluted due to the rarity of the disease and limited knowledge of PH in primary care. There are also barriers to obtaining the right treatment and we feel that a more holistic approach to care is needed. Mental health is commonly overlooked and should be an integral part of patient care, as should elements such as nutritional advice, cardiopulmonary rehabilitation, and sexual health. PH patient associations play a key role in providing social, educational, and financial support to patients and caregivers alongside PH research and advocacy. As patients, we feel that we need to advocate for correct diagnosis, timely referral, and optimal treatment, in addition to overcoming the financial and/or administrative hurdles to obtain these. We propose several future goals to help empower patients to play an active, central role in their care and to improve all aspects of PH management. We advocate for further use of the patient voice in research and clinical development programs, including the use of patient-reported outcomes that have been developed with patient input.
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Gorini A, De Maria B, Krasinska P, Bussotti M, Perego F, Dalla Vecchia LA. Physiological and Psychological Response to Acute Mental Stress in Female Patients Affected by Chronic Pulmonary Arterial Hypertension: An Explorative Controlled Pilot Trial. Pharmaceuticals (Basel) 2023; 16:ph16040493. [PMID: 37111250 PMCID: PMC10146967 DOI: 10.3390/ph16040493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Little is known about physiological and psychological responses to mental stress in stable patients affected by pulmonary arterial hypertension (PAH). The current explorative controlled pilot study was conducted to investigate whether heart rate (HR) and perceived stress would differ during standardized mental stress testing in PAH patients compared to healthy subjects. Correlation analysis between HR, perceived stress, participants’ psychological status and performance on the mental stress task was also performed. The study included 13 female PAH patients (average age: 44.38 ± 10.88 years; average education: 14 ± 3.07 years; mean duration of illness: 9.15 ± 5.37 years) and 13 female controls similar in age (mean age: 47.85 ± 6.36 years) and education (15.92 ± 1.55 years). Participants performed a standardized 9 min mental stress test (computer based, adaptive math task). HR and perceived stress during the task were compared to resting baseline and correlated with psychological state and task performance. Both HR and perceived stress significantly increased during mental stress in a similar way in both groups. A significant correlation was found between HR and perceived stress. Our data show that moderate mental stress has a comparable effect on HR and perceived stress increase in stable PAH patients and control subjects.
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Affiliation(s)
- Alessandra Gorini
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122 Milan, Italy
| | - Beatrice De Maria
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy
- Correspondence:
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Zhang Y, Zhang H, Zhang Y, Yang Z, Wang L, Pan W, Dai R, Ju Q, Ren D, Bao S, Fan J. Effect of MBSR, DBT and CBT on the hypertension patients with depression/anxiety: Protocol of a systematic review and Bayesian network meta-analysis. PLoS One 2023; 18:e0281469. [PMID: 36802399 PMCID: PMC9943006 DOI: 10.1371/journal.pone.0281469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 01/24/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Hypertension, one of the most common chronic diseases worldwide, usually requires lifetime managing blood pressure (BP) with medications. Due to quite large number of hypertension patients co-exist with depression and/or anxiety, and non-cooperated with medical instruction, consequently management of BP is impaired with serious complications, resulting in compromised quality of life. Consequently quality of life of such patients is impaired with serious complications. Therefore, management of depression and/or anxiety is equally important as the treatment of hypertension. Depression and/or anxiety are independent risk factors of hypertension, which is supported by the finding that there is close correlation between hypertension are depression/or anxiety. Psychotherapy (non-drug treatment) maybe useful for hypertensive patients with depression and/or anxiety to improve their negative emotions. We aim to quantify the effective of psychological therapies in the management of hypertension patients with depression or anxiety, by comparing and ranking a network meta-analysis (NMA). MATERIALS AND METHODS Literature search for randomized controlled trials (RCTs) will be performed in five electronic databases from inception to December 2021, including PubMed, the Cochrane library, Embase, Web of Science, and China Biology Medicine disc (CBM). The search terms mainly include "hypertension", "mindfulness-based stress reduction" (MBSR), "cognitive behavioral therapy" (CBT) and "dialectical behavior therapy" (DBT). Cochrane Collaboration quality assessment tool will be used for the risk of bias assessment. A Bayesian network meta-analysis will be performed, using WinBUGS 1.4.3, and Stata 14 will be applied to draw the network diagram, while RevMan 5.3.5 will be used to produce funnel plot for assessing the risk of publication bias. Recommended rating, development and grade methodology will also be utilized to assess the quality of evidence. RESULTS Effect of MBSR, CBT and DBT will be evaluated by traditional meta-analysis directly and Bayesian network meta-analysis indirectly. Our study will provide the evidence on the efficacy and safety of psychological treatments in the hypertension patients with anxiety. There is no research ethical requirement because this is a systematic review of published literature. The results of this study will be published in a peer-reviewed journal. TRIAL REGISTRATION Prospero registration number: CRD42021248566.
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Affiliation(s)
- Yan Zhang
- School of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Hailiang Zhang
- Department of Mental Health, Gansu Provincial Centre for Disease Control and Prevention, Lanzhou, Gansu, China
- School of Public Health, Center for Laboratory and Simulation Training, Center for Evidence-based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gans, China
| | - Yong Zhang
- Health Center of Dachaigou Town, Wuwei, Gansu, China
| | - Zijiao Yang
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Lingling Wang
- Community Health Service Center of Caochang Street, Lanzhou, Gansu, China
| | - Weimin Pan
- School of Public Health, Center for Laboratory and Simulation Training, Center for Evidence-based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gans, China
| | - Runjing Dai
- School of Public Health, Center for Laboratory and Simulation Training, Center for Evidence-based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gans, China
| | - Qianqian Ju
- School of Public Health, Center for Laboratory and Simulation Training, Center for Evidence-based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gans, China
| | - Dong Ren
- Psychosomatic and Sleep Medicine, Gansu Gem Flower Hospital, Lanzhou, Gansu, China
- * E-mail: (JF); (SB); (DR)
| | - Shisan Bao
- School of Public Health, Center for Laboratory and Simulation Training, Center for Evidence-based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gans, China
- * E-mail: (JF); (SB); (DR)
| | - Jingchun Fan
- School of Public Health, Center for Laboratory and Simulation Training, Center for Evidence-based Medicine, Gansu University of Chinese Medicine, Lanzhou, Gans, China
- * E-mail: (JF); (SB); (DR)
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Yang L, Ao Y, Li Y, Dai B, Li J, Duan W, Gao W, Zhao Z, Han Z, Guo R. Morinda officinalis oligosaccharides mitigate depression-like behaviors in hypertension rats by regulating Mfn2-mediated mitophagy. J Neuroinflammation 2023; 20:31. [PMID: 36765376 PMCID: PMC9912533 DOI: 10.1186/s12974-023-02715-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE Patients with hypertension have a risk of depression. Morinda officinalis oligosaccharides (MOOs) have anti-depressant properties. In this study, we aimed to determine whether MOOs can improve the symptoms of depression in individuals with hypertension. METHODS Dahl salt-sensitive rats fed with a high-salt diet were stimulated by chronic unpredictable mild stress to mimic hypertension with depression. Primary astrocytes and neurons were isolated from these rats. Astrocytes underwent LPS stimulation to simulate the inflammatory astrocytes during depression. MOOs were administrated at 0.1 mg/g/day in vivo and 1.25, 2.5, and 5 mg/mL in vitro. Mitophagy was inhibited using 5 mM 3-methyladenine (3-MA). Astrocyte-mediated neurotoxicity was detected by co-culturing astrocytes and neurons. RESULTS MOOs decreased systolic pressure, diastolic pressure, and mean arterial pressure, thereby improving depression-like behavior, including behavioral despair, lack of enthusiasm, and loss of pleasure during hypertension with depression. Furthermore, MOOs inhibited inflammation, astrocytic dysfunction, and mitochondrial damage in the brain. Then, MOOs promoted autophagosome and lysosome enriched in mitochondria in LPS-stimulated astrocytes. MOOs suppressed mitochondrial damage and the release of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and IL-1β in astrocytes undergoing LPS stimulation. Importantly, MOOs rescued the impaired neurons co-cultured with astrocytes. The effects of MOOs on LPS-stimulated astrocytes were reversed by 3-MA. Finally, MOOs upregulated LPS-downregulated Mfn2 expression in astrocytes. Mfn2 inhibition partly reversed the effects of MOOs on hypertension with depression. Intriguingly, Mfn2 suppression activated PI3K/Akt/mTOR pathway during MOOs treatment. CONCLUSIONS Astrocytes develop neuroinflammation in response to mitochondrial damage during hypertension with depression. MOOs upregulated Mfn2 expression to activate the PI3K/Akt/mTOR pathway-mediated mitophagy, thereby removing impaired mitochondria in astrocytes. HIGHLIGHTS 1. MOOs have anti-hypertensive and anti-depressive properties. 2. MOOs inhibit inflammation and injury in astrocytes during hypertension with depression. 3. MOOs induce mitophagy activation in inflammatory astrocytes with mitochondrial damage. 4. MOOs upregulate Mfn2 expression in astrocytes. 5. Mfn2 activates mitophagy to resist mitochondrial damage in astrocytes.
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Affiliation(s)
- Lixuan Yang
- grid.24695.3c0000 0001 1431 9176Second Clinical Medical College, Beijing University of Chinese Medicine, Beijing, 100029 People’s Republic of China
| | - Yutian Ao
- grid.24695.3c0000 0001 1431 9176Second Clinical Medical College, Beijing University of Chinese Medicine, Beijing, 100029 People’s Republic of China
| | - Yannan Li
- grid.24695.3c0000 0001 1431 9176Second Clinical Medical College, Beijing University of Chinese Medicine, Beijing, 100029 People’s Republic of China
| | - Baoan Dai
- grid.24695.3c0000 0001 1431 9176Second Clinical Medical College, Beijing University of Chinese Medicine, Beijing, 100029 People’s Republic of China
| | - Jingchun Li
- grid.24695.3c0000 0001 1431 9176Second Clinical Medical College, Beijing University of Chinese Medicine, Beijing, 100029 People’s Republic of China
| | - Wenzhe Duan
- grid.24695.3c0000 0001 1431 9176Second Clinical Medical College, Beijing University of Chinese Medicine, Beijing, 100029 People’s Republic of China
| | - Wei Gao
- grid.12527.330000 0001 0662 3178Department of Clinical Psychology, Yuquan Hospital of Tsinghua University, Beijing, 100049 People’s Republic of China
| | - Zhonghui Zhao
- grid.24695.3c0000 0001 1431 9176Second Clinical Medical College, Beijing University of Chinese Medicine, Beijing, 100029 People’s Republic of China ,grid.452402.50000 0004 1808 3430Department of Traditional Chinese Medicice, Qilu Hospital of Shandong University, Jinan, 250012 Shandong People’s Republic of China
| | - Zhenyun Han
- grid.24695.3c0000 0001 1431 9176Department of Neurology, Shenzhen Hospital of Beijing University of Chinese Medicine, Shenzhen, 518110 Guangdong People’s Republic of China
| | - Rongjuan Guo
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, No.6, Fangxingyuan 1st Block, Fengtai District, Beijing, 100078, People's Republic of China.
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Rawlings GH, Novakova B, Armstrong I, Thompson AR. Can self-compassion help us better understand the impact of pulmonary hypertension on those with the condition and their carers? A cross-sectional analysis. Pulm Circ 2023; 13:e12208. [PMID: 36937150 PMCID: PMC10016088 DOI: 10.1002/pul2.12208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/08/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Pulmonary hypertension (PH) can have a multifaced impact both on the affected individual and close family members. However there are relatively few studies that have sought to identify potential protective factors. Individual differences in ability to be self-compassionate are known to be implicated in adjustment in other long-term conditions and are now featuring in the provision of care for a number of conditions. This is a cross-sectional study that investigated the relationship between self-compassion, demographic, PH-related information, and measures of psychosocial functioning in adults with PH (n = 65) and caregivers (n = 29). Individuals with PH and caregivers of someone with PH completed self-report measures on demographic and clinical factors, anxiety, depression, self-compassion, and in those with PH, health-related quality of life, and in carers, caregiver burden. Data were analyzed using hierarchical regression analyses. Surprisingly, participants with PH and caregivers did not significantly differ on rates of depression (p = 0.19) or anxiety (p = 0.57) with both scoring relatively high. Components of self-compassion were associated with psychological functioning in both individuals and caregivers. Greater self-compassion was associated with fewer symptoms of anxiety and depression, and greater health-related quality of life in individuals with PH and lower burden in caregivers. More specifically, multiple regression analyses revealed after controlling for age, gender, and duration of PH, self-compassion was a significant predictor of anxiety and depression in people with PH, and of anxiety and caregiver burden in carers. These findings add to the evidence base indicating that there can be a range of burdens experienced by both people living with PH and their wider families. Further, this study uniquely suggests that psychological and supportive interventions that seek to build self-compassion may be useful to develop and test in this clinical group.
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Affiliation(s)
| | - Barbora Novakova
- Health and Wellbeing Service, Sheffield IAPTSheffield Health and Social Care NHS Foundation TrustSheffieldUK
| | - Iain Armstrong
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire HospitalSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Andrew R. Thompson
- South Wales Clinical Psychology Training ProgrammeCardiff and Vale University Health Board and Cardiff UniversityCardiffUK
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15
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Rawlings GH, Thompson AR, Armstrong I, Novakova B, Beail N. Coping styles associated with depression, health anxiety and health-related quality of life in pulmonary hypertension: cross-sectional analysis. BMJ Open 2022; 12:e062564. [PMID: 35948373 PMCID: PMC9379501 DOI: 10.1136/bmjopen-2022-062564] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pulmonary hypertension (PH) is a life-shortening disease associated with early mortality and high morbidity. With advancements in medical treatment, people are living longer with the disease, and research is now needed to explore variables that help to enhance patient-reported outcomes. This study investigated the coping strategies of individuals with PH and examined the relationship between coping, depression, health anxiety and health-related quality of life (HRQoL). DESIGN A cross-sectional survey design was used. PARTICIPANTS Participants (n=121) were recruited from membership of Pulmonary Hypertension Association (PHA) UK. OUTCOME MEASURES Participants completed a series of questionnaires assessing depression (Patient Health Questionnaire-9), health anxiety (Short Health Anxiety Inventory), HRQoL (emPHasis-10) and coping (Brief COPE). A principal component analysis was used to identify participants' coping profile. A series of correlational, linear and moderated multiple regression analyses were performed to examine the relationship between coping and health-related outcomes. RESULTS Overall, 43% participants met criteria for potential clinical depression. Depression and health anxiety were strongly associated with HRQoL, explaining 37% and 30% of variance respectively (p<0.001). A principal component analysis identified a four-component model of coping. Dimensions were named based on construct items: 'cognitive and affirmation coping' (seven items), 'passive coping' (four items), 'external coping' (seven items) and 'substance use coping' (two items). Cognitive and affirmation and external coping moderated the relationship between depression and HRQoL, with high use of these coping strategies reducing the impact of depression on HRQoL. External coping also moderated the effect of health anxiety on HRQoL. CONCLUSIONS The results uniquely highlight the importance of coping styles and psychological distress in predicting HRQoL in PH. Our findings indicate the importance to assess for psychological distress in this population and suggest the need to offer psychological interventions that take into account coping resources and strategies.
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Affiliation(s)
| | - Andrew R Thompson
- South Wales Clinical Psychology Training Programme, Cardiff University, Cardiff, UK
- Clinical Psychology Unit, The University of Sheffield, Sheffield, UK
| | - Iain Armstrong
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Barbora Novakova
- Health and Wellbeing Service, Sheffield IAPT, Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Nigel Beail
- Clinical Psychology Unit, The University of Sheffield, Sheffield, UK
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16
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Redina OE, Smolenskaya SE, Markel AL. Genetic Control of the Behavior of ISIAH Rats in the Open Field Test. RUSS J GENET+ 2022. [DOI: 10.1134/s1022795422070146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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17
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Cipolletta S, Ravasio G, Bussotti M. Sexual and Reproductive Health in Women with Pulmonary Hypertension: A Qualitative Study. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1647-1657. [PMID: 35165801 PMCID: PMC8853317 DOI: 10.1007/s10508-022-02284-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 06/14/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a devastating disease characterized by elevation in pulmonary artery pressure causing progressive symptoms: shortness of breath, fatigue, and a decline in functional ability. Research on the impact of PAH on sexual and reproductive health was sparse. The aim of this study is to explore sexual and reproductive health of women with PAH in relation to their illness experience. Twenty-five women with PAH participated in semistructured interviews. A thematic analysis was conducted on the transcripts using the ATLAS.ti software. Four main themes were identified: illness experience, intimate relationship, sexuality, and attitudes toward pregnancy. Results showed that illness changed women's self-perception, couples' relationship, sexuality, and the idea of an eventual pregnancy. The relationship with the partner was usually indicated as an important resource, whereas communication with health care professionals was a critical but also potential key resource for the future. Results point to the need for intervention strategies to support women with PAH and help them make aware choices. Moreover, intervention strategies may inform health care interventions and policies for tackling the challenges posed by this illness.
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Affiliation(s)
- Sabrina Cipolletta
- Department of General Psychology, University of Padua, Via Venezia 8, 35131, Padua, Italy.
| | - Giorgia Ravasio
- Cardiology Rehabilitative Unit, IRCCS, Maugeri Clinical Scientific Institutes, Milan, Italy
| | - Maurizio Bussotti
- Cardiology Rehabilitative Unit, IRCCS, Maugeri Clinical Scientific Institutes, Milan, Italy
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18
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Maulitz L, Stickeler E, Stickel S, Habel U, Tchaikovski SN, Chechko N. Endometriosis, psychiatric comorbidities and neuroimaging: Estimating the odds of an endometriosis brain. Front Neuroendocrinol 2022; 65:100988. [PMID: 35202605 DOI: 10.1016/j.yfrne.2022.100988] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/07/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
Abstract
Endometriosis is a chronic pain disorder that affects young women, impairing their physical, mental and social well-being. Apart from personal suffering, it imposes a significant economic burden on the healthcare system. We analyzed studies reporting comorbid mental disorders in endometriosis based on the ICD/DSM criteria, discussing them in the context of available neuroimaging studies. We postulate that at least one-third of endometriosis patients suffer from mental disorders (mostly depression or anxiety) and require psychiatric or psychotherapeutic support. According to three neuroimaging studies involving patients with endometriosis, brain regions related not only to pain processing but also to emotion, cognition, self-regulation and reward likely constitute the so-called "endometriosis brain". It is not clear, however, whether the neurobiological changes seen in these patients are caused by chronic pain, mental comorbidities or endometriosis itself. Given the paucity of high-quality data on mental comorbidities and neurobiological correlates in endometriosis, further research is needed.
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Affiliation(s)
- L Maulitz
- Department of Gynaecology and Obstetrics, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - E Stickeler
- Department of Gynaecology and Obstetrics, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - S Stickel
- Department of Psychiatry, Psychotherapy and Psychosomatics RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany
| | - U Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany
| | - S N Tchaikovski
- Department of Gynaecology and Obstetrics, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; Department of Gynaecology and Obstetrics, Otto von Guericke University Magdeburg, Gerhart-Hauptmann-Straße 35, 39108 Magdeburg, Germany
| | - N Chechko
- Department of Psychiatry, Psychotherapy and Psychosomatics RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany; Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany; Institute of Neuroscience and Medicine, Brain & Behavior (INM-7), Research Center Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany.
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19
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Cai Y, Chen M, Zhai W, Wang C. Interaction between trouble sleeping and depression on hypertension in the NHANES 2005–2018. BMC Public Health 2022; 22:481. [PMID: 35277151 PMCID: PMC8917766 DOI: 10.1186/s12889-022-12942-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/28/2022] [Indexed: 02/05/2023] Open
Abstract
Abstract
Background
Hypertension, trouble sleeping and depression, as three major public health problems, were closely related. This study evaluated the independent association of trouble sleeping and depression with hypertension and interaction effect between trouble sleeping and depression on hypertension in Americans.
Method
The data of this cross-sectional study was from the 2005–2018 National Health and Nutritional Examination Survey (NHANES) with hypertension, depression, trouble sleeping and confounding factor information. Multivariate logistic regression model and subgroup analyses of depression severity were conducted to assess the relationship between trouble sleeping and depression on hypertension. Relative excess risk due to interaction (RERI), attributable proportion of interaction (AP) and synergy index (S) were utilized to assess the additive interaction.
Results
A total of 30,434 participants (weighted n = 185,309,883) were examined with 16,304 (49.37%) known hypertensive subjects. Compared with participants without trouble sleeping, those with trouble sleeping had a higher risk of hypertension [OR = 1.359 (95% CI: 1.229–1.503)]. We also found the significant association of depression with an increased risk of hypertension [OR = 1.276 (95% CI: 1.114–1.462)], compared with those without depression. Moreover, there was a significant interaction between trouble sleeping and depression on hypertension risk [RERI = 0.528 (95% CI: 0.182–0.873), AP = 0.302 (95% CI: 0.140–0.465), S = 3.413 (95% CI: 1.301–8.951)].
Conclusion
There was a synergistic interaction between trouble sleeping and depression on hypertension, especially the significant synergistic effect between moderate depression and trouble sleeping on hypertension. The results suggested that improving the psychological status and trouble sleeping of patients may be beneficial to the prevention and treatment of hypertension.
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20
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Rawlings GH, Beail N, Armstrong I, Thompson AR. Self-help cognitive behavioural therapy for anxiety in pulmonary hypertension: pilot randomised controlled trial. ERJ Open Res 2022; 8:00526-2021. [PMID: 35265707 PMCID: PMC8899500 DOI: 10.1183/23120541.00526-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/14/2021] [Indexed: 11/05/2022] Open
Abstract
ObjectivePeople with pulmonary hypertension (PH) are at an increased risk of experiencing anxiety disorders. This study developed and tested the acceptability, feasibility and preliminary effectiveness of a cognitive behavioural self-help intervention for anxiety in adults with PH using a pilot randomised control trial design.MethodsIndividuals with PH recruited from pulmonary hypertension associations were randomised to either receive a newly developed self-help intervention (n=37) or a wait-list condition (n=40). Acceptability was explored using mixed-methods questionnaires. A 2×3 repeated-measures analysis of variance was used to explore anxiety (GAD-7), depression (PHQ-9), health-related quality of life (emPHAsis-10), dyspnoea (D-12), self-mastery (Self-Mastery Scale) and mood-related cognitions and behaviours (CBP-Q) at baseline, post-intervention and 1-month follow up. A mediation analysis was performed to examine potential mechanisms of change.ResultsDropout was low at 15.6%. All participants would recommend the intervention to another person with PH and felt it had helped with their anxiety. Participants in the intervention group reported a reduction in anxiety, depression and cognitive and behavioural processes linked with mood disorders, compared to the control group. Change in unhelpful cognitions and behaviours mediated the relationship between intervention condition and change in anxiety and depression.DiscussionThe intervention was found to be acceptable, feasible and safe. Anxiety at baseline was higher than previously observed, which could be associated with the additional burden caused by COVID-19 as the intervention was trialled during the pandemic. Findings add to the growing evidence supporting the use of psychological therapies, including cognitive behavioural therapy, in this clinical group.
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21
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Wallace K, Bowles T, Griffin A, Robinson R, Solis L, Railey T, Shaffery JP, Araji S, Spencer SK. Evidence of Anxiety, Depression and Learning Impairments following Prenatal Hypertension. Behav Sci (Basel) 2022; 12:bs12020053. [PMID: 35200304 PMCID: PMC8869594 DOI: 10.3390/bs12020053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 01/12/2023] Open
Abstract
Background: Hypertensive disorders of pregnancy, such as Preeclampsia (PreE) and HELLP (hemolysis, elevated liver enzyme, low platelet) syndrome, affects approximately 5–10% of pregnancies and increases the risk of women developing disorders, such as anxiety or depression, in the postpartum period. Using preclinical rodent models, we set out to determine whether rats with a history of PreE or HELLP had evidence of anxiety, depression or cognitive impairment and whether immune suppression during pregnancy prevented these changes in mood and/or cognition. Methods: Timed-pregnant rats were infused with sFlt-1 and/or sEng to induce PreE or HELLP beginning on gestational day 12. After delivery, a battery of validated behavioral assays was used to assess post-partum depression, anxiety and learning. Results: There was no negative effect on maternal pup interaction due to PreE or HELLP; however, hypertensive dams spent more time immobile in the forced swim test (p < 0.0001). Hypertensive dams also spent less time in the open area of the open field (p = 0.001). There were no significant changes in recognition memory (p = 0.08); however, spatial learning was impaired in hypertensive dams (p = 0.003). Immobility time in the forced swim test was positively correlated with increased circulating S100B (p = 0.04), while increased time spent in the outer zones of the open field was negatively correlated with BDNF levels (p < 0.0001). Conclusion: The results from this study suggest that hypertensive pregnancy disorders are associated with depression, anxiety and learning impairments in the post-partum period.
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Affiliation(s)
- Kedra Wallace
- Department of Pharmacology & Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA;
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (T.B.); (R.R.); (L.S.); (T.R.); (S.A.)
- Department of Neurobiology & Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Correspondence:
| | - Teylor Bowles
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (T.B.); (R.R.); (L.S.); (T.R.); (S.A.)
| | - Ashley Griffin
- Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Reanna Robinson
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (T.B.); (R.R.); (L.S.); (T.R.); (S.A.)
| | - Lucia Solis
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (T.B.); (R.R.); (L.S.); (T.R.); (S.A.)
| | - Teryn Railey
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (T.B.); (R.R.); (L.S.); (T.R.); (S.A.)
| | - James P. Shaffery
- Department of Psychiatry, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Sarah Araji
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (T.B.); (R.R.); (L.S.); (T.R.); (S.A.)
| | - Shauna-Kay Spencer
- Department of Pharmacology & Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA;
- Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS 39216, USA; (T.B.); (R.R.); (L.S.); (T.R.); (S.A.)
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22
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Mai AS, Lim OZH, Ho YJ, Kong G, Lim GEH, Ng CH, Ho C, Ho R, Lim Y, Kuntjoro I, Tay E, Yip J, Chew NWS, Low TT. Prevalence, Risk Factors and Intervention for Depression and Anxiety in Pulmonary Hypertension: A Systematic Review and Meta-analysis. Front Med (Lausanne) 2022; 9:765461. [PMID: 35252232 PMCID: PMC8892950 DOI: 10.3389/fmed.2022.765461] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCurrent guidelines recommend psychological support for patients with pulmonary hypertension suffering from psychological adversity. However, little is known about the prevalence and risk factors of depression and anxiety in patients with pulmonary hypertension (PH).MethodsMedline and Embase were searched from inception to 6 May 2021. Meta-analysis of proportions using the generalized linear mixed model was conducted to analyze the pooled prevalence rates of depression and anxiety in PH patients. Risk factors for depression and anxiety in PH patients were evaluated using meta regression.ResultsA total of 24 studies involving 2,161 PH patients were included. The pooled prevalence of depression in PH was 28.0% (95% CI: 20.5–36.8) and pooled prevalence of anxiety was 37.1% (95% CI: 28.7–46.4). There was a significantly higher prevalence of anxiety (p = 0.0013) amongst PH patients in Asia (61.1%) compared to Europe (40.3%) and North America (22.9%). In terms of risk factors, congenital heart disease-related pulmonary arterial hypertension (PAH-CHD) were significantly associated with both depression (OR: 1.68, 95% CI: 1.27–2.23, p = 0.024) and anxiety (OR: 1.63, 95% CI: 1.45–1.83, p = 0.002). On the other hand, chronic thromboembolic pulmonary hypertension (CTEPH, OR: 1.18, 95% CI: 1.10–1.26, p = 0.004) was significantly associated with depression, whereas worse pulmonary vascular resistance (β: 0.30, 95% CI: 0.09–0.52, p = 0.005) and cardiac index (β: −0.96, 95% CI: −1.58 to −0.35, p = 0.002) were significantly correlated with anxiety.ConclusionThe prevalence of anxiety and depression in PH patients is alarmingly high, with an increased prevalence of anxiety in Asia compared to Europe or North America. Psychological support is warranted for patients with PH, particularly those with underlying congenital heart disease, CTEPH, and severe disease.Systematic Review RegistrationCRD42021251733.
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Affiliation(s)
- Aaron Shengting Mai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Oliver Zi Hern Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yeung Jek Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Grace En Hui Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cheng Han Ng ; orcid.org/0000-0002-8297-1569
| | - Cyrus Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yinghao Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Deparment of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Ivandito Kuntjoro
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Deparment of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Edgar Tay
- Deparment of Cardiology, National University Heart Centre, Singapore, Singapore
| | - James Yip
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Deparment of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Nicholas W. S. Chew
- Deparment of Cardiology, National University Heart Centre, Singapore, Singapore
- *Correspondence: Nicholas W. S. Chew
| | - Ting-Ting Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Deparment of Cardiology, National University Heart Centre, Singapore, Singapore
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Park DH, Meltendorf T, Kahl KG, Kamp JC, Richter MJ, Hoeper MM, Olsson KM, Fuge J. Health Disparities and Differences in Health-Care-Utilization in Patients With Pulmonary Arterial Hypertension. Front Psychiatry 2022; 13:813506. [PMID: 35280178 PMCID: PMC8915113 DOI: 10.3389/fpsyt.2022.813506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Mental disorders are common in patients with pulmonary arterial hypertension (PAH) and contribute to impaired quality of life (QoL). The impact of mental disorders on access to health care, differences in clinical parameters and treatment in patients with PAH is unclear. In this study we sought to assess the impact of mental disorders and other health disparities on health-care-utilization in patients with PAH. METHODS In a cross-sectional observational study of patients with PAH, mental disorders were characterized using a structed clinical interview. In addition, patients completed a self-administered questionnaire to assess QoL, symptoms of anxiety and depression, lifestyle-factors and educational status. Number of outpatient visits and communication events per year were calculated as a surrogate for health-care-utilization and were compared by the presence of mental disorder. Linear regression analysis was conducted to assess the impact on health-care-utilization. RESULTS 117 patients with PAH participated in this study (70% female, median age 59 (interquartile range, 49-70) years). Significant differences between patients with or without mental disorders were found in anxiety, depression and QoL. There were no significant differences in clinical parameters. Patients with mental disorders had higher rates of outpatient visits and communication events than patients without mental disorders. Linear regression revealed a gain of 2.2 communication events per year in the presence of any mental disorders. CONCLUSION Mental disorders in patients with PAH are common and significantly affect health-care-utilization. This higher demand in patients with mental disorder needs to be addressed by physicians, psychiatrists and specialized nurses offering therapeutic strategies.
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Affiliation(s)
- Da-Hee Park
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Tanja Meltendorf
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Jan C Kamp
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Manuel J Richter
- Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Justus Liebig University Giessen, Giessen, Germany.,German Center for Lung Research (DZL), Giessen, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Karen M Olsson
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
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24
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Mahara G, Karki M. Heart diseases, anxiety disorders, and negative thoughts. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_45_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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25
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O'Leary GM. Pulmonary arterial hypertension: An overview. Nursing 2021; 51:37-43. [PMID: 34678820 DOI: 10.1097/01.nurse.0000795272.64847.1b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This article discusses the pathophysiology, risk factors, clinical manifestations, diagnostics, and pharmacologic treatment of pulmonary arterial hypertension, as well as nursing considerations for caring for patients with this rare disease.
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Affiliation(s)
- Geraldine M O'Leary
- Geraldine M. O'Leary is a clinical instructor at La Salle University in Philadelphia, Pa
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26
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Individually tailored 12-week home-based exercise program improves both physical capacity and sleep quality in patients with pulmonary arterial hypertension. COR ET VASA 2021. [DOI: 10.33678/cor.2020.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Chao HY, Hsu CH, Wang ST, Yu CY, Chen HM. Mediating effect of social support on the relationship between illness concealment and depression symptoms in patients with pulmonary arterial hypertension. Heart Lung 2021; 50:706-713. [PMID: 34107395 DOI: 10.1016/j.hrtlng.2021.03.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Depression symptoms are common in patients with pulmonary arterial hypertension (PAH). Social support may mediate the effect of illness concealment on depression symptoms. OBJECTIVE To examine the relationships between illness concealment, dimensions of social support, and depression symptoms and the mediating effect of the dimensions of social support on depression symptoms in PAH patients. METHODS A cross-sectional design and convenience sampling were applied. Data were collected with three questionnaires and analyzed with hierarchical regression and the PROCESS macro. RESULTS Ninety-seven participants were enrolled (mean age 50 ± 14 years). In total, 8% had a Patient Health Questionnaire (PHQ)-9 score ≥15. Hierarchical regression analysis showed that education level (β = 0.28, p < 0.05), illness concealment (β = 0.21, p < 0.05), and emotional support (β = 0.29, p < 0.01) were determinants of depression symptoms. Emotional support mediated the relationship between illness concealment and depression symptoms. CONCLUSIONS Emotional support can help patients reduce the effect of illness concealment on depression symptoms.
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Affiliation(s)
- Hsin-Yu Chao
- Department of Nursing, College of Medical, National Cheng Kung University, Tainan City, Taiwan.
| | - Chih-Hsin Hsu
- Division of Cardiology, Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
| | - Shan-Tair Wang
- Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Ching-Yun Yu
- School of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.
| | - Hsing-Mei Chen
- Department of Nursing, College of Medical, National Cheng Kung University, Tainan City, Taiwan.
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28
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Church C, Gin-Sing W, Grady D, Johnson M, Kiely DG, Lordan J, Turner N, Wort SJ, Condliffe R. Establishing expert consensus for the optimal approach to holistic risk-management in pulmonary arterial hypertension: a Delphi process and narrative review. Expert Rev Respir Med 2021; 15:1493-1503. [PMID: 34018901 DOI: 10.1080/17476348.2021.1931129] [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: 10/21/2022]
Abstract
Background: Pulmonary arterial hypertension (PAH) is associated with significant morbidity and reduced life expectancy. Various medical therapies, together with non-medical therapies such as exercise training, have been shown to improve outcomes for patients. We performed a Delphi consensus process to establish optimal approaches to optimizing patient care.Methods: A steering group of PAH experts formulated 38 statements grouped into 6 themes: burden of PAH, risk-stratification, the role of clinical phenotyping in the management of PAH, assessing clinical response to treatment, maximizing the medical treatment pathway and the role of other management options. An online survey was sent to PAH health-care professionals throughout the UK to assess consensus with these statements. Consensus was defined as high if ≥70% and very high if ≥90% of the respondents agreed with a statement. A narrative review for each theme was then performedResults: Consensus was very high in 27 (71%) statements, high in 7 (18%) statements and was not achieved in 4 (11%) statements.Conclusions: Based on the consensus scores, the steering group derived 13 recommendations which, if implemented, should result in improved holistic care of patients with PAH.
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Affiliation(s)
- Colin Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Wendy Gin-Sing
- Pulmonary Hypertension Service, Hammersmith Hospital, London, United Kingdom
| | - Duncan Grady
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital NHS Trust, Cambridge, United Kingdom
| | - Martin Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Jim Lordan
- Pulmonary Vascular Unit, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Nadine Turner
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - S John Wort
- Pulmonary Hypertension Service, Royal Brompton Hospital, London, United Kingdom
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Brewer J, Bartlett M, Harris D, Hui C. Improving communication between healthcare providers and pulmonary arterial hypertension patients: a survey of patient preferences. Pulm Circ 2021; 11:20458940211015813. [PMID: 34094504 PMCID: PMC8141997 DOI: 10.1177/20458940211015813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/17/2021] [Indexed: 11/24/2022] Open
Abstract
Effective communication within the patient–provider relationship is a key aspect of shared decision-making and associated with several positive patient outcomes. Although previous studies suggest that patients’ and providers’ conceptualization of what constitutes effective communication differ, there is no available literature discussing patient preferences for communication. The objective of this study was to determine the words and phrases pulmonary arterial hypertension patients prefer to hear when discussing their disease with their physician. A total of 227 pulmonary arterial hypertension patients completed a survey that included a 20-item questionnaire specifically designed to assess patient preference for words and phrases when discussing their disease and treatment; statistically significant differences were observed across all items of the questionnaire. Patients preferred their physician ask them how they have “been feeling” (63%) rather than how they have “been doing”. In addition, 96% of patients indicated that they wanted to hear that this is “… the best medicine for you” rather than this is “the best medicine”. Considerably more patients (60%) indicated they want their physician to say, “We want you to have fewer symptoms” rather than “We want you to feel more normal.” They also indicated they wanted the “most effective” medicine (82%) rather than the “most aggressive” medicine (7%). The results of this study suggest that pulmonary arterial hypertension patients have strong preferences for the language their providers use when discussing their disease and treatment options. Given the role that effective communication has on important health outcomes, pulmonary arterial hypertension providers need to consider these findings when communicating with patients.
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Affiliation(s)
| | | | | | - Christine Hui
- United Therapeutics, Research Triangle Park, NC, USA
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30
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Giri PC, Stevens GJ, Merrill-Henry J, Oyoyo U, Balasubramanian VP. Participation in pulmonary hypertension support group improves patient-reported health quality outcomes: a patient and caregiver survey. Pulm Circ 2021; 11:20458940211013258. [PMID: 34035896 PMCID: PMC8132099 DOI: 10.1177/20458940211013258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022] Open
Abstract
Support group participation has been shown to be effective in many chronic medical conditions. The evidence for integrating support group into pulmonary hypertension care and its effect on quality of life, physical and psychological well-being is limited. We sought to assess the effect of support group participation on quality of life in patients diagnosed with pulmonary hypertension and their caregivers. The emPHasis-10 questionnaire (a tool validated for quality of life assessment in pulmonary hypertension) was used to evaluate the effect of support group participation. Additional demographic and health-related quality measures were examined. Results showed that 165 subjects were enrolled in the study; 122 (74.4%) were patients with pulmonary hypertension, 41 (25.0%) were their caregivers, and 2 (0.02%) did not respond. The cohort was predominantly female (n = 128, 78%), Caucasian (n = 10, 61%), and the principal self-reported classification of pulmonary hypertension was World Health Organization Group 1 (n = 85, 51.8%) and the self-reported New York Heart Association Functional Class was II and III (n = 43, 57.3%). Most participants (n = 118, 71.5%) attended support groups and of them, a majority (n = 107, 90.6%) stated it helped them. There was no difference in quality of life as assessed by emPHasis-10 scores with support group participation (median score 30 vs 32, p = 0.387). There was self-reported improvement in understanding condition better including procedures such as right heart catheterization, medication compliance, and confidence in self-care (p < 0.05). Using multivariate logistic regression, baseline variables that were independently associated with emPHasis-10 scores for the entire cohort included knowledge of New York Heart Association Functional Class (odds ratio: 1.919, 95% CI: 1.004–3.67, p = 0.04) and greater distance traveled to visit pulmonary hypertension physician (odds ratio: 1.391, 95% CI: 0.998--1.94, p = 0.05). In conclusion, support group participation does not improve quality of life as assessed by emPHasis-10 scores but improves other meaningful health-related quality outcomes.
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Affiliation(s)
- Paresh C Giri
- Pulmonary and Critical Care Department, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Gizelle J Stevens
- Pulmonary and Critical Care Department, Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | - Udochukwu Oyoyo
- Department of Dental Education Services, Loma Linda University School of Dentistry, Loma Linda, CA, USA
| | - Vijay P Balasubramanian
- Pulmonary and Critical Care Department, University of California San Francisco-Fresno, Fresno, CA, USA
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Martínez Meñaca A, Blanco Vich I, López Meseguer M, López Reyes R, Bedate Díaz P, Elías Hernández T, Fernández-Cuesta Peñafiel I, Fernández G, Álvez Liste A, Escribano Subías P. From Health-Related Quality of Life (HRQoL) of Patients with Pulmonary Hypertension to Patient Experience with the Care Received: Should We Be More Aware of Current Patient Needs? Adv Ther 2021; 38:1860-1875. [PMID: 33675523 DOI: 10.1007/s12325-021-01625-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/13/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Self-perceived health-related quality of life (HRQoL) of patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) and their experience with the care received are important for improving their management. We conducted a study to assess both patient-reported outcomes (PROs) and how they interrelate. METHODS This was a cross-sectional, observational study of consecutive patients with PAH and CTEPH attending pulmonary hypertension (PH)-specialized units at 25 hospitals in Spain. PRO measurements used included CAMPHOR/EQ-5D-5L questionnaires (HRQoL) and IEXPAC (healthcare experience). Patient characteristics were collected. Relationships were analysed with Pearson's correlation coefficient and linear regression analyses. RESULTS A total of 185 patients with PAH and 93 patients with CTEPH aged 54.4 ± 14.4 and 64.8 ± 13.4 years were included: 63.6% and 72% were functional class (FC) I-II; median time from diagnosis was 3 and 2 years, respectively. Most patients with PAH received combination oral therapy. CAMPHOR scores indicated moderate-to-high impairment in the "activity" scale (PAH 21.6 ± 6.8; CTEPH 21.0 ± 6.3). EQ-5D-5L index and visual analogue scale (VAS) score (PAH 0.59 ± 0.15 and 65.55 ± 21.54; CTEPH 0.59 ± 0.13 and 66.95 ± 18.71, respectively) indicated moderate HRQoL impairment. HRQoL was mostly affected by FC. IEXPAC scores (PAH 7.08 ± 1.56 and CTEPH 7.13 ± 1.61) indicated good healthcare experience. In patients with PAH, the CAMPHOR "symptom" and "QoL" domains inversely correlated with the IEXPAC "patient self-management" factor. CONCLUSION In patients with long-standing PAH and CTEPH with good disease control, functional limitations greatly impact HRQoL while symptoms and generic QoL were less affected. Healthcare received was perceived as good; however, use of information and communication technologies, patient associations and promotion of self-management should improve for enhanced patient experience.
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Affiliation(s)
- Amaya Martínez Meñaca
- Pneumology Division, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Isabel Blanco Vich
- Pneumology Division, Hospital Universitario Clinic de Barcelona, Barcelona, Spain
| | | | - Raquel López Reyes
- Pneumology Division, Hospital Universitario Politécnico la Fe, Valencia, Spain
| | - Pedro Bedate Díaz
- Pneumology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | - Ana Álvez Liste
- Global Medical and Scientific Affairs, MSD Spain, Madrid, Spain
| | - Pilar Escribano Subías
- Cardiology Division, Hospital Universitario 12 de Octubre, Centro de Investigacion Biomedica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Nakazato L, Mendes F, Paschoal IA, Oliveira DC, Moreira MM, Pereira MC. Association of daily physical activity with psychosocial aspects and functional capacity in patients with pulmonary arterial hypertension: a cross-sectional study. Pulm Circ 2021; 11:2045894021999955. [PMID: 33854767 PMCID: PMC8010827 DOI: 10.1177/2045894021999955] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/07/2021] [Indexed: 11/24/2022] Open
Abstract
Pulmonary arterial hypertension impairs exercise tolerance and daily physical activity. Aside from the hemodynamic limitations, physical, cognitive, and emotional factors may play a relevant and as yet unexplored role. We investigated whether there is an association between the physical activity level and psychological disorders, health-related quality of life, and daily activities. We also searched for an association of the physical activity level with clinical factors and functional capacity. This was an analytical, cross-sectional, observational study conducted in a Brazilian University Hospital. Twenty stable pulmonary arterial hypertension subjects wore an accelerometer for a week and completed an activity diary. They answered the quality of life questionnaire (SF-36), as well as the Hospital Anxiety and Depression scale, and the Manchester Respiratory Activities of Daily Living questionnaire. Transthoracic echocardiography, the six-minute walk test, the one-minute sit-to-stand test, and spirometry were performed. For statistical analysis, we used Chi-square tests or Fisher's test as appropriate and the Mann-Whitney test to compare numerical values between two groups. The relationship between the parameters was assessed using the Spearman correlation test. The mean age was 44.3 years, 80% were women, 80% had idiopathic pulmonary arterial hypertension, and 20% had connective tissue disease. The mean daily step count was 4280 ± 2351, and the mean activity time was 41.6 ± 19.3 min. The distance covered (six-minute walk test) was 451.5 m, and the number of movements (one-minute sit-to-stand test) was 23.8. Thirty percent scored positive for anxiety, and 15% for depression (Hospital Anxiety and Depression scale). There was a significant correlation between accelerometer data and walking distance (six-minute walk test), number of movements (one-minute sit-to-stand test), level of daily physical activity (Manchester Respiratory Activities of Daily Living questionnaire), and depression symptoms. Our findings support the hypothesis that other aspects beyond physical and hemodynamic ones might impact the daily physical activity of patients with pulmonary arterial hypertension.
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Affiliation(s)
- Layse Nakazato
- Pulmonary Diseases Unit, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Felipe Mendes
- Department of Physical Therapy, University of São Paulo, São Paulo, Brazil
| | - Ilma A. Paschoal
- Pulmonary Diseases Unit, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Daniela C. Oliveira
- Cardiovascular Diseases Unit, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Marcos M. Moreira
- Pulmonary Diseases Unit, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
| | - Mônica C. Pereira
- Pulmonary Diseases Unit, School of Medical Sciences, State University of Campinas (UNICAMP), São Paulo, Brazil
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Anzai T, Sato T, Fukumoto Y, Izumi C, Kizawa Y, Koga M, Nishimura K, Ohishi M, Sakashita A, Sakata Y, Shiga T, Takeishi Y, Yasuda S, Yamamoto K, Abe T, Akaho R, Hamatani Y, Hosoda H, Ishimori N, Kato M, Kinugasa Y, Kubozono T, Nagai T, Oishi S, Okada K, Shibata T, Suzuki A, Suzuki T, Takagi M, Takada Y, Tsuruga K, Yoshihisa A, Yumino D, Fukuda K, Kihara Y, Saito Y, Sawa Y, Tsutsui H, Kimura T. JCS/JHFS 2021 Statement on Palliative Care in Cardiovascular Diseases. Circ J 2021; 85:695-757. [PMID: 33775980 DOI: 10.1253/circj.cj-20-1127] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Takuma Sato
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Akihiro Sakashita
- Department of Palliative Medicine, Kobe University Graduate School of Medicine
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takahiro Abe
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University
| | - Yasuhiro Hamatani
- Department of Cardiology, National Hospital Organization Kyoto Medical Center
| | - Hayato Hosoda
- Department of Cardiovascular Medicine, Chikamori Hospital
| | - Naoki Ishimori
- Department of Community Heart Failure Healthcare and Pharmacy, Hokkaido University Graduate School of Medicine
| | - Mika Kato
- Nursing Department, Hokkaido University Hospital
| | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Tottori University Hospital
| | - Takuro Kubozono
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shogo Oishi
- Department of Cardiovascular Medicine, Hyogo Brain and Heart Center
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | | | - Masahito Takagi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuko Takada
- Nursing Department, National Cerebral and Cardiovascular Center
| | | | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | | | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
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Bussotti M, Sommaruga M, Krasinska P, Dalla Vecchia LA. Effects of an outpatient service holistic rehabilitation program in a case of pulmonary atresia. Monaldi Arch Chest Dis 2021; 91. [PMID: 33594855 DOI: 10.4081/monaldi.2021.1605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022] Open
Abstract
A 42-year-old woman affected by pulmonary atresia came to our attention complaining of dyspnea and fatigue for minimal efforts with important desaturation. After assessing her basal functional capacity with a cardiopulmonary exercise test, the patient was enrolled in an extremely individualized rehabilitation program, which entailed a discreet improvement in the quality of life indices, in the absence of side effects. This paper shows that even patients with extremely severe forms of congenital heart disease, when clinical stable, can undergone a tailored cardiorespiratory rehabilitation program. This must be carried out in a monitored environment and under the supervision of expert personnel.
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Affiliation(s)
- Maurizio Bussotti
- Cardiorespiratory Rehabilitation Department, IRCCS Maugeri Clinical Scientific Institutes, Milan .
| | | | - Patrycja Krasinska
- Cardiorespiratory Rehabilitation Department, IRCCS Maugeri Clinical Scientific Institutes, Milan .
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35
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Roy B, Vacas S, Ehlert L, McCloy K, Saggar R, Kumar R. Brain Structural Changes in Patients with Pulmonary Arterial Hypertension. J Neuroimaging 2021; 31:524-531. [PMID: 33565204 DOI: 10.1111/jon.12840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Patients with pulmonary arterial hypertension (PAH) frequently present with anxiety, depression, autonomic, and cognitive deterioration, which may indicate brain changes in regions that control these functions. However, the precise regional brain-injury in sites that regulate cognitive, autonomic, and mood functions in PAH remains unclear. We examined the shifts in regional gray matter (GM) volume, using high-resolution T1-weighted images, and brain tissue alterations, using T2-relaxometry procedures, in PAH compared to healthy subjects. METHODS We collected two high-resolution T1-weighted series, and proton-density and T2-weighted images using a 3.0-Tesla magnetic resonance imaging scanner from 9 PAH and 19 healthy subjects. Both high-resolution T1-weighted images were realigned and averaged, partitioned to GM tissue type, normalized to a common space, and smoothed. Using proton-density and T2-weighted images, T2-relaxation maps were calculated, normalized to a common space, and smoothed. Whole-brain GM volume and T2-relaxation maps were compared between PAH and controls using analysis of covariance (covariates, age, sex, and total-brain-volume; false discover rate corrections). RESULTS Significantly decreased GM volumes, indicating tissue injury, emerged in multiple brain regions, including the hippocampus, insula, cerebellum, parahippocampus, temporal, frontal, and occipital gyri, cingulate, amygdala, and thalamus. Higher T2-relaxation values, suggesting tissue damage, appeared in the cerebellum, hippocampus, parahippocampus, frontal, lingual, and temporal and occipital gyri, and cingulate areas in PAH compared to healthy subjects. CONCLUSIONS PAH patients showed significant GM injury and brain tissue changes in sites that regulate cognition, autonomic, and mood functions. These findings indicate a brain structural basis for functional deficits in PAH patients.
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Affiliation(s)
- Bhaswati Roy
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA
| | - Susana Vacas
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA
| | - Luke Ehlert
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA
| | - Kathy McCloy
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Rajan Saggar
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Rajesh Kumar
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA.,Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA.,Department of Bioengineering, University of California Los Angeles, Los Angeles, CA.,Department of Brain Research Institute, University of California Los Angeles, Los Angeles, CA
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36
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Zhang J, Yin Y, Wen Y, Shi F, Wang J. Anxiety and Depression in Patients With Pulmonary Arterial Hypertension in Northwest China: A Cross-Sectional Study. Front Psychiatry 2021; 12:758120. [PMID: 35185632 PMCID: PMC8854771 DOI: 10.3389/fpsyt.2021.758120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/27/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Pulmonary arterial hypertension (PAH) is a rare life-threatening and incurable disease. Although symptoms of depression and anxiety have been widely reported, these traits and associated factors have not been systematically assessed in Northwest China. METHODS A cross-sectional study was conducted between March 2020 and February 2021. 106 PAH patients in Northwest China were evaluated by Self-rating Anxiety Scale (SAS) and the Self Rating Depression Scale (SDS) questionnaire. RESULTS Overall, the included patients had particularly high depressive symptoms (70.09%), while anxiety among them was 17.55%. Multivariate linear regression revealed that patients with lower age (p = 0.04), female (p < 0.01), smoking (p < 0.01), WHO functional class III/IV (p < 0.01), higher mean pulmonary hypertension (p < 0.01), lower left ventricular ejection fraction (p < 0.01), and lower 6-min walking distance (p < 0.01) had higher anxiety scores. Patients who lived in rural areas (p = 0.01), smoking (p < 0.01), WHO functional class III/IV (p < 0.01), higher mean pulmonary hypertension (p = 0.04), lower 6-min walking distance (p < 0.01), and college degree or above had higher depression scores (p = 0.02). CONCLUSIONS Mental health problems such as depression are common among patients with PAH in Northwest China. Patients' characteristics such as smoking status, WHO functional class, and 6-min walking distance were related to anxiety and depression scores. Thus, early detection of mental health problems such as depression and anxiety should be detected in PAH patients. Meanwhile, interventions against these problems should be used to improve such patients' mental status.
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Affiliation(s)
- Juxia Zhang
- Clinical Educational Department, Gansu Provincial Hospital, Lanzhou, China
| | - Yuhuan Yin
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yujie Wen
- Cardiovascular Department, Gansu Provincial Hospital, Lanzhou, China
| | - Fugui Shi
- Lanzhou Hand and Foot Surgery Hospital, Lanzhou, China
| | - Jiancheng Wang
- Geriatrics Department, Gansu Provincial Hospital, Lanzhou, China
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37
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Park DH, Fuge J, Meltendorf T, Kahl KG, Richter MJ, Gall H, Ghofrani HA, Kamp JC, Hoeper MM, Olsson KM. Impact of SARS-CoV-2-Pandemic on Mental Disorders and Quality of Life in Patients With Pulmonary Arterial Hypertension. Front Psychiatry 2021; 12:668647. [PMID: 34248706 PMCID: PMC8263927 DOI: 10.3389/fpsyt.2021.668647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023] Open
Abstract
Background/Objective: Covid-19 pandemic may affect mental health and quality of life (QoL) in patients with pulmonary arterial hypertension (PAH). We assessed changes in anxiety and depression, quality of life (QoL) and self-described impact of Covid-19 in patients with PAH during the Covid-19 pandemic. Methods: This study included 152 patients with PAH from two German referral centers. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS-A and HADS-D) at two different timepoints before and during the Covid-19 pandemic with a median of 232 days between baseline and follow-up. QoL was assessed using EQ-5D and emPHasis-10. Perceived impact of Covid-19 and related regulations and measures were assessed using a set of specific questions and statements. Results: More than two thirds of patients had an unsuspicious HADS-A and HADS-D. Median scores did not differ from baseline for both HADS-A and HADS-D (p = 0.202; p = 0.621). Overall, no significant changes in HADS-A or HADS-D categories from baseline to follow up were observed (p = 0.07; p = 0.13). QoL did not change between baseline and follow-up. The Covid-19 pandemic had little impact on access to medical care and established PAH therapy. Patients were in agreement with governmental measures and regulations and felt sufficiently safe. Conclusion: First waves of Covid-19 pandemic had little impact on anxiety, depression and QoL in patient with PAH. Established PAH therapy and access to medical care were not affected. Further studies on the impact of prolonged duration of the ongoing Covid-19 pandemic are needed.
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Affiliation(s)
- Da Hee Park
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Tanja Meltendorf
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Manuel J Richter
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, Giessen, Germany.,Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Henning Gall
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, Giessen, Germany.,Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Hossein A Ghofrani
- Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, Giessen, Germany.,Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Jan C Kamp
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Karen M Olsson
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
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38
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Olsson KM, Meltendorf T, Fuge J, Kamp JC, Park DH, Richter MJ, Gall H, Ghofrani HA, Ferrari P, Schmiedel R, Kulla HD, Heitland I, Lepsy N, Dering MR, Hoeper MM, Kahl KG. Prevalence of Mental Disorders and Impact on Quality of Life in Patients With Pulmonary Arterial Hypertension. Front Psychiatry 2021; 12:667602. [PMID: 34135787 PMCID: PMC8200462 DOI: 10.3389/fpsyt.2021.667602] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/06/2021] [Indexed: 12/15/2022] Open
Abstract
Objective: Mental health may affect the quality of life (QoL) in patients with pulmonary arterial hypertension (PAH). However, mental disorders have not been systematically assessed in these patients. We examined the prevalence of mental disorders using structured interviews and determined their impact on QoL in patients with PAH. Methods: This study included 217 patients with PAH from two German referral centers. Psychiatric disorders were assessed using the structured clinical interview for DSM-V. QoL was assessed using the WHO Quality of Life questionnaire (short form). The diagnostic value of the Hospital Anxiety and Depression Scale was evaluated by receiver operating characteristic curve analysis. Results: More than one third of the patients had psychological disorders with current or past adjustment disorder (38.2%), current major depressive disorder (23.0%), and panic disorder (15.2%) being the most prevalent mental illnesses. About half of the patients with a history of adjustment disorder developed at least one other mental illness. The presence of mental disorders had a profound impact on QoL. The Hospital Anxiety and Depression Scale ruled out panic disorder and depression disorder with negative predictive values of almost 90%. Conclusion: Mental disorders, in particular adjustment disorder, major depression, and panic disorder, are common in patients with PAH and contribute to impaired QoL in these patients. The Hospital Anxiety and Depression Scale may be used as a screening tool for the most common mental health disorders. Future studies need to address interventional strategies targeting mental disorders in patients with PAH.
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Affiliation(s)
- Karen M Olsson
- Department of Respiratory Medicine, German Center for Lung Research Biomedical Research in Endstage and Obstructive Lung Disease Hannover (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - Tanja Meltendorf
- Department of Respiratory Medicine, German Center for Lung Research Biomedical Research in Endstage and Obstructive Lung Disease Hannover (DZL/BREATH), Hannover Medical School, Hannover, Germany.,Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, German Center for Lung Research Biomedical Research in Endstage and Obstructive Lung Disease Hannover (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - Jan C Kamp
- Department of Respiratory Medicine, German Center for Lung Research Biomedical Research in Endstage and Obstructive Lung Disease Hannover (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - Da-Hee Park
- Department of Respiratory Medicine, German Center for Lung Research Biomedical Research in Endstage and Obstructive Lung Disease Hannover (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - Manuel J Richter
- Department of Internal Medicine, German Center for Lung Research (DZL), Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Henning Gall
- Department of Internal Medicine, German Center for Lung Research (DZL), Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Hossein A Ghofrani
- Department of Internal Medicine, German Center for Lung Research (DZL), Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center, Giessen, Germany.,Department of Pneumology, German Center for Lung Research (DZL), Kerckhoff Heart, Rheuma and Thoracic Center, Universities of Giessen and Marburg Lung Center, Bad Nauheim, Germany
| | - Pisana Ferrari
- Italian Pulmonary Hypertension (PH) Association Associazione Ipertensione Polmonare Italiana (AIPI), Bologna, Italy
| | | | | | - Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Nicole Lepsy
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Madelaine-Rachel Dering
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, German Center for Lung Research Biomedical Research in Endstage and Obstructive Lung Disease Hannover (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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39
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Rawlings GH, Beail N, Armstrong I, Condliffe R, Kiely DG, Sabroe I, Thompson AR. Adults' experiences of living with pulmonary hypertension: a thematic synthesis of qualitative studies. BMJ Open 2020; 10:e041428. [PMID: 33293321 PMCID: PMC7722804 DOI: 10.1136/bmjopen-2020-041428] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Pulmonary hypertension is a life-shortening disease that has a considerable impact on quality of life. Improving our understanding of how individuals are affected and cope with the disease will help to improve services and outcomes. This review synthesises the published qualitative research that has listened to adults discuss their experiences of living with the disease. DESIGN A comprehensive systematic search of four databases was conducted in May 2020: Web of Science, PubMed, PsycINFO and Cochrane Library. Suitable studies were evaluated using the Critical Appraisal Skills programme. Findings from the studies were extracted and subjected to a thematic synthesis. RESULTS Nineteen articles were identified reflecting the experiences of over 1900 individuals impacted by pulmonary hypertension from Europe, North and South America and Asia. Ten studies did not report participant's WHO functional class of pulmonary hypertension, which resulted in comparing experiences between different severity difficult. All studies met the majority of the quality assessment items. Six descriptive themes emerged discussing participant's experiences of diagnosis, treatment, prognosis, healthcare professionals, impact and coping with pulmonary hypertension. Four higher order analytical themes were developed from the descriptive themes, reflecting: (i) uncertainties and anxiety that participants encountered related to pulmonary hypertension; (ii) lack of recognition of the impact of the condition; (iii) frustration at the paucity of awareness of pulmonary hypertension in society and healthcare settings and (iv) participant's accounts of transitioning through different stages of living with the disease. CONCLUSIONS These findings form the first synthesis of experiences of life in individuals impacted by pulmonary hypertension and illustrate the multifaceted impact of the condition. The voices of numerous groups are missing from the literature highlighting the need for additional research. The results have implications for clinical practice emphasising the role of educational and psychological therapies to support those with the disease.
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Affiliation(s)
| | - Nigel Beail
- Clinical Psychology Unit, The University of Sheffield, Sheffield, UK
| | - Iain Armstrong
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Ian Sabroe
- School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK
| | - Andrew R Thompson
- South Wales Clinical Psychology Training Programme, Cardiff University, Cardiff, South Glamorgan, UK
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40
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Chia KSW, Brown K, Kotlyar E, Wong PKK, Faux SG, Shiner CT. 'Tired, afraid, breathless … .' An international survey of the exercise experience for people living with pulmonary hypertension. Pulm Circ 2020; 10:2045894020968023. [PMID: 33240490 PMCID: PMC7675876 DOI: 10.1177/2045894020968023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/30/2020] [Indexed: 12/21/2022] Open
Abstract
Patients with pulmonary hypertension are more sedentary than the general population, but attitudes and experiences that may influence their exercise behaviour remain poorly understood. This study identified patterns of behaviour, attitudes towards exercise, barriers and enablers of exercise for people living with pulmonary hypertension. Accessibility of rehabilitation services from a patient perspective was also explored. A voluntary, international survey of people living with pulmonary hypertension was conducted, with mixed quantitative and qualitative data collection. Data from 187 participants in 19 countries were included in the analyses. In total, 52% (95/183) of people with pulmonary hypertension reported that they attempted to engage in regular physical activity. This was less than the proportion who did so prior to diagnosis (61%, 112/184, p = 0.006) and was accompanied by uncertainty and anxiety about exercise. In total, 63% (113/180) of the cohort reported experiencing previous adverse events while exercising, which was associated with a greater likelihood of ongoing exercise concerns and anxiety. Fear, frustration and uncertainty about exercise were noted as common barriers to engaging in exercise with pulmonary hypertension. Other barriers to exercise included intrinsic factors such as debilitating breathlessness and fatigue, and external factors such as cost and access to appropriate services. Most respondents (76%, 128/169) did not have access to a multi-disciplinary rehabilitation service, although an overwhelming majority (92%, 159/172) reported that this would be helpful. Respondents rated education; a supervised, structured exercise programme; and psychology input as the most important components of a multi-disciplinary rehabilitation service for pulmonary hypertension. Health professionals must work together with consumers to co-design rehabilitation services that will facilitate exercise and increased activity for people living with pulmonary hypertension.
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Affiliation(s)
- Karen S W Chia
- Department of Rehabilitation, St Vincent's Hospital Sydney, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Karen Brown
- Department of Cardiology, St Vincent's Hospital Sydney, NSW, Australia
| | - Eugene Kotlyar
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.,Department of Cardiology, St Vincent's Hospital Sydney, NSW, Australia
| | - Peter K K Wong
- Department of Rheumatology, Western Sydney Local Health District, Westmead, NSW, Australia.,UNSW Rural Clinical School, Coffs Harbour, NSW, Australia
| | - Steven G Faux
- Department of Rehabilitation, St Vincent's Hospital Sydney, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Christine T Shiner
- Department of Rehabilitation, St Vincent's Hospital Sydney, NSW, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
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41
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Shapiro S, Bourge RC, Pozella P, Harris DF, Borg EH, Nelsen AC. Implantable system for treprostinil: a real-world patient experience study. Pulm Circ 2020; 10:2045894020907881. [PMID: 32363029 PMCID: PMC7177997 DOI: 10.1177/2045894020907881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/31/2020] [Indexed: 12/26/2022] Open
Abstract
Parenteral prostanoids are effective for improving outcomes in patients with pulmonary arterial hypertension. However, subcutaneous or intravenous delivery via an external pump places a significant burden on patients. Consequently, the Implantable System for Remodulin© (treprostinil) was developed and is associated with a low rate of complications (United Therapeutics (Research Triangle Park, NC) in collaboration with Medtronic, Inc. (Mounds View, MN)). The current real-world experience study evaluated pulmonary arterial hypertension patients' perceptions of their quality of life, ability to perform activities of daily living, perceptions on the benefits and risks of the implantable system, and their social interactions before and after receiving the implantable system. Pulmonary arterial hypertension patients who had been transitioned from an external infusion pump to the implantable system completed a mix of quantitative and qualitative questions administered online over the course of a six-day period. A total of 20 patients completed the study. All patients reported that their quality of life, confidence out in public, and ability to travel long distances had improved. Over 90% of patients reported that their overall level of independence was better since receiving the implantable system, and most patients indicated that their ability to independently perform specific activities of daily living had improved. Responses to the qualitative questions suggested that the implantable system saved time, improved interpersonal relationships, and increased freedom. Results from this real-world patient experience study suggest this novel delivery system provides improvements in factors that are of substantial importance to patients.
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Affiliation(s)
- Shelley Shapiro
- VA Greater Los Angeles Healthcare System Cardiology Section, David Geffen UCLA School of Medicine, UCLA Medical Center Department of Pulmonary Critical Care, Los Angeles, CA, USA
| | - Robert C Bourge
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patti Pozella
- United Therapeutics Corporation, Research Triangle Park, NC, USA
| | | | - Erick H Borg
- United Therapeutics Corporation, Research Triangle Park, NC, USA
| | - Andrew C Nelsen
- United Therapeutics Corporation, Research Triangle Park, NC, USA
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42
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Abstract
In recent years, there has been an increase in therapeutic options and treatment strategies for pulmonary arterial hypertension (PAH). However, patients still report delays in receiving a diagnosis, which is a significant burden associated with the disease, and which shows a general lack of disease awareness. This review has been written by two PAH patients to describe the patient experience and explore the ways in which patients are increasingly being given a voice in developing approaches to treatment. As patients with PAH are living longer, it is important that they work with healthcare professionals to develop treatment strategies that improve and maintain quality of life. Healthcare professionals should consider a holistic approach to disease management, including dietary recommendations, individually adapted exercise, and options for counselling where available, alongside therapeutic treatments. The experiences of patients with PAH are important not just for individual patient treatment but should also be considered in clinical trial design and guideline development. Patient representatives and patient associations can play an influential role in improving the treatment and management of PAH. In this review, we use our experiences as patient representatives to describe the current situation of patients with PAH from first experiencing symptoms to receiving treatment, using two patient cases as examples. We also discuss the role of patient advocacy in improving PAH care and future roles for patient associations and patient representatives in the design of clinical trials and development of new treatment guidelines.
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Affiliation(s)
- Pisana Ferrari
- Italian PH Association AIPI, Associazione Ipertensione Polmonare Italiana Onlus, Via Enrico Mattei, 92 - 40138 Bologna, Italy
| | - Hall Skåra
- Pulmonary Hypertension Association Europe, Wilhelmstraße 19, A - 1120 Vienna, Austria
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43
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Aguirre-Camacho A. Behavioral and Psychologic Symptoms in Patients With Pulmonary Hypertension: A Response to Doğan et al. PSYCHOSOMATICS 2019; 60:536-537. [PMID: 30792022 DOI: 10.1016/j.psym.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Aldo Aguirre-Camacho
- School of Biomedical Sciences, European University of Madrid, National Association of Pulmonary Hypertension, Madrid, Spain.
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