Does Illness Perception Predict Posttraumatic Stress Disorder in Patients with Myocardial Infarction?

Biopsychosocial factors should be considered when evaluating central sensitization in axial spondyloarthritis

To identify the determinants of central sensitization (CS) in patients with axial spondyloarthritis (axSpA). Central Sensitization Inventory (CSI) was used to determine CS frequency. Disease-related variables including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP/-ESR), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) and Numeric Rating Scale (NRS)GLOBAL were assessed. Biopsychosocial variables were evaluated by the Multidimensional Scale of Perceived Social Support (MSPSS), Brief Illness Perception Questionnaire (B-IPQ), Hospital Anxiety and Depression Scale (HADS) and subscales for Anxiety (HADS-A) and Depression (HADS-D), and Jenkins Sleep Evaluation Scale (JSS). To determine the predictors of the development and severity of CS, multiple linear and logistic regression analyses were performed. The frequency of CS was 57.4% in the study population (n = 108). CSI score was correlated with the duration of morning stiffness, BASDAI, ASDAS-CRP, ASDAS-ESR, NRSGLOBAL, BASFI, MASES, ASOoL, JSS, HADS, and B-IPQ total scores (ρ ranged from 0.510 to 0.853). Multiple regression analysis indicated that BASDAI (OR: 10.44, 95% CI: 2.65-41.09), MASES (OR: 2.47, 95% CI: 1.09-5.56) and HADS-A (OR: 1.62, 95% CI: 1.11-2.37) were independent predictors of the development of CS. Additionally, higher NRSGLOBAL, JSS, HADS-D, and HADS-A scores appeared to determine the severity of CS. This study confirms that worse disease activity, more enthesal involvement, and anxiety independently predict the development of CS. Additionally, higher patient-perceived disease activity, sleep impairment and poor mental health significantly contribute to the severity of CS.

The effect of illness perception levels of liver transplant patients receiving immunosuppressive therapy on their rational drug use levels

Objective

Since 50% of drug use all over the world is used other than rational drug use, rational drug use, which is associated with the perception of the disease, is important for the course of the disease. This study aimed to determine the effect of disease perception levels on rational drug use in liver transplant patients receiving immunosuppressive therapy.

Methods

This descriptive and cross-sectional study was conducted with patients who came to the outpatient clinic for control between May-September 2022 with the participation of patients who underwent liver transplantation and followed up in a liver transplant institute in eastern Turkey. In the collection of the study data, "sociodemographic information form" prepared by the researchers, "Brief Illness Perception Questionnaire", and "Rational Drug Use Scale" were employed.

Results

In this study conducted with 206 patients, the mean age of patients with liver transplantation was 48.66 ± 9.4 years, 59.7% were male, 80.1% were married, and 33.5% were high school graduates. It was determined that the disease perception levels and rational drug use levels of the patients who underwent liver transplantation were moderate. It was also determined that as the education levels of the liver transplant patients increased, their levels of illness perception and rational drug use also statistically significantly increased (p < 0.05). It was found that there was a significant and moderate relationship between illness perception and rational drug use, and that as their level of illness perception increased, their level of rational drug use also increased (r:0.622, p < 0.05). It was observed that the disease perception level explained 38.7% of the change in rational drug use (R²:387, p < 0.05).

Conclusions

In the study, it was observed that high illness perception levels of liver transplant patients increased their levels of rational drug use. It is important to raise the awareness of patients in order for them to cope with illnesses and to have a high level of illness perception.

Perceived health, adversity, and posttraumatic stress disorder in Syrian and Iraqi refugees

BACKGROUND

Exposure to armed conflict and fleeing country of origin for refugees has been associated with poorer psychological health.

METHODS

Within the first month following their arrival in the United States, 152 Syrian and Iraqi refugees were screened in a primary care setting for posttraumatic stress disorder (PTSD), anxiety, and depression and rated their perceived health, and perceived level of adversity of violence, armed conflict/flight. The moderating effects of psychiatric symptoms on the relation between perceived adversity and perceived health were assessed.

RESULTS

Three models based on diagnosis (PTSD, anxiety, and depression) were tested. While significant effects were found on perceived adversity negatively influencing perceived health across diagnoses, slightly different patterns emerged based on diagnosis.

DISCUSSION

Findings suggest that refugees' perception regarding adversity of violence, armed conflict, and flight may contribute to perceived health, with a moderating role of clinically significant symptoms of PTSD, anxiety, and depression.

Role of illness perception in explanation of severity of post-traumatic stress disorder symptoms after cardiovascular problems

BACKGROUND

Given the role of post-traumatic stress disorder (PTSD) in morbidity and mortality of cardiac patients, the present study was conducted to determine the relationship between the perception of heart disease and severity of PTSD symptoms.

METHODS

Sampled using simple random sampling, 202 cardiovascular patients (50.5% women) were selected and included in this cross-sectional study. The patients admitted to a hospital from January to May 2017 in western Iran were selected and asked to complete the self-report demographic and cardiac risk factors inventory, Brief Illness Perception Questionnaire (Brief-IPQ), and National Stressful Events Survey PTSD Short Scale (NSESSS) checklist. The results were analyzed using the Pearson correlation coefficient and multiple regression analysis.

RESULTS

The mean age of patients was 53.5 ± 11.9 years. The results of the correlation coefficient showed a significant relationship between all the components of illness perception, except personal and treatment control, with PTSD (P < 0.05). The regression model could predict 22.5% of PTSD variance and the greatest role was for the emotional representation (P = 0.002) and female sex (P = 0.008).

CONCLUSION

The perception of cardiovascular patients of the cognitive and emotional components of the disease, especially in women, plays a significant role in experiencing the symptoms of PTSD. Thus, health professionals have to monitor all these components, especially the patient's perceptions and emotional reactions, and to come up with proper and timely interventions for patients at risk to control the adverse effects of PTSD after cardiovascular events.

Post-traumatic Stress Disorder and Risk Factors in Patients With Acute Myocardial Infarction After Emergency Percutaneous Coronary Intervention: A Longitudinal Study

This study aimed to investigate the status and risk factors of post-traumatic stress disorder (PTSD) in patients with acute myocardial infarction (AMI) after emergency percutaneous coronary intervention (PCI) in acute and convalescence phases. A longitudinal study design was used. Two questionnaire surveys were conducted in the acute stage of hospitalization, and 3 months after onset in patients. Logistic regression was used to analyze the risk factors for PTSD in AMI patients. The incidence of PTSD was 33.1 and 20.4% in acute and convalescent patients, respectively. The risk factors related to PTSD were door-to-balloon time (DTB) (≥92.6 min), left ventricular ejection fraction (LVEF) (<50%), smoking, anxiety, and depression. AMI patients after PCI had PTSD in the acute and convalescent stage. The findings indicate that tailored measures should be developed and carried out to prevent PTSD and improve the mental health of patients with AMI after undergoing PCI.

Posttraumatic stress disorder prevalence in medical populations: A systematic review and meta-analysis

OBJECTIVE

PTSD is increasingly recognized following medical traumas although is highly heterogeneous. It is difficult to judge which medical contexts have the most traumatic potential and where to concentrate further research and clinical attention for prevention, early detection and treatment. The objective of this study was to compare PTSD prevalence in different medical populations.

METHODS

A systematic review of the literature on PTSD following medical traumas was conducted as well as a meta-analysis with final pooled result and 95% confidence intervals presented. A meta-regression was used to investigate the impact of potential effect modifiers (PTSD severity, age, sex, timeline) on study effect size between prevalence studies.

RESULTS

From 3278 abstracts, the authors extracted 292 studies reporting prevalence. Using clinician-administered reports, the highest 24 month or longer PTSD prevalence was found for intraoperative awareness (18.5% [95% CI=5.1%-36.6%]) and the lowest was found for epilepsy (4.5% [95% CI=0.2%-12.6%]). In the overall effect of the meta-regression, only medical events or procedures emerged as significant (p = 0.006) CONCLUSION: This review provides clinicians with greater awareness of medical contexts most associated with PTSD, which may assist them in the decision to engage in more frequent, earlier screening and referral to mental health services.

Impact of peritraumatic distress on posttraumatic stress disorder symptoms at 6 months after acute coronary syndrome: a prospective cohort study

Background: Posttraumatic stress disorder (PTSD) symptoms are known to occur after acute coronary syndrome (ACS). Peritraumatic distress has been indicated as a risk factor for PTSD and can be measured by the Peritraumatic Distress Inventory (PDI). However, no studies have yet measured peritraumatic distress after ACS using the PDI to predict PTSD. Objectives: This prospective cohort study examined the impact of peritraumatic distress on PTSD symptoms at 6 months after ACS. Methods: We used the PDI to assess peritraumatic distress in patients treated for ACS at a teaching hospital in Tokyo within 7 days after percutaneous coronary intervention. They were followed up over the next 6 months and were assessed for PTSD symptoms at 6 months using the Impact of Event Scale-Revised. The association between peritraumatic distress and PTSD symptoms was examined by multiple linear regression analysis. Results: The study enrolled 101 ACS patients, and 97 completed the follow-up assessment. PDI total score was an independent predictor of PTSD symptoms after adjustment for potential covariates (beta = 0.38; p < 0.01). Limitations: The results were obtained from a single teaching hospital and assessment of PTSD symptoms was questionnaire based. Conclusion: We provide the first evidence that PDI score can predict the development of PTSD symptoms in ACS patients. Assessing peritraumatic distress after ACS with the PDI may be useful for initiating early intervention against PTSD symptoms.

MDMA-assisted psychotherapy for treatment of anxiety and other psychological distress related to life-threatening illnesses: a randomized pilot study

The success of modern medicine creates a growing population of those suffering from life-threatening illnesses (LTI) who often experience anxiety, depression, and existential distress. We present a novel approach; investigating MDMA-assisted psychotherapy for the treatment of anxiety in people with an LTI. Participants with anxiety from an LTI were randomized in a double-blind study to receive MDMA (125 mg, n = 13) or placebo (n = 5) in combination with two 8-h psychotherapy sessions. The primary outcome was change in State-Trait Anxiety Inventory (STAI) Trait scores from baseline to one month post the second experimental session. After unblinding, participants in the MDMA group had one open-label MDMA session and placebo participants crossed over to receive three open-label MDMA sessions. Additional follow-up assessments occurred six and twelve months after a participant’s last experimental session. At the primary endpoint, the MDMA group had a greater mean (SD) reduction in STAI-Trait scores, − 23.5 (13.2), indicating less anxiety, compared to placebo group, − 8.8 (14.7); results did not reach a significant group difference (p = .056). Hedges’ g between-group effect size was 1.03 (95% CI: − 5.25, 7.31). Overall, MDMA was well-tolerated in this sample. These preliminary findings can inform development of larger clinical trials to further examine MDMA-assisted psychotherapy as a novel approach to treat individuals with LTI-related anxiety.

Trial Registration: clinicaltrials.gov Identifier: NCT02427568, first registered April 28, 2015.

Illness perceptions of Turkish Cypriot patients receiving haemodialysis: A qualitative study

BACKGROUND

Illness perceptions refer to cognitive appraisals that help patients understand and make sense of their condition. Although their importance in health behaviour and outcomes has been evidenced, less is known about cultural influences on mental representations of kidney failure amongst patients receiving haemodialysis in different settings.

OBJECTIVE

To explore the illness perceptions of Turkish patients receiving haemodialysis in North Cyprus (Turkish Cypriots).

DESIGN

A qualitative study involving individual semistructured interviews.

PARTICIPANTS

Fourteen patients receiving haemodialysis, recruited from three state hospitals in North Cyprus.

APPROACH

All interviews were conducted in Turkish, audio-recorded, and transcribed verbatim. They were analysed inductively in the original language using reflexive thematic analysis. Once the analysis was completed, it was translated into English. Quality assurance was integral to the research process to retain semantic equivalence.

FINDINGS

Three themes were developed. "Illness appraisal" highlighted a lack of factual knowledge about kidney failure and how this is related to attempts at sense-making, whilst retaining hope for the future. "Life-changing effects" centred around the negative consequences of haemodialysis across multiple domains (e.g., emotional and physical). "Active coping strategies" focused on mechanisms that patients adopt to manage the burden of haemodialysis, particularly approaches that are culturally rooted.

CONCLUSION

There is a need for better communication to address the lack of individual patient knowledge about kidney failure. Haemodialysis is described as a burdensome treatment though existing coping mechanisms suggest that psycho-spiritual interventions may be advantageous to aid adjustment for Turkish Cypriots receiving haemodialysis.

Illness Perception and Its Changes During Six Months After Cardiac Rehabilitation

Abstract. Illness perception is a concept that reflects patients' emotional and cognitive representations of disease. This study assessed the illness perception change during 6 months in 195 patients (33% women and 67% men) with acute coronary syndrome, taking into account the biological, psychological, and social factors. At baseline, more threatening illness perception was observed in women, persons aged 65 years or more, with poorer functional capacity (New York Heart Association [NYHA] class III or IV) and comorbidities ( p < .05). Type D personality was the only independent factor related to more threatening illness perception (βs = 0.207, p = .006). At follow-up it was found that only self-reported cardiovascular impairment plays the role in illness perception change (βs = 0.544, p < .001): patients without impairment reported decreasing threats of illness, while the ones with it had a similar perception of threat like at baseline. Other biological, psychological, and social factors were partly associated with illness perception after an acute cardiac event but not with perception change after 6 months.

Illness perception and high readmission health outcomes

This review identified associations between illness perception and health outcomes of patients with a medical diagnosis included in the Hospital Readmissions Reduction Program. Inclusion criteria were English language, use of quantitative methodology, health outcomes specified, and identifiable effect size and statistical significance of the relationship. Most of the 31 studies in this review showed that favorable illness perception has been associated with better health outcomes, while unfavorable illness perception has been associated with worse outcomes. A multifaceted approach might include behavioral, clinical, educational, and psychosocial components to improve one’s illness perception through educative, cognitive-behavioral, or psychodynamic counseling.

The Role of Illness Perception and Its Association With Posttraumatic Stress at 3 Months Following Acute Myocardial Infarction

Background: The aim of this study was to investigate the relationship between illness perception and posttraumatic stress disorder (PTSD) symptoms at three months following acute myocardial infarction (MI). Methods: Patients (n = 96) were examined within 48 h and 3 months after the illness episode. The brief revised illness perception questionnaire (Brief-IPQ) was used to assess patients' cognitive representation of their MI. At 3-month follow-up, the Posttraumatic Diagnostic Scale (PDS) and the Clinician-Administered PTSD Scale (CAPS) were used to assess the level of PTSD symptoms. Results: The subjective perception of the illness, including higher harmful consequences (r > 0.35, p < 0.01), higher illness concerns (r > 0.24, p < 0.05) and more emotional impairment (r > 0.23, p < 0.05), was associated with both self-rated and clinician-rated PTSD symptoms. Beliefs regarding harmful consequences after acute MI were independently associated with levels of PTSD symptoms assessed with both the self-rated PDS and CAPS interview (standardized β coefficient = 0.24; P < 0.05) adjusted for demographic factors, cognitive depressive symptoms, fear of dying during MI, factors related to study design, and illness severity. Conclusions: The findings suggest that initial perception of acute MI is significantly associated with PTSD symptoms attributable to MI at 3 months follow-up.

A picture paints a thousand words: Heart drawings reflect acute distress and illness perception and predict posttraumatic stress symptoms after acute myocardial infarction

The aim of this study was to examine whether heart drawings of patients with acute myocardial infarction reflect acute distress symptoms and negative illness beliefs and predict posttraumatic stress symptoms 3 months post-myocardial infarction. In total, 84 patients aged over 18 years drew pictures of their heart. The larger the area drawn as damaged, the greater were the levels of acute distress (r = 0.36; p < 0.05), negative illness perceptions (r = 0.42, p < 0.05), and posttraumatic stress symptoms (r = 0.54, p < 0.01). Pain drawings may offer a tool to identify maladaptive cognitions and thus patients at risk of posttraumatic stress disorder.