Psychological burden and disease-related quality of life in dialysis patients during the first wave of the COVID-19 pandemic - a cross-sectional observational study

OBJECTIVES

Since the first reports of the spread of the new SARS-CoV-2 virus, experts have pointed to the possible psychological consequences of the pandemic. In this study, we tried to answer the question of whether the level of perceived stress related to the pandemic affects the quality of life related to the disease and the functioning of patients on peritoneal and hemodialysis.

METHODS

Out of 106 patients from the dialysis center of the University Clinical Hospital in Wrocław during the first wave of the pandemic, 73 patients were enrolled, including 61 hemodialysis (HD) and 12 peritoneal dialysis (PD). The study used The Perceived Stress Scale (PSS), The General Health Questionnaire (GHQ-28), The Impact of Events Scale-Revised (IES-R), and The Kidney Disease and Quality of Life (KDQOL-SF™).

RESULTS

Nearly half of the respondents (48%) experienced psychological distress and 5.6% of the respondents showed clinically significant psychopathological symptoms (GHQ). Half of the study group declared a significant occurrence of post-traumatic stress symptoms (IES-R). A high score of subjectively perceived stress related to the pandemic was observed in both study groups. Numerous significant negative correlations were found between the results of the KDQOL subscales and psychopathological symptoms (IES-R and GHQ) without significant differences between the two groups (HD vs. PD). Almost all KDQOL subscales were significantly moderately or strongly correlated with the level of perceived stress related to the pandemic.

CONCLUSIONS

The level of subjectively assessed stress related to the pandemic and the severity of psychopathological symptoms, including post-traumatic stress, were significant in the entire group of patients undergoing renal replacement therapy, regardless of the dialysis type. Numerous confirmed relationships between the domains of the quality of life related to the disease and the level of perceived stress and psychopathological symptoms indicate an urgent need to provide effective psychological support to this group of patients and to develop preventive programs in the field of mental health of people undergoing renal replacement therapy.

Coping of Chronically-Ill Patients during the COVID-19 Pandemic: Comparison between Four Groups

In many countries, the COVID-19 pandemic led to healthcare reorganization limiting access to diagnostic or therapeutic procedures for chronically-ill patients. In this article, we describe the psychological consequences and coping strategies of several groups of chronically-ill patients. During the cross-sectional survey conducted in 2020, we enrolled 398 patients with four different chronic conditions (psoriasis, multiple sclerosis, and patients who have undergone a kidney transplant or received dialysis). The study sample was examined regarding the experienced stress levels (Perceived Stress Scale) and coping strategies (Brief-COPE). All four groups of patients most commonly declared using problem-focused coping strategies and least commonly reported the use of avoidant coping. Higher levels of perceived stress strongly correlated with self-blaming. The participants who declared previous psychiatric treatment or psychotherapy were more likely to use self-blaming, behavioral disengagement, substance use, and avoidant coping, while previous psychotherapy additionally correlated with emotion-focused coping. Group comparison identifies patients with a chronic neurological disease, such as multiple sclerosis, at higher risk of a less beneficial coping profile than kidney transplant recipients. Further focus on education and early interventions in at-risk individuals is needed, and widely targeted mental health programs are indicated in order to improve the mental health of patients suffering from chronic diseases.

Psychopathological Symptoms Among Chronically Ill Patients During SARS-CoV-2 Pandemic in Poland

Introduction

The global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic had a drastic psychological and economic impact on the global population. Having a chronic disease during the pandemic is associated with numerous limitations and challenges like regular hospital visits, access to health-care units and getting specialized treatment. In addition, chronically ill patients are at great risk of acquiring the SARS-CoV-2 virus and at experiencing a more severe course of illness, due to comorbid conditions as well as more frequent encounters with health-care workers and other patients in medical facilities. The aim of this study was to examine the psychological disturbances, during the pandemic in chronically ill patients.

Methods

During the cross-sectional survey conducted between May and October 2020, 398 patients with four different chronic conditions (psoriasis, multiple sclerosis and patients who have undergone a kidney transplant or received dialysis). Study sample was examined regarding the occurrence of psychopathological symptoms (General Health Questionnaire 28) and their perceived stress levels (Perceived Stress Scale).

Results

The highest scores were found in the MS group and the lowest scores were found in the kidney transplantation group in every subscale of the GHQ-28. Close to half of the studied population (48.74%, n = 193) patients scored above the cut-off for psychopathology.

Conclusion

As the study was conducted during the SARS-CoV-2 pandemic in Poland, it stands to reason that the pandemic affected the psychological wellbeing of chronically ill patients. A COVID-19 infection, being quarantined and having had contact with a person who was infected, did not significantly affect the outcome measures; however, further research is needed to explore this topic.

Various neuromodulation methods including Deep Brain Stimulation of the medial forebrain bundle combined with psychopharmacotherapy of treatment-resistant depression-Case report

BACKGROUND

Treatment-resistant depression remains one of the main concerns of modern psychiatry. Novel methods such as Transcranial Magnetic Stimulation (including deep and theta burst protocols, iTBS) and Deep Brain Stimulation (DBS) can be considered as alternative treatment options.

CASE PRESENTATION

Twenty-nine-year-old Caucasian female, single, higher-educated was treated with major depressive disorder initially with standard pharmaco- and psychotherapy. Due to diagnosed treatment resistance additional therapeutic approaches were introduced sequentially: Electroconvulsive therapy (efficient only 4 months) and Transcranial Magnetic Stimulation (intermittent Theta Burst Stimulation, iTBS improved just insomnia). Finally the patient was enrolled to the Deep Brain Stimulation (DBS) study with the medial forebrain bundle target. After 20 months of active DBS a reduction of over 80% of depressive symptom severity was observed (Montgomery-Asberg and Hamilton Depression Rating Scales), together with an 87% reduction of anxiety symptoms intensity (Hamilton Anxiety Rating Scale) and a 90% increase in social and occupational functioning. Subjective assessment of the patient performed with questionnaires and visual analog scales showed less pronounced improvement in terms of depressive and anxiety symptoms, and high reduction of anhedonia. Some mild, transient side effects of neurostimulation were eliminated with an adjustment in stimulation parameters.

CONCLUSIONS

The presented clinical case confirms the possibility of achieving remission after the use of MFB DBS in treatment-resistant depression, but postponed for many months. Nevertheless, personalization of every combined therapy with DBS is necessary with exploration of individual factors as past traumas and personality traits. More reports on long-term observations in DBS treatment in TRD trials (especially focused on MFB target) are needed.

Transcranial magnetic stimulation (TMS) in treatment of psychiatric disorders - review of current studies

Current progress of basic and clinical science creates background for new therapeutic appliances of brain stimulation methods in disorders of central nervous system. This review describes present state of knowledge regarding practical aspects of one of those methods - transcranial magnetic stimulation, TMS. The review was based on contemporary literature on use of transcranial magnetic stimulation in various diseases, particularly including present recommendations and guidelines as well as systematic reviews, published after year 2000. TMS is a quite novel, non-invasive, well tolerated treatment method with alow amount of transient adverse effects and complications. Development of new therapeutic protocols makes it possible to introduce this procedure in new groups of patients, including a wide range of mental disorders such as depression, bipolar disorder, schizophrenia, also cognitive function disorders and posttraumatic stress disorder. In Poland it is still hardly available, though more and more clinical centers start to perform this kind of therapy, providing proper equipment and trained personnel.

Perceived stress level among patients with chronic illness during covid pandemia

Introduction

The emergence of SARS-CoV-2 has enormously impacted healthcare systems around the world. Both patients and health care professionals have been subjected to a novel stressor which affects their everyday life and functioning. This issue is especially important to patients suffering from chronic diseases which had already been exposed to a psychological strain related to their primary diagnosis. As chronically ill patients are depending on the availability of a specific treatment i.e. in need of specific healthcare facilities and have more reasons to worry about their future and hence be more prone to suffer adverse psychological consequences than the general population.

Objectives

In this study we aimed to examine whether the psychological results of the pandemic affect chronically ill and whether the specific illness and other demographic factors account for any changes in perceived stress levels.

Methods

An online questionnaire has been distributed to 4 groups (n=369): 92 psoriasis patients, 73 dialysis patients, 100 patients after kidney transplantation and 104 multiple sclerosis patients. The study was conducted during the pandemic in Poland (June-July 2020). Perceived stress levels were measured by the Perceived Stress Scale (PSS).

Results

The preliminary results suggest elevated perceived stress levels among the studied groups. As the data are currently under statistical evaluation specific statistical conclusions are to be expected in November 2020.

Conclusions

As the described study was conducted during the SARS-CoV-2 pandemic in Poland, it stands to reason that the epidemiological situation affected the levels of perceived stress among chronically ill patients.

The psychological burden of long-term care facilities personnel during the SARS-COV-2 pandemic – a national survey in poland

Introduction

The high COVID-19 morbidity and mortality are observed among residents in long-term care facilities (LTCF) worldwide. Employees of LTCF, who are facing a critical epidemiological situation endangering the vulnerable residents, are exposed to pandemic’s psychological consequences daily.

Objectives

The main aim of this study was to assess psychological consequences (somatic symptoms, anxiety and insomnia, social dysfunction, and depression) among LTCF employees exposed to the SARS-CoV-2 pandemic crisis. Moreover, we investigated if factors such as: personal protective equipment (PPE) availability, safety guidelines or access to psychiatric and psychological support at the workplace, correlated with the level of psychological distress experienced by personnel.

Methods

A cross-sectional study was conducted among personnel of LTCF in Poland. The survey consisted of the sociodemographic section, the authors’ questionnaire with questions related to COVID-19 exposure, working conditions, access to PPE and mental health services, GHQ Questionnaire-28.

Results

show that access to PPE (P= .018), to workplace safety guidelines (P= .031), psychological support at workplace (P<0.01), fixed shift schedule (P= .05) and feeling that the right number of staff are employed in the workplace (P= .009), were related to the lower severity of psychopathological symptoms evaluated with the GHQ-28.

Conclusions

The study indicates an evidence that LTCF personnel are susceptible to the development of anxiety, depression, insomnia and social dysfunction during the pandemic crisis. However, these can be modified by: access to PPE, safety guidelines and psychological support. Findings from this study lay a basis for effective interventions aiming to support psychological health within this group.

Coping Styles, Mental Health, and the COVID-19 Quarantine: A Nationwide Survey in Poland

Background: The outbreak of the novel coronavirus COVID-19 that began from March 2020 is yet to be contained. Consequences of the ongoing pandemic may have a negative impact on the mental health of affected individuals. This particularly refers to those quarantined. Since the COVID-19 pandemic is currently one of the biggest health issues worldwide, a higher demand emerges for research concentrating on the worsening of psychological well-being among the general and the quarantined population, as well as on individual coping strategies that may moderate the occurrence of psychopathologies. Method: Data were collected within the first weeks of the COVID-19 pandemic in Poland. Participants represented quarantine (+) and quarantine (-) groups. Quarantine (+) group, different from quarantine (-), consisted of people who experienced it themselves or someone close to them did after contacting an infected individual. To measure psychopathological symptoms a General Health Questionnaire (GHQ-28) was used. For measuring PTSD symptoms, the Impact of Event Scale-Revised (IES-R) was used. This study followed the coping strategies manifested among the participants using the MiniCope questionnaire. Results: A total of 2,036 individuals participated in this study. Quarantine (+) individuals had significantly higher total and subscales GHQ-28 scores (anxiety, insomnia, and somatic symptoms) as well as a higher IES-R arousal score. The quarantine (+) individuals were more likely to use self-distraction as a coping strategy. This research identified positive and negative correlations between presented coping styles and manifested psychopathology. Conclusion: This nationwide study suggests occurrence of negative effects on mental health due to the COVID-19 pandemic and quarantine. It is observed on most of the measured psychopathological symptoms. The present research provides a line of action that should be followed in the future in case of another epidemic and in the event restrictions like quarantine have to be introduced again.

Quality of life, depression and anxiety in living donor kidney transplantation

Due to its numerous advantages, transplantation from a living kidney donor is the best method of renal replacement therapy. However, the characteristics of the procedure require to consider well-being of not only the recipient, but also the donor - a person who suddenly becomes a patient despite former good health. The living donation is a selfless act, but also a decision that may endanger one's own health. The aim of this article was to review the current knowledge concerning the quality of life, symptoms of anxiety and depression occurring among living kidney donors and recipients. In order to do that, we performed a systematic research in the PubMed, Google Scholar and CINAHL databases for the years 2000-2019 with the use of key words. The inclusion and exclusion criteria were met by only 15 articles. This study shows that the mental state of donors is generally better than that of recipients. Additionally, reduction of anxiety and depression as well as increase in the quality of life occurs in both donors and recipients in the post-transplant period compared to the time before surgery. Further research is needed on this topic in order to improve psychological aspects of care of live kidney donors and recipients.

Deep brain stimulation in obsessive-compulsive disorder - case report of two patients

Obsessive-compulsive disorder (OCD) occurs in 2-3% of the general population. Due to its chronicity and high resistance to standard treatment, alternative clinical management based on neuroscientific findings has been sought. Deep brain stimulation (DBS) is a modern and dynamic approach in the treatment of OCD giving hope to patients who are resistant to current pharmacotherapy and psychotherapy based treatments. This paper presents two cases of patients diagnosed with refractory OCD who received DBS therapy with concurrent pharmacotherapy and cognitive behavioral psychotherapy (CBT). Both patients underwent a neurosurgical procedure to implant electrodes into the anterior limb of the internal capsule (ALIC) and nucleus accumbens (NAc). Before and after the start of neurostimulation, patients underwent a clinical evaluation which consisted of a psychiatric examination and psychometric measurements (Y-BOCS, HAMA, HDRS, GAF, SOFAS). During the follow-up period, a blind attempt to switch off the neurostimulation was made. During the 6-month follow-up period, a significant reduction in the obsessive-compulsive, depressive and anxiety symptoms was achieved as well as an improvement in global patient functioning. The tolerance of DBS was found to be very good and no significant side effects were observed. The obtained results provide the basis for the implementation of this method in patients with OCD who are resistant to current treatment.

Deep brain stimulation: new possibilities for the treatment of mental disorders

Deep brain stimulation (DBS) is a treatment method that is currently getting more and more attention from psychiatrists. It has proven to be efficacious and safe in the treatment of neurological disorders, mainly Parkinson's disease (PD), dystonia and essential tremor. DBS has very often contributed to successful treatment in cases that had proved resistant to all other methods of treatment. Nowadays treatment-resistant obsessive-compulsive disorder (OCD) is the main psychiatric indication for DBS. Many studies have focused on assessing the efficacy and safety of this method in different mental disorders, including depressive disorders, Alzheimer's disease, anorexia nervosa, Tourette syndrome, substance addiction or aggressive behaviors. Single cases of successful treatment in bipolar disorder, schizophrenia and post-traumatic stress disorder have also emerged in recent years. In this review the current state of knowledge on the applicability of DBS in psychiatry is presented, based on the available systematic reviews, clinical trials and case studies, as well as on neurophysiological and neuroimaging data.

The evolution of natural alimentation

Advances in medicine and the evolution of health-related behaviors through time and across cultures have contributed to changes in attitudes toward natural alimentation. In the past, women who breastfed their babies were educated by word of mouth and family traditions passed on by their female relatives and communities, and the act of breastfeeding itself constituted a socio-cultural process. The health-related benefits of breast milk for infant nutrition have long been known. Throughout the ages, the image of the breastfeeding woman has inspired many artists and promoted natural alimentation. Ancient beliefs and religious practices were combined with the teachings of the church as well as alchemy principles, and lactation counseling was based on popular belief rather than scientific or medical knowledge. In modern times, breastfeeding has experienced a rise in popularity and is recommended to mothers during pregnancy and as part of contraception education. Anecdotal beliefs regarding the beneficial effects of breastfeeding on children’s overall psychological wellbeing have become a subject of scientific investigation. Within the current pregnancy-related standards, the modern promotion of breastfeeding encompasses nutritional, immunological and psychological aspects. In this paper we have summarized the evolution of the beliefs that have surrounded breastfeeding from antiquity to the present day.

Are all models susceptible to dysfunctional cognitions about eating and body image? The moderating role of personality styles

OBJECTIVE

We investigated dysfunctional cognitions about eating and body image in relation to personality styles in a group of professional models.

METHOD

Dysfunctional cognitions in professional models (n = 43) and a control group (n = 43) were assessed with the 'Eating Disorder Cognition Questionnaire' (EDCQ), eating attitudes with the 'Eating Attitudes Test' (EAT), and personality with the 'Personality Styles and Disorders Inventory' (PSDI-S).

RESULTS

Models had higher scores than controls on the EDCQ and EAT and on nine scales of the PSDI-S. Moderation analyses showed significant interactions between groups and personality styles in predicting EDCQ scales: The ambitious/narcissistic style was related to "negative body and self-esteem", the conscientious/compulsive style to "dietary restraint", and the spontaneous/borderline style to "loss of control in eating".

CONCLUSIONS

The results indicate that not all models are susceptible to dysfunctional cognitions about eating and body image. Models are at a higher risk of developing negative automatic thoughts and dysfunctional assumptions relating to body size, shape and weight, especially if they have high scores on the above personality styles.