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Poisblaud L, Kröger E, Jauvin N, Pelletier-Jacob J, Bélanger RE, Foldes-Busque G, Aubin M, Pluye P, Guillaumie L, Amiri M, Dagenais P, Dionne CE. Perceptions and Preoccupations of Patients and Physicians Regarding Use of Medical Cannabis as an Intervention Against Chronic Musculoskeletal Pain: Results from a Qualitative Study. J Pain Res 2023; 16:3463-3475. [PMID: 37873024 PMCID: PMC10590559 DOI: 10.2147/jpr.s413450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/27/2023] [Indexed: 10/25/2023] Open
Abstract
Objective Explore perceptions and preoccupations regarding use of medical cannabis against chronic musculoskeletal pain, among patients and physicians. Design Qualitative study using interviews with patients and physicians, based on the Theory of Planned Behavior (TPB). Setting The study was conducted in Quebec, Canada, in spring 2020. Subjects We included 27 adult patients and 11 physicians (GPs, anesthesiologists, psychiatrists, and a rheumatologist); the mean age of patients was 48.2 years; 59.3% of patients and 36.4% of physicians were women; 59.3% of patients used no medical cannabis at the time of study; 45.5% of physicians had never authorized it. Methods Semi-structured interviews were conducted, transcribed and for the qualitative analysis codes were developed in a hybrid, inductive and deductive approach. Guided by the TPB, facilitators and barriers, perceived benefits and harms, and perceived norms that may influence cannabis use or authorization were documented. Results Although medical cannabis is an interesting avenue for the relief of chronic musculoskeletal pain, doctors and patients agreed that it remained a last line option, due to the lack of scientific evidence regarding its safety and efficacy. The norms surrounding medical cannabis also play an important role in the social and professional acceptance of this therapeutic option. Conclusion Medical cannabis is seen as a last line option among interventions in the management of chronic pain, and attitudes and prior experiences play a role in the decision to use it. Study results may contribute to improved shared decision making between patients and physicians regarding this option.
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Affiliation(s)
- Lise Poisblaud
- Centre d’excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Quebec, Canada
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Quebec, Canada
| | - Edeltraut Kröger
- Centre d’excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Quebec, Canada
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Quebec, Canada
- Faculty of Pharmacy, Université Laval, Québec, Quebec, Canada
| | - Nathalie Jauvin
- Institut national de santé publique du Québec, Québec, Quebec, Canada
| | - Julie Pelletier-Jacob
- Centre d’excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Quebec, Canada
| | - Richard E Bélanger
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Quebec, Canada
- School of Psychology, Université Laval, Québec, Quebec, Canada
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, Québec, Quebec, Canada
- Research Centre, Centre Intégré de Santé et de Services Sociaux (CISSS) de Chaudière-Appalaches, Lévis, Quebec, Canada
| | - Michèle Aubin
- Centre d’excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Quebec, Canada
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Quebec, Canada
- School of Psychology, Université Laval, Québec, Quebec, Canada
| | - Pierre Pluye
- Faculty of Medicine, McGill University, Montréal, Quebec, Canada
| | | | - Malek Amiri
- Faculty of Nursing, Université Laval, Québec, Quebec, Canada
| | - Pierre Dagenais
- Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Clermont E Dionne
- Centre d’excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, Quebec, Canada
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Quebec, Canada
- School of Psychology, Université Laval, Québec, Quebec, Canada
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Denis I, Turcotte S, Morin CM, Belleville G, Foldes-Busque G. A preliminary validation of the pediatric adaptation of the Insomnia Severity Index. Encephale 2023; 49:474-480. [PMID: 36244838 DOI: 10.1016/j.encep.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The prevalence of insomnia in children aged 5 to 12 years old is 20% to 31%. Currently, there is no well-validated questionnaire assessing all the components of insomnia in school-aged children. The present study aims to introduce an adaptation of the Insomnia Severity Index for this purpose. METHOD Fifty-nine children aged 8- to 12-years-old with at least one anxiety disorder were recruited from youth mental health care settings. Their parents completed the pediatric adaptation of the Insomnia Severity Index which includes two scales used to report insomnia symptoms in children and their impact on the child (ISI-Child) and parents (ISI-Parent), My Child's Sleep Habits questionnaire, and the Child Behavior Checklist. RESULTS Both the ISI-Child and the ISI-Parent scales presented adequate factorial structure (RMSEA ≤ 0.05) and internal consistency (ISI-Child: α=0.87; ISI-Parent: α=0.88). Furthermore, the results of the two scales were strongly correlated (r=0.91, P<0.001). The convergent validity was assessed using the Waking During the Night scale of the My Child's Sleep Habits questionnaire and was adequate for the ISI-Child (r=0.52, P<0.001) and the ISI-Parent (r=0.53, P<0.001). Finally, the Rule-Breaking Behavior (r ≤ 0.26, P ≥ 0.05) and Aggressive Behavior (r ≤ 0.19, P ≥ 0.19) scales of the Child Behavior Checklist showed small correlations with both subscales, indicating good divergent validity. CONCLUSION The pediatric adaptation of the Insomnia Severity Index is a potentially reliable and valid measure for screening and assessing insomnia in children.
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Affiliation(s)
- I Denis
- School of Psychology, Université Laval, G1V 0A6 Québec City, Canada; Research Centre, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, G6V 3Z1 Lévis, Canada; Centre de recherche universitaire sur les jeunes familles, G1C 3S2 Québec City, Canada.
| | - S Turcotte
- Research Centre, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, G6V 3Z1 Lévis, Canada
| | - C M Morin
- Research Centre, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, G6V 3Z1 Lévis, Canada; Centre d'étude des troubles du sommeil, centre de recherche, institut universitaire en santé mentale, G1J 2G3 Québec City, Canada
| | - G Belleville
- Research Centre, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, G6V 3Z1 Lévis, Canada
| | - G Foldes-Busque
- School of Psychology, Université Laval, G1V 0A6 Québec City, Canada; Research Centre, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, G6V 3Z1 Lévis, Canada; Research Centre, Quebec Heart and Lung Institute, G1V 4G5 Québec City, Canada
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de Lafontaine MF, Turcotte S, Denis I, Foldes-Busque G. Investigating the relationship between the five-factor model of distress tolerance, anxiety and anxiety sensitivity. Anxiety Stress Coping 2023; 36:353-365. [PMID: 35587513 DOI: 10.1080/10615806.2022.2077929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND Distress tolerance (DT) has been conceptualized as a vulnerability factor for several psychopathologies. A five factor model of DT has been suggested, but its associations with anxiety and anxiety sensitivity have yet to be explored. OBJECTIVES This study aimed to further validate the five-factor model of DT, identify the associations between its factors and elevated anxiety, and assess if anxiety sensitivity mediates the association between DT and anxiety. DESIGN AND METHODS This observational study included 330 students and university workers (women = 82.7%; mean age = 27.7 years, SD = 9.4). They completed online questionnaires assessing DT, anxiety sensitivity and anxiety levels. RESULTS The five-factor model was a good fit to the data (RMSEA = .04). Two factors, and the sex of the participants, contributed to the variance in anxiety (r2 = .418, p < .001). Tolerance of negative emotion was directly (β = -1.98, 95% CI = [-2.53, -1.42]) and indirectly (β = -1.10, 95% CI = [-1.55, -.78]) associated with lower anxiety through anxiety sensitivity. Tolerance of uncertainty was also directly (β = -.08, 95% CI = [-.10, -.06]) and indirectly (β = -.04, 95% CI = [-.05, -.02]) associated with lower anxiety through anxiety sensitivity. CONCLUSIONS Tolerance of negative emotion and uncertainty were associated with anxiety independently of the other factors of DT. These associations seem partially explained by the effect of anxiety sensitivity.
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Affiliation(s)
- Marie-France de Lafontaine
- School of Psychology, Université Laval, Québec, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Canada
- Research Centre of the Quebec Heart and Lung Institute, Québec, Canada
| | - Stéphane Turcotte
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, Québec, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Canada
- Centre de recherche sur les jeunes et les familles (CRUJeF), Québec, Canada
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, Québec, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Canada
- Research Centre of the Quebec Heart and Lung Institute, Québec, Canada
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Liblik K, Hu R, Mensour EA, Foldes-Busque G, Sedlak T, Udell J, Mulvagh SL, Johri AM. Female Risk Factors for Post-Infarction Depression and Anxiety: Trial Design. Cardiology 2023; 148:12-19. [PMID: 36716710 DOI: 10.1159/000528386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 11/19/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Female patients are at elevated risk for adverse mental health outcomes following hospital admission for ischemic heart disease. These psychosocial characteristics are correlated with unacceptably higher rates of cardiovascular (CV) morbidity and mortality. Guidelines to address mental health following acute coronary syndrome (ACS) can only be developed with the aid of studies elucidating which subgroups of female patients are at the highest risk. METHODS/DESIGN The Female Risk factors for post-Infarction Depression and Anxiety (FRIDA) Study is a prospective multicenter questionnaire-based study of female participants admitted to hospital with ACS. Data are collected within 72 h of admission as well as at 3 and 6 months. At baseline, participants complete a sociodemographic questionnaire, social support survey, and Hospital Depression and Anxiety Scale (HADS). Follow-up will consist of a demographic questionnaire, HADS, changes to health status, and quality of life indicators. Statistical analysis will include descriptive and inferential methods to observe baseline distributions and significance between groups. DISCUSSION/CONCLUSION Our primary outcome is to determine if specific CV and sociodemographic factors correlate with increased depression and anxiety scores (HADS-D >7; HADS-A >7) at baseline. Our secondary aim is to determine if increased HADS scores at baseline and follow-up correlate with 3 and 6-month health and quality of life outcomes. A total of 2,000 patients will be enrolled across seven study sites. The aim of the FRIDA Study is to understand which groups of female patients have the highest rates of depression and anxiety following ACS to better inform care.
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Affiliation(s)
- Kiera Liblik
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ricky Hu
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Emma A Mensour
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Tara Sedlak
- Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacob Udell
- Department of Medicine, Division of Cardiology, Women's College Research Institute, Toronto, Ontario, Canada
| | - Sharon L Mulvagh
- Department of Medicine, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amer M Johri
- Department of Medicine, Cardiovascular Imaging Network at Queen's University, Kingston, Ontario, Canada
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Poisblaud L, Dionne C, Aubin M, Bélanger R, Dagenais P, Foldes-Busque G, Guillaumie L, Pluye P, Carmichael PH, Jauvin N, Kröger E. 282 - Douleurs chroniques non cancéreuses et cannabis à des fins médicales : mieux comprendre ce choix de traitement. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.06.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Tremblay MA, Denis I, Turcotte S, DeGrâce M, Tully PJ, Foldes-Busque G. Cognitive-Behavioral Therapy for Panic Disorder in Patients with Stable Coronary Artery Disease: A Feasibility Study. J Clin Psychol Med Settings 2022; 30:28-42. [PMID: 35543901 PMCID: PMC9093559 DOI: 10.1007/s10880-022-09876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/18/2022]
Abstract
Implementing cognitive-behavioral therapy (CBT), the first-line psychological treatment for panic disorder (PD), may be challenging in patients with comorbid coronary artery disease (CAD).This study aimed at assessing the feasibility and acceptability of a CBT for PD protocol that was adapted to patients suffering from comorbid CAD. It also aimed at evaluating the efficacy of the intervention to reduce PD symptomatology and psychological distress and improve quality of life. This was a single-case experimental design with pre-treatment, post-treatment and 6-month follow-up measures. Patients with PD and stable CAD received 14 to 17 individual, 1-h sessions of an adapted CBT for PD protocol. They completed interviews and questionnaires at pre-treatment, post-treatment and at a 6-month follow-up assessing intervention acceptability, PD symptomatology, psychological distress and quality of life. A total of 6 patients out of 7 completed the intervention and 6-month follow-up, indicating satisfactory feasibility. Acceptability was high (medians of ≥ 8.5 out of 9 and ≥ 80%) both at pre and post treatment. Remission rate was of 83% at post-treatment and 6-month follow-up. The intervention appeared to have positive effects on comorbid anxiety and depression symptoms and quality of life. The intervention appeared feasible and acceptable in patients with comorbid CAD. The effects of the adapted CBT protocol on PD symptoms, psychological distress and quality of life are promising and were maintained at the 6-month follow-up. Further studies should aim at replicating the present results in randomized-controlled trials
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Affiliation(s)
- Marie-Andrée Tremblay
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada.,Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada.,Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Stéphane Turcotte
- Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Michel DeGrâce
- Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Phillip J Tully
- Faculty of Health and Medical Sciences, The University of Adelaide, 30 Frome Road, Adelaide, SA, 5000, Australia
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada. .,Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada. .,Research Center of the Quebec Heart and Lung Institute, 2725, chemin Sainte-Foy, Quebec, QC, G1V 4G5, Canada.
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Hamel S, Denis I, Turcotte S, Fleet R, Archambault P, Dionne CE, Foldes-Busque G. Anxiety disorders in patients with noncardiac chest pain: association with health-related quality of life and chest pain severity. Health Qual Life Outcomes 2022; 20:7. [PMID: 35012545 PMCID: PMC8751105 DOI: 10.1186/s12955-021-01912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with noncardiac chest pain (NCCP) report more severe symptoms and lowered health-related quality of life when they present with comorbid panic disorder (PD). Although generalized anxiety disorder (GAD) is the second most common psychiatric disorder in these patients, its impact on NCCP and health-related quality of life remains understudied. This study describes and prospectively compares patients with NCCP with or without PD or GAD in terms of (1) NCCP severity; and (2) the physical and mental components of health-related quality of life. METHODS A total of 915 patients with NCCP were consecutively recruited in two emergency departments. The presence of comorbid PD or GAD was assessed at baseline with the Anxiety Disorder Schedule for DSM-IV. NCCP severity at baseline and at the six-month follow-up was assessed with a structured telephone interview, and the patients completed the 12-item Short-Form Health Survey Version 2 (SF-12v2) to assess health-related quality of life at both time points. RESULTS Average NCCP severity decreased between baseline and the six-month follow-up (p < .001) and was higher in the patients with comorbid PD or GAD (p < .001) at both time points compared to those with NCCP only. However, average NCCP severity did not differ between patients with PD and those with GAD (p = 0.901). The physical component of quality of life improved over time (p = 0.016) and was significantly lower in the subset of patients with PD with or without comorbid GAD compared to the other groups (p < .001). A significant time x group interaction was found for the mental component of quality of life (p = 0.0499). GAD with or without comorbid PD was associated with a lower mental quality of life, and this effect increased at the six-month follow-up. CONCLUSIONS Comorbid PD or GAD are prospectively associated with increased chest pain severity and lowered health-related quality of life in patients with NCCP. PD appears to be mainly associated with the physical component of quality of life, while GAD has a greater association with the mental component. Knowledge of these differences could help in the management of patients with NCCP and these comorbidities.
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Affiliation(s)
- Stéphanie Hamel
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC G1V 0A6 Canada
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC G1V 0A6 Canada
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Centre de Recherche Universitaire Sur Les Jeunes Et Les Familles (CRUJeF), 2915 avenue du Bourg-Royal, Quebec, QC G1C 3S2 Canada
| | - Stéphane Turcotte
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
| | - Richard Fleet
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Department of Family and Emergency Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Patrick Archambault
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Department of Family and Emergency Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Clermont E. Dionne
- CHU de Quebec Research Centre, Saint-Sacrement Hospital, 1050, Chemin Sainte-Foy, Quebec, QC G1S 4L8 Canada
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC G1V 0A6 Canada
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Quebec Heart and Lung Institute Research Centre, 2725 chemin Sainte-Foy, Quebec, QC G1V 4G5 Canada
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Trépanier A, Turcotte S, Foldes-Busque G. [Distress tolerance and experience of chronic pain]. Encephale 2021; 48:653-660. [PMID: 34801233 DOI: 10.1016/j.encep.2021.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Chronic pain is a highly prevalent condition that is associated with distressing somatic and emotional experiences. Consequently, an individual's distress tolerance, the perceived capacity to tolerate negative psychological and physical states, may influence their pain experience. This effect could be explained in part by a reduction in the catastrophic interpretation of pain which is associated with increased pain intensity and interference in everyday activities. AIMS The first aim of this study was to explore the association between the components of the 5-factor model of distress tolerance and (1) pain intensity and (2) pain interference in everyday activities. The secondary aim was to assess the potential mediating effect of pain catastrophizing in the eventual association between components of distress tolerance and (1) pain intensity or (2) pain interference in everyday activities. METHOD This is a cross-sectional study of adult (18 years or older) university students and staff with chronic pain (3 months). They were invited to complete the online questionnaire through an email invitation. Pain intensity and interference in everyday functioning were assessed with the corresponding subscales of the Brief Pain Inventory. The following instruments were used to assess the components of the 5-factor model of distress tolerance: Ambiguity Tolerance Scale (tolerance to ambiguity), Intolerance to Uncertainty Scale (reversed score: tolerance to uncertainty), Discomfort Intolerance Scale (reversed score: discomfort tolerance), Distress Tolerance Scale (tolerance to negative emotions), Frustration Discomfort Scale (tolerance to frustration). Participants also completed the Pain Catastrophizing Scale. RESULTS Eighty participants were recruited (57 % women, mean age=33.09; standard deviation=12,87). Tolerance to negative emotions was the only component of distress tolerance that was associated with pain (ß=-0.04; 95% CI): -0.07--0.01; t (78)=-3.06, p<0.01) or pain interference in everyday functioning (ß=-0.07; 95% CI: -0.10--0.03; t (78)=-3.97, p<0.01), independently of the others. Combined with age, these factors explained 16.2 % of the variance in pain intensity and 19.4 % of the variance in pain interference. Pain catastrophizing partially mediated the association between tolerance to negative emotions and pain interference in everyday functioning, but it was not involved in the association between tolerance to negative emotions and pain intensity. CONCLUSION Tolerance to negative emotions appears to be the most relevant aspect of distress tolerance in the context of chronic pain and is a potential clinical target that is independent and complementary from pain catastrophizing.
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Affiliation(s)
- A Trépanier
- École de psychologie, faculté des sciences sociales, 2325, rue des Bibliothèques, local L-042, Québec, G1V 0A6, Canada; Centre de recherche du Centre intégré de santé et de service sociaux Chaudière-Appalaches, Lévis, QC, Canada
| | - S Turcotte
- Centre de recherche du Centre intégré de santé et de service sociaux Chaudière-Appalaches, Lévis, QC, Canada
| | - G Foldes-Busque
- École de psychologie, faculté des sciences sociales, 2325, rue des Bibliothèques, local L-042, Québec, G1V 0A6, Canada; Centre de recherche du Centre intégré de santé et de service sociaux Chaudière-Appalaches, Lévis, QC, Canada; Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada.
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Liblik K, Hu R, Foldes-Busque G, Johri A. THE FRIDA PILOT STUDY (FEMALE RISK FACTORS FOR POST-INFARCTION DEPRESSION AND ANXIETY). Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Furrer D, Kröger E, Marcotte M, Jauvin N, Bélanger R, Ware M, Foldes-Busque G, Aubin M, Pluye P, Dionne CE. Cannabis against chronic musculoskeletal pain: a scoping review on users and their perceptions. J Cannabis Res 2021; 3:41. [PMID: 34481519 PMCID: PMC8418709 DOI: 10.1186/s42238-021-00096-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background Chronic musculoskeletal pain (CMP) may lead to reduced physical function and is the most common cause of chronic non-cancer pain. Currently, the pharmacotherapeutic options against CMP are limited and frequently consist of pain management with non-steroidal anti-inflammatories, gabapentinoids, or opioids, which carry major adverse effects. Although the effectiveness of medical cannabis (MC) for CMP still lacks solid evidence, several patients suffering from it are exploring this therapeutic option with their physicians. Objectives Little is known about patients’ perceptions of their MC treatment for CMP. We aimed to increase this knowledge, useful for healthcare professionals and patients considering this treatment, by conducting a scoping literature review, following guidance by Arksey and O’Malley, to describe the views and perceptions of adult patients who had consumed MC to relieve chronic CMP. Methods Databases (PUBMED, EMBASE, Web of Science) and websites were searched using combinations of controlled and free vocabulary. All studies and study designs reporting on patients’ perceptions regarding MC against CMP were considered. Studies had to include adult patients reporting qualitatively or quantitatively, i.e., through questionnaires, on MC use to treat CMP or other non-cancer pain, since studies reporting exclusively on perceptions regarding CMP were very rare. Study characteristics were extracted and limitations of the study quality were assessed. The review includes patients’ demographic characteristics, patterns of MC use, perceived positive and negative effects, use of alcohol or other drugs, reported barriers to CM use, and funding sources of the studies. Results Participants of the 49 included studies reported that MC use helped them to reduce CMP and other chronic non-cancer pain, with only minor adverse effects, and some reported improved psychological well-being. In the included studies, men represent between 18 and 88% of the subjects. The mean age of participants in these studies (42/49) varied between 28.4 and 62.8 years old. The most common route of administration is inhalation. Conclusion MC users suffering from CMP or other chronic non-cancer pain perceived more benefits than harms. However, the information from these studies has several methodological limitations and results are exploratory. These user-reported experiences must thus be examined by well-designed and methodologically sound clinical or observational studies, particularly regarding CMP, where reports are very scarce. Supplementary Information The online version contains supplementary material available at 10.1186/s42238-021-00096-8.
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Affiliation(s)
- Daniela Furrer
- Centre d'excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, QC, Canada.,Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, QC, Canada. .,Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada. .,Faculty of Pharmacy, Université Laval, Québec, QC, Canada. .,Hôpital du Saint-Sacrement, 1050 Chemin Ste-Foy, room L2-30, Québec, QC, G1S 4L8, Canada.
| | - Martine Marcotte
- Centre d'excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, QC, Canada
| | - Nathalie Jauvin
- Centre d'excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, QC, Canada
| | - Richard Bélanger
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada.,Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Mark Ware
- Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, Québec, QC, Canada.,Research Centre of the Centre Intégré de Santé et de Services Sociaux (CISSS) de Chaudière-Appalaches, Lévis, QC, Canada
| | - Michèle Aubin
- Centre d'excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, QC, Canada.,Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Pierre Pluye
- Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Clermont E Dionne
- Centre d'excellence sur le vieillissement de Québec (CEVQ), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale (CIUSSSCN), Québec, QC, Canada.,Centre de Recherche du CHU de Québec-Université Laval, Québec, QC, Canada.,Faculty of Medicine, Université Laval, Québec, QC, Canada
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11
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Foldes-Busque G, de Lafontaine MF, Turcotte S, Denis I. Are Patients at Risk for Developing Panic Disorder After an Emergency Department Visit With Noncardiac Chest Pain? J Acad Consult Liaison Psychiatry 2021; 63:23-31. [PMID: 34352451 DOI: 10.1016/j.jaclp.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Panic disorder (PD) is common in emergency department (ED) patients with noncardiac chest pain (NCCP). The literature suggests that initially PD-free patients may be at increased risk of developing PD in the months or years following an ED visit. OBJECTIVES This study aims to determine the incidence of PD in the 2 years following an ED visit with NCCP and to identify predictors of incident PD. METHODS This study was conducted using a longitudinal, observational design. Five hundred and eighty-five patients with NCCP (without PD) were recruited in two EDs. They underwent an interview and completed a series of questionnaires assessing anxiety disorders, perceived social support, psychological distress, anxiety sensitivity, comorbidities, and stressful life events. PD was assessed 6 months, 1 year, and 2 years after the initial interview. RESULTS PD incidence was 11.1% (95% confidence interval: 8.7-13.9) in the two years following the baseline assessment. Anxiety sensitivity (odds ratio = 1.08; 95% confidence interval: 1.04-1.11; P < .001) and stress related to life events (odds ratio = 1.14; 95% confidence interval: 1.06-1.24; P = .001) significantly predicted incident PD. CONCLUSIONS Patients with NCCP are at high risk for developing PD in the 2 years following an ED visit with NCCP. Anxiety sensitivity and stress related to life events may be promising clinical targets for preventive interventions.
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Affiliation(s)
- Guillaume Foldes-Busque
- School of Psychology, Université Laval, Québec, QC, Canada; Research Centre of the Chaudière-Appalaches Integrated Center for Health and Social Services, Lévis, QC, Canada; Research Centre of the Quebec Heart and Lung Institute, Québec, QC, Canada.
| | - Marie-France de Lafontaine
- School of Psychology, Université Laval, Québec, QC, Canada; Research Centre of the Chaudière-Appalaches Integrated Center for Health and Social Services, Lévis, QC, Canada; Research Centre of the Quebec Heart and Lung Institute, Québec, QC, Canada
| | - Stéphane Turcotte
- Research Centre of the Chaudière-Appalaches Integrated Center for Health and Social Services, Lévis, QC, Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, Québec, QC, Canada; Research Centre of the Chaudière-Appalaches Integrated Center for Health and Social Services, Lévis, QC, Canada; Centre de recherche universitaire sur les jeunes et les familles (CRUJeF), QC, Canada
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12
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Foldes-Busque G, Dionne CE, Turcotte S, Tully PJ, Tremblay MA, Poirier P, Denis I. Epidemiology and prognostic implications of panic disorder and generalized anxiety disorder in patients with coronary artery disease: rationale and design for a longitudinal cohort study. BMC Cardiovasc Disord 2021; 21:26. [PMID: 33435888 PMCID: PMC7801787 DOI: 10.1186/s12872-021-01848-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/01/2021] [Indexed: 01/25/2023] Open
Abstract
Background Anxiety is associated with poorer prognosis in patients with coronary artery disease (CAD). Due to their severity and chronic course, anxiety disorders, particularly generalized anxiety disorder (GAD) and panic disorder (PD), are of considerable interest and clinical importance in this population. This study has two main objectives: (1) to estimate the prevalence and incidence of GAD and PD in patients with CAD over a 2-year period and (2) to prospectively assess the association between PD or GAD and adverse cardiac events, treatment adherence, CAD-related health behaviors, quality of life and psychological distress. Design/Method This is a longitudinal cohort study in which 3610 participants will be recruited following a CAD-related revascularization procedure. They will complete an interview and questionnaires at 5 time points over a 2-year period (baseline and follow-ups after 3, 6, 12 and 24 months). The presence of PD or GAD, adherence to recommended treatments, health behaviors, quality of life and psychological distress will be assessed at each time point. Data regarding mortality and adverse cardiac events will be collected with a combination of interviews and review of medical files. Discussion This study will provide essential information on the prevalence and incidence of anxiety disorders in patients with CAD and on the consequences of these comorbidities. Such data is necessary in order to develop clear clinical recommendations for the management of PD and GAD in patients with CAD. This will help improve the prognosis of patients suffering from both conditions.
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Affiliation(s)
- Guillaume Foldes-Busque
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, bureau 1018, Québec, QC, G1V 0A6, Canada. .,Research Center of the Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada. .,Research Center of the Quebec Heart and Lung Institute, Québec, QC, Canada.
| | - Clermont E Dionne
- Hôpital du Saint-Sacrement, Québec, QC, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Stéphane Turcotte
- Research Center of the Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Phillip J Tully
- School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Marie-Andrée Tremblay
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, bureau 1018, Québec, QC, G1V 0A6, Canada.,Research Center of the Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Paul Poirier
- Research Center of the Quebec Heart and Lung Institute, Québec, QC, Canada.,Faculty of Pharmacy, Université Laval, Québec, QC, Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, bureau 1018, Québec, QC, G1V 0A6, Canada.,Research Center of the Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
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13
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Castonguay J, Turcotte S, Fleet RP, Archambault PM, Dionne CE, Denis I, Foldes-Busque G. Physical activity and disability in patients with noncardiac chest pain: a longitudinal cohort study. Biopsychosoc Med 2020; 14:12. [PMID: 32612673 PMCID: PMC7324967 DOI: 10.1186/s13030-020-00185-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/23/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Noncardiac chest pain (NCCP) is one of the leading reasons for emergency department visits and significantly limits patients' daily functioning. The protective effect of physical activity has been established in a number of pain problems, but its role in the course of NCCP is unknown. This study aimed to document the level of physical activity in patients with NCCP and its association with NCCP-related disability in the 6 months following an emergency department visit. METHODS In this prospective, longitudinal, cohort study, participants with NCCP were recruited in two emergency departments. They were contacted by telephone for the purpose of conducting a medical and sociodemographic interview, after which a set of questionnaires was sent to them. Participants were contacted again 6 months later for an interview aimed to assess their NCCP-related disability. RESULTS The final sample consisted of 279 participants (57.0% females), whose mean age was 54.6 (standard deviation = 15.3) years. Overall, the proportion of participants who were physically active in their leisure time, based on the Actimètre questionnaire criteria, was 22.0%. Being physically active at the first measurement time point was associated with a 38% reduction in the risk of reporting NCCP-related disability in the following 6 months (ρ = .047). This association remained significant after controlling for confounding variables. CONCLUSIONS Being physically active seems to have a protective effect on the occurrence of NCCP-related disability in the 6 months following an emergency department visit with NCCP. These results point to the importance of further exploring the benefits of physical activity in this population.
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Affiliation(s)
- Joanne Castonguay
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 Allée des Bibliothèques, Québec, QC G1V 0A6 Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 Rue Wolfe,, Lévis, QC G6V 3Z1 Canada
| | - Stéphane Turcotte
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 Rue Wolfe,, Lévis, QC G6V 3Z1 Canada
| | - Richard P Fleet
- Département de médecine familiale et de médecine d’urgence, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Québec, QC G1V 0A6 Canada
| | - Patrick M Archambault
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 Rue Wolfe,, Lévis, QC G6V 3Z1 Canada
| | - Clermont E Dionne
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 Rue Wolfe,, Lévis, QC G6V 3Z1 Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 Allée des Bibliothèques, Québec, QC G1V 0A6 Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 Rue Wolfe,, Lévis, QC G6V 3Z1 Canada
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 Allée des Bibliothèques, Québec, QC G1V 0A6 Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 Rue Wolfe,, Lévis, QC G6V 3Z1 Canada
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14
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Heppell JL, Denis I, Turcotte S, Fleet RP, Dionne CE, Foldes-Busque G. Incidence of panic disorder in patients with non-cardiac chest pain and panic attacks. J Health Psychol 2019; 26:985-994. [DOI: 10.1177/1359105319859062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study documented the 6-month incidence of panic disorder and its predictors in emergency department patients with panic attacks and non-cardiac chest pain. The assessment included a validated structured interview to identify panic attacks and questionnaires measuring the potential predictors of panic disorder. Presence of panic disorder was assessed 6 months later. The incidence of panic disorder was 10.1 percent ( n = 14/138). Anxiety sensitivity was the only significant predictor of the incidence of panic disorder (odds ratio = 1.06; 95% confidence interval = 1.01–1.12). Patients with panic attacks and non-cardiac chest pain are at an elevated risk for panic disorder. This vulnerability appears to increase with anxiety sensitivity.
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Affiliation(s)
- Jenny-Lee Heppell
- Université Laval, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Canada
| | - Isabelle Denis
- Université Laval, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Canada
| | - Stéphane Turcotte
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Canada
| | - Richard P Fleet
- Université Laval, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Canada
| | - Clermont E Dionne
- Université Laval, Canada
- Research Centre of the Québec University Hospital, Canada
| | - Guillaume Foldes-Busque
- Université Laval, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Canada
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15
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Chiasson C, Bisson-Bernatchez E, Turcotte S, Tremblay MA, Denis I, Foldes-Busque G. Validation of the French-Canadian version of the Cardiac Anxiety Questionnaire (CAQ-FR). Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement 2019. [DOI: 10.1037/cbs0000123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Foldes-Busque G, Denis I, Poitras J, Fleet RP, Archambault PM, Dionne CE. The Revised-Panic Screening Score for emergency department patients with noncardiac chest pain. Health Psychol 2018; 37:828-838. [PMID: 30138020 DOI: 10.1037/hea0000632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES We sought to reduce the 90% rate of missed diagnoses of panic-like anxiety (panic attacks with or without panic disorder) among emergency department patients with low risk noncardiac chest pain by validating and improving the Panic Screening Score (PSS). METHOD A total of 1,102 patients with low risk noncardiac chest pain were prospectively and consecutively recruited in two emergency departments. Each patient completed a telephone interview that included the PSS, a brief 4-item screening instrument, new candidate predictors of panic-like anxiety, and the Anxiety Disorder Interview for the Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition to identify panic-like anxiety. RESULTS The original 4-item PSS demonstrated a sensitivity of 51.8% (95% CI [48.4, 57.0]) and a specificity of 74.8% (95% CI [71.3, 78.1]) for panic-like anxiety. Analyses prompted the development of the Revised-PSS; this 6-item instrument was 19.1% (95% CI [12.7, 25.5]) more sensitive than the original PSS in identifying panic-like anxiety in this sample (χ2(1, N = 351) = 23.89 p < .001) while maintaining a similar specificity (χ2(1, N = 659) = 0.754, p = .385; 0.4%, 95% CI [-3.6, 4.5]). The discriminant validity of the Revised-PSS proved stable over the course of a 10-fold cross-validation. CONCLUSIONS The Revised-PSS has significant potential for improving identification of panic-like anxiety in emergency department patients with low risk noncardiac chest pain and promoting early access to treatment. External validation and impact analysis of the Revised-PSS are warranted prior to clinical implementation. (PsycINFO Database Record
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Affiliation(s)
| | | | - Julien Poitras
- University Affiliated Hospital Hotel- Dieu de Levis Research Centre
| | - Richard P Fleet
- University Affiliated Hospital Hotel- Dieu de Levis Research Centre
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17
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Foldes-Busque G, Denis I, Poitras J, Fleet RP, Archambault P, Dionne CE. A closer look at the relationships between panic attacks, emergency department visits and non-cardiac chest pain. J Health Psychol 2017; 24:717-725. [DOI: 10.1177/1359105316683785] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examined the prevalence of emergency department visits prompted by panic attacks in patients with non-cardiac chest pain. A validated structured telephone interview was used to assess panic attacks and their association with the emergency department consultation in 1327 emergency department patients with non-cardiac chest pain. Patients reported at least one panic attack in the past 6 months in 34.5 per cent (95% confidence interval: 32.0%–37.1%) of cases, and 77.1 per cent (95% confidence interval: 73.0%–80.7%) of patients who reported panic attacks had visited the emergency department with non-cardiac chest pain following a panic attack. These results indicate that panic attacks may explain a significant proportion of emergency department visits for non-cardiac chest pain.
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Affiliation(s)
- Guillaume Foldes-Busque
- Université Laval, Canada
- Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, Canada
| | - Isabelle Denis
- Université Laval, Canada
- Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, Canada
| | - Julien Poitras
- Université Laval, Canada
- Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, Canada
| | - Richard P Fleet
- Université Laval, Canada
- Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, Canada
| | - Patrick Archambault
- Université Laval, Canada
- Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, Canada
| | - Clermont E Dionne
- Université Laval, Canada
- Research Centre of the Québec University Hospital (CHU), Canada
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18
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Gilbert É, Savard J, Gagnon P, Savard MH, Ivers H, Foldes-Busque G. To be or not to be positive: Development of a tool to assess the relationship of negative, positive, and realistic thinking with psychological distress in breast cancer. J Health Psychol 2016; 23:731-742. [PMID: 27923883 DOI: 10.1177/1359105316681062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
There is a widespread belief that positive thinking is a key strategy to cope with cancer. While dispositional optimism is associated with lower psychological distress, the literature supporting the efficacy of cognitive-behavioral therapy indirectly suggests that realistic thinking is also effective. This article describes the development of the Thoughts and Anticipations about Cancer questionnaire designed to directly compare the effect of realistic thinking versus positive thinking on adjustment to cancer. Preliminary data on its relationships with psychological distress gathered in 10 breast cancer patients are promising. The validity of the Thoughts and Anticipations about Cancer questionnaire will need to be confirmed in larger studies.
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Affiliation(s)
- Émilie Gilbert
- 1 School of Psychology, Université Laval, Québec, Canada
- 2 CHU de Québec-Université Laval Research Center, Québec, Canada
- 3 Université Laval Cancer Research Center, Québec, Canada
| | - Josée Savard
- 1 School of Psychology, Université Laval, Québec, Canada
- 2 CHU de Québec-Université Laval Research Center, Québec, Canada
- 3 Université Laval Cancer Research Center, Québec, Canada
| | - Pierre Gagnon
- 1 School of Psychology, Université Laval, Québec, Canada
- 2 CHU de Québec-Université Laval Research Center, Québec, Canada
- 3 Université Laval Cancer Research Center, Québec, Canada
| | - Marie-Hélène Savard
- 2 CHU de Québec-Université Laval Research Center, Québec, Canada
- 3 Université Laval Cancer Research Center, Québec, Canada
| | - Hans Ivers
- 1 School of Psychology, Université Laval, Québec, Canada
- 2 CHU de Québec-Université Laval Research Center, Québec, Canada
- 3 Université Laval Cancer Research Center, Québec, Canada
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19
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Foldes-Busque G, Hamel S, Belleville G, Fleet R, Poitras J, Chauny JM, Vadeboncoeur A, Lavoie KL, Marchand A. Factors associated with pain level in non-cardiac chest pain patients with comorbid panic disorder. Biopsychosoc Med 2016; 10:30. [PMID: 27777612 PMCID: PMC5070074 DOI: 10.1186/s13030-016-0081-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/12/2016] [Indexed: 12/02/2022] Open
Abstract
Background Panic disorder (PD) is highly prevalent in patients with non-cardiac chest pain (NCCP). This study aims to explore the role of psychological factors (PD intensity, anxiety sensitivity, heart-related fear, attention and avoidance) common to NCCP and PD in predicting chest pain levels in patients with both conditions. Methods This association was investigated in emergency department patients with NCCP and PD receiving either evidence-based treatment of PD or treatment as usual. Patients were assessed at baseline and 14 weeks later for post-treatment. Results Only heart-focused fear and attention for cardiac sensations independently explained a significant portion of the variance in baseline pain (n = 66). At 3 months follow-up (n = 53), changes in heart-related fear was the only factor independently associated with changes in chest pain intensity. Even in patients with PD, fear specific to cardiac sensations seems to play a central role in determining NCCP intensity. Conclusion These results suggest that the efficacy of intervention for patients with PD and comorbid NCCP could be improved by targeting heart-related fear and attention. Trial registration NCT00736346
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Affiliation(s)
- Guillaume Foldes-Busque
- School of Psychology, Université Laval, 2325, rue des Bibliothèques, Bureau 1116, Québec, G1V 0A6 Canada ; Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada
| | - Stéphanie Hamel
- School of Psychology, Université Laval, 2325, rue des Bibliothèques, Bureau 1116, Québec, G1V 0A6 Canada ; Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada
| | - Geneviève Belleville
- School of Psychology, Université Laval, 2325, rue des Bibliothèques, Bureau 1116, Québec, G1V 0A6 Canada
| | - Richard Fleet
- Research Chair in Emergency Medicine of Laval University, University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada ; Department of Family and Emergency Medicine, Université Laval, 1050 Avenue de la Médecine, Bureau 4617, Québec, G1V 0A6 Canada
| | - Julien Poitras
- Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada ; Department of Family and Emergency Medicine, Université Laval, 1050 Avenue de la Médecine, Bureau 4617, Québec, G1V 0A6 Canada
| | - Jean-Marc Chauny
- Research Centre, Montreal Sacré-Coeur Hospital, 5400 Boulevard Gouin Ouest, local K-3000, Montréal, Québec H4J 1C5 Canada
| | - Alain Vadeboncoeur
- Research Centre, Montreal Heart Institute, 5000 rue Bélanger, Montréal, Québec H1T 1C8 Canada
| | - Kim L Lavoie
- Research Centre, Montreal Sacré-Coeur Hospital, 5400 Boulevard Gouin Ouest, local K-3000, Montréal, Québec H4J 1C5 Canada ; Research Centre, Montreal Heart Institute, 5000 rue Bélanger, Montréal, Québec H1T 1C8 Canada ; Psychology Department, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, Québec H3C 3P8 Canada
| | - André Marchand
- Psychology Department, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, Québec H3C 3P8 Canada ; Fernand-Séguin Research Centre, Louis-Hippolyte Lafontaine Hospital, 7331 rue Hochelaga, Montréal, Québec H1N 3V2 Canada
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Belleville G, Foldes-Busque G, Poitras J, Chauny JM, Diodati JG, Fleet R, Marchand A. Insomnia in patients with unexplained chest pain. Psychosomatics 2014; 55:458-68. [PMID: 24636487 DOI: 10.1016/j.psym.2013.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The current study was designed (1) to assess insomnia symptoms and sleep-related beliefs in a population of patients presenting in emergency department with unexplained chest pain (UCP) and (2) to examine the associations between insomnia and pain. METHODS This is a report of secondary data from a cross-sectional study performed in the emergency department of 2 academic hospitals. Patients with UCP seen in an emergency department were assessed using sleep questionnaires and the Anxiety Disorders Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, fourth edition. RESULTS Nearly every second patient with UCP (44%) seen in an emergency department suffered from clinically significant insomnia symptoms. Most patients with an anxiety or a mood disorder had insomnia, but a minority of patients with insomnia had an anxiety or a mood disorder. Insomniacs with an anxiety disorder were similar to insomniacs without comorbid anxiety for sleep-related beliefs and depressive symptoms, and both groups of insomniacs reported more depressive symptoms and faulty beliefs than both groups of good sleepers, i.e., either with or without an anxiety disorder. Results from regression analyses revealed that insomnia was associated with pain on univariate regression analysis and accounted for 1.3% of the variance in both pain intensity and interference. However, this association was rendered nonsignificant when additional variables were added to the model. CONCLUSIONS Insomnia symptoms are an important, but often disregarded, feature present in a significant proportion of patients with UCP. As insomnia showed stronger associations with pain than anxiety or depression, it may represent an important factor contributing to the development and recurrence of UCP.
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Affiliation(s)
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, Québec, Canada (GB, G F-B); The University-Affiliated Hospital of Lévis, Québec, Canada (G F-B, JP, RF)
| | - Julien Poitras
- The University-Affiliated Hospital of Lévis, Québec, Canada (G F-B, JP, RF); Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada (JP, RF)
| | - Jean-Marc Chauny
- Sacré-Coeur Hospital Research Centre, Québec, Canada (J-M C, JGD)
| | - Jean G Diodati
- Sacré-Coeur Hospital Research Centre, Québec, Canada (J-M C, JGD)
| | - Richard Fleet
- The University-Affiliated Hospital of Lévis, Québec, Canada (G F-B, JP, RF); Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada (JP, RF)
| | - André Marchand
- Department of Psychology, Université du Québec à Montréal, Montréal, Canada (AM); Intervention Axis, Centre de Recherche Fernand-Seguin, Mentréal, Canada (AM)
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Fleet R, Foldes-Busque G, Grégoire J, Harel F, Laurin C, Burelle D, Lavoie K. A study of myocardial perfusion in patients with panic disorder and low risk coronary artery disease after 35% CO2 challenge. J Psychosom Res 2014; 76:41-5. [PMID: 24360140 DOI: 10.1016/j.jpsychores.2013.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/02/2013] [Accepted: 08/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND We have previously reported that 35% CO2 challenge induced myocardial ischemia in 81% of coronary artery disease (CAD) patients with comorbid panic disorder (PD) and previous positive nuclear exercise stress tests. However, it is yet unclear whether this is the case among CAD patients with PD and normal nuclear exercise stress test results. We hypothesized that a potent mental stressor such as a panic challenge among CAD patients with PD would also induce ischemia in patients with normal exercise stress tests. METHODS Forty-one coronary artery disease patients with normal nuclear exercise stress tests (21 patients with PD and 20 without PD) were submitted to a well-established panic challenge test (with 1 vital capacity inhalation of a gas mixture containing 35% CO2 and 65% O2) and injected with Tc-99m-tetrofosmin (Myoview), upon inhalation. Single photon emission computed tomography imaging was used to assess per-panic challenge reversible myocardial ischemia and HR, BP, and a 12 lead ECG was continuously measured during the procedure. RESULTS Fifty-eight percent of panic disorder patients (12/21) had a panic attack during the panic challenge vs 15% (3/20) of controls (p=0.005). Only 10% of patients in each group displayed myocardial ischemia per panic challenge. CONCLUSIONS These findings suggest that panic attacks among panic disorder patients with lower-risk coronary artery disease may not confer a risk for myocardial ischemia.
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Affiliation(s)
- Richard Fleet
- Department of Family Medicine Emergency Medicine, Université Laval, Quebec, Canada; Research Chair in Emergency Medicine, Université Laval-Hôtel-Dieu de Lévis, Quebec, Canada.
| | - Guillaume Foldes-Busque
- Research Chair in Emergency Medicine, Université Laval-Hôtel-Dieu de Lévis, Quebec, Canada; School of Psychology, Université Laval, Quebec, Canada
| | - Jean Grégoire
- School of Psychology, Université Laval, Quebec, Canada; Research Centre, Montreal Heart Institute, affiliated with Université de Montréal, Montreal, Canada; Nuclear Medicine Service, Montreal Heart Institute, Montreal, Canada
| | - François Harel
- Research Centre, Montreal Heart Institute, affiliated with Université de Montréal, Montreal, Canada; Nuclear Medicine Service, Montreal Heart Institute, Montreal, Canada
| | - Catherine Laurin
- Department of Medicine, Montreal Heart Institute, Montreal, Canada; Montreal Behavioural Medicine Centre, Research Centre, Department of Chest Medicine, Hôpital du Sacré-Cœur de Montréal, affiliated with Université de Montréal, Montreal, Canada
| | - Denis Burelle
- Research Centre, Montreal Heart Institute, affiliated with Université de Montréal, Montreal, Canada; Department of Medicine, Montreal Heart Institute, Montreal, Canada
| | - Kim Lavoie
- Research Centre, Montreal Heart Institute, affiliated with Université de Montréal, Montreal, Canada; Montreal Behavioural Medicine Centre, Research Centre, Department of Chest Medicine, Hôpital du Sacré-Cœur de Montréal, affiliated with Université de Montréal, Montreal, Canada; Department of Psychology, Université du Québec à Montréal (UQAM), Montreal, Canada; Department of Psychology, University of Calgary, Alberta, Canada
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Foldes-Busque G, Denis I, Poitras J, Fleet RP, Archambault P, Dionne CE. A prospective cohort study to refine and validate the Panic Screening Score for identifying panic attacks associated with unexplained chest pain in the emergency department. BMJ Open 2013; 3:e003877. [PMID: 24163208 PMCID: PMC3808760 DOI: 10.1136/bmjopen-2013-003877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Panic-like anxiety (panic attacks with or without panic disorder), a highly treatable condition, is the most prevalent condition associated with unexplained chest pain in the emergency department. Panic-like anxiety may be responsible for a significant portion of the negative consequences of unexplained chest pain, such as functional limitations and chronicity. However, more than 92% of panic-like anxiety cases remain undiagnosed at the time of discharge from the emergency department. The 4-item Panic Screening Score (PSS) questionnaire was derived in order to increase the identification of panic-like anxiety in emergency department patients with unexplained chest pain. METHODS AND ANALYSIS The goals of this prospective cohort study were to (1) refine the PSS; (2) validate the revised version of the PSS; (3) measure the reliability of the revised version of the PSS and (4) assess the acceptability of the instrument among emergency physicians. Eligible and consenting patients will be administered the PSS in a large emergency department. Patients will be contacted by phone for administration of the criterion standard for panic attacks as well as by a standardised interview to collect information for other predictors of panic attacks. Multivariate analysis will be used to refine the PSS. The new version will be prospectively validated in an independent sample and inter-rater agreement will be assessed in 10% of cases. The screening instrument acceptability will be assessed with the Ottawa Acceptability of Decision Rules Instrument. ETHICS AND DISSEMINATION This study protocol has been reviewed and approved by the Alphonse-Desjardins research ethics committee. The results of the study will be presented in scientific conferences and published in peer-reviewed scientific journals. Further dissemination via workshops and a dedicated website is planned.
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Affiliation(s)
- Guillaume Foldes-Busque
- École de psychologie, Faculté des sciences sociales, Université Laval, Québec, Québec, Canada
- Centre de santé et de services sociaux Alphonse-Desjardins, Research Centre of the University-Affiliated Hospital of Lévis, Québec, Québec, Canada
| | - Isabelle Denis
- Centre de santé et de services sociaux Alphonse-Desjardins, Research Centre of the University-Affiliated Hospital of Lévis, Québec, Québec, Canada
| | - Julien Poitras
- Centre de santé et de services sociaux Alphonse-Desjardins, Research Centre of the University-Affiliated Hospital of Lévis, Québec, Québec, Canada
- Department of Family and Emergency Medicine, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Richard P Fleet
- Centre de santé et de services sociaux Alphonse-Desjardins, Research Centre of the University-Affiliated Hospital of Lévis, Québec, Québec, Canada
- Department of Family and Emergency Medicine, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Patrick Archambault
- Centre de santé et de services sociaux Alphonse-Desjardins, Research Centre of the University-Affiliated Hospital of Lévis, Québec, Québec, Canada
- Department of Family and Emergency Medicine, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Clermont E Dionne
- Centre de recherche FRQS du Centre hospitalier universitaire (CHU) de Québec, Hôpital du St-Sacrement, Québec, Québec, Canada
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Belleville G, Foldes-Busque G, Dixon M, Marquis-Pelletier E, Barbeau S, Poitras J, Chauny JM, Diodati JG, Fleet R, Marchand A. Impact of seasonal and lunar cycles on psychological symptoms in the ED: an empirical investigation of widely spread beliefs. Gen Hosp Psychiatry 2013; 35:192-4. [PMID: 23158676 DOI: 10.1016/j.genhosppsych.2012.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 09/21/2012] [Accepted: 10/06/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study evaluates the impacts of seasonal and lunar cycles on anxiety and mood disorders, panic and suicidal ideation in patients consulting the emergency department (ED) with a complaint of unexplained chest pain (UCP). METHODS Patients with UCP were recruited from two EDs. Psychiatric diagnoses were evaluated with the Anxiety Disorders Interview Schedule for DSM-IV. RESULTS Significant seasonal effects were observed on panic and anxiety disorders, with panic more frequently encountered during spring [odds ratio (OR)=1.378, 95% confidence interval (CI)=1.002-1.896] and anxiety disorders during summer (OR=1.586, 95% CI=1.037-2.425). Except for one significant finding, no significant effects of lunar cycles were observed. These findings encourage ED professionals and physicians to abandon their beliefs about the influence of lunar cycles on the mental health of their patients. Such unfounded beliefs are likely to be maintained by self-fulfilling prophecies.
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Pelland MÈ, Marchand A, Lessard MJ, Belleville G, Chauny JM, Vadeboncoeur A, Poitras J, Foldes-Busque G, Bacon SL, Lavoie KL. Efficacy of 2 interventions for panic disorder in patients presenting to the ED with chest pain. Am J Emerg Med 2011; 29:1051-61. [DOI: 10.1016/j.ajem.2010.06.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 06/27/2010] [Indexed: 11/28/2022] Open
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Foldes-Busque G, Fleet R, Poitras J, Chauny JM, Belleville G, Denis I, Diodati JG, Pelland MÈ, Lessard MJ, Marchand A. Preliminary investigation of the Panic Screening Score for emergency department patients with unexplained chest pain. Acad Emerg Med 2011; 18:322-5. [PMID: 21352398 DOI: 10.1111/j.1553-2712.2011.01009.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective was to demonstrate the derivation and the preliminary validation of a brief screening score to improve recognition of panic-like anxiety in emergency department (ED) patients with unexplained chest pain. METHODS This cross-sectional study included 507 ED patients with unexplained chest pain randomly assigned to the derivation condition (n = 201) or the validation condition (n = 306). The Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) acted as the criterion standard for panic diagnosis. Receiver operating characteristic (ROC) curves were used to determine which of the sociodemographic, medical, and questionnaire response variables best predicted the presence of panic-like anxiety in the derivation condition. The selected predictors were entered in a logistic regression analysis to determine variables to be included in the screening score. The predictive validity of the resulting score was evaluated in both conditions. RESULTS The four-item Panic Screening Score (PSS) identified panic-like anxiety with a sensitivity of 63% (95% confidence interval [CI] = 52% to 73%) and a specificity of 84% (95% CI = 76% to 90%) in the derivation phase. The positive predictive value was 74% (95% CI = 62% to 93%) and the negative predictive value was 76% (95% CI = 68% to 89%). In the validation phase, the sensitivity and specificity were 53% (95% CI = 44% to 62%) and 85% (95% CI = 78% to 89%), respectively. The positive predictive value was 72% (95% CI = 62% to 80%) and the negative predictive value was 71% (95% CI = 65% to 77%). CONCLUSIONS The PSS may be useful to identify patients with unexplained chest pain who could benefit from referral to mental health professionals or their primary care providers for evaluation of panic attack and panic disorder. Prospective studies to improve and validate the PSS, followed by impact analysis, are mandatory before clinical implementation.
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Foldes-Busque G, Marchand A, Chauny JM, Poitras J, Diodati J, Denis I, Lessard MJ, Pelland MÈ, Fleet R. Unexplained chest pain in the ED: could it be panic? Am J Emerg Med 2010; 29:743-51. [PMID: 20825891 DOI: 10.1016/j.ajem.2010.02.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 02/23/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE This study aimed at (1) establishing the prevalence of paniclike anxiety in emergency department (ED) patients with unexplained chest pain (UCP); (2) describing and comparing the sociodemographic, medical, and psychiatric characteristics of UCP patients with and without paniclike anxiety; and (3) measuring the rate of identification of panic in this population. BASIC PROCEDURE A structured interview, the Anxiety Disorders Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, was administered to identify paniclike anxiety and evaluate patients' psychiatric status. Anxious and depressive symptoms were evaluated with self-report questionnaires. Medical information was extracted from patients' medical records. MAIN FINDINGS The prevalence of paniclike anxiety was 44% (95% CI, 40%-48%) in the sample (n = 771). Psychiatric disorders were more common in panic patients (63.4% vs 20.1%), as were suicidal thoughts (21.3% vs 11.3%). Emergency physician diagnosed only 7.4% of panic cases. PRINCIPAL CONCLUSIONS Paniclike anxiety is common in ED patients with UCP, and this condition is rarely diagnosed in this population.
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Foldes-Busque G, Marchand A, Landry P. [Early detection and treatment of panic disorder with or without agoraphobia: update]. Can Fam Physician 2007; 53:1686-1693. [PMID: 17934032 PMCID: PMC2231433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To describe for family physicians screening, diagnosis, and treatment of panic disorder with or without agoraphobia (PD/A). QUALITY OF EVIDENCE Articles were identified through PsycLIT, PsyINFO, and MEDLINE (1985 to 2006) using the terms panic disorder, psychotherapy, psychosocial treatment, treatment, and pharmacotherapy. Recommendations on treatment choices and guidelines are based on data from high-quality studies only. Information about assessment and diagnosis of PD/A is supported by the most recent epidemiologic studies, as well as expert consensus and opinion. MAIN MESSAGE Panic disorder with or without agoraphobia is a psychiatric disease frequently encountered in primary care. It appears to be underdiagnosed and undertreated in this medical setting. Early successful screening requires a focus on unexplained symptoms and specific questions aimed at identifying panic attacks and their meaning for patients. The treatment of choice for PD/A is cognitive-behavioral therapy administered by a specialized psychologist or psychiatrist. When such therapy is hard to come by or unavailable, family physicians can prescribe drug therapy. CONCLUSION Family physicians can contribute greatly to early detection and treatment of PD/A.
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Affiliation(s)
- Guillaume Foldes-Busque
- Département de psychologie, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, QC.
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