Panic Disorder and Agoraphobia in OCD patients: Clinical profile and possible treatment implications

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Occurrence of bipolar spectrum disorder and comorbidities in women with eating disorders

Abstract Background Eating disorder (ED) patients often have comorbidities with other psychiatric disorders, especially with mood disorders. Although recent studies suggest an intimate relationship between ED and bipolar disorder (BD), the study on a broader bipolar spectrum definition has not been done in this population. We aimed to study the occurrence of bipolar spectrum (BS) and comorbidities in eating disorder patients of a tertiary service provider. Methods Sixty-nine female patients diagnosed with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified were evaluated. The assessment comprised the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), clinical criteria for diagnosis of the Zurich bipolar spectrum. Mann–Whitney tests compared means of continuous variables. The association between categorical variables and the groups was described using contingency tables and analyzed using the chi-square or Fisher's exact test. The level of significance alpha was set at 5%. Results The results showed that 68.1% of patients had comorbidity with bipolar spectrum, and this was associated with higher family income, proportion of married people, and comorbidity with substance use. The ED with BS group showed higher rates of substance use comorbidity (40.4%) than the ED without BS group (13.6%). Discussion These results showed that the bipolar spectrum is a common comorbidity in patients with eating disorders and is associated with correlates of clinical importance, notably the comorbidity with substance use. Due to the pattern of similarity between the groups with and without comorbid bipolar spectrum in relation to various outcomes evaluated, the identification of comorbidity can be difficult. However, the precise diagnosis and careful identification of clinical correlates may contribute to future advances in treating these conditions. Further studies are necessary to evaluate the association of other clinical correlates and its possible causal association.

Stima dei parametri spazio temporali del cammino a partire da sensori inerziali: Una revisione critica della letteratura

L’analisi del cammino è uno strumento in grado di fornire importanti informazioni sul ciclo del passo; in particolare è fondamentale per migliorare le conoscenze biomeccaniche del cammino, sia normale che patologico, e su come questo viene eseguito dai singoli soggetti. I parametri spazio temporali del passo rappresentano alcuni degli indici più interessanti per caratterizzare il cammino ed il passo nelle sue diverse fasi. Essi permettono infatti il confronto e il riconoscimento di patologie e disturbi dell’andatura. Negli ultimi anni è notevolmente aumentato l’impiego di sensori inerziali (Inertial Measurement Unit, IMU), che comprendono accelerometri, giroscopi e magnetometri. Questi dispositivi, utilizzati singolarmente o insieme, possono essere posizionati direttamente sul corpo dei pazienti e sono in grado fornire, rispettivamente, il segnale di accelerazione, di velocità angolare e del campo magnetico terrestre. A partire da questi segnali, ottenuti direttamente dal sensore, si è quindi cercato di ricavare i parametri caratteristici dell’andatura, per valutare il cammino anche al di fuori dell’ambiente di laboratorio. Vista la loro promettente utilità e la potenziale vasta applicabilità nell’analisi del ciclo del cammino; negli ultimi anni un vasto settore della ricerca scientifica si è dedicata allo sviluppo di algoritmi e metodi per l’estrazione dei parametri spazio temporali a partire da dati misurati mediante sensori inerziali. Data la grande quantità di lavori pubblicati e di studi proposti è emersa la necessità di fare chiarezza, riassumendo e confrontando i metodi conosciuti, valutando le prestazioni degli algoritmi, l’accuratezza dei parametri ricavati, anche in base alla tipologia del sensore e al suo collocamento sull’individuo, e gli eventuali limiti. Lo scopo della presente tesi è quindi l’esecuzione di una revisione sistematica della letteratura riguardante la stima dei parametri spazio temporali mediante sensori inerziali. L’intento è di analizzare le varie tecniche di estrazione dei parametri spazio temporali a partire da dati misurati con sensori inerziali, utilizzate fino ad oggi ed indagate nella letteratura più recente; verrà utilizzato un approccio prettamente metodologico, tralasciando l’aspetto clinico dei risultati.

Eating disorders in children and adolescents: an update

Purpose of review Children and adolescents with eating disorders frequently present to child mental health and paediatric services and have significant morbidity, psychosocial impairment and mortality. Efforts to treat these individuals have been hampered by a poor evidence base for effective interventions. This article reviews research published during 2004 with a primary focus on this challenging clinical area. Recent findings Research published during 2004 has replicated past epidemiological findings and expanded our understanding of the relationship of family meal structure and disordered eating. Research has provided assistance in the well known clinical conundrums of excessive exercising in anorexia nervosa and predicting when return of menses will occur. There has also been clarification of adolescent bingeing. Potential advances include a new, noninvasive method of measuring body composition and investigations in adolescents on leptin, neuro and gastrointestinal peptides. Importantly, further evidence of the effectiveness of family therapy for anorexia nervosa and short-term benefits from intervention programs have been published. Summary The research base that will influence clinical practice in child and adolescent eating disorders is increasing. More research is required in all areas of intervention.

Illness perceptions, beliefs and prevention of Type 2 Diabetes among British Pakistani mothers and young British Pakistani women

The prevalence rates of type2 diabetes mellitus (T2DM) continues to rise among British Pakistanis. The aim of this project was to explore T2DM perceptions and any preventative intentions among British Pakistani women and to discover whether they are doing anything to prevent the onset in themselves and their families. Initially a systematic review was conducted to investigate 20 existing prevention interventions and to assess their effectiveness (n=12,419). Mixed methods approach was adopted and three studies were conducted. The first study consisted of two focus groups with T2DM mothers (n=8) and three focus groups with non-T2DM mothers (n=17). The second study consisted of four focus groups young British Pakistani females (n=11). All focus groups were transcribed verbatim and analysed using thematic analysis. Following these a quantitative study was undertaken comprising of a questionnaire survey; 12 prevention-perception items (derived from the qualitative data) and the Illness-Perception Questionnaire Revised (IPQ-R) using participants from the same populations: T2DM mothers (n=41), non-T2DM mother (n=47) and young women (n=42). Results were analysed using multiple/hierarchical regression. The systematic review highlighted that the most effective prevention programmes focussed on behaviour and lifestyle with a combination of support and education to participants. The research studies demonstrated that T2DM was seen as an older person’s disease to be dealt with if/when it happens. T2DM mothers demonstrated knowledge and prevention understanding. There were non-significant relationships between prevention perceptions and T2DM illness perceptions across all three groups. The finding of this thesis emphasised that lifestyle interventions are crucial to aiding T2DM preventions as a good healthy diet and regular physical activity are the key components to T2DM prevention, and the importance of personal experience in perceived severity and lay-beliefs regarding T2DM and on family/cultural influences in British-Pakistanis. The findings of this project can be used to design culturally specific interventions towards preventing T2DM in the British Pakistani community.

Can illness perceptions and coping predict psychological distress amongst allergy sufferers?

Objective. The aim of the present study was to measure the extent to which illness perceptions and coping strategies are associated with the levels of psychological distress amongst allergy sufferers. Design and method. One hundred and fifty-six allergy sufferers (all members of Allergy U.K.) completed a postal survey consisting of the Revised Illness Perception Questionnaire (IPQ-R) and the COPE. Psychological distress was measured using the General Health Questionnaire (GHQ-28) and the Perceived Stress Scale (PSS). Results. Multiple regression analyses indicated that illness perceptions explained between 6 and 26% of variance on measures of psychological distress; coping strategies explained between 12 and 25%. A strong illness identity and emotional representations of the allergy were associated with higher levels of psychological distress; as were less adaptive coping strategies such as focusing on and venting of emotions. Strong personal control beliefs were associated with the lower levels of distress, as were adaptive coping strategies such as positive reinterpretation and growth. Coping partially mediated the link between the illness perceptions and the outcome; however, illness identity, emotional representations and personal control retained an independent significant association with psychological distress. Conclusion. The findings support a role for illness perceptions and coping in explaining levels of psychological distress amongst allergy sufferers. This has implications for targeted health interventions aimed at reducing the strength of illness identity and emotional representations and increasing a sense of control and the use of more adaptive coping strategies.

Illness perceptions and hearing difficulties in King-Kopetzky syndrome:what determines help seeking?

The present study explored illness perceptions of hearing difficulties amongst one hundred participants who reported experiencing hearing difficulties despite normal audiometric thresholds. This experience is referred to as King-Kopetzky syndrome (KKS), obscure auditory dysfunction (OAD), or auditory processing disorder (APD). Logistic regression was used to consider the associations between help-seeking and a range of audiological and illness perception measures. Results indicate that help-seekers present with poorer speech in noise thresholds than non help-seekers, and that coherent illness perceptions and a negative belief in the consequences of hearing difficulties are associated with help-seeking status, regardless of hearing sensitivity.

Percepções de doença e tratamento, estado emocional e satisfação nos cuidados de saúde em imagiologia

Mestrado em Intervenção Sócio-Organizacional na Saúde - Área de especialização: Políticas de Administração e Gestão de Serviços de Saúde.

Adesão à terapêutica e controlo da doença na asma: papel das perceções de doença

Objetivo: Identificar perceções de doença e sua associação com a adesão e controlo da doença na asma. Metodologia: Estudo observacional-descritivo transversal, em que participaram 33 estudantes de ambos os sexos, 18-29 anos, que completaram o Illness Perception Questionnaire, a Medida de Adesão aos Tratamentos e o Asthma Control Test. Resultados: A maioria perceciona a asma como doença crónica cíclica, controlável pela sua ação ou tratamento, tem perceção adequada do controlo da sua asma e bom nível de adesão, embora refira comportamentos de não adesão. Foi encontrada correlação significativa negativa entre adesão e perceção de duração da doença e positiva entre perceção de controlo (tratamento) e nível de controlo da doença e entre sintomas e perceção de controlo. Discussão: Os resultados evidenciam o papel das perceções de doença na adoção de comportamentos de saúde, reforçando a necessidade de intervenções centradas no doente, que potenciem o seu envolvimento no controlo da asma.

Perceções de doença como determinantes de comportamentos de saúde na asma

Objetivos: Identificar e caracterizar perceções de doença e sua associação com níveis de adesão à terapêutica e controlo da doença na asma. Métodos: Estudo observacional-descritivo transversal cuja amostra é constituída por 33 estudantes asmáticos, de ambos os sexos e idade 18-29 anos (M=20,33; DP=2,04), que completaram o Illness Perception Questionnaire (IPQ-R), a Medida de Adesão aos Tratamentos (MAT) e o Asthma Control Test (ACT). Resultados: A maioria dos indivíduos percepciona a asma como doença crónica, cíclica, que pode ser controlada pela sua acção e/ou tratamento. A maioria apresenta um bom nível de controlo da asma, evidenciando 84,8% uma perceção adequada do controlo da sua doença. Embora apresentem um bom nível de adesão, apenas 28% toma medicação preventiva diariamente, referindo 45,2% já ter interrompido a medicação por se sentir melhor. Foram encontradas correlações significativas entre nível de adesão e perceção de duração cíclica da doença (rs (30)= -0,38; p<0,05), entre perceção de controlo através do tratamento e nível de controlo da doença (rs (33) = 0,386; p<0,05) e entre sintomas e perceção de controlo da doença (rs (33) = 0,737; p<0,01). Conclusões: Os resultados evidenciam o papel das perceções de doença na adoção de comportamentos de saúde na asma, nomeadamente a adesão à terapêutica, que vão traduzir-se no nível de controlo alcançado pelos doentes. Desenvolver intervenções individualizadas, centradas no doente, que contribuam para corrigir crenças inadequadas poderá, pois, potenciar um envolvimento ativo do doente no controlo da sua doença, contribuindo para uma melhoria da sua Qualidade de Vida.

Reproducibility and Reliability of the Quality of Life Questionnaire in Patients With Atrial Fibrillation

Abstract Background: Studies have shown the impact of atrial fibrillation (AF) on the patients' quality of life. Specific questionnaires enable the evaluation of relevant events. We previously developed a questionnaire to assess the quality of life of patients with AF (AFQLQ version 1), which was reviewed in this study, and new domains were added. Objective: To demonstrate the reproducibility of the AFQLQ version 2 (AFQLQ v.2), which included the domains of fatigue, illness perception and well-being. Methods: We applied 160 questionnaires (AFQLQ v.2 and SF-36) to 40 patients, at baseline and 15 days after, to measure inter- and intraobserver reproducibility. The analysis of quality of life stability was determined by test-retest, applying the Bartko intraclass correlation coefficient (ICC). Internal consistency was assessed by Cronbach's alpha test. Results: The total score of the test-retest (n = 40) had an ICC of 0.98 in the AFQLQ v.2, and of 0.94 in the SF36. In assessing the intra- and interobserver reproducibility of the AFQLQ v.2, the ICC reliability was 0.98 and 0.97, respectively. The internal consistency had a Cronbach's alpha coefficient of 0.82, compatible with good agreement of the AFQLQ v.2. Conclusion: The AFQLQ v.2 performed better than its previous version. Similarly, the domains added contributed to make it more comprehensive and robust to assess the quality of life of patients with AF.

Les représentations émotionnelles de la maladie chez les proches aidants de personnes atteintes de schizophrénie

Problématique : Les proches aidants fournissent un soutien considérable aux patients atteints de schizophrénie et peuvent dans ce contexte éprouver des sentiments pénibles conduisant à une augmentation de leur détresse qui peut elle-même accroître le risque de rechutes des patients. Des chercheurs préconisent de mieux connaître les sentiments pénibles des proches pour mieux cibler les interventions psychoéducatives comme le programme Profamille. Selon Leventhal, Leventhal et Schaefer (1991), ces sentiments pénibles font partie du concept de représentations émotionnelles. But : Examiner les représentations émotionnelles formées suite à l'apparition de la maladie chez les proches aidants de personnes atteintes de schizophrénie et explorer les relations entre ces représentations émotionnelles, les caractéristiques des proches aidants et les caractéristiques de ceux ou celles dont ils s'occupent. Méthode : Selon une méthode d'échantillonnage non probabiliste par convenance, cette étude descriptive exploratoire a inclus 45 proches aidants membres de trois associations du Réseau Profamille en Suisse romande ayant plus d'une heure de contact par mois avec le proche atteint de schizophrénie dont ils ou elles s'occupent. Les deux instruments auto-administrés étaient un questionnaire sociodémographique et une sous-échelle du Illness Perception Questionnaire for Schizophrenia: Relatives' Version. Résultats : Les participants, âgés en moyenne de 57 ans et tous membres de la famille du patient, étaient le plus fréquemment des femmes et des parents ayant effectué le programme Profamille. Les proches atteints de schizophrénie, âgés en moyenne de 35 ans et utilisant en moyenne deux services professionnels de la communauté, étaient le plus souvent des hommes vivant en dehors du foyer familial. Les dimensions des représentations émotionnelles remportant le plus haut niveau d'accord des proches aidants étaient les inquiétudes, le sentiment d'être bouleversé, l'anxiété, le sentiment de perte et le sentiment d'être déprimé. Les dimensions remportant moins d'accords étaient la peur, la frustration et la colère, tandis que la dimension de la dévalorisation remportait le plus souvent aucun accord. Les résultats indiquent également que : plus les proches aidants sont âgés, plus ils rapportent vivre de l'anxiété ; plus le nombre de personnes dans leur foyer est élevé, moins les proches aidants rapportent vivre les sentiments d'être bouleversés et anxieux ; plus le nombre de services de la communauté utilisés par le proche atteint de schizophrénie est élevé, plus les participants rapportent vivre une inquiétude. En outre, les participants présentaient des scores significativement moins élevés à la sous-échelle représentations émotionnelles et à sa dimension sentiment d'être déprimé, si leur proche malade était suivi par un généraliste. D'un autre côté, les participants étaient significativement plus bouleversés, si leur proche atteint de maladie avait un suivi infirmier. Conclusion : Ces résultats ne peuvent être généralisés qu'à des proches aidants présentant les mêmes caractéristiques que ceux inclus dans cette étude et vivant dans des contextes similaires. Les dispositifs professionnels, comme le programme Profamille, pourraient renforcer leurs capacités à explorer les émotions pénibles des proches aidants, en premier lieu leurs inquiétudes, et leurs habiletés à trouver, en collaboration avec ces derniers, des moyens permettant de les diminuer.

Préconditionnement ischémique et exercice : de la réadaptation à la performance

La pratique d’activité physique fait partie intégrante des recommandations médicales pour prévenir et traiter les maladies coronariennes. Suivant un programme d’entraînement structuré, serait-il possible d’améliorer la réponse à l’exercice tout en offrant une protection cardiaque au patient? C’est ce que semblent démontrer certaines études sur le préconditionnement ischémique (PCI) induit par un test d’effort maximal. Les mêmes mécanismes physiologiques induits par le PCI sont également observés lorsqu’un brassard est utilisé pour créer des cycles d’ischémie/reperfusion sur un muscle squelettique. Cette méthode est connue sous l’appellation : préconditionnement ischémique à distance (PCID). À l’autre extrémité du spectre de l’activité physique, des sportifs ont utilisé le PCDI durant leur échauffement afin d’améliorer leurs performances. C’est dans l’objectif d’étudier ces prémisses que se sont construits les projets de recherches suivants. La première étude porte sur les effets du PCID sur des efforts supra maximaux de courte durée. Les sujets (N=16) ont exécuté un test alactique (6 * 6 sec. supra maximales) suivi d’un test lactique (30 secondes supra maximales) sur ergocycle. Les sujets avaient été aléatoirement assignés à une intervention PCID ou à une intervention contrôle (CON) avant d’entreprendre les efforts. La procédure PCID consiste à effectuer quatre cycles d’ischémie de cinq minutes à l’aide d’un brassard insufflé à 50 mm Hg de plus que la pression artérielle systolique sur le bras. Les résultats de ce projet démontrent que l’intervention PCID n’a pas d’effets significatifs sur l’amélioration de performance provenant classiquement du « système anaérobie », malgré une légère hausse de la puissance maximal en faveur du PCID sur le test de Wingate de trente secondes (795 W vs 777 W) et sur le test de force-vitesse de six secondes (856 W vs 847 W). Le deuxième essai clinique avait pour objectif d’étudier les effets du PCID, selon la méthode élaborée dans le premier projet, lors d’un effort modéré de huit minutes (75 % du seuil ventilatoire) et un effort intense de huit minutes (115 % du seuil ventilatoire) sur les cinétiques de consommation d’oxygène. Nos résultats démontrent une accélération significative des cinétiques de consommation d’oxygène lors de l’intervention PCID par rapport au CON aux deux intensités d’effort (valeur de τ1 à effort modéré : 27,2 ± 4,6 secondes par rapport à 33,7 ± 6,2, p < 0,01 et intense : 29,9 ± 4,9 secondes par rapport à 33,5 ± 4,1, p < 0,001) chez les sportifs amateurs (N=15). Cela se traduit par une réduction du déficit d’oxygène en début d’effort et une atteinte plus rapide de l’état stable. Le troisième projet consistait à effectuer une revue systématique et une méta-analyse sur la thématique du préconditionnement ischémique (PCI) induit par un test d’effort chez les patients coronariens utilisant les variables provenant de l’électrocardiogramme et des paramètres d’un test d’effort. Notre recherche bibliographique a identifié 309 articles, dont 34 qui ont été inclus dans la méta-analyse, qui représente un lot de 1 053 patients. Nos analyses statistiques démontrent que dans un effort subséquent, les patients augmentent leur temps avant d’atteindre 1 mm de sous-décalage du segment ST de 91 secondes (p < 0,001); le sous-décalage maximal diminue de 0,38 mm (p < 0,01); le double produit à 1 mm de sous-décalage du segment ST augmente de 1,80 x 103 mm Hg (p < 0,001) et le temps total d’effort augmente de 50 secondes (p < 0,001). Nos projets de recherches ont favorisé l’avancement des connaissances en sciences de l’activité physique quant à l’utilisation d’un brassard comme stimulus au PCID avant un effort physique. Nous avons évalué l’effet du PCID sur différentes voies métaboliques à l’effort pour conclure que la méthode pourrait accélérer les cinétiques de consommation d’oxygène et ainsi réduire la plage du déficit d’oxygène. Nos découvertes apportent donc un éclaircissement quant à l’amélioration des performances de type contre-la-montre étudié par d’autres auteurs. De plus, nous avons établi des paramètres cliniques permettant d’évaluer le PCI induit par un test d’effort chez les patients coronariens.