Level of incongruence during cardiac rehabilitation and prediction of future CVD-related hospitalizations plus all-cause mortality

Independent of traditional risk factors, psychosocial risk factors increase the risk of cardiovascular disease (CVD). Studies in the field of psychotherapy have shown that the construct of incongruence (meaning a discrepancy between desired and achieved goals) affects the outcome of therapy. We prospectively measured the impact of incongruence in patients after undergoing a cardiac rehabilitation program. We examined 198 CVD patients enrolled in a 8–12 week comprehensive cardiac rehabilitation program. Patients completed the German short version of the Incongruence Questionnaire and the SF-36 Health Questionnaire to measure quality of life (QoL) at discharge of rehabilitation. Endpoints at follow-up were CVD-related hospitalizations plus all-cause mortality. During a mean follow-up period of 54.3 months, 29 patients experienced a CVD-related hospitalization and 3 patients died. Incongruence at discharge of rehabilitation was independent of traditional risk factors a significant predictor for CVD-related hospitalizations plus all-cause mortality (HR 2.03, 95% CI 1.29–3.20, p = .002). We also found a significant interaction of incongruence with mental QoL (HR .96, 95% CI .92–.99, p = .027), i.e. incongruence predicted poor prognosis if QoL was low (p = .017), but not if QoL was high (p = .74). Incongruence at discharge predicted future CVD-related hospitalizations plus all-cause mortality and mental QoL moderated this relationship. Therefore, incongruence should be considered for effective treatment planning and outcome measurement.

Trauerarbeit und Therapie der anhaltenden Trauer

Der Verlust einer nahestehenden Person löst eine Trauerreaktion aus, die eine Anpassung an die veränderte Lebenssituation ermöglicht. In ca. 5 bis15 Prozent der Fälle ist jedoch eine Komplizierung der Trauerreaktion durch eine bestehende psychische Störung oder durch besonders traumatisierende Umstände dokumentiert. Symptome sind überaus starkes Verlangen sowie anhaltendes gedankliches Kreisen um den Verstorbenen und dessen Tod („preoccupation“), Schwierigkeiten, den Tod zu akzeptieren, Bitterkeit oder Ärger über den Verlust und Vermeidungsverhalten. Entsprechend der Intensität der Realitätsverleugnung und allfälliger motivationaler Konflikte sind unterschiedliche Behandlungsprioritäten angezeigt. Die therapeutischen Interventionen lassen sich mit Klärung, bewältigungsorientiertem Vorgehen, Ressourcen- und Problemaktivierung global umschreiben. Forschungsbefunde weisen bei normaler Trauer äußerst geringe, bei komplizierter Trauer hohe Effektstärken psychologischer Interventionen nach.

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

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

Psychische Adaptation nach Verwitwung im Alter : die Rolle personaler Ressourcen und kontextueller Faktoren (Mantelpapier)

Verwitwung stellt ein typisches und dennoch sehr stressreiches kritisches Lebensereignis des späteren Lebensalters dar. Die Forschung zeigt, dass Betroffene Einbussen in verschiedenen Dimensionen des Wohlbefindens im Vergleich zu verheirateten Gleichaltrigen aufweisen. Die Stärke und Dauer dieser negativen Folgen ist jedoch sehr individuell. Sowohl die Multidimensionalität des Wohlbefindens wie auch die Variabilität in der psychischen Adaptation nach Verwitwung wurden in der bisherigen Forschung überwiegend vernachlässigt. Ausgehend davon ist es das Ziel der vorliegenden Inauguraldissertation, die Folgen der Verwitwung für das Wohlbefinden wie auch die individuellen Unterschiede in der psychischen Adaptation differentiell – unter Berücksichtigung von emotionalen, kognitiven, sozialen und physischen Indikatoren – zu untersuchen. Basierend auf einer interaktionistischen Perspektive werden dabei sowohl personale Ressourcen als auch beziehungs-­‐ und verlustbezogene sowie sozio-­‐historische Faktoren als mögliche Determinanten der psychischen Adaptation nach Verwitwung im Alter berücksichtigt. Auf der Grundlage empirischer Daten zweier Forschungsprojekte des Nationalen Forschungsschwerpunkts LIVES zu Partnerschaft und Altern in der Schweiz, wurden zu diesem Ziel vier Artikel veröffentlicht. Diese bestätigen das im Mittel tiefere emotionale, kognitive und soziale Wohlbefinden Verwitweter, wobei das Ausmass dieser Einbussen stark individuell variiert, besonders abhängig von den verfügbaren intrapersonalen Ressourcen. Der Vergleich über dreissig Jahre zeigt, dass sich die sozialen und wirtschaftlichen Fortschritte dieser Zeit besonders für Frauen günstig auf die Herausforderungen der Verwitwung im Alter ausgewirkt haben. Die psychische Bewältigung jedoch zeigt sich unabhängig von den gesellschaftlichen Rahmenbedingungen und so bestätigt sich die Verwitwung – zumindest aus psychologischer Sicht – als eine der grossen Herausforderungen des Alters. Die Artikel werden im vorliegenden Manteltext in den zugrundeliegenden Forschungsstand und theoretischen Zugang eigebettet, ihre Ergebnisse thematisch zusammengefasst, diskutiert und Implikationen für weitere Forschung und Praxis abgeleitet.

Association of Trait Resilience With Peritraumatic and Posttraumatic Stress in Patients With Myocardial Infarction.

OBJECTIVE Acute myocardial infarction (MI) is a life-threatening condition, leading to immediate fear and distress in many patients. Approximately 18% of patients develop posttraumatic stress disorder in the aftermath of MI. Trait resilience has shown to be a protective factor for the development of posttraumatic stress disorder. However, whether this buffering effect has already an impact on peritraumatic distress and applies to patients with MI is elusive. METHODS We investigated 98 consecutive patients with acute MI within 48 hours after having reached stable circulatory conditions and 3 months thereafter. Peritraumatic distress was assessed retrospectively with three single-item questions about pain, fear, and helplessness during MI. All patients completed the Posttraumatic Diagnostic Scale (PDS) and the Resilience Scale to self-rate posttraumatic stress and trait resilience. RESULTS Multivariate models adjusting for sociodemographic and medical factors showed that trait resilience was not associated with peritraumatic distress, but significantly so with posttraumatic stress. Patients with greater trait resilience showed lower PDS scores (b = -0.06, p < .001). There was no significant relationship between peritraumatic distress scores and PDS scores; resilience did not emerge as a moderator of this relationship. CONCLUSIONS The findings suggest that trait resilience does not buffer the perception of acute MI as stressful per se but may enhance better coping with the traumatic experience in the longer term, thus preventing the development of MI-associated posttraumatic stress. Trait resilience may play an important role in posttraumatic stress symptoms triggered by medical diseases such as acute MI.

Perception of a hectic hospital environment at admission relates to acute stress disorder symptoms in myocardial infarction patients.

OBJECTIVE Hospital crowding is a public health problem that may impact on the quality of medical treatment and increase the risk of developing traumatic stress, e.g., after myocardial infarction (MI). This study examines whether subjective appraisal of crowding at hospital admission due to MI is associated with acute stress disorder (ASD) symptoms. METHOD We investigated 102 consecutive patients with acute MI within 48h after having reached stable circulatory conditions. The appraisal of crowding was measured by the retrospective assessment of the perception of a hectic hospital environment at admission. Furthermore, patients completed the Acute Stress Disorder Scale to rate the psychological stress reaction. RESULTS The perception of a hectic hospital environment was associated with the development of ASD symptoms (r=0.254, P=.013) independently of demographic, peritraumatic and medical factors. Post hoc analysis revealed associations with dissociative (r=0.211, P=.041), reexperiencing (r=0.184, P=.074) and arousal (r=0.179, P=.083) symptoms. CONCLUSION The findings suggest that, besides objective circumstances, the way hospital admission due to MI is perceived by the patient may influence the development of MI-triggered ASD symptoms. The psychological and physiological long-term outcomes of the perception of a hectic hospital environment and the role of preventive interventions need further examination.

Minimally invasive extracorporeal circulation resuscitation in hypothermic cardiac arrest.

Current guidelines for the treatment of hypothermic cardiocirculatory arrest recommend extracorporeal life support and rewarming, using cardiopulmonary bypass or extracorporeal membrane oxygenation circuits. Both have design-related shortcomings which may result in prolonged reperfusion time or insufficient oxygen delivery to vital organs. This article describes clear advantages of minimally invasive extracorporeal circulation systems during emergency extracorporeal life support in hypothermic arrest. The technique of minimally invasive extracorporeal circulation for reperfusion and rewarming is represented by the case of a 59-year-old patient in hypothermic cardiocirculatory arrest at 25.3°C core temperature, with multiple trauma. With femoro-femoral cannulation performed under sonographic and echocardiographic guidance, extracorporeal life support was initiated using a minimally invasive extracorporeal circulation system. Perfusing rhythm was restored at 28°C. During rewarming on the mobile circuit, trauma surveys were completed and the treatment initiated. Normothermic weaning was successful on the first attempt, trauma surgery was completed and the patient survived neurologically intact. For extracorporeal resuscitation from hypothermic arrest, minimally invasive extracorporeal circulation offers all the advantages of conventional cardiopulmonary bypass and extracorporeal membrane oxygenation systems without their shortcomings.

The temporal evolution of nonverbal synchrony in outpatient psychotherapy: An aggregation of single-case studies

Objective: The authors quantified nonverbal synchrony—the coordination of patient's and therapist's movement—in a random sample of same-sex psychotherapy dyads. The authors contrasted nonverbal synchrony in these dyads with a control condition and assessed its association with session-level and overall psychotherapy outcome. Method: Using an automated objective video analysis algorithm (Motion Energy Analysis; MEA), the authors calculated nonverbal synchrony in (n = 104) videotaped psychotherapy sessions from 70 Caucasian patients (37 women, 33 men, mean age = 36.5 years, SD = 10.2) treated at an outpatient psychotherapy clinic. The sample was randomly drawn from an archive (N = 301) of routinely videotaped psychotherapies. Patients and their therapists assessed session impact with self-report postsession questionnaires. A battery of pre- and postsymptomatology questionnaires measured therapy effectiveness. Results: The authors found that nonverbal synchrony is higher in genuine interactions contrasted with pseudointeractions (a control condition generated by a specifically designed shuffling procedure). Furthermore, nonverbal synchrony is associated with session-level process as well as therapy outcome: It is increased in sessions rated by patients as manifesting high relationship quality and in patients experiencing high self-efficacy. Higher nonverbal synchrony characterized psychotherapies with higher symptom reduction. Conclusions: The results suggest that nonverbal synchrony embodies the patients' self-reported quality of the relationship and further variables of therapy process. This hitherto overlooked facet of therapeutic relationships might prove useful as an indicator of therapy progress and outcome. (PsycINFO Database Record (c) 2015 APA, all rights reserved)

Trennung, Tod und Trauer - Geschichten zum Verlusterleben und zu dessen Transformation

Einen nahestehenden Menschen zu verlieren, kann langfristig das ganze Leben verändern. Doch was bedeutet „trauern“ eigentlich? Hansjörg Znoj, Experte für Trauer und Trauerverarbeitung, stellt sich dieser Frage und beschreibt ohne Pathos, was wir allgemein unter Trauer verstehen und was wir meinen tun zu müssen, wenn wir einen Verlust erlitten haben. Fakt ist, dass der Verlust eines Angehörigen das soziale Gefüge durcheinanderbringt. Die Auswirkungen betreffen nicht nur die physische Gesundheit, sondern ebenso das seelische Gleichgewicht. Studien weisen darauf hin, dass bis zu 40% aller Trauernden nicht nur unmittelbar, sondern bis zu vielen Jahren nach dem Verlust Symptome einer Depression aufweisen. - Heisst das, dass die übrigen 60% „falsch“ trauern? Nicht immer hat der Verlust einer nahestehenden Person eine emotionale Destabilisierung zur Konsequenz. Muss man sich deswegen schlechtfühlen? Oder hat man zu wenig geliebt?

Das Gebett So Ihr Kön. May. in Schweden Anno 1630 im Monat Aprill in der Insel Riga ankommen, da Er alßbald auff seine Knye nidergefallen, mit auffgereckten Händen zu Gott in Him̄el gethan

[angebl.: Gustav Adolf II. Kupferst.: Hans Jörg Mannasser]