Risk Factors and Psychosocial Correlates of Emotionally Negative Dreams in Patients Referred to a Cardiac Rehabilitation Centre

@#Introduction: Dream, as a kind of mental activity, includes various functions such as mood regulation, adjustment and integration of new information with the available memory system. The study was done for assessing the relationship between physiological and psychological components of cardiac diseases with emotionally negative dreams in cardiac rehabilitation. Methods: At the baseline of this cross-sectional study, 156 patients from Western Iran participated during April–November 2016. People 20 years–80 years able to recall the emotional content of dreams after cardiac surgery entered the study. The Beck depression inventory (BDI), Beck anxiety inventory (BAI), Buss and Perry’s aggression questionnaire (BPAQ) and Schredl’s dream emotions manual were used for collecting data. A binary logistic regression analysis used for the study of the relationship between risk factors and emotionally negative dreams. Results: The mean age of participants was 59 (SD = 9) years (men: 64.1%). The results showed that 25% of patients have negative emotional content. After adjustment for demographic variables, the results showed that increased anxiety [adjusted odds ratio (adj OR) = 1.08 [1.01– 1.16], P = 0.020] and anger (adj OR = 1.03 [1.00–1.06], P = 0.024) and hypertension (adj OR = 2.71 [1.10–6.68], P = 0.030) can predict the dreams with negative content significantly. Conclusion: The increasing rates of anxiety and anger and history of hypertension are related to increasing dreams with the negative emotional load. The control of risk factors of dreams with negative emotional load can be the target of future interventions.

The Mediator Role of Aggression in the Relationship between Marital Stress and Depression among Patients with Coronary Artery Disease

@#Background: Depression is one of the most important consequences of cardiovascular diseases (CVDs), and to control and treat it, it is necessary to identify its direct and indirect triggers and underlying factors. Therefore, the current study aims to evaluate and investigate the mediator role of aggression in the relationship between marital stress and depression. Methods: The sample of current cross-sectional study includes 212 patients with coronary artery disease (CAD) in Iran evaluated from Jan to Jun 2017. The required data were gathered using Beck’s Depression Inventory (BDI) questionnaire, Buss and Perry’s Aggression Questionnaire (BPAQ), and Hudson’s Marital Satisfaction Index (HMSI). The data were analysed using Pearson’s correlation coefficient and structural equation modeling (SEM) using SPSS20 and AMOS software. Results: The mean age of participants (68.4% male) was 58.5 ± 8.9. The results show that there is a significant positive relationship between all the variables (P < 0.05). The results of the model show that marital stress cannot directly predict depression (P = 0.586). However, through aggression, marital stress can significantly predict 18% of the variance of depression (P < 0.001). Conclusions: Not directly, but indirectly through aggression, marital stress can significantly predict increased depression among patients with CAD. The physiological and psychological pathways of the findings can be discussed.

A hybrid cardiac rehabilitation is as effective as a hospital-based program in reducing chest pain intensity and discomfort

BACKGROUND: Health care services effort to provide alternative cardiac rehabilitation (CR) models to serve patients according to their preferences and needs. So, the present study aimed to assess and compare the effects of hospital-based and hybrid CR programs on chest pain intensity and discomfort in cardiac surgery patients. METHODS: In this prospective study, 110 cardiac surgery patients were invited to the CR department of a hospital in the western part of Iran between March and July 2016. Patients were divided into two groups: hospital-based and hybrid CR. The hospital-based program included 26 sessions, and the hybrid program included 10 training sessions and exercise. The Brief Pain Inventory and Pain Discomfort Scale were used as research instrument, and data were analyzed using the paired t-test and ANCOVA. RESULTS: The results indicated that both hospital-based and hybrid CR are effective in reducing the chest pain intensity and discomfort of cardiac surgery patients (P 0.05). CONCLUSIONS: Traditional hospital-based CR delivery is still the first choice for treatment in developing countries. However, hybrid CR is as effective as a hospital-based program in reducing pain components and it includes only 38% of the total cost in comparison to hospital-based delivery. So, we recommend using hybrid CR according with the recommendations of American Heart Association about using CR for the management of angina symptoms.

Irrational beliefs predict pain/discomfort and emotional distress as a result of pain in patients with non-cardiac chest pain

No abstract available.

How effective is the use of metaphor therapy on reducing psychological symptoms and pain discomfort in patients with non-cardiac chest pain: a randomized, controlled trial

Introduction: Psychological symptoms of non-cardiac chest pain [NCCP] including perceptual, emotional, and behavioral problems can effect patient perception of chest pain. This study was conducted to determine the effect of metaphor therapy on mitigating depression, anxiety, stress, and pain discomfort in patients with NCCP

Materials and Methods: This randomized, controlled, trial was conducted on 28 participants, who had visited the emergency department of Kermanshah Imam Ali Heart Hospital because of experiencing NCCP during the June to September 2014. The patients were randomly assigned to metaphor therapy and control groups [n=14 for each group] during a four-week period. Our data collection questionnaires included Pain Discomfort Scale [PDS] and Depression, Anxiety and Stress Scale [DASS]. Chi-square and MANCOVA tests were run, using SPSS version 20

Results: Twenty patients [71.4%] completed the trial period until the final assessment. Our findings showed that metaphor therapy couldn't lower depression, anxiety, stress, and pain discomfort; In fact, there was not a significant difference between the metaphor therapy and control groups regarding the aforementioned variables [P>0.05]

Conclusions: Although the study results did not support the effectiveness of metaphor therapy for NCCP, further studies on the potential role of metaphor therapy in attenuating NCCP symptoms seem to be necessary

Non-Coronary Patients with Severe Chest Pain Show More Irrational Beliefs Compared to Patients with Mild Pain / 가정의학회지

BACKGROUND: Despite providing insufficient medical evidence of the existence of a real cardiac condition, patients with non-coronary chest pain still interpret their pain incorrectly. The present study, therefore, sought to compare the irrational beliefs in non-coronary patients with mild chest pain against those with severe chest pain. METHODS: A cross-sectional design was used. The statistical population comprised non-coronary patients who presented to the Heart Emergency Center of Kermanshah city, Iran. Using a matching method, 96 participants were selected and studied in two groups of 48. The instruments used were the Comorbidity Index, Brief Pain Index, and the Jones Irrational Beliefs Test (short-form). The multivariate analysis of variance, chi-square test, and t-test were used for data analysis. RESULTS: Controlling for the effects of age and comorbid conditions, the severity of three types of irrational beliefs, including emotional irresponsibility (P<0.001), hopelessness changes (P<0.001), and problem avoiding (P=0.002) was higher among patients with severe chest pain (according to effect level). However, in terms of demand for approval, no difference was seen between the two groups (P=0.180). CONCLUSION: Non-coronary patients with severe chest pain showed a greater number of irrational beliefs in comparison to patients with mild pain. Irrational beliefs are common mental occurrences in patients with non-coronary chest pain, and they should be attended to by health professionals, especially in severe non-coronary chest pain. Further investigation to determine the association between irrational beliefs and non-coronary chest pain is necessary.

Sociodemographic Predictors in Failure to Complete Outpatient Cardiac Rehabilitation

OBJECTIVE: To investigate the role of sociodemographic factors in failure to complete outpatient cardiac rehabilitation (CR). METHODS: This was a retrospective study that used information obtained from the database of the cardiac rehabilitation department of a cardiac hospital in Iran. Data from 1,050 CR patients treated at the hospital between January 2001 and January 2013 was analyzed using binary logistic regression analysis. RESULTS: Only 49% of the patients completed the CR program. After adjustment for baseline variables, it was found that the following were significantly associated with failure to complete the CR program: illiteracy (p<0.001), old age (p<0.001), being an employee or retired (p<0.05), having a low capacity for exercise (p<0.001), depression (p<0.001), low anxiety (p<0.001), and not currently being a smoker (p<0.001). CONCLUSION: Paying more attention to older patients with low literacy levels and limited exercise capacity, who are employed or retired, and who are not current smokers, and taking therapeutic measures to control psychological complications such as depression, may be effective in ensuring that patients complete outpatient cardiac rehabilitation.

Which Factors Unexpectedly Increase Depressive Symptom Severity in Patients at the End of a Cardiac Rehabilitation Program?

OBJECTIVE: To investigate predictors of depressive symptom aggravation at the end of a cardiac rehabilitation (CR) program. METHODS: The design of the study was retrospective. The administrative data were obtained from the database of the CR department of a heart hospital in Iran. The demographic and clinical information of 615 CR patients between January 2000 and January 2010 was analyzed using binary logistic regression analysis. RESULTS: The results showed that 10.7% of the patients completed the CR program with aggravated depressive symptoms. After adjustment for gender, age, and pre-intervention depression score, lower education level (p<0.05) and smoking (p<0.01) were significant predictors of increased depressive symptoms at the end of the program. Our model variables could explain 6% to 13% of the dependent variable variance. CONCLUSION: The results suggest that targeting patients who are less literate or who smoke could allow for taking the required measures to prevent or control depression at the end of a CR program. It is suggested that future studies consider other variables.

Reducing Irrational Beliefs and Pain Severity in Patients Suffering from Non-Cardiac Chest Pain (NCCP): A Comparison of Relaxation Training and Metaphor Therapy

BACKGROUND: Patients suffering from non-cardiac chest pain (NCCP) can interpret their chest pain wrongly despite having received a correct diagnosis. The objective of this study was to compare the efficacy of the relaxation method with metaphor therapy for reducing irrational beliefs and pain severity in patients with NCCP. METHODS: Using a randomized controlled trial, 33 participants were randomly divided into a relaxation training group (n= 13), a metaphor therapy group (n = 10), and a control group (n = 10), and were studied for 4 weeks. The two tools used in this research were the Brief Pain Inventory (BPI) index for determining the degree of pain and the short version of the Jones Irrational Belief Test. Metaphor therapy and a relaxation technique based on Ost's treatment were used as the interventions. The collected data were analyzed with a multivariate analysis of covariance (MANCOVA), a Chi-square test, and the Bonferroni procedure of post-hoc analysis. RESULTS: The relaxation training method was significantly more effective than both metaphor therapy and the lack of treatment in reducing the patients' beliefs of hopelessness in the face of changes and emotional irresponsibility, as well as the pain severity. Metaphor therapy was not effective on any of these factors. In fact, the results did not support the effectiveness of metaphor therapy. CONCLUSIONS: Regarding the effectiveness of the relaxation method as compared with metaphor therapy and the lack of treatment in the control group, this study suggests that relaxation should be paid greater attention as a method for improving the status of patients. In addition, more studies are needed to determine the effectiveness of metaphor therapy in this area.

Gender differences in patients' beliefs about biological, environmental, behavioral, and psychological risk factors in a cardiac rehabilitation program

Introduction: There are significant gender differences in the epidemiology and presentation of cardiovascular diseases [CVDs], physiological aspects of CVDs, response to diagnostic tests or interventions, and prevalence or incidence of the associated risk factors. Considering the independent influence of gender on early dire consequences of such diseases, this study was conducted to investigate gender differences in patients' beliefs about biological, environmental, behavioral, and psychological risk factors in a cardiac rehabilitation program

Materials and Methods: This study has cross sectional design. The sample was composed of 775 patients referred to cardiac rehabilitation unit in Imam Ali Hospital in Kermanshah, Iran. The data were collected using clinical interview and patients' medical records. The data were analyzed using descriptive statistics such as mean, standard deviation, and chi-square test. To do the statistical analysis, SPSS version 20 was utilized

Results: As the results indicated, there was a significant difference between the beliefs of men and women about risk factors of heart disease [X[2]= 48.36; P<0.01]. Men considered behavioral [55.1%] and psychological [33.7%] risk factors as the main causes of their disease, respectively. On the other hand, women regarded psychological [38.2%] and behavioral factors [26.6%] as the most common causes of cardiac conditions, respectively. Both men and women considered stress as the most important heart disease risk factor [21% and 22.3%, respectively]. Also, women were less aware of the risk factors, compared to men

Conclusion: From the patients' perspective, psychological and behavioral risk factors were the most important causes of cardiovascular diseases [CVDs]; moreover, stress was the most influential risk factor for developing cardiac diseases. Thus, learning to control and manage these risk factors can help to prevent the development of CVDs and reduce the occurrence of subsequent cardiac events

[Changes in exercise capacity and modifiable risk factors after a comprehensive cardiac rehabilitation in patients with and without left ventricular systolic dysfunction]

Although the positive effects of cardiac rehabilitation [CR] for patients with heart failure have been known, only a small proportion of such patients have been referred for comprehensive CR. The aim of this study is to compare the extent to which a CR program improved the exercise capacity and modifiable risk factors of patients with and without impaired systolic function. This study was an observational study undertaken in Imam Ali Hospital in Kermanshah [2001 - 2006], the only referral center for CR in the west of Iran. 503 patients, who completed CR program, were included in this study. They were divided into two groups: impaired systolic function with ejection fractions [EF] < 50% [n=185] and normal systolic function [EF >/= 50%, n=317]. Both groups were comparable in terms of all baseline characteristics such as BMI, hypertension, smoking and diabetes. There were significant improvements in exercise capacity, BMI, waist circumference, total cholesterol, LDL, triglyceride, systolic and diastolic blood pressure and depression score in both groups after CR [P<0.001]. However, the effect of CR on HDL did not reach a statistical significant level in either group. In addition further analyses showed that there was no statistically significant differences between patients with severe impaired systolic function [EF < 35%] and normal EF, however changes in lipid profiles were not statistically significant. This study confirmed that the effects of CR on improvement of exercise capacity and risk profiles are almost equal in patients with and without systolic dysfunction