Factores asociados con la ansiedad por la salud en estudiantes de Medicina de una universidad privada en Lima, Perú / Factors Associated with Health Anxiety in Medical Students at a Private University in Lima, Peru

RESUMEN Introducción: Existen pocos estudios que examinen los factores asociados con los distintos niveles ansiedad por la salud en los estudiantes de Medicina. El objetivo es determinar los factores asociados con los niveles de ansiedad por la salud en estudiantes de Medicina en el ario 2018. Métodos: Se realizó un estudio transversal analítico con 657 estudiantes de Medicina de una universidad privada peruana. Los participantes respondieron a un cuestionario donde se recopiló la información respecto a los niveles de ansiedad por la salud (SHAI). Para el análisis se empleó la regresión lineal para calcular los betas, brutos y ajustados, y sus intervalos de confianza del 95%. Resultados: El promedio de la puntuación de ansiedad por la salud fue de 14 ± 6,7. Se reporta una asociación entre la ansiedad por la salud y el año de estudio, y el segundo año es el que revela puntuaciones más altas. Además, pone de manifiesto la asociación entre la ansiedad por la salud y el consumo de tabaco, pues hay niveles más altos en los fumadores ocasionales, así como una débil correlación inversa con la edad. No se revela asociación con el sexo, el lugar de nacimiento, tener un familiar de primer grado médico o un familiar de primer grado personal saiario. Conclusiones: El presente estudio evidenció que la edad, el año de estudios y el consumo de tabaco se asocian con los niveles de ansiedad por la salud. Se requieren más estudios, especialmente de naturaleza longitudinal.

ABSTRACT Introduction: There are few studies that examine the factors associated with the different levels of health anxiety in medical students. The objective was to determine the factors associated with the levels of health anxiety in medical students in 2018. Methods: An analytical cross-sectional study was carried out with 657 medical students from a private Peruvian university. Participants answered a questionnaire from which information was collected regarding levels of health anxiety (SHAI). For the analysis, linear regression was used to calculate crude and adjusted betas, and their 95% confidence intervals. Results: The mean health anxiety score was 14 ± 6.7. An association between health anxiety and the year of study is reported, with the second year showing the highest scores. In addition, an association between health anxiety and smoking is highlighted, as there are higher levels in occasional smokers, as well as a weak inverse correlation with age. No association was found with sex, place of birth, or having a first-degree relative that is a doctor or health worker. Conclusions: The present study showed that age, year of studies and smoking are associated with health anxiety levels. More studies are required, especially of a longitudinal nature.

Reliability and Validity of the Korean Version of Health Anxiety Questionnaire

OBJECTIVE: Health anxiety can be defined by concern about health in the absence of a pathology. The Health Anxiety Questionnaire (HAQ) based on the cognitive-behavioral model can be useful for evaluating the severity and the structure of health anxiety. This study aims to verify the reliability and validity of Korean version of HAQ (K-HAQ). METHODS: For reliability, test-retest reliability and internal consistency were analyzed. For construct validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted. Receiver Operating Characteristic (ROC) analysis was performed to identify the optimal cut-off score. RESULTS: Cronbach’s alpha was 0.92, and r value of test-retest reliability was 0.84. In the EFA, 4- and 5-factor model showed cumulative percentile of variance of 60% or more. In the CFA, the 4-factor model was found to be the most appropriate and simplest (χ²=397.33, df=187, CFI=0.909, TLI=0.888, RMSEA=0.077). In the ROC analysis, the cut-off score was 20 points. CONCLUSION: It is expected that K-HAQ can be helpful to evaluate the severity of health anxiety and make therapeutic plans because K-HAQ can help explore the cognitive, emotional, and behavioral structure of health anxiety by each factor.

Personality assessment in chronic pain patients / Avaliação da personalidade em pacientes com dor crônica

Abstract In Brazil, studies investigating the personality characteristics of chronic pain patients are scarce. The present study aimed to evaluate the personality characteristics of patients with chronic pain and to compare them with those of patients without this condition. To this end, the Personality Disorders Dimensional Inventory and the Hypochondriasis scale of the Brazilian version of the Minnesota Multiphasic Personality Inventory were administered. Two different statistical analyses were carried out: the t - test to determine the differences between the scores for the two groups and the logistic regression analysis to examine the predictive power of the scales for the diagnosis of chronic pain. The results revealed significant differences (p < 0.05) among the Histrionic, Hypochondriasis, and Sadistic scales as predictors for the groups studied, with larger effect sizes on the Histrionic and Hypochondriasis scales. The authors suggest that the use of these scales in a clinical context may provide important information for health professionals.

Resumo No Brasil, estudos investigando as características da personalidade em pacientes com dor crônica são escassos. O objetivo da presente pesquisa foi avaliar as características da personalidade em pacientes com dor crônica e compará-las com as de pessoas sem esse diagnóstico. Para tanto, foram aplicados o Inventário Dimensional de Transtornos da Personalidade e a Escala de Hipocondria da versão brasileira do Minnesota Multiphasic Personality Inventory. Duas análises estatísticas distintas foram empregadas, sendo elas o teste t, para verificar diferenças entre as pontuações dos dois grupos, e a análise de regressão logística, para investigar a capacidade preditiva das escalas para o diagnóstico de dor crônica. Os resultados indicaram diferenças significativas (p < 0,05) nas escalas Histriônico, Hipocondria e Sádico como preditores dos grupos estabelecidos, com maiores magnitudes as escalas Histriônico e Hipocondria. Os autores sugerem que o uso das escalas para o contexto clínico pode agregar informações relevantes para o profissional.

Hazardous Drinking-Related Characteristics of Depressive Disorders in Korea: The CRESCEND Study

This study aimed to identify clinical correlates of hazardous drinking in a large cohort of Korean patients with depression. We recruited a total of 402 depressed patients aged > 18 yr from the Clinical Research Center for Depression (CRESCEND) study in Korea. Patients' drinking habits were assessed using the Korean Alcohol Use Disorder Identification Test (AUDIT-K). Psychometric scales, including the HAMD, HAMA, BPRS, CGI-S, SSI-Beck, SOFAS, and WHOQOL-BREF, were used to assess depression, anxiety, overall psychiatric symptoms, global severity, suicidal ideation, social functioning, and quality of life, respectively. We compared demographic and clinical features and psychometric scores between patients with and without hazardous drinking behavior after adjusting for the effects of age and sex. We then performed binary logistic regression analysis to identify independent correlates of hazardous drinking in the study population. Our results revealed that hazardous drinking was associated with current smoking status, history of attempted suicide, greater psychomotor retardation, suicidal ideation, weight loss, and lower hypochondriasis than non-hazardous drinking. The regression model also demonstrated that more frequent smoking, higher levels of suicidal ideation, and lower levels of hypochondriasis were independently correlates for hazardous drinking in depressed patients. In conclusion, depressed patients who are hazardous drinkers experience severer symptoms and a greater burden of illness than non-hazardous drinkers. In Korea, screening depressed patients for signs of hazardous drinking could help identify subjects who may benefit from comprehensive therapeutic approaches.

Hypochondriasis: considerations for ICD-11

The World Health Organization (WHO) is currently revisiting the ICD. In the 10th version of the ICD, approved in 1990, hypochondriacal symptoms are described in the context of both the primary condition hypochondriacal disorder and as secondary symptoms within a range of other mental disorders. Expansion of the research base since 1990 makes a critical evaluation and revision of both the definition and classification of hypochondriacal disorder timely. This article addresses the considerations reviewed by members of the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders in their proposal for the description and classification of hypochondriasis. The proposed revision emphasizes the phenomenological overlap with both anxiety disorders (e.g., fear, hypervigilance to bodily symptoms, and avoidance) and obsessive-compulsive and related disorders (e.g., preoccupation and repetitive behaviors) and the distinction from the somatoform disorders (presence of somatic symptom is not a critical characteristic). This revision aims to improve clinical utility by enabling better recognition and treatment of patients with hypochondriasis within the broad range of global health care settings.

Dubois d'amiens e a sua concepção sistemática da hipocondria e da histeria na França / Dubois d'amiens and his systematic conception of hypochondria and hysteria in France / Dubois d'amiens et sa conception systématique de l'hypocondrie et de l'hystérie en France / Dubois d'amiens y su concepción sistemática de la hipocondría y de la histeria en Francia

Frédéric Dubois d'Amiens foi o vencedor do concurso da Sociedade Real de Medicina de Bordeaux em 1830, graças à apresentação da sua tese intitulada "História filosófica da hipocondria e da histeria". De um ponto de vista existencial, sistemático e por meio de um método histórico-filosófico, ele propõe uma descrição inédita da hipocondria, pois descreve passo a passo a constituição do sujeito afetado, revolucionando assim as concepções médicas e psicopatológicas dessa doença. Apesar das diversas críticas que lhe são apontadas, Dubois d'Amiens reconhece à hipocondria, desde 1830, um sofrimento psíquico e físico específico e vê nela uma forma de pensar, enquanto que Freud a classificará mais tarde como uma neurose atual.

In 1830, Frédéric Dubois d'Amiens won a selection process at the Royal Medical Society of Bordeaux with his thesis entitled "Philosophical history of hypochondriasis and hysteria." From an existential and systematic point of view and based on historical-philosophical methodology, the author presents an unpublished description of hypochondriasis by describing, step-by-step, the constitution of the individual suffering from this affection, thus revolutionizing medical and psychopathological conceptions of the disease. Despite severe criticism of his positions, in 1830 Dubois d'Amiens recognized hypochondriasis as a specific psychological and physical disturbance and described it as a way of thinking. Only much later did Freud classify it as an actual neurosis.

En 1830, Frédéric Dubois d'Amiens remporte le concours de la Société Royale de Médecine de Bordeaux en soutenant son Mémoire intitulé "Histoire Philosophique de l'Hypochondrie et de l'Hystérie". Sous l'angle existentiel et systématique et en s'appuyant sur une méthode historico-philosophique, il propose une description inédite de l'hypocondrie en décrivant pas à pas la constitution de l'individu hypocondriaque, révolutionnant ainsi les conceptions médicales et psychopathologiques de cette affection. Malgré les nombreuses critiques qui lui ont été adressées, Dubois d'Amiens reconnaît à l'hypocondrie dès 1830 une souffrance psychique et physique spécifique et voit en elle une manière de penser, tandis que Freud verra en elle des années plus tard une névrose actuelle.

Frédéric Dubois d'Amiens es el ganador de la competencia de la Real Sociedad de Medicina de Burdeos en 1830, con la presentación de su tesis intitulada "Historia filosófica de la hipocondría y de la histeria". Desde un punto de vista existencial, sistemático y a través un método histórico-filosófico, propone una descripción inédita de la hipocondría, pues describe paso a paso la constitución del individuo afectado, revolucionando así las concepciones médicas y psicopatológicas de esa enfermedad. A pesar de las varias críticas que le son apuntadas, Dubois d'Amiens reconoce la hipocondría desde 1830 como un sufrimiento psíquico y físico específico y la ve como una forma de pensar, mientras que Freud la clasificará mas tarde como una neurosis actual.

Neurosis profesional o enfermedad común: Síntomas y estresores / Clinical differences between patients consulting for occupational neurosis and common illnesses

Background: In Chile, occupational illnesses are defined by the "Work-related accidents and occupational illnesses law". The institutions that administer that law have the legal obligation to determine the "occupational" or "common" origin of accidents and diseases. Aim: To compare symptoms and problems at work in a group of workers consulting for presumptive occupational neurosis (ON), distinguishing cases of OC from cases of common illness (CI). Material and Methods: Two consecutive series of patients were reviewed: 100 cases diagnosed as ON (71 percent women) and 200 cases diagnosed as CI (69 percent women). The general health questionnaire-30 (GHQ-30) and a questionnaire specially devised at the institution to evaluate ON were applied to participants. Social and demographic features, reasons for consulting and clinical diagnoses were compared in both types of patients. Results: Age, marital status, educational level and type of work were similar among patients with ON and CI. Subjects with CI had a higher frequency of depressive symptoms. The main reason to consult among patients with ON was work overload. The reasons for consulting among patients with CI were interpersonal conflicts and feeling of undervaluation. Conclusions: Patients with CI are predominantly depressive and those with ON have a feeling of work overload.

A importância do foco da terapia cognitivo-comportamental direcionado às sensações corporais no transtorno do pânico: relato de caso / The importance of the focus of the cognitive-behavior therapy related to the body sensation in the panic disorder: case report

CONTEXTO: A conceituação cognitiva do transtorno de pânico (TP) realça os medos de sensações corporais (SC) em conseqüência de avaliações distorcidas pelo indivíduo, que interpreta erroneamente as SC de forma catastrófica. OBJETIVO:A importância desse relato de caso é apresentar um trabalho intensivo de indução dos sintomas de ataque de pânico, com técnicas da terapia cognitivo-comportamental (TCC) relacionadas às SC. MÉTODO: O caso de E., feminino, 56 anos, foi retirado de uma pesquisa realizada no Laboratório de Pânico e Respiração do IPUB (UFRJ), com um grupo de pacientes com diagnóstico de TP que se tratou com medicação e sessões de TCC (16), com enfoque em exercícios de indução de sintomas, comparados com grupo controle que usou apenas medicação. RESULTADOS: Os resultados foram controlados por questionários e escalas aplicados antes e após as intervenções. A paciente apresentava sintomas de hipocondria, queixas de falta de ar, taquicardia e medo de perder o controle, especialmente ao estar em ônibus, metrôs ou túneis. Ela recebeu prescrição do antidepressivo tricíclico, imipramina, 75 mg/dia, e 16 sessões de TCC. CONCLUSÃO: Ao final, a paciente obteve remissão dos ataques de pânico e apresentou melhora significativa do comportamento agorafóbico.

BACKGROUND: The current cognitive conceptualization for the panic disorder (PD) enhances the fears of body sensations (BS) in consequence of evaluations distorted by the individual who interprets in an erroneous form the BS as catastrophic. OBJECTIVE: The importance of this study is to emphasize the importance of an intensive work of induction of panic symptoms, with cognitive-behavioral therapy (CBT) techniques related to the BS. METHOD: The case of E., woman, 56 year-old, was selected from a research carried through in the Laboratory of Panic and Respiration - IPUB (UFRJ) with a group of patients with PD diagnosis treated with medication and 16 CBT sessions targeted in panic symptoms induction exercises, compared with a control group that used only medication. RESULTS: The results had been controlled through questionnaires and scales applied before and after the interventions. The patient presented hypochondriac symptoms, sensation of shortness of breath, palpitations and fear or loosing control, especially when inside of buses, subways or tunnels. She received a tricycle antidepressant, imipramina, 75 mg/day and 16 CBT sessions. CONCLUSION: At the end of the trial, the patient had panic free status and presented significant improvement of the agoraphobic behavior.

Transtorno de pânico e hipocondria / Panic disorder and hypocondriasis

A hipocondria é associada a diversos transtornos de ansiedade, sobretudo ao transtorno de pânico (TP). Estima-se que 50 porcento a 70 porcento dos pacientes com TP tenham sintomas hipocondríacos e que 13 porcento a 17 porcento dos hipocondríacos tenham TP associado. Considera-se que há co-morbidade com hipocondria no TP quando as preocupações com saúde não se restringem aos sintomas das crises de pânico. Relatamos um caso de uma paciente que, durante seu acompanhamento, evoluiu com hipocondria e transtorno de pânico associado. Discutimos as manifestações psiquiátricas manifestadas pela paciente, assim como analisamos aspectos conceituais, diagnósticos e prognósticos.

Hypocondriasis is associated with several anxiety disorders, including panic disorder. The available estimates of panic disorder patients with identified hypochondriacal symptoms are 50% to 70%. Complimentary, 13% to 17% of hypochondriac patients were associated with panic disorder. Comorbidity and hypocondriasis occur when health care issues are not delimited by panic disorder symptoms. We reported a patient that, during the follow-up-period, has evolved to an associated hypocondriasis and panic disorder scenario. The psychiatric symptoms were properly addressed and discussed, as well the associated conceptual aspects, diagnoses and prognosis.

The Psychoanalysis on Medical students' Hypochondriasis / 中华医学教育探索杂志

As a regular mental disease,Hypochondriasis more takes place on medical students.It affects seriously the undergraduates both physically and mentally,and disturbs their life and studies.If proper enlightenment and treatment are not given to the students,hypochondriasis may possibly evolve to neuropathy and psychoses,leading to the prolonged and refractory diseases.Therefore by psychoanalyzing medical students' hypochondriasis and discussing how to prevent its occurrence,we put forward that it is important to build the students' psychological character and personality characteristics in cultivating the students' clinical thinking ways and basic practice ability.

MMPI Profile in Patients with Chronic Low Back Pain / 대한정형외과학회잡지

PURPOSE: The causative pathology of chronic low back pain cannot be defined in many patients. To evaluate the relations between psychoneurotic status and chronic low back pain, the authors surveyed Minnesota Multiphasic Personal Inventory (MMPI) in the patients with chronic low back pain. MATERIALS AND METHODS: From July 1997 to December 1998, questionaire including MMPI were given to the patients who visited our Department for chronic (>6 weeks) low back pain. 50 patients (33 male, 17 female) completed MMPI. The mean age was 33.4 years (range 17-55) . MMPI scores were evaluated in two ways for each individual, mean scores of each clinical scale and two code method. Then mean scores were compared according to sex, radiating pain, radiologic abnormalities. RESULTS: In total 50 patients, three scales showed mean score over 55. Those were Hs:59.1 +/- 10.3, D:55.4 +/- 11.2 and Hy: 59.0 +/- 10.8. No significant differences were observed between the groups divided according to the sex, radiating pain, radiologic abnormalities. The two code method revealed that at least one of the neurotic triad (Hy, Hs, D) ranked within the highest two in 46 (92%) patients. CONCLUSION: It seemed that large proportion of patients with chronic low back pain had psychological tendency to hypochondriasis and/or depression and/or hysteria. MMPI seemed to be one of the useful methods in evaluation of psychogenic factors in chronic low back pain patients without definite organic pathology.

The Objective Personality Characteristic of the Dry Eye Syndrome Patients

To investigate personality characteristic of dry eye patient, an investigation on objective personality characteristics of 41 dry eye syndrome patients was performed with MMPI (Minnesota Multiphasic Personality Inventory). Of 41 patients tested, 14 (34.1%)patients had at least one MMPI clinical scale more than 70 point of T-score, abnormality greater than 70 point of T-score occurred most frequently in the scales for ypochondriasis, psychasthe-nia, depression, hysteria, social introversion.In the group profile study, mean T-scores on each clinical scale were within normal range, and the highest scales in rank order were hypochondriasis, depression, psychasthenia. In the relation between results of TBUT and Schirmer test and T-scores of each clinical scale, correlation coefficient is insignificantly low (r0.4). Therefore we recommend comprehension of their emotional condition and an additional psycholgical management with classical treatment as dry eye syndrome management.

A Study on Stress and Personality Characteristics of the Central Serous Chorioretinopathy Patients

To investigate the relationship between psychological behavior and the development of central serous chorioretinopathy, we performed a study on stress and personality characteristics on 39 central serous chorioretinopathy patients and 38 healthy subjects as a control group. We used Life Change Inventory(MMPI) for personality characteristics. As a result, the mean stress scale in the patients group was significantly higher than in the normal control group(p<0.05) and the mean T-xcore of three neurotic scales such as hypochondriasis, depression and hysteria in the patients group were significantly higher than in the normal control group(p=0.029, 0.004, 0.012).

A Study on Objective Personality Characteristics of the Central Serous Chorioretinopathy Patients

A study on objective personality characteristics of 41 central serous chorioretinopathy patients was performed to investigate the etiologic relationship of psychological behaviors about the central serous chorioretinopathy. Fourty-one healthy subjects were used as a control group. Authors used the Minnesota Multiphasic Personality Inventory (MMPI) which consisted of 4 validity scales and 10 clinical scales. Three neurotic scales of hypochondriasis, depression and hysteria in the atients group were significantly higher than in the normal control group even though the mean scores on each clinical scale were within normal ranges in both groups.