Subject(s)
Brain Ischemia/prevention & control , Carotid Artery Diseases/complications , Carotid Artery Diseases/diagnostic imaging , Catheterization, Central Venous/methods , Intraoperative Complications/prevention & control , Plaque, Atherosclerotic/complications , Plaque, Atherosclerotic/diagnostic imaging , Stroke/prevention & control , Aged , Aged, 80 and over , Carotid Arteries/diagnostic imaging , Catheterization, Central Venous/adverse effects , Female , Humans , Jugular Veins/diagnostic imaging , Male , Middle Aged , UltrasonographyABSTRACT
OBJECTIVE: The influences of alexithymia and social support on depression among chronically ill patients were examined prospectively. METHODS: The study population was 230 outpatients receiving chronic hemodialysis (HD) therapy. The Beck Depression Inventory-II (BDI-II), the 20-item Toronto Alexithymia Scale (TAS-20), and two subscales of the Social Support Questionnaire were given to the subjects. The BDI-II was readministered after a 6-month interval, and subjects who showed deterioration in their depression score above the level predicted from their baseline score were identified. Multivariate logistic analysis adjusted for age, gender, cause of dialysis, and psychosocial variables were performed. RESULTS: Baseline depression was significantly and independently associated with alexithymia and low satisfaction with available support. Deterioration of depression after 6 months was predicted by alexithymia and poor available support. CONCLUSIONS: Alexithymia and reduced social support might have independent associations with the presence and the prognosis of depression among HD patients.
Subject(s)
Affective Symptoms/epidemiology , Affective Symptoms/psychology , Depressive Disorder, Major/epidemiology , Depressive Disorder, Major/psychology , Renal Dialysis/psychology , Renal Dialysis/statistics & numerical data , Social Support , Adult , Affective Symptoms/diagnosis , Aged , Chronic Disease , Depressive Disorder, Major/diagnosis , Female , Humans , Male , Middle Aged , Prevalence , Prognosis , Prospective Studies , Severity of Illness Index , Surveys and QuestionnairesABSTRACT
BACKGROUND: Ventricular arrhythmias have been shown to be the major cause of sudden cardiac death in hemodialysis (HD) patients. We investigated whether angiographic coronary stenosis was responsible for the induction of ventricular arrhythmias in HD patients. METHODS: HD patients (n = 150) showing ischemic signs in exercise electrocardiography or echocardiography were divided into 2 groups: the stenotic group (n = 61), with significant coronary stenosis (> or =75% in diameter), and the nonstenotic group (n = 89), without significant coronary stenosis on coronary angiography. Severity of ventricular arrhythmias was evaluated by means of ambulatory 24-hour Holter monitoring in HD patients with and without significant coronary stenosis. RESULTS: The frequency of ventricular premature contractions and prevalence of patients with Lown class 4 ventricular arrhythmias were significantly greater in the stenotic than nonstenotic group during HD and for 12 hours after HD (P < 0.03). In the stenotic group, a significantly greater frequency of ventricular premature contractions and prevalence of patients with complex arrhythmias were observed during HD (1.33% and 31.1%, respectively) compared with before HD (0.50% and 11.5%, respectively), and the high incidence persisted for 6 hours after HD. In the nonstenotic group, a slightly increased incidence was observed only during HD compared with before HD. Multivariate analysis showed only coronary stenosis (odds ratio, 5.69; P = 0.041) as an independent and significant factor for the induction of complex arrhythmias. CONCLUSION: These data clearly indicate that severe coronary stenosis, which may cause myocardial ischemia, is an important factor for the induction and lengthy persistence of ventricular arrhythmias during and after HD.
