Resilience in patients and spouses faced with malignant melanoma. A qualitative longitudinal study.

Life-threatening diseases like malignant tumours are associated with considerable existential distress. Little is known about the factors that promote resilience within these individuals. This longitudinal qualitative partner study aimed to analyse resilience as per Antonovsky's sense of coherence. Eight patients with malignant melanoma and their partners were interviewed. They were asked about their coping strategies, attitudes towards the meaning of life and their cancer, and comprehension of what is happening to them. The questions were asked shortly after their diagnosis was made and 6 months later. All interviews were audio-taped and later transcribed and analysed according to the method of qualitative content analysis described by P. Mayring. At baseline, the majority of statements made (261; patients = 141/spouses = 120) related to coping/manageability of disease, with only 26 statements (patients = 15/spouses = 11) related to meaning and 127 (patients = 64/spouses = 63) to comprehension. There were no significant differences between the responses of patients and their partners and no significant changes in the number of statements during the 6-month interview. The most significant theme that emerged was manageability of disease, with distraction the most commonly utilised coping skill. The comprehension and meaning themes were far less prevalent. Hence, support should focus on disease and situational manageability.

Fear-learning deficits in subjects with fibromyalgia syndrome?

BACKGROUND: Fibromyalgia syndrome (FMS) is frequently associated with psychiatric conditions, particularly anxiety. Deficits in contingency learning during fear conditioning have been hypothesized to increase anxiety and, consequently, pain sensation in susceptible individuals. The goal of this study was to examine the relationship between contingency learning and pain experience in subjects with FMS and rheumatoid arthritis (RA). METHODS: Fourteen female FMS subjects, 14 age-matched female RA subjects and 14 age-matched female healthy controls (HCs) were included in a fear-conditioning experiment. The conditioned stimulus (CS) consisted of visual signs, the unconditioned stimulus (US) of thermal stimuli. CS- predicted low-temperature exposure (US), while CS+ was followed by low or high temperature. RESULTS: In the FMS group, only 50% of the subjects were aware of the US-CS contingency, whereas 86% of the RA subjects and all of the HCs were aware of the contingency. CS+ induced more anxiety than CS- in RA subjects and HCs. As expected, low-temperature exposure was experienced as less painful after CS- than after CS+ in these subjects. FMS subjects did not show such adaptive conditioning. The effects of the type of CS on heart rate changes were significant in the HCs and the aware FMS subjects, but not in the unaware FMS subjects. CONCLUSIONS: Contingency learning deficits represent a potentially promising and specific, but largely unstudied, psychopathological factor in FMS. Deficits in contingency learning may increase anxiety and, consequently, pain sensation. These findings have the potential to contribute to the development of novel therapeutic approaches for FMS.

Mutual influence of posttraumatic stress disorder symptoms and chronic pain among injured accident survivors: a longitudinal study.

The relationship between acute stress disorder (ASD), posttraumatic stress disorder symptoms (PTSD), and chronic pain was investigated in a longitudinal study of injured accident victims (N = 323, 64.7% men). Assessments took place 5 days (T1), 6 (T2) months, and 12 (T3) months postaccident. Relations between pain and posttraumatic stress symptoms were tested by structural equation modeling. Subjects diagnosed with full or subsyndromal PTSD at T2 and at T3 (14 and 19%) reported significantly higher pain intensity. Cross-lagged panel analysis yielded a mutual maintenance of pain intensity and ASD or PTSD symptoms across T2. Across the second half year, PTSD symptoms impacted significantly on pain but not vice versa. Clinicians need to pay careful attention to PTSD symptoms in accident survivors suffering from chronic pain.

Quality of life and dyadic adjustment in oral cancer patients and their female partners.

The diagnosis of cancer affects not only the lives of patients, but also the lives of their family members. The purpose of this study was to examine the impact of oral cancer on quality of life (QoL), psychological distress and marital satisfaction in a sample of patients and their wives. Thirty-one men treated for oral cancer (mean time since diagnosis 3.7 years) and their female partners (n = 31) were assessed by questionnaires with regard to QoL (WHOQOL-BREF), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), quality of relationship (Dyadic Adjustment Scale, DAS) and physical complaints (EORTC QOL-H&N35). Quality of life was remarkably high in patients and their partners. In patients, lower QoL was associated with more physical complaints and higher levels of psychological distress (HADS), whereas in wives, QoL was found to be related to marital quality (DAS) and levels of distress. In couples with highly discrepant ratings of marital satisfaction, wives reported more psychological distress. The findings indicate that overall QoL is considerably high in patients treated for oral cancer and their partners living in stable relationships. Quality of life correlates stronger with the quality of relationship in spouses than in patients. Generally, marital satisfaction appears to be an important moderating factor regarding QoL and psychological distress.

Parents' mental health after the birth of an extremely preterm child: a comparison between bereaved and non-bereaved parents.

OBJECTIVE: To assess the impact of extremely preterm birth (24-26 weeks of gestation) on the mental health of parents two to six years after delivery, and to examine potential differences in post-traumatic growth between parents whose newborn infant died and those whose child survived. METHOD: A total of 54 parents who had lost their newborn and 38 parents whose preterm child survived were assessed by questionnaires with regard to depression and anxiety (HADS) and post-traumatic growth (PTGI). RESULTS: Neither group of parents had clinically relevant levels of depression and anxiety. Mothers showed higher levels of anxiety than fathers. Bereaved parents with no other, living child reported higher levels of depression than bereaved parents with one or more children. Mothers reported higher post-traumatic growth compared to fathers. In particular, bereaved mothers experienced the value and quality of their close social relationships more positively compared to the non-bereaved parents. CONCLUSION: In the long term, bereaved and non-bereaved parents cope reasonably well with an extremely preterm birth of a child. Post-traumatic growth appears to be positively related to bereavement, particularly in mothers.

Brain imaging in psychiatry - a study of 435 psychiatric in-patients at a university clinic.

OBJECTIVE: The use of brain imaging in psychiatry still lacks clear guidelines. We investigated the referral practice, outcome and predictive factors of neuroimaging in a Swiss psychiatric university clinic. METHOD: Medical files were reviewed retrospectively for 435 consecutively hospitalized patients who were subjected to neuroimaging. The association between the sociodemographic and clinical characteristics and the scan results was analyzed using bivariate and multivariate analyses. RESULTS: Of overall examinations, 69.4% were normal, 16.3% equivocal and 14.3% abnormal; 2.9% of scans ordered for screening only showed pathology. Neurologic signs and advanced age of patients predicted abnormal scan findings, whereas other variables such as EEG results showed no significant association. CONCLUSION: Our results support the need for clear indications for using brain imaging in psychiatric in-patients. Focal neurologic signs and advanced patient age seems to predict abnormal scan results. However, these criteria are not sufficiently sensitive to predict significant scan findings in all patients.

Prediction of psychiatric morbidity in severely injured accident victims at one-year follow-up.

The objective of this study was to assess the prevalence of posttraumatic stress disorder (PTSD) and symptoms of depression and anxiety in severely injured accident victims 1 yr posttrauma and to predict psychiatric morbidity by means of variables assessed shortly after the accident. The sample consisted of 106 consecutive patients with accidental injuries (mean Injury Severity Score = 21.9, mean Glasgow Coma Scale score = 14.4) admitted to the intensive care unit of a University Hospital. Patients with severe head injuries, suicide attempters, and victims of physical assault were excluded. At 1-yr follow-up, two patients (1.9%) had PTSD, and 13 (12.3%) had subsyndromal PTSD. Eighteen patients (17%) had clinically relevant symptoms of anxiety, and nine (8.5%) were depressed. Overall, 27 patients (25.5%) showed some form of psychiatric morbidity (full or subsyndromal PTSD and/or anxiety and/or depression). Logistic regression analysis, using 1-yr psychiatric morbidity status as the dependent variable, allowed correct classification of 83.8% of patients 12 mo postaccident (specificity 91.8%, sensitivity 61.5%). Biographical risk factors and a sense of death threat contributed significantly to the predictive model. We conclude that a substantial proportion of severely injured accident victims develop some form of psychiatric morbidity that can be predicted to some degree by mainly psychosocial variables.

Incidence and prediction of posttraumatic stress disorder symptoms in severely injured accident victims.

OBJECTIVE: This study was designed to assess the incidence of posttraumatic stress disorder (PTSD) in severely injured accident victims and to predict the presence of PTSD symptoms at a 12-month follow-up. METHOD: A longitudinal, 1-year follow-up study was carried out with 106 consecutive patients with severe accidental injuries who were admitted to the trauma surgeons' intensive care unit at a university hospital. Patients were interviewed within 1 month and 12 months after the accident. Assessments included an extensive clinical interview, the Impact of Event Scale, the Clinician-Administered PTSD Scale, the Sense of Coherence questionnaire, and the Freiburg Questionnaire of Coping With Illness. RESULTS: A total of 13.4 days (SD=6.6) after the accident, five patients (4.7%) met all criteria for PTSD with the exception of the time criterion. A total of 22 other patients (20.8%) had subsyndromal PTSD. At the 1-year follow-up, two patients (1.9%) had PTSD, and 13 (12.3%) had subsyndromal PTSD. Multiple regression analysis explained 34% of the variance of PTSD symptoms 12 months after the accident. Biographical risk factors, the sense of a death threat, symptoms of intrusion, and problem-oriented coping each contributed significantly to the predictive model. CONCLUSIONS: In severely injured accident victims who were healthy before experiencing trauma, the incidence of PTSD was low. One-third of the variance of PTSD symptoms at 1-year follow-up could be predicted by mainly psychosocial variables.