Psychological burden and quality of life in newly diagnosed inflammatory bowel disease patients.

Objective: Psychological factors, such as stress, anxiety, and depression, are frequently related to inflammatory bowel disease (IBD). However, few studies have examined these factors in patients newly diagnosed with IBD. The aim of the present study was to test the psychological burden in patients with a recent diagnosis of IBD and the factors related to this psychological burden. Methods: We performed a prospective, multi-center, observational study in patients with a new diagnosis of IBD (≤6 months). The patients were recruited from four different Spanish hospitals. Clinical and demographic characteristics were collected. Patients were evaluated using the Hospital Anxiety and Depression Scale and quality of life questionnaire for patients with inflammatory bowel disease (IBDQ-32). The Scale of Stress Perceived by the Disease was used to assess stressful life events. Results: We included 156 patients newly diagnosed with IBD [69 women; 80 Crohn's disease (CD) and 76 ulcerative colitis (UC)], with a mean age of 42.3 (SD 16.21) years. A total of 37.2% of patients had symptoms of anxiety and 17.3% had symptoms of depression. Quality of life was affected in 30.1% of patients. Factors related to anxiety in early IBD were being a woman and having CD. The only factor related to depression was the presence of comorbidity. Being a woman and having suffered previous stressful life events were factors related to impaired quality of life. Conclusion: Anxiety, depression, and impaired quality of life are frequent in patients with a recent diagnosis of IBD. This psychological burden is greater in women.

Effectiveness of the Brief Guided Self-Change Therapy Combined with Varenicline under "Real-Life" Conditions and Mediators for Smoking Cessation.

Background: Brief therapies have proven to reduce tobacco cost-effectively, however, unsuccessful quit attempts remain notable in real-life conditions, and the underlying mechanisms of treatment success are still unclear. Objectives: We aimed to analyze the effectiveness of the Guided Self-Change (GSC) therapy combined with varenicline (VAR+T) in public health services against varenicline alone (VAR), and to identify mediators of treatment outcomes. We conducted a two-arm quasi-experimental study with 126 treatment-seeking smokers (age=57.3±9.1 years; 59.5% women). Before treatment, and at weeks 12 and 24, we assessed tobacco use and five potential mediators: withdrawal, craving, motivation to quit, anxiety, and depression. Results: Only 25% of participants adhered to varenicline prescription, and 54% to GSC therapy. VAR+T group showed a greater proportion of abstainers compared to VAR group at week 12 (75% vs 57.4%; φc=0.21) and week 24 (62.9% vs 52.5%; φc=0.10). When controlling for weeks taking varenicline, motivation showed a significant indirect effect over abstinence rates in VAR+T compared with VAR (a1b1=1.34; 95%CI=0.04, 5.03). Conclusions: The GSC effectiveness seems to increase motivation which in turn contributes to reducing tobacco use. The implementation of GSC therapy in public health services could minimize treatment duration and increase smoking abstinence in 'real-life' conditions where varenicline adherence remains low.

Gender Biases and Diagnostic Delay in Inflammatory Bowel Disease: Multicenter Observational Study.

BACKGROUND: Female gender could be a cause of diagnostic delay in inflammatory bowel disease (IBD). The aim of this study was to investigate the diagnostic delay in women vs men and potential causes. METHODS: This multicenter cohort study included 190 patients with recent diagnosis of IBD (disease duration <7 months). Reconstruction of the clinical presentation and diagnostic process was carried out in conjunction with the semistructured patient interview, review, and electronic medical records. RESULTS: The median time from symptom onset to IBD diagnosis was longer in women than in men: 12.6 (interquartile range, 3.7-31) vs 4.5 (2.2-9.8) months for Crohn's disease (CD; P = .008) and 6.1 (3-11.2) vs 2.7 (1.5-5.6) months for ulcerative colitis (UC; P = .008). Sex was an independent variable related to the time to IBD diagnosis in Cox regression analysis. The clinical presentation of IBD was similar in both sexes. Women had a higher percentage of misdiagnosis than men (CD, odds ratio [OR], 3.9; 95% confidence [CI], 1.5-9.9; UC, OR 3.0; 95% CI, 1.2-7.4). Gender inequities in misdiagnosis were found at all levels of the health system (emergency department, OR 2.4; 95% CI, 1.1-5.1; primary care, OR 2.5; 95% CI, 1.3-4.7; gastroenterology secondary care, OR 3.2; 95% CI, 1.2-8.4; and hospital admission, OR 4.3; 95% CI, 1.1-16.9). CONCLUSIONS: There is a longer diagnostic delay in women than in men for both CD and UC due to a drawn-out evaluation of women, with a higher number of misdiagnoses at all levels of the health care system.

This paper shows a longer delay in the diagnosis of inflammatory bowel disease in women compared with men for both Crohn's disease and ulcerative colitis. These differences are present at all levels of the health care system, and misdiagnosis is also more common in women.

Effectiveness of a Multicomponent Group Psychological Intervention Program in Patients with Inflammatory Bowel Disease: A Randomized Trial.

(1) Background: Stress, anxiety, and depression have been identified as factors that influence the development of inflammatory bowel disease (IBD). The main aim of this study was to test the effectiveness of group multicomponent cognitive-behavioral therapy at reducing stress, anxiety, and depression, and improving quality of life and the clinical course of the disease. (2) Methods: A total of 120 patients were evaluated using the General Perceived Stress Scale, Scale of Stress Perceived by the Disease, the anxiety and depression scale, and quality of life questionnaire for patients with IBD. Disease activity was measured using the Mayo Index for ulcerative colitis and CDAI for Crohn's disease, as well as the number of relapses self-reported by patients. Patients were randomized to receive group multicomponent cognitive-behavioral therapy or treatment as usual. (3) Results: The psychological intervention reduced stress (EAE: 45.7 ± 8.8 vs. 40.6 ± 8.4, p = 0.0001; PSS: 28.0 ± 7.3 vs. 25.1 ± 5.9, p = 0.001) and improved quality of life (164.2 ± 34.3 vs. 176.2 ± 28.0, p = 0.001). An improvement was found in the number of relapses self-reported by patients (0.2 relapses/patient vs. control 0.7 relapses/patient; p = 0.027). No differences were found in disease activity indexes. (4) Conclusions: Psychological therapy was associated with improved stress, quality of life and with a decrease in the number of relapses self-reported by patients. Clinical trial registration number: NCT02614014.

Neurocognitive Impairment in Well-Controlled HIV-Infected Patients: A Cross-Sectional Study.

The reported prevalence of HIV-associated neurocognitive disorders in HIV people depends on the population studied and the methodology used. We analyze the prevalence of neurocognitive impairment (NCI) and associated factors in patients on successful antiretroviral therapy (ART), without comorbidities. Cross-sectional observational study in HIV subjects, ≥18 years old, on stable ART, and HIV viral load of <50 copies/mL. Patients with medical or psychiatric comorbidities and substance abuse were excluded. NCI was diagnosed using Frascati criteria, examining seven neurocognitive domains (NDs). We analyzed the association between NCI and HIV-related clinical variables, carotid intima-media thickness, bacterial translocation, and plasma inflammatory biomarkers [soluble CD14, interleukin-6 (IL-6), and tumor necrosis factor-α]. The prevalence of NCI was calculated with a 95% confidence interval (CI). We fitted a logistic regression model to assess the strength of the associations. Eighty-four patients were included with an observed NCI prevalence of 29.8% (95% CI: 21.0-40.2): 19% had asymptomatic NCI, 8.3% had mild neurocognitive disorder, and 2.4% had HIV-associated dementia. Delayed recall was the most commonly affected ND (27.4%). People diagnosed at least 10 years ago (odds ratio [OR]: 6.5, 95% CI: 1.6-21.7) and those with IL-6 levels above 1.8 pg/mL (OR: 6.0, 95% CI: 1.1-31.3) showed higher odds of NCI in adjusted analyses. Participants with carotid plaques had lower scores for delayed recall: -0.9 ± 1.1 versus -0.2 ± 1.1 (p = .04). Prevalence of NCI is high in otherwise healthy adults with HIV-infection. In this population, more than 10 years since HIV diagnosis and high IL-6 levels are associated with NCI. Delayed recall ND is worse in patients with subclinical atherosclerosis.

The Adjective Rating Scale for Withdrawal: Validation of its ability to assess severity of prescription opioid misuse.

BACKGROUND: Withdrawal symptoms have been widely shown to be a useful indicator of the severity of opioid dependence. One of the most used instruments to assess them is the Adjective Rating Scale for Withdrawal (ARSW). However, there is a lack of adaptations and validations for its use with prescription opioids, even less for chronic pain patients under treatment with these analgesics. Thus, the aims of this study were to analyse the psychometric properties and invariance across gender of the ARSW in a sample of chronic noncancer pain patients. METHODS: Data were collected from 208 consumers of opioid medication, chronic noncancer pain patients. Participants completed sociodemographic, ARSW, prescription opioid dependence (DSM-IV-TR) and prescription opioid-use disorder (DSM-5) measurements. Gender invariance was assessed through multigroup confirmatory factor analysis (CFA). RESULTS: The ARSW showed a unidimensional factor structure and high internal consistency (Cronbach's alpha = 0.85). Multigroup CFA showed configural, metric, scalar and strict invariances of ARSW across gender. Predictive validity analyses indicated that ARSW has good capacity for identifying the severity of prescription opioid-use disorder, using both DSM-IV-TR and DSM-5 criteria. CONCLUSIONS: These findings show that the ARSW is a valid and reliable tool for use in the assessment of the withdrawal of prescription opioids in chronic pain patients under treatment with these analgesics, regardless of their gender. SIGNIFICANCE: Findings supported the reliability and validity of the ARSW to assess withdrawal of prescription opioids in individuals with chronic noncancer pain. The instrument can be applied indistinctly in men and women. An increase in the ARSW scores could be used as an indicator of potential risk of prescription opioid-use disorder during long-term treatments.

Randomized, Controlled, Crossover Study of Self-administered Jacobson Relaxation in Chronic, Nonspecific, Low-back Pain.

CONTEXT: Opioids decrease pain and improve functional capacity and quality of life; however, they are not always effective and are associated with harmful side effects. Few studies have shown that relaxation-based therapies, in comparison with usual care, can decrease pain. OBJECTIVE: The objective of the study was to investigate whether a controlled relaxation treatment, Jacobson progressive muscular relaxation (PMR), was effective in relieving chronic low-back pain (CLBP) and reducing pain comorbidities. The research team hypothesized that PMR-controlled relaxation could be more effective in reducing CLBP than music. DESIGN: The research team designed a randomized, controlled, crossover study. SETTING: The study took place in the pain unit, a clinic, in the Department of Health at Alicante-General Hospital (Alicante, Spain). PARTICIPANTS: Participants in this study were 58 adults with nononcological CLBP, secondary to lumbar canal stenosis, who had been treated with opioids without any changes in the 3 mo prior to the study. INTERVENTION: Participants were randomly assigned to 1 of 2 groups, each of which received 2 treatments, but in a different order (ie, either AB or BA where A was the standardized PMR, the intervention, and B was relaxing music, the control. For both groups, the 2 treatment periods were 8 wk in length, with a 1-mo washout period between them. OUTCOME MEASURES: The primary outcome measures included (1) a visual analogue scale-pain and relief intensity; (2) the 12-item short form health survey-quality of life; (3) the hospital anxiety and depression scale-anxiety and depression; and (4) the medical outcomes study sleep scale-sleep disturbances. Secondary outcome measures included a self-efficacy scale and a measure of satisfaction with treatment and compliance. RESULTS: Pain was mostly mild to moderate. Greater decreases in pain between baseline and postintervention were observed for the PMR vs the control treatment in the mild pain category, with a VAS difference of 1.8 cm and P = .018. Significant differences were also found in anxiety, depression, quality of life, and sleep between participants in the 3 pain categories. Self-rated adherence was high. CONCLUSIONS: Findings support the efficacy and acceptability of a self-guided PMR intervention for reducing CLBP with minimal time with a therapist.

Individual differences in personality profiles among potential living kidney transplant donors / Diferencias individuales en perfiles de personalidad de donantes vivos potenciales para trasplante renal

Background: Although the psychological assessment of potential living kidney donors (PLKD) is part of the recommendations for action for any transplant coordination, there are not many studies that provide data about the importance of selecting donors for improving transplant outcomes. This work aims to raise awareness of potential kidney donors by designing methods for early detection of potential problems after the transplant, as well as by selecting the most suitable donors. Methods: This is a study of 25 PLKD drawn from the General University Hospital of Alicante. Participants completed the Millon Clinical Multiaxial Inventory (MCMI-III) for the study of personality characteristics. Results: Women scored higher than men in the compulsive personality scale, and individuals with a genetic link with the recipient scored higher on depressive and dependent scales than did those with other relationships (emotional or altruistic). Conclusions: Women showed a pattern of significantly more compulsive personality traits (cautious, controlled, perfectionist) within a non-pathological style. Among the PLKD, there were significantly more women, which is contrary to what typically happens with donations from cadavers. Genetically related subjects scored higher on depression than did those that were emotionally related. The personality assessment of candidates for PLKD can help with developing a post-transplant follow-up regimen for an improved quality of life.

Antecedentes: Aunque la evaluación psicológica de los donantes potenciales vivos de riñón (DPVR) forma parte de las recomendaciones de actuación de cualquier coordinación de trasplantes, sin embargo, no existen muchos trabajos que aporten datos sobre su importancia a la hora de seleccionar donantes o de mejorar los resultados del trasplante. Objetivos: Este trabajo tiene como objetivo el aumentar el conocimiento sobre los donantes potenciales de riñón a través del diseño de métodos para detectar precozmente posibles problemas después del trasplante, así como seleccionar a los donantes más idóneos. Métodos: Se presenta un estudio de 25 DPVR del Hospital General Universitario de Alicante. Los participantes completaron el Inventario Clínico Multiaxial de Millon (MCMI-III) para el estudio de sus características de personalidad. Resultados: las mujeres puntuaron más alto que los varones en la escala de personalidad compulsiva, y los individuos con un vínculo genético con el receptor puntuaron más alto en personalidad depresiva y dependiente que aquellos con otro tipo de relación (emocional o altruista). Conclusiones: Las mujeres presentaron un patrón de personalidad significativamente más compulsivo (prudente, controlado, perfeccionista), dentro de un estilo no patológico. Entre los DPVR, hay un número significativamente mayor de mujeres, contrariamente a lo que sucede en la donación procedente de cadáver. Los sujetos emparentados genéticamente puntúan más alto en depresión que los emparentados emocionalmente. La evaluación de la personalidad de los candidatos a DPVR, puede ayudar a programar un seguimiento postrasplante que mejoren su calidad de vida.

Individual differences in personality profiles among potential living kidney transplant donors.

BACKGROUND: Although the psychological assessment of potential living kidney donors (PLKD) is part of the recommendations for action for any transplant coordination, there are not many studies that provide data about the importance of selecting donors for improving transplant outcomes. This work aims to raise awareness of potential kidney donors by designing methods for early detection of potential problems after the transplant, as well as by selecting the most suitable donors. METHODS: This is a study of 25 PLKD drawn from the General University Hospital of Alicante. Participants completed the Millon Clinical Multiaxial Inventory (MCMI-III) for the study of personality characteristics. RESULTS: Women scored higher than men in the compulsive personality scale, and individuals with a genetic link with the recipient scored higher on depressive and dependent scales than did those with other relationships (emotional or altruistic). CONCLUSIONS: Women showed a pattern of significantly more compulsive personality traits (cautious, controlled, perfectionist) within a non-pathological style. Among the PLKD, there were significantly more women, which is contrary to what typically happens with donations from cadavers. Genetically related subjects scored higher on depression than did those that were emotionally related. The personality assessment of candidates for PLKD can help with developing a post-transplant follow-up regimen for an improved quality of life.

ANTECEDENTES: Aunque la evaluación psicológica de los donantes potenciales vivos de riñón (DPVR) forma parte de las recomendaciones de actuación de cualquier coordinación de trasplantes, sin embargo, no existen muchos trabajos que aporten datos sobre su importancia a la hora de seleccionar donantes o de mejorar los resultados del trasplante. OBJETIVOS: Este trabajo tiene como objetivo el aumentar el conocimiento sobre los donantes potenciales de riñón a través del diseño de métodos para detectar precozmente posibles problemas después del trasplante, así como seleccionar a los donantes más idóneos. MÉTODOS: Se presenta un estudio de 25 DPVR del Hospital General Universitario de Alicante. Los participantes completaron el Inventario Clínico Multiaxial de Millon (MCMI-III) para el estudio de sus características de personalidad. RESULTADOS: las mujeres puntuaron más alto que los varones en la escala de personalidad compulsiva, y los individuos con un vínculo genético con el receptor puntuaron más alto en personalidad depresiva y dependiente que aquellos con otro tipo de relación (emocional o altruista). CONCLUSIONES: Las mujeres presentaron un patrón de personalidad significativamente más compulsivo (prudente, controlado, perfeccionista), dentro de un estilo no patológico. Entre los DPVR, hay un número significativamente mayor de mujeres, contrariamente a lo que sucede en la donación procedente de cadáver. Los sujetos emparentados genéticamente puntúan más alto en depresión que los emparentados emocionalmente. La evaluación de la personalidad de los candidatos a DPVR, puede ayudar a programar un seguimiento postrasplante que mejoren su calidad de vida.

Alexitimia y reconocimiento de emociones inducidas experimentalmente en personas con somatizaciones / Alexithymia and experimentally induced emotion recognition in people with somatizations

Este estudio forma parte de una investigación dirigida a valorar el proceso cognitivo-emocional de reconocimiento emocional en pacientes somatizadores. El objetivo específico ha sido verificar si se producían diferencias en la autoevaluación de la reacción emocional entre pacientes que presentan somatización y controles no-clínicos. Para obtener la autoevaluación de la reacción emocional en las dimensiones afectivas de valencia y activación, en participantes clínicos y controles, se recurrió a un procedimiento que minimiza el empleo de habilidades y comprensión verbal. Participaron 119 sujetos, 47 pacientes y 72 sujetos no-clínicos. La prevalencia de alexitimia en el grupo clínico fue del 42,55%, mientras que en los controles no-clínicos fue del 30,55%. Los resultados mostraron la existencia de un déficit en la autoevaluación de la activación del grupo clínico en respuesta a las imágenes correspondientes con los niveles altos de la dimensión afectiva de activación y en las imágenes de valencia alta, de forma asociada a la condición clínica y no a la alexitimia. La alexitimia presenta un efecto modulador en la evaluación de los sujetos clínicos y controles a la valencia de las imágenes desagradables o de baja valencia (AU)

This study is part of an investigation aimed at assessing the cognitive-emotional process of emotional recognition in somatizing patients. The specific objective was to verify whether there were differences in the selfassessment of emotional reaction among patients with somatization and non-clinical controls. To obtain the self-assessment of their emotional reaction in the affective dimensions of valence and activation in clinical and control participants, we resorted to a procedure that minimizes the use of verbal skills and comprehension. Participants were 119 people, 47 patients and 72 non-clinical participants. The prevalence of alexithymia in the clinical group was 42.55%, whereas in non-clinical controls, it was 30.55%. Results showed the existence of a deficit in the clinical group’s self-assessment of activation in response to the corresponding images with high levels of the affective dimension of activation and high valence images, associated with the clinical condition but not with alexithymia. Alexithymia has a modulatory effect on the clinical participants’ and controls’ evaluation of the valence of the unpleasant images or of low valence pictures (AU)

[Alexithymia and experimentally induced emotion recognition in people with somatizations]. / Alexitimia y reconocimiento de emociones inducidas experimentalmente en personas con somatizaciones.

This study is part of an investigation aimed at assessing the cognitive-emotional process of emotional recognition in somatizing patients. The specific objective was to verify whether there were differences in the self-assessment of emotional reaction among patients with somatization and non-clinical controls. To obtain the self-assessment of their emotional reaction in the affective dimensions of valence and activation in clinical and control participants, we resorted to a procedure that minimizes the use of verbal skills and comprehension. Participants were 119 people, 47 patients and 72 non-clinical participants. The prevalence of alexithymia in the clinical group was 42.55%, whereas in non-clinical controls, it was 30.55%. Results showed the existence of a deficit in the clinical group's self-assessment of activation in response to the corresponding images with high levels of the affective dimension of activation and high valence images, associated with the clinical condition but not with alexithymia. Alexithymia has a modulatory effect on the clinical participants' and controls' evaluation of the valence of the unpleasant images or of low valence pictures.