Beyond rose colored glasses: the adaptive role of depressive and anxious symptoms among individuals with heart failure who were evaluated for transplantation.

The prospect of and the evaluative period for transplantation can be stressful for individuals with heart failure (HF). Little is known about the impact of psychosocial factors on service utilization and health outcomes. The current study examined the impact of depression, dysthymia, and anxiety on two-yr hospitalization and mortality among 96 individuals with HF who were evaluated for transplantation. Results revealed that only a small percentage of individuals endorsed sufficient symptomatology to meet criteria for a psychiatric, Axis I disorder (3.1% = anxiety; 2.1% = depression; 1.0% = dysthymia) although a significant proportion of the sample was prescribed an antidepressant or an anxiolytic (37%). Multivariable regression analysis was conducted to examine the association between significant independent demographic, medical, and psychiatric predictors and total duration of hospitalizations; logistic regression analysis was used to examine the relation between predictors and mortality. An increase in anxious symptoms was associated with a decrease in total number of days hospitalized during the two-yr period following the initial evaluation. Similarly, as depressive symptoms increased, risk of two-yr mortality decreased. Future research should assess communication between the patient and providers to further elucidate the potential relationship between psychiatric symptoms, service utilization/hospitalization, and mortality in this patient population.

Quality of life in patients awaiting lung transplant: cystic fibrosis versus other end-stage lung diseases.

The symptoms associated with chronic lung disease can impair quality of life and psychosocial functioning. The purpose of the present study was to provide a thorough baseline assessment of quality of life in patients with end-stage lung disease and being evaluated for transplant; and to assess potential differences in quality of life between patients with cystic fibrosis (CF) and those with other types of end-stage lung disease (e.g., chronic obstructive pulmonary disease (COPD), interstitial pulmonary fibrosis (IPF)). We evaluated 58 patients with CF and 52 patients with other types of end-stage lung disease who were recruited for this study during an assessment of their candidacy for lung transplant. Subjects completed a battery of questionnaires that assessed demographic factors (including work and educational status), the presence of psychological distress (anxiety and depression), availability of social support, coping styles, and physical functioning. Despite significant impairment in physical functioning in the areas of recreation, household activities, sleep, and ambulation, other indices of life quality suggested good adaptation in the majority of patients. Also, quality of life differed for patients with CF and for those with other types of end-stage lung disease. Patients with CF were more likely to be working, had lower levels of anxiety and higher levels of social support, and used more functional coping strategies than did patients with other end-stage lung disease. These results highlight the fact that patients with different types of lung disease may require different psychosocial services as they await transplant. These findings also raise the question of whether there is a difference in quality of life after transplant between patients with CF and those with other types of lung disease.

Factors associated with adherence to treatment regimens after lung transplantation.

CONTEXT: The number of patients currently awaiting lung transplantation far exceeds the supply of available organs. Adherence to postoperative treatment regimens is essential for optimal posttransplant success. OBJECTIVE: The present study was designed to examine the demographic and psychological factors associated with compliance in patients who have had lung transplants. DESIGN: Eighteen women and 13 men participated in this study an average of 24 months after transplantation, completing a demographic form, a self-report compliance measure, a social support questionnaire, and the Multidimensional Health Locus of Control Scale. A significant other or family member and the posttransplant nurse coordinator also rated each subject's compliance with the posttransplant regimen. RESULTS: Although patients rated themselves as being compliant with aspects of their self-care, on more subtle measures of compliance, their self-reported compliance was not as impressive. Patients who had had their transplants more recently appeared to be more compliant. Patients with cystic fibrosis used their spirometer more often than patients with other lung diseases. Family support was significantly correlated with self-reported compliance. CONCLUSIONS: This study suggests that how patients are asked about adherence to treatment regimens influences how compliant they appear. The data also indicate that the longer after transplant, the less compliant the patient, and suggests the need for patient reeducation at some point after transplant. Longitudinal studies are needed to assess the degree to which compliance affects the number of rejection and febrile episodes as well as patient mortality after lung transplant.

Self-efficacy and adjustment in cancer patients: a preliminary report.

The relation between cancer self-efficacy and patient cancer adjustment, depression, psychological distress, and behavioral dysfunction in 42 cancer patients was studied in a preliminary investigation. Participants were male cancer outpatients recruited from a Veterans Administration Medical Center who completed a Cancer Self-Efficacy Scale, the Center for Epidemiological Studies-Depression Scale, the Affect Balance Scale, and the Sickness Impact Profile. Correlational analyses indicated that self-efficacy was related to all adjustment measures. Regression analyses revealed that when age, education, time since initial diagnosis, and current disease status were controlled, the relationships between patient self-efficacy expectations and cancer adjustment, psychological distress, negative affect, positive affect, and behavioral dysfunction remained statistically significant. Taken together, the results of the analyses suggested that patient expectancies about control over cancer-related symptoms were related to several important aspects of patient functioning. The results underscored the need for further investigation of this construct in cancer patients.

Meeting the educational needs of patients with oral lichen planus.

Lichen planus is a chronic oral disorder that is often painful and annoying. The patients have been described as usually over 50 years old, with a high educational level, anxious and high-strung. In previous research studies, these patients have reported unusual and highly stressful life events. Because dentists are in a position to advise their patients about chronic illness, this study was designed to (1) determine what information was given to lichen planus patients by their dentists; (2) determine what questions the patients asked their dentists; and (3) assess what educational materials would be helpful for this group of patients. A survey was sent to 151 biopsy-confirmed lichen planus patients, with a response rate of 55 percent. The results indicated that the patients were concerned about the possibility of malignancy and of contagion, and that they were frustrated by the lack of available patient education.

Assessing the characteristics of patients with oral lichen planus.

The authors assessed the medical history, lifestyles and health habits of 146 patients with oral lichen planus as confirmed by biopsy. The results support a relationship between stress and the development of oral lichen planus. Fifty-one percent of the subjects reported that they had experienced stressful events at the time of the lichen planus onset. Practitioners may want to consider the benefits of stress management and bereavement counseling in managing patients with oral lichen planus.

Predictors of fear of falling in dizzy and nondizzy elderly.

Fear of falling may constitute an independent risk factor for disability, leading older people to unnecessarily restrict their activity. Sixty older adults with chronic dizziness and 66 healthy controls were studied to help clarify the interrelationships among demographic factors, psychological status, physical health, and fear of falling. Chronic dizziness was strongly associated with fear of falling; among dizzy patients, nearly half (47%) expressed fear of falling, in comparison with 3% of controls. In participants with dizziness, 3 factors predicted fear of falling: an activity of daily living score, the revised Symptom Checklist 90 Depression (Derogatis, 1983) score, and stability when standing with feet together. These results support the concept that fear of falling is multiply determined and that psychological factors play a major role in influencing the symptoms and responses in many older patients with dizziness.

Depression in male and female patients undergoing cardiac surgery.

The present longitudinal study was designed to determine the prevalence of depression in male and female patients undergoing cardiac surgery, and to examine what factors are associated with depression before and after surgery. One day prior to surgery (T1), and one day prior to discharge from the hospital (T2), 141 patients completed a psychometric test battery including the Center for Epidemiological Studies Depression Scale (CES-D), the State-Trait Anxiety Inventory (STAI), and the Perceived Social Support Scale (PSSS). Data were also collected on 13 physiological measures. Forty-seven per cent of patients were depressed (defined as a score of 16 or above on the CES-D) at T1. Scores on the CES-D significantly increased from T1 (M = 15) to T2 (M = 20), with 61 per cent of patients classified as depressed at T2. Factors associated with depression at T1 were female gender, higher state anxiety, and less social support. Depressed patients at T2 were characterized by higher scores on the STAI at T2 and higher scores on the CES-D at T1. The prevalence of depression in cardiac surgery patients, particularly women, may be underrecognized and warrants increased attention.

The Mini Mental State Exam as a predictor of neuropsychological functioning after cardiac surgery.

OBJECTIVE: The present longitudinal study was designed to: 1) determine the ability of the Mini Mental State Exam (MMSE) to predict neuropsychologic impairment based on neuropsychologic testing five to seven days and six weeks after cardiac surgery; and 2) to determine whether the traditional or the education-related MMSE norms are more appropriate to use for this purpose. METHOD: The day before surgery (T1), before hospital discharge (T2), and six weeks after surgery (T3), 247 subjects completed a battery of five neuropsychologic tests. Subjects also completed the Center for Epidemiological Studies Depression Scale and the Speilberger State-Trait Anxiety Inventory. Subjects completed the MMSE two to three days after surgery. RESULTS: Stepwise regression analyses revealed that the MMSE significantly predicted only a small portion of the variance in neuropsychologic test performance at T2, and to an even lesser extent at T3, over and above the demographic variables. In assessing the association between an impairment score (derived from the neuropsychologic test battery) and the MMSE, we found that the traditional MMSE cut-off score maximized specificity (number of true negatives) while the education-adjusted MMSE cut-off scores maximized sensitivity (number of true positives). CONCLUSIONS: These results suggest that although the MMSE is widely used to assess cognitive mental status, it may have limited value in identifying patients with cognitive impairment post-cardiac surgery, and special attention must be paid to the cut-off scores used in interpreting the MMSE.

Patient predictors of caregiver burden, optimism, and pessimism in rheumatoid arthritis.

The authors of the present study investigated the relationship between rheumatoid arthritis (RA) patients' demographic, medical, and functional status and caregivers' burden, optimism, and pessimism. Subjects were 65 RA patients and their caregivers who were recruited from an outpatient rheumatology clinic. Each caregiver completed the Burden Interview to measure caregiver burden and the Life Orientation Test to measure optimism and pessimism. Each RA patient completed the Arthritis Impact Measurement Scale to measure pain and physical disability as well as a number of cognitive measures to assess two summary psychological cognitive factors labeled self-efficacy expectations and distorted cognitions. These cognitive factors were based on the following commonly used measures in RA research: the Cognitive Errors Questionnaire, the Arthritis Self-Efficacy Scale, the Coping Strategies Questionnaire, and the Pain Beliefs and Perceptions Inventory. Correlational analyses indicated that patients' functional and psychological measures (including poor self-efficacy expectations regarding symptoms) were related to caregiver burden, that patient self-efficacy expectations were related to caregiver optimism, and that patient physical disability was related to caregiver pessimism. Regression analyses revealed that, when competing with other demographic and disease severity variables, the relationships between patient self-efficacy expectations and caregiver burden and caregiver optimism, and patient physical function and caregiver pessimism remained significant. Taken together, these findings suggest that patient expectancies about control over arthritis-related symptoms (including pain) are strongly related to caregiver burden and caregiver optimism and that patient physical status is strongly related to caregiver pessimism.

Serum lipids, neuroendocrine, and cardiovascular responses to stress in men and women with mild hypertension.

In this study, we examined the relation between serum lipid levels, gender, and cardiovascular and neuroendocrine stress reactivity in patients with mild hypertension. Ninety-nine individuals (62 men, 37 women) with mild hypertension performed four mental stress tasks: mental arithmetic, public speaking, cold stress, and a computer videogame. Cardiovascular reactivity scores were computed by subtracting the minimum resting blood pressure (BP) and heart rate (HR) values from the maximum values obtained during each task. Neuroendocrine reactivity was calculated as the change from epinephrine and norepinephrine values from mean rest to mean task. High and low reactors were identified on the basis of median splits of reactivity scores, averaged across all four stressors. High systolic blood pressure reactors had higher levels of total (TC), low-density lipoprotein cholesterol (LDL-C), and apo-B than did low reactors. High diastolic blood pressure reactors had lower levels of high-density lipoprotein cholesterol (HDL-C) and higher levels of LDL-C and apo-B than did low reactors. High HR reactors had higher apo-AI:apo-AII ratios than low reactors. Lipid levels were not different for high and low epinephrine and norepinephrine reactors. Although women were noted to have more favorable lipid profiles than men, both male and female hypertensive patients who were high reactors had less favorable lipid profiles than low reactors.

Effects of changing contingencies on the behavior of depressed and nondepressed individuals.

The effects of rules versus shaping on the behavior of depressed and nondepressed individuals were compared. Extending the findings in the depressive realism literature to a learning paradigm, the behavior of depressed individuals was more sensitive to changing contingencies than was the behavior of nondepressed individuals. Contrary to hypotheses, however, this effect appeared due primarily to the nondepressive Ss' strategy of continuing to follow an experimenter's inaccurate rules. Results suggest the relative absence of self-presentational concerns may lead depressed individuals to be more accurate in judging environmental contingencies.

Psychological outcomes of a pulmonary rehabilitation program.

This study assessed physiologic, psychological, and cognitive functioning in outpatients with COPD. Sixty-four subjects, 53 to 82 years of age, participated in the 30-day exercise rehabilitation program. The program consisted of exercise, education and psychosocial counselling. Participants were assessed prior to beginning the program and at the end of 30 days. Assessments at both times included physiologic functioning (bicycle ergometry testing, pulmonary function tests, 12-min walk), psychological well-being (anxiety, depression, psychiatric symptoms, perceived well-being) and an abbreviated neuropsychological test battery. Results indicate significant improvement in physical endurance and pulmonary function, significant reductions in symptoms of depression and anxiety, and improvement in measures of general well-being and neuropsychological functioning. The study suggests that exercise rehabilitation of older adults with COPD contributes not only to improvements in physical functioning and endurance, but also to enhanced cognitive functioning and psychological well-being.

A preliminary study of the effects of cardiac procedures on cognitive performance.

The effects of three commonly performed cardiac procedures on cognitive performance were evaluated in patients undergoing coronary artery bypass graft (CABG) surgery (N = 20), percutaneous transluminal coronary angioplasty (PTCA) procedure (N = 8), or cardiac valve repair (N = 11). Patients completed a neuropsychological test battery on the day prior to their surgery and at discharge. Results showed that valve and CABG patients exhibited declines in performance on the Digit Symbol subtest, while PTCA patients did not change. Reaction time performance improved for the PTCA patients but declined significantly for valve patients. These results suggest that common cardiac procedures may have measurable effects on cognitive performance, as assessed by a relatively brief test battery.