Psychopathology and psychotherapeutic intervention in diabetes: particularities, challenges, and limits.

Diabetes is a problem of great public health importance, creating a considerable burden to the affected individuals and society. The psychological approach of this disease implies the early acknowledging of behavioral symptoms and the construction of effective psychotherapeutic interventions. Regarding the psychological symptoms, cognitive malfunctions in diabetes include a slowing of information processing, attention, memory, and concentration, which, in turn, can significantly diminish motivation for therapy, compliance, and ability for self-care. Restrictions pertaining to daily activities, risks of treatment itself and the perceived inability to control the disease can furthermore reduce the perceived quality of life of these patients. Depression can complicate the picture, by a supplementary decrease in compliance and an increase of care expenses. A proper management of diabetes involves a joint action of the patient, physician, and the psychologist. A better self-care can include commuting from passive to active coping, getting informed, maintaining realistic hopes, and long-term thinking. Physicians can express more consistent empathy, thereby increasing confidence. A substantial gain can be brought by considering variables involved in modulating compliance (e.g. the patient's representations of gains and losses, group norms, ability vs. desire of control). Psychotherapeutic interventions include techniques such as counseling, cognitive-behavioral therapy, relaxation, hypnosis, and family therapy.

Current challenges and pitfalls in the pharmacological treatment of depression.

The multifactorial etiology of depression obliges needs an individual assessment, the psychopharmacological approach involving a biopsychosocial analysis for each individual case. The rebalancing of the depressive patient, seen as a return to a normal level of psychosocial functioning and reduced risk of relapse is achieved with a prompt and constant support of specialized teams. Treatment should include psychopharmacological and psychosocial approaches, the results being interrelated and contributing to the prognosis of the disorder. Progress in clinical and pharmacological research, vivid dynamics of socio-economic environment, the complexity of diagnostic evaluation and the need for an interdisciplinary approach may cause difficulties in addressing the depressive patient and the ethical controversies. The aim of this paper is to present a brief analysis of challenges encountered in the present psychiatric practice, starting from the heterogeneity of depressive manifestations and finishing with the prioritization of interventional forms.

Psychological intervention - a critical element of rehabilitation in chronic pulmonary diseases.

Chronic pulmonary diseases represent a segment of pathology with an increasing prevalence worldwide, this requiring joint efforts from specialists in this field to (a) identify those factors insufficiently explored so far, but critical for their evolution and (b) address them via new therapies. This study aims to explore the existing data regarding the psychological factors involved in the dynamics of chronic pulmonary diseases and the main possibilities of psychological intervention, as a distinct part of pulmonary rehabilitation (PR). 49 articles published on this topic in peer-reviewed journals between 1979 and 2010, indexed in PubMed, ProQuest and EBSCO databases, were examined for evidence. Among psychological factors considered important by study authors were the following: 1) the deficient instruction of the patient, 2) decreased treatment motivation, 3) a marginal social role, 4) a disadaptive cognitive style and 5) psychiatric comorbidity (especially anxiety and depression). Efficient interventions were, for physicians, 1) patient education and 2) designing a personalized self-management plan, and for the clinical psychologists, 1) cognitive-behavioral therapy, 2) biofeedback, 3) family therapy, 4) relaxation and 5) hypnosis. Despite the undeniable effect of these methods in selected cases, the high heterogeneity of designs and personal affiliations of researchers do not allow new generalizations about their efficacy or their routine implementation into PR. Further research including larger samples, more uniform designs, construction of consensual international standards regarding the objectives of PR, and assessments done by experts from multiple study domains could contribute to a better understanding of the role psychological interventions could play in PR.

Cause and effect: the linkage between the health information seeking behavior and the online environment--a review.

Today, health care consumers are taking more control over their health care problems, investing more time in finding and getting information as well as looking for proper methods in order to investigate more closely the health care information received from their physicians. Unfortunately, in health care consumers' views, the trustworthiness of health authorities and institutions has declined in the last years. So, consumers have found a new solution to their health problems, that is, the Internet. Recently, studies revealed that consumers seeking for health information have more options to look for data in comparison to the methods used a few years ago. Therefore, due to the available technology, consumers have more outlets to search for information. For instance, the Internet is a source that has revolutionized the way consumers seek data due its customized methods of assessing both quantitative and qualitative information which may be achieved with minimal effort and low costs, offering at the same time, several advantages such as making the decision process more efficient.

Psychological factors mediating health-related quality of life in COPD.

COPD is a chronic disease that has not only a high prevalence and social costs, but is tightly connected to a significant decrease of health-related quality of life (HRQoL). The aim of this study was to evaluate the comparative impact on HRQoL of two psychological factors (self-efficacy, optimism) vs. classical medical determinants (forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), functional impairment). 26 women and 28 men, aged 45-64 years old (mean = 58.1; standard deviation = 9.7), diagnosed with COPD and with self-reported dyspnea requiring medication were administered COPD Self-Efficacy Scale, LOT-R (Life Orientation Test - Revised) to evaluate optimism, Quality of Well-Being (QWB) Scale, as an accepted measure of HRQoL and Functional Impairment Scale (FIS), used to assess the deterioration of functionality in respiratory diseases. Their respiratory parameters (FEV1, PEF) were also measured, via spirometry. Results showed that self-efficacy and optimism were positively correlated to HRQoL (r = .34 (p < .05) and r = .29 (p < .05), respectively). A reduced model that eliminated the direct influence of respiratory parameters on HRQoL proved to be equally satisfactory in terms of predictor value, compared to the full model (that contained all studied variables) (χ² = 0.067, ns). The functional impairment (FI) scores were inversely correlated with HRQoL (r = -.46, p < .01). These results have implications in considering self-efficacy and optimism as important factors when aiming HRQoL improvement in COPD, and for the inclusion of psychological interventions in the treatment plan of COPD patients. Abbreviations COPD = chronic obstructive pulmonary disease; WHO = World Health Organization; HRQoL = health-related quality of life; PEF = peak expiratory flow; FEV1 = forced expiratory flow in one second; LOT-R = Life Orientation Test - Revised; QWB = Quality of Well-Being; FI = functional impairment; SE = self-efficacy; Opt. = optimism.

Issues of therapeutic communication relevant for improving quality of care.

Communication issues are extensively considered a topic of high interest for improving the efficacy of the therapeutic act. This article aimed to overview several issues of therapeutic communication relevant for improving quality of care. A number of 15 bibliographic resources on these topics published in peer-reviewed journals between 1975 and 2010, and indexed in PubMed, ProQuest and EBSCO databases were examined, to seek for evidence regarding these data. Results highlight a number of communication problems commonly reported in the literature, such as the lack of physician communicational skills or their deterioration, the persistence of an asymmetric therapeutic communicational model, communication obstacles brought by the disease itself or by several variables pertaining to the patient, including specific demographic and psychological contexts. Equally, literature reports ways of improving therapeutic communication, such as optimizing the clinical interview, better time management techniques or assertiveness. Integration of communication training in the bio-psycho-social model of care and monitoring parameters like adherence and quality of life as tools reflecting also a good therapeutic communication can be valuable future approaches of obtaining better results in this area.