Frans Verhage

Predictability of Beneficial Effects in Cardiac Rehabilitation: A Randomized Clinical Trial of Psychosocial Variables

The effects of a cardiac rehabilitation program on psychologic functioning, resumption of work, habitual exercise, and smoking habits were studied over a period of five years. In 1977, 80 post-myocardial infarction (MI) patients were randomly allocated to either a six-month systematic rehabilitation program (Rehab) or to individual home rehabilitation (Home). The two groups were tested at intake, after six months, and after five years. Habitual exercise was improved in the Rehab group, but psychologic outcome either after six months or after five years was similar in both groups. Patients who smoked at intake, did not exercise habitually, and had strong feelings of disability or a low level of social inhibition showed predictable benefit from Rehab. Home patients exhibited beneficial effects five years later if at intake they did not exercise habitually and were socially inhibited. Thus, referral to Rehab after MI is indicated only for specific psychosocial dysfunction.

Psychological effects of presymptomatic DNA testing for Huntington's disease in the Dutch program.

&NA; This study assessed the 6‐month follow‐up effects of presymptomatic DNA testing for Huntingtons disease (HD) in 73 individuals at 50% prior risk who were identified either as carriers of the HD gene (N = 29) or as noncarriers (N = 44). The subjects knowledge of being a gene carrier was expected to induce intrusive emotions, denial‐avoidance behavior, and pessimistic expectancies of the future and adjustment problems. The Impact of Event Scale, the Beck Hopelessness Scale, and the General Health Questionnaire were used as standard measures of psychological distress. At the disclosure of the test results, carriers had a strong increase in pessimistic expectations but showed a decline to baseline levels 6 months later. Noncarriers reported a steep decline in hopelessness compared with their pretest conditions but had increased scores after 6 months. Six months after the disclosure of the test results, both gene carriers and noncarriers reported a significant decrease in unwanted intrusive thoughts about HD. Carriers showed a slight increase in denial‐avoidance behavior, whereas noncarriers showed a clear decrease. Our observations might indicate that tested individuals found relief from the prior psychological distress and that they were able to acknowledge the impact of the test result on their future. An unresolved question is how the foreknowledge will affect carriers as they approach the impending onset of the disease. Longer observation periods (> 6 months after disclosure) are required to study changes of the impact of DNA test results over time.

Prediction of postoperative pain and duration of hospitalization using two anxiety measures

&NA; This study examined the extent to which measures of anxiety could predict pain and the length of hospitalization following surgery in 111 patients with gallstones over and above what could be predicted on the basis of biographical and medical status variables. Self‐reported pain on the third day postoperative could hardly be explained by the variables measured. Preoperative anxiety did not increase the value of the prediction. Age, type of surgery, cystitis and wound infection explained a significant proportion of the variance in postoperative hospital stay. Over and above these variables, A‐state on the third postoperative day and also A‐state and specific anxiety measured 1 day before surgery exerted a significant increase on the values of prediction of the length of postoperative hospitalization.

Psychic effects of physical training and relaxation therapy after myocardial infarction

The psychological impact of exercise training and relaxation therapy was investigated in 156 myocardial infarction patients. They were randomly assigned to either exercise plus relaxation and breathing therapy (Treatment A: n = 76) or exercise training only (Treatment B: n = 80). Patients in Treatment A improved on three out of eight psychological measurements (anxiety, well-being, feelings of invalidity). No change was demonstrable in Treatment B. The difference between the treatments was significant for wellbeing (p less than 0.005). Physical outcome, measured by exercise testing was positive in about half of the patients (Treatment A: 55%, Treatment B: 46%). A negative outcome occurred less in Treatment A (p less than 0.05). Training success was not associated with psychic benefit. The association differed for the two treatments. It was concluded that exercise training was effective for some but not for all cardiac patients, and that a psychic effect of exercise could not be demonstrated. Relaxation therapy enhanced physical and psychic outcome of rehabilitation.

Relaxation Training in School Classes Does Not Reduce Headache Complaints

SYNOPSIS

Psychological variables as predictors of the length of post-operative hospitalization

The extent to which measures of anxiety and personality characteristics, which had been assessed preoperatively, could predict the length of hospital stay following surgery, above and beyond what could be predicted on the basis of biographical, medical-status and post-operative anxiety variables, was examined in 58 patients with gall-bladder disease. Hierarchical multiple regression analysis revealed that gender, previous operations, complications and State Anxiety (A-State) measured on the third day post-operatively, jointly explained a significant proportion of the variance in the length of hospitalization. Neither preoperative anxiety measures nor personality characteristics had any significant incremental value in the prediction.

Attitudes of Dutch general practitioners towards presymptomatic DNA-testing for Huntington disease

The attitudes of 1020 Dutch GPs towards presymptomatic and prenatal testing for Huntington disease (HD) were studied by means of a postal questionnaire. The questionnaire contained questions about: approval of presymptomatic DNA‐testing, informing individuals at‐risk who do not request predictive testing, referral to a clinical genetics center, and opinions about different strategies of informing and supporting individuals at‐risk. The response rate was 62%. More than two‐thirds of the GPs considered post‐test counselling and support as their responsibility. Twenty‐six per cent were of the opinion that the test results should be disclosed by the GP. Fifty‐nine per cent of GPs who had an individual at‐risk in their practice were familiar with the test. The attitudes of GPs towards giving support and giving test results were independent of familiarity with the test and the incidence of HD‐patients or at‐risk individuals in the practice. Although GPs were willing to play an important role in presymptomatic DNA‐testing procedures, there is a risk that they might underestimate the difficulties in communicating genetic information and the psychosocial effects of DNA‐testing. Hence, we favor the premise that extensive pretest counselling and test disclosure should remain the prime responsibility of the clinical geneticist. Increasing involvement of GPs should, however, be encouraged and combined with appropriate postgraduate education about predictive DNA‐testing in general.

Suggestibility and headache reports in schoolchildren: a problem in epidemiology.

SYNOPSIS

Home measures of anxiety, avoidant coping and defence as predictors of anxiety, heart rate and skin conductance level just before invasive cardiovascular procedures

The question was whether anxiety, heart rate and skin conductance level just before invasive cardiac procedures could be predicted by anxiety related measures obtained at patients homes approximately 3 weeks before treatment. Trait measures of avoidant coping and defence were provided by sixty-three male and thirty-three female patients who were scheduled for a diagnostic or interventional heart catheterization. In hospital physiological measures were registered continuously during a 20 min interview and subsequently patients reported their anxiety. Results with hierarchical regression analysis showed that sex, age, medical variables and state anxiety at home explained 62% of state anxiety in hospital. Female sex predicted high anxiety in hospital while advanced age predicted low anxiety. Medical variables and measures of coping and defence did not add a significant contribution to this prediction of anxiety. Skin conductance and heart rate measures could not be predicted by the psychological measures collected at home.

Denial and Overcompensation in Male Patients with Myocardial Infarction

In psychoanalytic literature it is asserted that in patients with acute myocardial infarction (AMI) the period prior to the infarction is characterized by denial of resentment, dependency, anxiety and vital exhaustion. AMI patients overcompensate these characteristics by means of aggressive and active behavior. In the present study an instrument was constructed to measure these defense mechanisms. 122 male AMI patients and their partners completed a questionnaire for the purpose of judging the afore-mentioned characteristics in the AMI patients. The judgement related to the 3 months prior to the infarction. The study showed that the questionnaire was internally consistent (reliable) and valid. It was found that AMI patients saw themselves as having been less resentful, dependent, anxious and exhausted than their partners judged them to have been. The AMI patients did not judge themselves to have been more aggressive or active than their partners judged them to have been. The results indicate the potential usefulness of the method of comparing scores (patients vs. partners) in measuring defense mechanisms. Methodological problems and problems regarding the interpretation of scores are critically discussed.