Ozen Onen Sertoz

Comparison of 4- and 8-h dialysis sessions in thrice-weekly in-centre haemodialysis A prospective, case-controlled study

BACKGROUND Longer dialysis sessions may improve outcome in haemodialysis (HD) patients. We compared the clinical and laboratory outcomes of 8- and 4-h thrice-weekly HD. METHODS Two-hundred and forty-seven HD patients who agreed to participate in a thrice-weekly 8-h in-centre nocturnal HD (NHD) treatment and 247 age-, sex-, diabetes status- and HD duration-matched control cases to 4-h conventional HD (CHD) were enrolled in this prospective controlled study. Echocardiography and psychometric measurements were performed at baseline and at the 12th month. The primary outcome was 1-year overall mortality. RESULTS Overall mortality rates were 1.77 (NHD) and 6.23 (CHD) per 100 patient-years (P = 0.01) during a mean 11.3 ± 4.7 months of follow-up. NHD treatment was associated with a 72% risk reduction for overall mortality compared to the CHD treatment (hazard ratio = 0.28, 95% confidence interval 0.09-0.85, P = 0.02). Hospitalization rate was lower in the NHD arm. Post-HD body weight and serum albumin levels increased in the NHD group. Use of antihypertensive medications and erythropoietin declined in the NHD group. In the NHD group, left atrium and left ventricular end-diastolic diameters decreased and left ventricular mass index regressed. Both use of phosphate binders and serum phosphate level decreased in the NHD group. Cognitive functions improved in the NHD group, and quality of life scores deteriorated in the CHD group. CONCLUSIONS Eight-hour thrice-weekly in-centre NHD provides morbidity and possibly mortality benefits compared to conventional 4-h HD.

The role of BDNF and HPA axis in the neurobiology of burnout syndrome

Chronic stress is known to affect the HPA axis. The few clinical studies which have been conducted on HPA-axis function in burnout have produced inconsistent results. The etiological relationship between sBDNF and burnout has not yet been studied. The aim of the current study was to investigate the role of BDNF and HPA axis in the neurobiology of burnout. In the current study 37 clinically diagnosed burnout participants were compared with 35 healthy controls in terms of BDNF, HPA axis, burnout symptoms, depression, anxiety and psychosomatic complaints. Basal serum cortisol, sBDNF and cortisol level after 1 mg DST was sampled. We found no significant differences in terms of HPA-axis function (for basal serum cortisol, p=0.592; for cortisol level after 1 mg DST, p=0.921), but we did find lowered sBDNF levels in burnout group (88.66+/-18.15 pg/ml) as compared to healthy controls (102.18+/-20.92 pg/ml) and the difference was statistically significant (p=0.005). Logistic Regression Analysis revealed that emotional exhaustion (p=0.05), depersonalization (p=0.005) and depression (p=0.025) were significantly associated with burnout. sBDNF levels correlated negatively with emotional exhaustion (r=-,268, p=0.026), depersonalization (r=-,333, p=0.005) and correlated positively with competence (r=0.293, p=0.015) sub-scales of burnout inventory. However, there were no significant relationships between cortisol levels and sBDNF levels (r=0.80, p=0.51), depression, anxiety, psychosomatic complaints and burnout inventory. Our results suggest that low BDNF might contribute to the neurobiology of burnout syndrome and it seems to be associated with burnout symptoms including altered mood and cognitive functions.

Body image and self-esteem in somatizing patients

Aim:  The aim of the present study was to determine dissatisfaction with body appearance and bodily functions and to assess self‐esteem in somatizing patients.

Hopelessness in Turkish cancer inpatients: the relation of hopelessness with psychological and disease-related outcomes.

The purpose of this study was to investigate the hopelessness level and the relationship of depression, anxiety and disease-related factors to the presence of hopelessness among Turkish patients with cancer. Ninety-five patients hospitalized for cancer treatments were recruited for current study. Data were collected by using a demographic questionnaire, the Pain Numeric Rating Scale, the Beck Hopelessness Scale, and the Hospital Anxiety Depression Scale. The mean hopelessness score was 5.20+/-4.39. There were significant differences in terms of hopelessness between the patients who had metastasis and pain as compared with those without metastasis and pain (p<0.05). There were also found that significant correlation between hopelessness and depression and between hopelessness and anxiety (r=0.721; r=0.645, respectively, p<0.001). Foreword stepwise multiple regression analysis revealed that the independent predictors of hopelessness were depression score and thr presence of metastasis (F=55.133; p<0.001). The findings suggest that levels of hopelessness among cancer patients with pain and metastasis are higher than among those without pain and metastasis, and that the severity of pain, anxiety, and depression is positively correlated with hopelessness level. The assessment of hopelessness, pain, anxiety and depression levels of the patients with cancer should be an essential part of health care practice. Therefore, when arranging care assessment, to evaluate hopelessness could help professionals to appropriately refer patients to further psychological care resources.

Variables Affecting Patient Satisfaction in Breast Surgery: A Cross-Sectional Sample of Turkish Women with Breast Cancer

Objective: In Turkey, despite the fact that breast cancer accounts for 24.1% of all cancer in women, a very small number of these patients receive breast reconstruction. This low percentage would seem to indicate that there are several factors affecting the decision of which surgical procedure should be selected. The aim of this study was to establish the demographical, medical, and psychological factors associated with the breast cancer patients decision-making process, and assess their satisfaction with the type of surgery received. Method: We assessed long-term satisfaction with the type of surgery received; satisfaction with the information process by which the surgery decision is taken; feelings of ambivalence or regret regarding the type of surgery received in both mastectomy (n = 50) and breast reconstruction patients (n = 25). Additionally, breast cancer survivors were compared with age-matched healthy control volunteers (n = 50) in terms of demographics, body image and self-esteem, which could be expected to affect their preferences. We administered a demographical and medical information form, Structured Clinical Interview for DSM-IV, Clinical Version (SCID-I), the Body Cathexis Scale (BCS); and the Rosenberg Self-Esteem Scale (RSE). Results: In both groups, women with a low income and less education were more likely to experience decision regret or low satisfaction. Moreover, total mastectomy-alone patients had lower self-esteem compared to reconstructive surgery patients and healthy women. Conclusion: Early stage breast cancer is a chronic disease and patients have to live with the consequences of their decision for many years. At the same time, the type of surgery is decided on when patients are in an acute phase and under intense pressure. Therefore, the decision making process needs to be explored more, especially breast cancer patients with less education and low income need better assistance and more detailed explanation of their options.

Planning a Social Activity to Improve Psychological Well-being and Quality of Life of Hemodialysis Patients: A Pilot Study

We aimed to investigate the impact of social activity on anxiety‐depression, self‐esteem and quality of life in hemodialysis patients. Ninety‐one patients were recruited to the current study. Of these, 31 patients wanted to take part in a theater play, while 60 patients (group C) did not. Thirty‐one patients were randomly assigned to two groups: Group A (N = 15) started activities immediately and group B (N = 16) was assigned to a waiting list to be included in the activity of theater acting four months later. Beck Depression Inventory, Beck Anxiety Inventory, Rosenberg Self‐esteem Scale and World Health Organization Quality of Life Scale short form (WHOQOL‐BREF) were used to compare psychological parameters and quality of life of the groups before and after the social activity. The patients who were younger, more literate, and wealthier, had longer disease duration, and who were feeling physically and psychologically well, were willing to participate in social activity. The impact of social activity was evaluated between group A and C. After the social activity, there were significant differences in terms of depression (P = 0.008), self‐esteem (P = 0.003), and physical (P = 0.04) and psychological (P = 0.05) sub‐dimensions of quality of life between the groups. The depression score of the patients in group A decreased while their self‐esteem increased, but the increase in the physical and psychological sub‐dimension scores of quality of life scale did not reach statistical significance. This pilot study showed that social activity primarily improved depression and self‐esteem in hemodialysis patients.

Depression and anxiety disorders during pegylated interferon treatment in patients with chronic hepatitis B

ABSTRACT Objectives: Interferon (IFN) treatment has many neuropsychiatric side effects such as depression and anxiety disorder. Although untreated depression is a major contributor to dosage reduction or premature discontinuation of the IFN treatment, it is found that depressive symptoms among patients undergoing hepatitis C virus (HCV) treatment are commonly overlooked during routine clinical interviews. Besides depression, anxiety disorders are shown to affect adherence to pegylated IFN (Peg-IFN) treatment in patients with hepatitis C. Despite the occurrence of neuropsychiatric side effects of IFN treatment being widely reported in patients with hepatitis C, there are few studies studying patients infected with hepatitis B virus (HBV). The aim of this prospective study was to evaluate the incidence and risk factors of depressive and anxiety disorders that occur during Peg-IFN treatment of patients with HBV. Methods: The sample consisted of volunteer patients who were diagnosed with HBV infection and who were decided to receive IFN treatment. During the study period, all consecutive patients with HBV infection and who would have IFN treatment were informed about the study and invited to participate. Thirty-seven chronic hepatitis B (CHB) patients were recruited for the study, but four of them were excluded due to psychiatric diagnosis at the initiation of the treatment. Therefore, the sample consisted of 33 patients with CHB, meeting the inclusion criteria. The participants had psychiatric assessment before the treatment and at 1st, 3rd, 6th, and 12th months. At each visit, the subjects were assessed with Clinical Global Impressions Scale, Hamilton Rating Scale for Depression (HRSD), and Hamilton Anxiety Rating Scale (HAM-A). Results: Among the 33 patients with HBV, 22 (66.7%) were men. Mean age was 35.97 ± 10.73 years. While follow-up, 6 patients dropped out from the study. Also, 13 patients were excluded from the study as they developed depression and/or anxiety disorder. Mean baseline HRSD and HAM-A scores were smaller than the following visits’ scores. The difference was not statistically significant only for the 12th month assessments. Totally 14 (42.4%) patients developed depression/anxiety disorder during 1 year follow-up. Six (42.86%) of them received the diagnosis at the 1st month, 3 (21.43%) at the 3rd, 4 (28.57%), at 6th months, and 1 (7.14%) at the 12th month. When we compared the patients who developed depression/anxiety disorder with the patients who did not develop any psychiatric disorder, we found that the mean baseline HRSD score (t = 2.303, p = .028) and female percentage (p = .017) were statistically significantly higher in the depression/anxiety disorder group. Conclusions: There is an incidence of 42.4% for depression and/or anxiety disorders during Peg-IFN treatment. Females and patients with subsyndromal depressive symptoms should be referred to a psychiatrist and closely monitored especially for the first three months of the IFN treatment.

Irritable Bowel Syndrome in Renal Transplant Patients: Prevalence, Link with Quality of Life, Anxiety, and Depression

Background: Gastrointestinal complications are common in renal transplant recipients and may arise from any part of the gastrointestinal tract. Irritable bowel syndrome (IBS) is highly common in the general population, but the status is not known in renal transplant patients. In this study, we evaluated the prevalence of IBS and its association with health-related quality of life (HRQOL), anxiety, and depression in renal transplant patients. Methods: One hundred and ninety-eight patients were enrolled in this study. Sociodemographic and laboratory variables were recorded. Severity of depressive and anxiety symptoms and HRQOL were assessed by the Beck Depression Inventory, State-Trait Anxiety Inventory, and Short Form 36 (SF-36), respectively. Diagnosis of IBS was based on Rome III criteria. Results: The mean age was 38 ± 10 years and 61% were male. The mean transplant duration was 62 ± 54 months. Among 198 patients, 55 (27%) had IBS. Patients with IBS had lower SF-36 scores and had higher depressive and anxiety symptoms than patients without IBS. Conclusions: IBS is highly prevalent in renal transplant patients. The presence of IBS is closely related with HRQOL anxiety and depression.

557 THE RELATIONSHIP OF PAIN AND HOPELESSNESS IN PATIENTS WITH CANCER

Objective: The aim of the study was to compare the level of hopelessness between patients with cancer who have pain and those who have not. Method: A cross-sectional and descriptive correlational design was used in this study. A hundred thirty six patients who were hospitalized for cancer treatments and palliative care at Tülay Aktaş Oncology Hospital of Ege University School of Medicine between December 2005 and March 2006 were recruited to current study. Of them 95 patients completed information on the measures of hope and pain. Hopelessness was assessed with the Beck Hopelessness Scale (BHS). Data were analyzed by using descriptive statistics, chi square test, t test, ANOVA and Pearson’s correlation test. Results: There were no statistical differences between patients who have pain and those who have not in terms of sociodemographic variables. Patients who have pain had advanced disease by means of disease stage and occurrence of metastasis than the ones who have no pain (respectively p = 0.019, p = 0.030). Levels of hopelessness were statistically higher in patients with pain than the patients without pain (p = 0.047). When the patients with pain separated into three groups in terms of pain severity (mild-moderate-severe), it was found that pain severity did not affect the level of hopelessness (F = 0.370, p = 0.693). Similarly no correlation was found between pain severity and hopelessness in current study (r = 0.180, p = 0.175). Conclusion: Perception of pain in cancer patients increases hopelessness.