S. Abbey

Gender and psychosomatic aspects of ischemic heart disease

While women and their doctors have traditionally worried about mortality from breast and gynecological malignancies, over the past 5 years they have come to realize that ischemic cardiac disease (IHD) is the number one killer of women in most Western countries. This has led to public and professional education campaigns and a new emphasis on gender and gender-specific research in IHD. Unfortunately, this literature remains poorly developed and much work remains to be done. Even in samples in which there may be sufficient numbers to allow for the evaluation of gender and gender differences, these important analyses have often been overlooked. This article provides a review of what is known about gender and gender differences in psychosocial and behavioral issues in IHD.

Stress, coping, and depression in non-ulcer dyspepsia patients.

Thirty adults with upper gastrointestinal symptoms in the absence of structural organic disease diagnosed with non-ulcer dyspepsia (NUD) were compared to 30 healthy adults who had visited the hepatobiliary clinic for medical evaluation of non-organic complaints without NUD. Medical investigation in both groups were negative. Before independent gastrointestinal physicians conducted diagnostic evaluations, all subjects were evaluated for anxiety and depressive symptoms, stressful life events, coping style, and social support. The measures included Symptom Checklist 90-Revised (SCL-90-R), Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory (STAI), Ways of Coping Checklist, and Interpersonal Support Evaluation List, and a self-report questionnaire, which measured the quantity of perceived stressful life events. The NUD patients reported significantly more symptoms of depression, more perceived stressful life events, less problem-focused coping, and less social support than the control subjects. Depressive symptoms were negatively correlated with interpersonal support, whereas, problem-focused coping was positively correlated with interpersonal support in the NUD patients. The two groups did not differ significantly in terms of anxiety and emotion-focused coping. The implications of these findings for the diagnosis and treatment of NUD are discussed.

Choices: a Study of Preferences for End-of-life Treatments in Patients With Advanced Heart Failure

BACKGROUND The purpose of this study is to describe the treatment preferences of patients with heart failure among three distinct treatment options--optimal medical management, oral inotropes or left ventricular device (LVAD) support--to determine if there were differences in preferences between patients with mild heart failure (New York Heart Association [NYHA] Class II) and severe heart failure (NYHA Class IV), and also to determine whether quality of life, perceived severity of symptoms and overall health influenced treatment preferences. METHODS We enrolled 91 patients who completed the Minnesota Living with Heart Failure Questionnaire (MLHFQ); visual analog scales for depicting their perceived severity of overall health, dyspnea and fatigue; and a treatment trade-off tool. RESULTS The most preferred treatment options were oral inotropes, LVAD and standard medical management. There were no differences in treatment preferences between NYHA II and NYHA IV patients. Patient preferences correlated poorly with MLHFQ, symptom and overall health scores. Although not statistically significant, there was a trend toward patients with worse quality of life and symptom scores preferring more aggressive treatment. CONCLUSIONS The results of our study identified two distinct groups of patients: one group preferring treatments that prolonged survival time and another group that favored strategies that improved quality of life but reduced survival time. Treatment preferences were independent of functional or symptom status, suggesting that preferences may be decided early in the course of illness.

The relationship between lipodystrophy-associated body changes and measures of quality of life and mental health for HIV-positive adults

Objectives:To investigate the relationship between lipodystrophy-specific symptom severity and wellbeing. Methods:HIV-positive adult patients with body fat redistribution (lipodystrophy syndrome) associated with antiretroviral therapy reported their total non-lipodystrophy symptoms and side effects and completed measures assessing body fat changes (yielding Atrophy, Hypertrophy and Total Lipodystrophy scores), mental health and quality of life. Effects of total symptom complex and lipodystrophy severity on quality of life and mental health were analyzed using Spearman’s rho correlations. Logistic regression analyses were utilized to determine the relative-odds of depression produced by overall symptom count and lipodystrophy score increments. Results:Mean ratings for Hypertrophy and Atrophy corresponded to ‘very mild’ and ‘mild’ degrees of severity, respectively. The total symptom complex was associated with ratings for most of the mental health and quality of life measures. Patient-perceived body image scores were the sole study variable responsive to lipodystrophy severity ratings. In comparison to reference norms, a pronounced degree of body image impairment was evident. Conclusion: Although responsive to the total symptom profile, psychosocial measures typically utilized for evaluating quality of life and mental health status in HIV disease lacked sensitivity and specificity for measuring the consequences of lipodystrophy-associated fat distribution changes alone. Lipodystrophy severity did impact negatively on body image.

Relationship between personality disorder symptoms and temperament in the young male general population of South Korea.

Abstract  The aim of the present study was to identify the characteristics of temperament and character in personality disorder symptoms in the young male general population. A total of 585 male subjects from the same community were included in the study (mean age, 19.06 ± 0.26 years). There was no difference in socioeconomic and educational background. Subjects completed the Personality Disorder Questionnaire‐IV+ (PDQ‐IV+) and Temperament and Character Inventory (TCI). There were unique correlations between each personality disorder symptom and four temperament profiles. When classification was done through three cluster symptoms by DSM‐IV, cluster A symptoms were most strongly associated with low reward dependence (r = −0.46), cluster B with high novelty seeking (r = 0.33), and cluster C with high harm avoidance (r = 0.47). The character dimension, self‐directedness was the most powerful predictor of the presence of any personality disorders. In homogenous male general population, unique combinations were found between temperament and each personality disorders. Although the subjects were relatively young and therefore their characters had not yet fully matured, character played an important role in the presence of personality disorder. Temperament can be used to differentiate the personality symptoms and characters used to predict the presence of personality disorder.

Evaluation of a mentorship program for Heart Transplant patients

The Heart Transplant Mentor Programme (HTMP) was initiated to augment patient care by providing patients and families with information and support from a peer perspective. We assessed program effectiveness with a pilot study of semi-structured interviews of 63% (10/16) of the mentored patients and an open-ended inquiry that rated the program on a 5-point scale (1, poor, to 5, excellent) and that selected descriptors of the program. Qualitative and quantitative analyses indicated that participants found the information and support provided by their mentors positive (3.8 and 4.0, respectively), discussion focused on medical rather than psychosocial topics, pre-transplant dissatisfaction with the program was caused by late or little mentor contact, and post-transplant dissatisfaction was attributed to difference in clinical course between mentor and patient. Although findings indicate that HTMP augments patient care, recommendations to increase patient satisfaction include earlier introduction of a mentor and individualizing mentors according to demographics and clinical course.

Choosing Psychiatry as a Career: Motivators and Deterrents at a Critical Decision-Making Juncture

Objective: To examine factors influencing the choice of psychiatry as a career between residency program application and ranking decision making. Methods: Using an online questionnaire, applicants to the largest Canadian psychiatry residency program were surveyed about the impact of various factors on their ultimate decision to enter psychiatry residency training. Results: Applicants reported that patient-related stigma was a motivator in considering psychiatry as a career, but that negative comments from colleagues, friends, and family about choosing psychiatry was a deterrent. Training program length, limited treatments, and insufficient clerkship exposure were noted as deterrents to choosing psychiatry, though future job prospects, the growing role of neuroscience, and diagnostic complexity positively influenced choosing psychiatry as a specialty. Research and elective time away opportunities were deemed relatively unimportant to ranking decisions, compared with more highly weighted factors, such as program flexibility, emphasis on psychotherapy, service–training balance, and training program location. Most applicants also reported continuing to fine tune ranking decisions between the application and ranking submission deadline. Conclusions: Stigma, exposure to psychiatry, diagnostic complexity, and an encouraging job market were highlighted as positive influences on the choice to enter psychiatry residency. Interview and information days represent opportunities for continued targeted recruitment activity for psychiatry residency programs.

QUALITATIVE STUDIES BETTER REFLECT PATIENT DISTRESS VERSUS STANDARDIZED QUALITY OF LIFE QUESTIONNAIRES: 2418

S. Abbey1, E. De Luca1, M. Shildrick2, P. McKeever3, J. Poole4, O. Mauthner5, H. Ross6 1Transplant, University Health Network, Toronto/ON/CANADA, 2School Of Sociology, Social Policy & Social Work, Queen’s University Belfast, Belfast/IRELAND, 3, Bloorview Research Institute, Toronto/ ON/CANADA, 4School Of Social Work, Faculty Of Community Services, Ryerson University, Toronto/ON/CANADA, 5, , Toronto/ Ontario/CANADA, 6, University Health Network, Toronto/CANADA