Tone Tangen

Prevalence of psychiatric disorders in sick listed chronic low back pain patients

Background: Previous findings have shown a high degree of comorbid psychopathology in chronic low back pain (CLBP), but less is known about the broad range of comorbid psychiatric disorders. The prevalence is reported to be between 40% and 100% depending on methods being used, sample or setting.

INSPIRE study: Does stress management improve the course of inflammatory bowel disease and disease‐specific quality of life in distressed patients with ulcerative colitis or crohn's disease? A randomized controlled trial

Background: The use of stress management psychotherapy is hypothesized to produce greater improvement in disease course and disease‐specific quality of life (IBDQ) compared to usual medical care alone in patients with ulcerative colitis (UC) or Crohns disease (CD) showing high levels of stress (based on the Perceived Stress Questionnaire [PSQ]). Methods: Fifty‐eight patients with UC and 56 patients with CD who had experienced continuous disease activity or had relapsed over the previous 18 months, with an activity index for UC or CD ≥4, a PSQ ≥60, and without serious psychiatric disorders or other serious medical conditions were randomized to receive either treatment as usual (TAU) or TAU plus stress management psychotherapy. Psychotherapy consisted of three group sessions (psychoeducation, problem‐solving, relaxation) and 6–9 individual sessions based on cognitive behavior therapy‐related methods with 1–3 booster sessions at 6 and 12 months follow‐up. Gastroenterologists blinded to intervention group assessed disease activity and course at baseline and at 3, 6, 12, and 18 months. Patients completed the IBDQ at baseline, 6, 12, and 18 months. Results: The intervention did not improve disease or reduce relapse; however, it increased the IBDQ score (P = 0.009, mean differences 16.3 [SD 6.1]). On analysis of UC and CD separately, improvement of IBDQ was only found in the UC group. Conclusions: Stress management psychotherapy does not appear to improve disease course or reduce relapse in patients with IBD. It might improve quality of life, particularly in patients with UC. (Inflamm Bowel Dis 2011;)

Depression and anxiety through the climacteric period: an epidemiological study (HUNT-II).

Aim. The aim of this study was to examine the prevalence of anxious and depressive symptoms related to menstruational status in a large community sample. Method. In the HUNT-II study all adults in Nord-Trøndelag County of Norway were asked about demographic factors, lifestyle, physical symptoms and somatic diseases, a total of 94 197 persons. Anxious and depressive symptoms were recorded by the Hospital Anxiety and Depression Scale (HADS). Of female persons invited aged 35–60 years (N = 19 677), 16 080 (82%) took part. The menstruation status were defined as pre-, peri- and postmenopausal periods, calculated as the time period from last menstruation to examination date. Results. There was a significantly higher score on depression and anxiety in the peri- and the postmenopausal period compared to the premenopausal period. Comparing the postmenopausal period with the perimenopausal period, the score for depressive symptoms was somewhat higher while the score for anxious symptoms was somewhat lower. These differences did not reach significance. Conclusion. There was a general effect of age on the scores on HADS-D. For scores on HADS-A there was a peak in the score in the perimenopausal period, indicating a high degree of anxiety symptoms in this time period which is especially connected to fluctuations in the serum level of gonadal hormones.

Quality of life among patients undergoing bariatric surgery: associations with mental health- A 1 year follow-up study of bariatric surgery patients

BackgroundPreoperative mental health seems to have useful predictive value for Health Related Quality of Life (HRQOL) after bariatric surgery. The aim of the present study was to assess pre- and postoperative psychiatric disorders and their associations with pre- and postoperative HRQOL.MethodData were assessed before (n = 127) and one year after surgery (n = 87). Psychiatric disorders were assessed by Mini International Neuropsychiatric Interview (M.I.N.I.) and Structured Clinical Interview (SCID-II). HRQOL was assessed by the Short Form 36 (SF-36) questionnaire.ResultsSignificant improvements were found in HRQOL from preoperative assessment to follow-up one year after surgery. For the total study population, the degree of improvement was statistically significant (p values < .001) for seven of the eight SF-36 subscales from preoperative assessment to follow-up one year after surgery. Patients without psychiatric disorders had no impairments in postoperative HRQOL, and patients with psychiatric disorders that resolved after surgery had small impairments on two of the eight SF-36 subscales compared to the population norm (all effect sizes < .5) at follow-up one year after surgery. Patients with psychiatric disorders that persisted after surgery had impaired HRQOL at follow-up one year after surgery compared to the population norm, with effect sizes for the differences from moderate to large (all effect sizes ≥ .6).ConclusionThis study reports the novel finding that patients without postoperative psychiatric disorders achieved a HRQOL comparable to the general population one year after bariatric surgery; while patients with postoperative psychiatric disorders did not reach the HRQOL level of the general population. Our results support monitoring patients with psychiatric disorders persisting after surgery for suboptimal improvements in quality of life after bariatric surgery.Trial RegistrationThe trial is registered at http://www.clinicaltrials.gov prior to patient inclusion (ProtocolID16280).

The impact of preoperative counseling on postoperative treatment adherence in bariatric surgery patients: A randomized controlled trial

OBJECTIVE To assess if attendance to a preoperative counseling program improved weight loss or adherence to treatment guidelines in patients who underwent bariatric surgery. METHODS One-hundred-forty-one patients were included in the study. Sixty-nine percent chose to participate in the counseling groups. They were randomized to a Treatment group and a Control group. Thirty-one percent chose not to participate in the counseling. However, they gave their consent to assessment before and after surgery (Reference group). RESULTS One year after bariatric surgery, 88% had a weight loss of ≥ 50% EWL, 37% reported more than 30 min of physical activity daily, 74% had 5-7 meals daily, and 87% took recommended vitamins. There were no differences in weight loss, eating habits, or physical exercise between the Treatment group, the Control group and the Reference group one year after surgery. CONCLUSION Preoperative group counseling did not increase treatment adherence to recommended life-style changes. PRACTICE IMPLICATIONS In accordance with findings in the present study, it is not reasonable to offer a preoperative counseling program for all patients undergoing bariatric surgery. Further research should focus on developing and evaluating programs for postsurgical follow-up, and identifying patients that are in need for more comprehensive treatment programs.

Prevalence of psychiatric disorders before and 1 year after bariatric surgery: The role of shame in maintenance of psychiatric disorders in patients undergoing bariatric surgery

Objective: The present study examined prevalence of psychiatric disorders before and 1 year after weight loss surgery. Furthermore, we studied if level of pre-operative shame could be a maintaining factor for psychiatric disorders at 1-year follow-up. Method: One-hundred and twenty-seven patients (F/M: 94/33) with mean body mass index (BMI) ± standard deviation (s) =45.3±5.2 kg/m2 and mean age 41.3±10.3 years participated in the study. Eighty-seven patients met for follow-up 1 year after surgery. Psychiatric disorders were assessed by the Mini International Neuropsychiatric Interview (M.I.N.I.) and the Structured Clinical Interview (SCID-II). Levels of depression, anxiety and shame were assessed by the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and the Internalized Shame Scale (ISS). Results: Sixty-one patients (48%) at pre-operative assessment and 16 patients (18%) at 1-year follow-up had a comorbid psychiatric disorder. The strongest predictor of post-operative psychiatric disorder was pre-operative psychiatric disorder, odds ratio of 27.7 (95% CI for EXP (B) 3.2–239.8, P =0.003). Pre-operative level of shame (higher than 50-point ISS score) was also a significant predictor for post-operative psychiatric disorders, odds ratio of 9.1 (95% CI for EXP (B) 1.8–44.4, P =0.007). Conclusion: There was a significant reduction in prevalence of psychiatric disorders from pre-operative assessment to follow-up 1 year after surgery. Level of shame at pre-operative assessment was associated with maintenance of psychiatric problems. This finding is of clinical importance, since psychiatric disorders persisting after bariatric surgery have strong impact on the course of weight loss and quality of life.

Anxiety and depression in patients with self-reported food hypersensitivity

OBJECTIVE Self-reported food hypersensitivity (SFH) is common. Psychological factors are assumed to be associated. We assessed anxiety and depression in SFH patients, using both questionnaires and interview. METHODS Consecutive patients (n=130) and randomly selected healthy volunteers (n=75) completed the Hospital Anxiety and Depression Scale (HADS), the neuroticism scale of the Eysenck Personality Questionnaire (EPQ-N) and the General Health Questionnaire (GHQ). Seventy-six of the patients were also interviewed by use of the Mini International Neuropsychiatric Interview and the Montgomery-Aasberg Depression Rating Scale. All patients underwent extensive allergological, gastroenterological and dietary examinations. RESULTS According to interviews, 57% of patients fulfilled the DSM-IV criteria for at least one psychiatric disorder. Anxiety disorders (34%) and depression (16%) predominated. According to questionnaires, patients scored significantly higher than controls on all psychometric scales except for depression (HADS). We also found an underreporting of depression in HADS compared with interviews (2.5% vs. 16%, P=.001). Food hypersensitivity was rarely confirmed by provocation tests (8%). Eighty-nine percent of the patients had irritable bowel syndrome. CONCLUSIONS Anxiety and depression are common in patients with IBS-like complaints self-attributed to food hypersensitivity. Anxiety disorders predominate. In this setting, depression may be underreported by HADS.

Diurnal cortisol rhythm: Associated with anxiety and depression, or just an indication of lack of energy?

Dysregulation of hypothalamus-pituitary-adrenal-activity has been associated with low back pain (LBP). The underlying mechanisms are not fully explained, but psychological mechanisms are considered important. In this study we examine the association between psychiatric disorders/symptoms measured with different instruments, and cortisol in a population with LBP. Participants (n=305) sick-listed 2-10 months due to non-specific LBP were included in the study. The screening instruments were the MINI-interview, HADS and HSCL-25. Saliva cortisol were measured on 2 consecutive days; at awakening, 30min later, at 15:00h and 22:00h. Results showed no associations between any of the main diagnostic categories from the MINI-interview, or anxiety/depression measured with HADS or HSCL-25 and cortisol. However, significant associations were found between low cortisol awakening response, low cortisol slope during the day and the somatization scale from HSCL-25 (dizziness or lack of energy, lack of sexual interest, the feeling that everything requires substantial efforts, difficulties to fall asleep, headache). The results indicate that cortisol, may not be directly associated with psychopathology, such as anxiety and depression, but instead are associated with one dimension of the psychopathology, namely lack of energy. This could help explain the inconsistency in the literature, and it should be explored further.

Cognitive Interventions and Nutritional Supplements (The CINS Trial): A Randomized Controlled, Multicenter Trial Comparing a Brief Intervention with Additional Cognitive Behavioral Therapy, Seal Oil, and Soy Oil for Sick-Listed Low Back Pain Patients

Study Design. A randomized controlled trial. Objective. The aim of this study was to evaluate whether a tailored and manualized cognitive behavior therapy (CBT) or nutritional supplements of seal oil and soy oil had any additional benefits over a brief cognitive intervention (BI) on return to work (RTW). Summary of Background Data. Brief intervention programs are clinically beneficial and cost-effective for patients with low back pain (LBP). CBT is recommended for LBP, but evidence on RTW is lacking. Seal oil has previously been shown to have a possible effect on muscle pain, but no randomized controlled trials have so far been carried out in LBP patients. Methods. Four hundred thirteen adults aged 18 to 60 years were included. Participants were sick-listed 2 to 10 months due to LBP. Main outcome was objectively ascertained work participation at 12-month follow-up. Participants were randomly assigned to BI (n = 100), BI and CBT (n = 103), BI and seal oil (n = 105), or BI and soy oil (n = 105). BI is a two-session cognitive, clinical examination program followed by two booster sessions, while the CBT program is a tailored, individual, seven-session manual-based treatment. Results. At 12-month follow-up, 60% of the participants in the BI group, 50% in the BI and CBT group, 51% in the BI and seal oil group, and 53% in the BI and soy oil group showed reduced sick leave from baseline, and had either partly or fully RTW. The differences between the groups were not statistically significant (&khgr;2 = 2.54, P = 0.47). There were no significant differences between the treatment groups at any of the other follow-up assessments either, except for a significantly lower sick leave rate in the BI group than the other groups during the first 3 months of follow-up (&khgr;2 = 9.50, P = 0.02). Conclusion. CBT and seal oil had no additional benefits over a brief cognitive intervention on sick leave. The brief cognitive intervention alone was superior in facilitating a fast RTW. Level of Evidence: 2

P02-60 Subjective health complaints in a sample with morbid obesity and the complaints' relation with work ability

Background and aims Obesity is associated with psychological, social and physical problems. The aim of this study was to examine the prevalence of subjective health complaints and their impact on work ability in a sample with morbid obesity. Method Fortysix patients, 31 women and 15 men, aged 23 to 65 years (mean 43.7, s.d. 10.7), with BMI from 37 to 60 kg/m 2 (mean 45 kg/m 2 , s.d. 5.02), on a waiting list for bariatric surgery participated. Subjective health complaints were measured by the 29-items Subjective Health Complaint Inventory. Five subscales were computed; Allergy, Flu, Musculoskeletal pain, Gastrointestinal problems and Pseudoneurology. Results All participants reported subjective health complaints the last month, in particular they suffered from musculoskeletal (mean 8.2, s.d. 5.46), pseudoneurological (mean 4.7, s.d. 4.31) and gastrointestinal (mean 3.2, s.d. 5.46) complaints. Mean sickness absence the last year was 185 days (s.d. 163.32). Days of sickness absence were significant correlated with the Musculoskeletal ( r = .35, p = .023) and Pseudoneurological ( r= .40, p = .009) subscales. Conclusion All patients reported subjective health complaints, with mean levels of symptoms considerably higher than in the general population. In particular, levels of musculoskeletal and pseudoneurological complaints were high, and these complaints were significantly related to work absence. It thus seems like subjective health complaints influence work ability to a significant degree in patients with morbid obesity.