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Evaluation by multidimensional instruments of health-related quality of life of elderly cancer patients undergoing three different “psychosocial” treatment approaches

Our study belongs to the clinical trials in which the health-related quality of life (HQL) evaluation constitutes the primary endpoint. It was carried out with the aim of comparing the impact of three different types of psychological intervention, namely a psychopharmacological treatment alone, the same treatment plus social support carried out by volunteers (SSV) and a third treatment modality including “structured psychotherapy” (autogenous training), on improving the HQL of elderly cancer patients undergoing antineoplastic therapy with symptoms of anxiety and/or depression related to their disease. The eight questionnaires used for HQL evaluation were generally. self-rated and multidimensional but unidimensional models were also employed. Seventy-four patients aged over 65 years with either solid tumors in different sites or hematological malignancies, generally in advanced stages (III–IV), were enrolled in the study. Of these patients, 72 (42 men and 30 women, mean age 70.68 years, range 66–85) were evaluable. Our study high-lighted the usefulness of the pharmacological therapy (alprazolam + sulpiride) and of other specific ancillary treatments in reducing the incidence of the main HQL-related side-effects of antineoplastic therapy and the superiority of an “integrated” strategy, based both on psychopharmacology and psychosocial interventions, such as SSV with or without structured psychotherapy. The one-way analysis of variance carried out by us did not allow us to draw definitive conclusions about which of the two integrated treatments was to be considered the treatment of choice, as they proved to be almost equally effective.

Psychiatric comorbidity and quality of life in obese patients. Results from a case-control study

Objective: The authors sought to evaluate psychiatric comorbidity, subjective quality of life, and impact of psychopathology on quality of life measures in a clinical sample of patients attending a center for the diagnosis and treatment of obesity compared to a matched sample of non-obese subjects. Methods: Two hundred ninety-three consecutive obese patients (48 males, 245 females, mean age 45.41 α 13.55 yrs; mean BMI 35.60 α 6.20) were compared with a control group made of 293 non obese subjects (48 males, 245 females, mean age 45.66 α 13.86 yrs; mean BMI 21.8 α 2.06); all subjects were interviewed by means of SCID I and SCID II and completed the WHO-QoL-Bref, a self-administered instrument for evaluation of subjective quality of life. Results: Obesity was associated with a significant lifetime major risk both for axis I (OR = 3.47, p = 0.000) and axis II disorders (OR = 2.27, p = 0.000); obesity was also associated with significantly lower measures of subjective quality of life on physical, social, and psychological domains; comorbidity with axis I/II disorders was associated with lower QoL measures on WHO-QoL-Bref, in particular among obese patients. Conclusions: Obesity is significantly associated with a significant major risk of psychiatric comorbidity and poor quality of life; comorbid mental disorders play a significant role in worsening quality of life of obese patients; a multimodal approach to the treatment of obesity, including psychiatric evaluation and intervention, is needed to improve quality of life of patients.

Obesity, alexithymia and psychopathology: A case-control study

OBJECTIVE: The relationship between psychopathology and alexithymia in obese patients is uncertain. The present study was performed to evaluate this relationship in a clinical sample of patients attending a centre for the diagnosis and treatment of obesity compared to a matched sample of non-obese subjects. METHODS: 293 consecutive obese patients (48 males, 245 females, mean age 45, 41±13.55 yrs; mean BMI 35.60±6.20) were compared with a control group made of 293 non-obese subjects (48 males, 245 females, mean age 45, 66±13.86 yrs; mean BMI 21.8±2.06); all subjects were interviewed by means of SCID I and SCID II together with several self-evaluation instruments including the TAS-20 (Toronto Alexithymia Scale) and SCL-90 (Symptom Check List, Revised). RESULTS: Alexithymia was significantly more frequent among obese patients compared to “normal” controls (12.9% vs 6.9%, p=0.010); moreover obese patients achieved significantly higher mean scores on subscales 1 and 2 and on overall scale of the Toronto Alexithymia Scale; comorbidity with axis I/II disorders, in particular Binge Eating Disorder, was associated with a significantly higher frequency of alexithymic traits and higher scores at TAS. CONCLUSIONS: Alexithymia and psychopathology are strongly correlated among obese patients seeking treatment. Routine evaluation of personality traits and comorbid psychopathology may be relevant in treatment of obesity.

Obesity and psychopathology. A study of psychiatric comorbidity among patients attending a specialist obesity unit

AIMS The study aims to evaluate the frequency of association between Axis I and II disorders according to DSMIVTR criteria and obesity, and use of mental health services in a clinical sample of patients attending a centre for the diagnosis and treatment of Obesity. METHODS 150 consecutive patients (32 Males, 118 females, mean age 44.6 +/- 14.3 yrs; mean BMI 35.4 +/- 6.2) were interviewed by means of SCID I and SCID II. RESULTS Lifetime Prevalence of Axis I disorders was 58% (males 50%; females 61%); the highest prevalence rate was found for Anxiety Disorders (approx 35%), whilst 30% of subjects were affected by Mood disorders, chiefly Major Depression (20%), and 18% by Eating Disorders. 28% of obese patients presented a Personality Disorder, 23% of patients being affected both by an Axis I and Axis II disorder. Mood Disorders, in particular Major Depression, were significantly prevalent among female obese. 50% of females and approx 37% males included in the sample had contacted mental health units for treatment. CONCLUSION Data obtained in the present study confirm the high prevalence rates of mental disorders in obese patients seeking treatment. Specialist units should therefore include thorough psychiatric evaluation of patients as a routine practice.

Alexithymia and Early Diagnosis of Uterine Carcinoma: Results of a Case-Control Study

Accessible online at: www.karger.com/journals/pps Todarello et al. [1, 2] investigated the relationship between alexithymia and carcinogenesis in women who were unconsciously suffering from precancerous lesions of the cervix (CIN); in two separate studies, they demonstrated a high level of association between alexithymia and CIN [1, 2]. Further confirmation is provided by data obtained in a study structured to provide additional information concerning the association between alexithymia and cancer. Asymptomatic women who had visited a prevention centre for their routine pap test were included in the project. At the time of the study, women were unaware of the possible presence of the illness, as psychodiagnostic evaluation was performed prior to collecting the results of the oncological examination. Moreover, contrary to other previous investigations, symptoms were totally absent in these subjects who were not sent for tests or examinations for uterine disorders. All women who had come to the centre with a positive history of previous gynaecological complaints or who had made the appointment after noting symptoms were excluded from the study. The following screening instruments were applied: Toronto Alexithymia Self-Administered Rating Sclae (TAS) [3] and Eysenck Personality Inventory (EPI) [4]. The Italian version of the TAS used in the present study was made up of 26 items and was structured with 4 main factors [5], similar to the Canadian [6] and the Spanish [7] version. The sample examined was made up of 239 subjects (age 51 B 12.3, ranging from 19 to 67 years); of these, 226 had not manifested any form of uterine pathology (unmatched controls); 8 presented benign neoplastic uterine lesions (benign cases) at colposcopy and uterine biopsy; and 5 were diagnosed at colposcopy and uterine biopsy as being affected by cancer of the uterine cervix (malignant cases). From the unmatched group of controls, two groups age-matched with the two groups of cases were obtained by simple randomization after having matched each case with all possible controls of the same age. In the control group with benign tumours, randomized techniques led to the matching of 1:4 cases/controls (malignant matched controls), and 1:2 were matched in the control group for benign tumours (benign matched controls) due to the insufficient number of controls available. Statistical analysis was performed using the two-direction-hypothesis MannWhitney U test. The results obtained are summarized in table 1. No statistically significant differences were revealed between the groups with regard to the EPI. The malignant cases obtained a higher mean score on the TAS (73.2 B 8.0) compared to both the unmatched control group (63.0 B 2.1, U = 120, p ! 0.01) and age-matched control group (64.3 B 13.7, U = 180, p ! 0.05). Similarly, scores obtained for factor 4 of the TAS (operating thought) were higher among malignant cases (15.2 B 3.2) compared to unmatched (13.3 B 3.3, U = 180, p ! 0.01) and

Psychopathology, psychosocial factors and obesity.

AIMS The aims of this study were to evaluate the association between obesity and socio-demographic and psychopathological variables in a clinical sample of patients referred to a center for the diagnosis and treatment of obesity, compared with a homogeneous sample of normal-weight subjects. METHODS In the context of a research project regarding obesity and psychopathology, a multivariate logistic regression analysis was used to examine the association between obesity and the demographic and clinical variables, on the basis of the dataset of a consecutive sample of 293 obese patients (48 males, 245 females, mean age: 45.41±13.55, mean body mass index [BMI] 35.6±6.2)compared with a control group of 293 non-obese subjects (48 males, 245 females, mean age 45.66±13.86, mean BMI 21.8±2.06). All subjects were assessed by structured clinical interview, the Structured Clinical Interview for Diagnosis for axis I DSM-IV (SCID-I) and for axis II DSM-IV(SCID-II). RESULTS Multivariate statistical analysis showed that the status of housewife and the presence of lifetime axis I and II psychiatric diagnosis in general, and of depressive, anxiety, eating and some personality disorders in particular, significantly increased the likelihood of being overweight/obese. The likelihood for different combinations of risk factors increased from a value of 32.3% for an individual not exposed to any risk factor, to a value of 86.7% for those exposed to all risk factors considered. CONCLUSIONS The presence of an axis I and/or II diagnosis and housewife status are both independently associated with an increased likelihood of being overweight/obese. The interaction of these factors increases this likelihood. Even taking into account the limits of the study, in particular of its cross-sectional nature, these findings may have important implications in both prevention and treatment of obesity.