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Seiler A, Amann M, Hertler C, Christ SM, Schettle M, Kaeppeli BM, Jung-Amstutz J, Nigg C, Pestalozzi BC, Imesch P, Dummer R, Blum D, Jenewein J. Effects of dignity therapy on psychological distress and wellbeing of palliative care patients and family caregivers - a randomized controlled study. BMC Palliat Care 2024; 23:73. [PMID: 38486192 PMCID: PMC10938771 DOI: 10.1186/s12904-024-01408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND This study extended the original Dignity Therapy (DT) intervention by including partners and family caregivers (FCs) of terminally-ill cancer patients with the overall aim of evaluating whether DT can mitigate distress in both patients nearing the end of life and their FCs. METHODS In this multicenter, randomized controlled trial (RCT), a total of 68 patients with life expectancy < 6 months and clinically-relevant stress levels (Hospital Anxiety Depression total score; HADStot ≥ 8) including their FCs were randomly assigned to DT, DT + (including their FCs), or standard palliative care (SPC) in a 1:1:1 ratio. Study participants were asked to complete a set of questionnaires pre- and post-intervention. RESULTS The coalesced group (DT and DT +) revealed a significant increase in patients' perceived quality of life (FACIT-Pal-14) following the intervention (mean difference 6.15, SD = 1.86, p < 0.01). We found a statistically significant group-by-time interaction effect: while the HADStot of patients in the intervention group remained stable over the pre-post period, the control group's HADStot increased (F = 4.33, df = 1, 82.9; p < 0.05), indicating a protective effect of DT. Most patients and their FCs found DT useful and would recommend it to other individuals in their situation. CONCLUSIONS The DT intervention has been well-received and shows the potential to increase HRQoL and prevent further mental health deterioration, illness burden and suffering in terminally-ill patients. The DT intervention holds the potential to serve as a valuable tool for facilitating end-of-life conversations among terminally-ill patients and their FCs. However, the implementation of DT within the framework of a RCT in a palliative care setting poses significant challenges. We suggest a slightly modified and less resource-intensive version of DT that is to provide the DT inventory to FCs of terminally-ill patients, empowering them to ask the questions that matter most to them over their loved one's final days. TRIAL REGISTRATION This study was registered with Clinical Trial Registry (ClinicalTrials.gov -Protocol Record NCT02646527; date of registration: 04/01/2016). The CONSORT 2010 guidelines were used for properly reporting how the randomized trial was conducted.
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Affiliation(s)
- Annina Seiler
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Manuel Amann
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Sebastian M Christ
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Markus Schettle
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | | | | | | | - Bernhard C Pestalozzi
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Patrick Imesch
- Department of Gynecology, University Hospital Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology, Competence Center for Palliative Care, University Hospital Zurich and University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Josef Jenewein
- Privatklinik Hohenegg, Meilen, Switzerland
- University of Zurich, Zurich, Switzerland
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Bohny P, Boettger S, Jenewein J. Dose-dependent QTc interval prolongation under haloperidol and pipamperone in the management of delirium in a naturalistic setting. Front Psychiatry 2023; 14:1257755. [PMID: 37854439 PMCID: PMC10579563 DOI: 10.3389/fpsyt.2023.1257755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023] Open
Abstract
Objective Delirium is an acute, life-threatening neuropsychiatric disorder frequently occurring among hospitalized patients. Antipsychotic medications are often recommended for delirium management but are associated with cardiovascular risks. This study aimed to investigate the frequency and magnitude of QTc interval prolongation and clinically relevant side effects occurring in delirium patients managed with haloperidol and/or pipamperone. Methods This descriptive retrospective cohort study evaluated 102 elderly (mean age: 73.2 years) inpatients with delirium treated with either haloperidol, pipamperone, a combination of both, or neither in a naturalistic setting over the course of up to 20 days or until the end of delirium. Results A total of 86.3% of patients were treated with haloperidol and/or pipamperone at a mean daily haloperidol-equipotent dose of 1.2 ± 1 mg. Non-cardiovascular side effects were registered in 2.9% of all patients and correlated with higher scores on the Delirium Observation Screening Scale. They did not occur more frequently under antipsychotic treatment. The frequency of QTc interval prolongation was comparably common among all groups, but prolongation magnitude was higher under antipsychotic treatment. It was positively correlated with antipsychotic dosage and the total number of QTc interval-prolonging substances administered. Critical QTc interval prolongation was registered in 21.6% (n = 19) of patients in the group treated with antipsychotics compared to 14.3% (n = 2) of patients in the unmedicated group; however, the difference was not statistically significant. Polypharmacy was associated with a higher risk of critical QTc interval prolongation and increased mortality during delirium. Conclusion Delirium treatment with haloperidol and/or pipamperone was not associated with a higher risk of QTc-interval prolongation in this naturalistic patient sample but was greater in magnitude and correlated with equipotent dosage and the number of QT interval-prolonging substances used. Polypharmacy was associated with higher mortality and increased risk of critical QTc prolongation.
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Affiliation(s)
- Philipp Bohny
- Center for Psychiatry and Psychotherapy, Triaplus Clinic Zugersee, Zug, Switzerland
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Soenke Boettger
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Josef Jenewein
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Privatklinik Hohenegg, Meilen, Switzerland
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Muijres P, Weitkamp K, Bodenmann G, Jenewein J. Discrepancies in dyadic coping: associations with distress and quality of life in couples facing early stage dementia. Front Psychol 2023; 14:1056428. [PMID: 37292502 PMCID: PMC10246685 DOI: 10.3389/fpsyg.2023.1056428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/30/2023] [Indexed: 06/10/2023] Open
Abstract
Objectives Due to an aging population, the number of persons living with dementia (PWDs) is increasing worldwide. Romantic partners, as informal caregivers (IC) of PWDs, are often adopting additional tasks. The concept of dyadic coping (DC) addresses how couples cope with stress together. For dyadic coping to be successful, efforts of both partners should be equal. The current study examines how discrepancies in PWDs and ICs perspectives on DC relate to distress and quality of life in each partner within couples facing early stage dementia (ESD). Methods A total of 37 mixed-sex couples including one partner with ESD completed self-report questionnaires. Discrepancies in reciprocity (comparing provided or received levels of DC between partners), equity (each partner balancing own levels received and provided), and congruence (the agreement about levels of DC exchanged between partners) and their covariation with distress and quality of life (QoL) of each partner were measured. Results Both partners indicated a discrepancy in reciprocity: PWDs reported receiving more DC than ICs reported receiving, which was associated with higher QoL in PWDs and lower QoL in ICs. Inequities were found in ICs only, who reported receiving less DC, than providing. No relation between inequities and distress or QoL was found. ICs reported more incongruencies than PWDs did, which was associated with higher QoL and less depression in partners. Discussion A redivision of tasks and roles in the early stage of dementia is associated with different experiences and views between partners. Whereas ICs take over most household and care tasks within the couple, their effort was considered less helpful by PWDs than by ICs. A high care burden is associated with a compromised quality of ICs' social life and living conditions. The clinical implications of the results are discussed.
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Affiliation(s)
- Peter Muijres
- University of Zurich, Department of Psychology, Clinical Psychology for Children/Adolescents and Couples/Families, Zurich, Switzerland
| | - Katharina Weitkamp
- University of Zurich, Department of Psychology, Clinical Psychology for Children/Adolescents and Couples/Families, Zurich, Switzerland
| | - Guy Bodenmann
- University of Zurich, Department of Psychology, Clinical Psychology for Children/Adolescents and Couples/Families, Zurich, Switzerland
| | - Josef Jenewein
- Private Clinic Hohenegg, Meilen, Switzerland
- Department of Psychiatry and Psychotherapy, University of Zurich, Zurich, Switzerland
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Wu Y, Levis B, Daray FM, Ioannidis JPA, Patten SB, Cuijpers P, Ziegelstein RC, Gilbody S, Fischer FH, Fan S, Sun Y, He C, Krishnan A, Neupane D, Bhandari PM, Negeri Z, Riehm KE, Rice DB, Azar M, Yan XW, Imran M, Chiovitti MJ, Boruff JT, McMillan D, Kloda LA, Markham S, Henry M, Ismail Z, Loiselle CG, Mitchell ND, Al-Adawi S, Beck KR, Beraldi A, Bernstein CN, Boye B, Büel-Drabe N, Bunevicius A, Can C, Carter G, Chen CK, Cheung G, Clover K, Conroy RM, Costa-Requena G, Cukor D, Dabscheck E, De Souza J, Downing M, Feinstein A, Ferentinos PP, Flint AJ, Gallagher P, Gandy M, Grassi L, Härter M, Hernando A, Jackson ML, Jenewein J, Jetté N, Julião M, Kjærgaard M, Köhler S, König HH, Krishna LKR, Lee Y, Löbner M, Loosman WL, Love AW, Löwe B, Malt UF, Marrie RA, Massardo L, Matsuoka Y, Mehnert A, Michopoulos I, Misery L, Nelson CJ, Ng CG, O'Donnell ML, O'Rourke SJ, Öztürk A, Pabst A, Pasco JA, Peceliuniene J, Pintor L, Ponsford JL, Pulido F, Quinn TJ, Reme SE, Reuter K, Riedel-Heller SG, Rooney AG, Sánchez-González R, Saracino RM, Schellekens MPJ, Scherer M, Benedetti A, Thombs BD, Et Al. Comparison of the accuracy of the 7-item HADS Depression subscale and 14-item total HADS for screening for major depression: A systematic review and individual participant data meta-analysis. Psychol Assess 2023; 35:95-114. [PMID: 36689386 DOI: 10.1037/pas0001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The seven-item Hospital Anxiety and Depression Scale Depression subscale (HADS-D) and the total score of the 14-item HADS (HADS-T) are both used for major depression screening. Compared to the HADS-D, the HADS-T includes anxiety items and requires more time to complete. We compared the screening accuracy of the HADS-D and HADS-T for major depression detection. We conducted an individual participant data meta-analysis and fit bivariate random effects models to assess diagnostic accuracy among participants with both HADS-D and HADS-T scores. We identified optimal cutoffs, estimated sensitivity and specificity with 95% confidence intervals, and compared screening accuracy across paired cutoffs via two-stage and individual-level models. We used a 0.05 equivalence margin to assess equivalency in sensitivity and specificity. 20,700 participants (2,285 major depression cases) from 98 studies were included. Cutoffs of ≥7 for the HADS-D (sensitivity 0.79 [0.75, 0.83], specificity 0.78 [0.75, 0.80]) and ≥15 for the HADS-T (sensitivity 0.79 [0.76, 0.82], specificity 0.81 [0.78, 0.83]) minimized the distance to the top-left corner of the receiver operating characteristic curve. Across all sets of paired cutoffs evaluated, differences of sensitivity between HADS-T and HADS-D ranged from -0.05 to 0.01 (0.00 at paired optimal cutoffs), and differences of specificity were within 0.03 for all cutoffs (0.02-0.03). The pattern was similar among outpatients, although the HADS-T was slightly (not nonequivalently) more specific among inpatients. The accuracy of HADS-T was equivalent to the HADS-D for detecting major depression. In most settings, the shorter HADS-D would be preferred. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Federico M Daray
- Institute of Pharmacology, School of Medicine, University of Buenos Aires
| | | | - Scott B Patten
- Department of Community Health Sciences, University of Calgary
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit
| | | | - Simon Gilbody
- Department of Health Sciences, Hull York Medical School, University of York
| | - Felix H Fischer
- Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin
| | - Suiqiong Fan
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Ying Sun
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Chen He
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Dipika Neupane
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | | | - Zelalem Negeri
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Kira E Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Xin Wei Yan
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | | | - Jill T Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University
| | - Dean McMillan
- Department of Health Sciences, Hull York Medical School, University of York
| | | | - Sarah Markham
- Department of Biostatistics and Health Informatics, King's College London
| | - Melissa Henry
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Zahinoor Ismail
- Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary
| | | | | | - Samir Al-Adawi
- Department of Behavioural Medicine, College of Medicine & Health Sciences, Sultan Qaboos University
| | - Kevin R Beck
- Department of Psychiatry, Singapore General Hospital, Singapore
| | - Anna Beraldi
- kbo Lech-Mangfall-Klinik für Psychatrie, Psychotherapie und Psychsomatik, Garmisch-Partenkirchen
| | | | - Birgitte Boye
- Department of Behavioural Medicine, University of Oslo
| | | | | | - Ceyhun Can
- Adana City Training and Research Hospital
| | - Gregory Carter
- School of Medicine and Public Health, University of Newcastle
| | - Chih-Ken Chen
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Gary Cheung
- Department of Psychological Medicine, University of Auckland
| | - Kerrie Clover
- Centre for Brain and Mental Health Research, University of Newcastle
| | - Ronán M Conroy
- Division of Population Health Sciences, Royal College of Surgeons in Ireland
| | - Gema Costa-Requena
- Department of Psychiatry, Clinical Psychology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Centro de Investigacióo Biomédica en Red de Salud Mental
| | | | | | | | | | | | - Panagiotis P Ferentinos
- 2nd Department of Psychiatry, Attikon General Hospital, National and Kapodistrian University of Athens
| | | | | | - Milena Gandy
- The School of Psychological Sciences, Macquarie University
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg, University of Hamburg
| | | | | | - Josef Jenewein
- Department of Medical Psychology and Psychotherapy, Medical University of Graz
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai
| | - Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra
| | - Marie Kjærgaard
- Endocrinology Research Group, Medical Clinic, University Hospital of North Norway
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf
| | | | - Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig
| | | | | | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf
| | - Ulrik F Malt
- Department of Research and Education Division of Surgery and Clinical Neuroscience, University of Oslo
| | - Ruth Ann Marrie
- Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba
| | - Loreto Massardo
- Centro de Biología Celular y Biomedicina, Facultad de Medicina y Ciencia, Universidad San Sebastián
| | - Yutaka Matsuoka
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University of Leipzig
| | - Ioannis Michopoulos
- 2nd Department of Psychiatry, Attikon General Hospital, National and Kapodistrian University of Athens
| | | | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Chong Guan Ng
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya
| | | | | | | | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig
| | - Julie A Pasco
- The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University
| | - Jurate Peceliuniene
- Faculty of Medicine, Clinic of Internal Diseases, Family Medicine and Oncology, Vilnius University
| | - Luis Pintor
- Instituto de Investigaciones Biomédicas Augusto Pi i Sunyer
| | | | | | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow
| | - Silje E Reme
- Department of Psychology, Faculty of Social Sciences, University of Oslo
| | - Katrin Reuter
- Private Practice for Psychotherapy and Psycho-oncology, Freiburg, Baden-Württemberg
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig
| | | | - Roberto Sánchez-González
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Centre Emili Mira, Parc de Salut Mar
| | - Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | | | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital
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Götz A, Kröner A, Jenewein J, Spirig R. Evaluation of distress management in inpatients with cancer by means of the distress thermometer: A mixed methods approach. Palliat Support Care 2022:1-8. [PMID: 36367151 DOI: 10.1017/s1478951522001493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To improve psychosocial care for oncology inpatients, we implemented screening for distress by means of distress thermometer (DT) at the Comprehensive Cancer Centre Zurich in 2011. Since then, several screening barriers have been reported regarding the application of the DT. This study aimed to evaluate the distress screening process between 2012 and 2016 to identify barriers preventing sustainability. METHODS In this sequential explanatory mixed methods study, we synthesized the results of 2 quantitative retrospective descriptive studies and 1 qualitative focus group study. To compare and analyze the data, we used thematic triangulation. RESULTS Nurses screened 32% (N = 7034) of all newly admitted inpatients with the DT, and 47% of the screenings showed a distress level ≥5. Of these cases, 9.7% were referred to psycho-oncological services and 44.7% to social services. In 15.7% of these cases, nurses generated a psychosocial nursing diagnosis. In focus group interviews, nurses attributed the low screening rate to the following barriers: adaptation to patients' individual needs, patient-related barriers and resistance, timing, communication challenges, established referral practice, and lack of integration in the nursing process. SIGNIFICANCE OF RESULTS To improve distress screening performance, the screening process should be tailored to patients' needs and to nurses' working conditions (e.g., timing, knowledge, and setting-specific factors). To gain more evidence on distress management as a basis for practical improvements, further evaluations of distress screening are required.
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Affiliation(s)
- Anna Götz
- Comprehensive Cancer Centre Zurich, University Hospital Zurich, Zürich, Switzerland
- Department of Nursing Science, University Witten/Herdecke, Witten, Germany
| | - Anja Kröner
- Department of Oncology, Cantonal Hospital Glarus AG, Glarus, Switzerland
| | - Josef Jenewein
- Comprehensive Cancer Centre Zurich, University Hospital Zurich, Zürich, Switzerland
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, University Hospital Graz, Graz, Austria
- Private Clinic Hohenegg, Meilen, Switzerland and University of Zurich, Zurich, Switzerland
| | - Rebecca Spirig
- Department of Nursing Science, University Witten/Herdecke, Witten, Germany
- Institute of Nursing Science, University of Basel, Basel, Switzerland
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Auschra B, Wilhelm MJ, Husung C, Jenewein J, Flammer AJ, Jellestad L. The use of serotonin reuptake inhibitors increases the risk of bleeding in patients with assist devices. BMC Cardiovasc Disord 2022; 22:121. [PMID: 35317724 PMCID: PMC8939197 DOI: 10.1186/s12872-022-02557-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Bleedings are frequent and dreaded complications in heart failure patients with ventricular assist devices (VAD). Serotonin reuptake inhibitor (SRI) antidepressants are widely used to treat depression in these patients, though they are attributed an increased risk of bleeding due to their modification of hemostasis. Evidence on bleeding risk of VAD patients under SRI medication is scarce and limited. We therefore aimed to assess if SRI use is associated with an elevated bleeding risk in this particularly vulnerable population. Methods We analyzed the medical records of 92 VAD patients at the University Heart Center Zurich between September 2004 and April 2018 for the occurrence of bleedings and the concomitant use of an SRI. Bleeding was defined as any type of post-implantation bleeding requiring medical treatment. We performed univariate analyses and linear mixed-effects models, adjusting for baseline clinical characteristics as potential predictors to identify differences in bleeding rates in patients with vs. without SRI intake. Results The cohort comprised 60.9% of patients with a continuous-flow VAD and 39.1% with a pulsatile-flow VAD. A total of 77.2% of patients experienced at least one bleeding incident. Overall, 28.6% of bleedings occurred under SRI therapy. A generalized linear mixed model showed a predictive effect of SRI medication on bleeding rate, independent of VAD type (z = 2.091, p = 0.037). Conclusions Bleeding events in heart failure patients occur frequently after VAD implantation. Patients with SRI medication were at increased risk of bleeding. The indication and use of SRI, therefore, should be considered carefully.
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Affiliation(s)
- Bianca Auschra
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Markus J Wilhelm
- Clinic for Cardiac Surgery, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Claudia Husung
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Josef Jenewein
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Andreas J Flammer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Lena Jellestad
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
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Fazekas C, Linder D, Matzer F, Jenewein J, Hanfstingl B. Interpreting physical sensations to guide health-related behavior : An introductory review on psychosomatic competence. Wien Klin Wochenschr 2021; 134:3-10. [PMID: 34893940 PMCID: PMC8825406 DOI: 10.1007/s00508-021-01988-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022]
Abstract
From a biopsychosocial perspective, maintaining health requires sufficient autoregulatory and self-regulatory capacity to both regulate somatic physiology and manage human-environment interactions. Increasing evidence from neuroscientific and psychological research suggests a functional link between so called interoceptive awareness and self-regulatory behavior. Self-regulation can, again, influence autoregulatory patterns as it is known from biofeedback training or meditation practices. In this review, we propose the psychosomatic competence model that provides a novel framework for the interrelation between interoceptive and self-regulatiory skills and health behavior. The term psychosomatic competence refers to a set of mind- and body-related abilities which foster an adequate interpretation of interoceptive signals to drive health-related behavior and physical well-being. Current related empirical findings and future directions of research on interoception and self-regulation are discussed.
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Affiliation(s)
- Christian Fazekas
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Auenbruggerplatz 3, 8036, Graz, Austria.
| | - Dennis Linder
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Auenbruggerplatz 3, 8036, Graz, Austria
- Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Franziska Matzer
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Auenbruggerplatz 3, 8036, Graz, Austria
| | - Josef Jenewein
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Auenbruggerplatz 3, 8036, Graz, Austria
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Ledermann K, von Känel R, Berna C, Sprott H, Burckhardt M, Jenewein J, Garland EL, Martin-Sölch C. Understanding and restoring dopaminergic function in fibromyalgia patients using a mindfulness-based psychological intervention: a [18F]-DOPA PET study. Study protocol for the FIBRODOPA study—a randomized controlled trial. Trials 2021; 22:864. [PMID: 35078536 PMCID: PMC8790842 DOI: 10.1186/s13063-021-05798-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/04/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Fibromyalgia (FM) is a very prevalent and debilitating chronic pain disorder that is difficult to treat. Mindfulness-based techniques are regarded as a very promising approach for the treatment of chronic pain and in particular FM. The Mindfulness-Oriented Recovery Enhancement (MORE) intervention, a mindfulness-based group intervention, has shown beneficial effects in opioid-treated chronic pain patients, including reduced pain severity, functional interference, and opioid dosing, by restoring neurophysiological and behavioral responses to reward. The first evidence for a hypodopaminergic state and impaired reward processing in FM has been reported. However, little is known about its impact on dopamine (DA) function and in particular with regard to DA responses to monetary reward in FM. The aim of the present study protocol is to evaluate if MORE is able to restore the DA function in FM patients, in particular with regard to the DA responses to reward, and to reduce pain and mood complaints in FM.
Methods
The present study is a multi-center interventional RCT with 3 time points: before the intervention, after completion of the intervention, and 3 months after completion of the intervention. Sixty-four FM patients will be randomly assigned to either the MORE intervention (N = 32) or a non-intervention control group (N = 32). Additionally, a comparison group of healthy women (N = 20) for PET measures will be enrolled and another group of healthy women (N = 15) will do the ambulatory assessments only. The MORE intervention consists of eight 2-h-long group sessions administered weekly over a period of 8 weeks. Before and after the intervention, FM participants will undergo [18F] DOPA positron emission tomography (PET) and functional MR imaging while performing a reward task. The primary outcome will be endogeneous DA changes measured with [18F] DOPA PET at baseline, after the intervention (after 8 weeks for the non-intervention control group), and at 3 months’ follow-up. Secondary outcomes will be (1) clinical pain measures and FM symptoms using standardized clinical scales; (2) functional brain changes; (3) measures of negative and positive affect, stress, and reward experience in daily life using the ambulatory assessment method (AA); and (4) biological measures of stress including cortisol and alpha-amylase.
Discussion
If the findings of this study confirm the effectiveness of MORE in restoring DA function, reducing pain, and improving mood symptoms, MORE can be judged to be a promising means to improve the quality of life in FM patients. The findings of this trial may inform health care providers about the potential use of the MORE intervention as a possible non-pharmacological intervention for FM.
Trial registration
ClinicalTrials.govNCT 04451564. Registered on 3 July 2020. The trial was prospectively registered.
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9
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Wagner-Skacel J, Mörkl S, Dalkner N, Fellendorf F, Fitz W, Brix B, Neshev R, Wedenig S, Mächler P, Dorr A, Picha R, Rudlof ME, Bartel TO, Tatschl JM, Gostner JM, Bengesser SA, Reininghaus EZ, Jenewein J, Goswami N. The Impact of Cardiovascular Rehabilitation on Psychophysiological Stress, Personality and Tryptophan Metabolism: A Randomized Pilot Feasibility Study. Antioxidants (Basel) 2021; 10:antiox10091425. [PMID: 34573057 PMCID: PMC8467958 DOI: 10.3390/antiox10091425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 01/17/2023] Open
Abstract
Multicomponent cardiac rehabilitation (CR) is a secondary prevention strategy for cardiac patients to tackle stress and psychosocial wellbeing. However, there is a lack of data on its psychoneuroimmunological effects and of biomarkers to determine individual risk and to develop treatment strategies. We conducted a pilot randomized controlled trial (RCT) to investigate the feasibility of deriving psychophysiological stress markers in patients with cardiovascular diseases. Thirty individuals with cardiovascular disease (mean age 58.8 years; 23.3% female) were enrolled and randomized into three treatment groups: standard rehabilitation, yoga, or transcendental meditation (TM). Depression, anxiety, sleep, stress perception, personality functioning, hair cortisol, serum tryptophan, kynurenine and neopterin concentrations were estimated at baseline and after a four-week intervention. Hair cortisol levels decreased significantly after rehabilitation in all groups (F = 15.98, p < 0.001). In addition, personality functioning improved in all patients over time. Participants with impairments in personality functioning showed a positive correlation with baseline neopterin that did not remain significant after Bonferroni correction. Concentrations of serum tryptophan and its metabolite kynurenine did not change significantly. This pilot RCT provides preliminary evidence of multicomponent CR leading to stabilization of hair cortisol levels and improved psychophysiological wellbeing and personality functioning. Impairments in personality functioning were correlated with neopterin levels, which may impact the symptomatology and outcome.
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Affiliation(s)
- Jolana Wagner-Skacel
- Department of Medical Psychology and Psychotherapy, Medical University Graz, 8036 Graz, Austria; (J.W.-S.); (J.J.)
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
- Correspondence: ; Tel.: +43-316-3858-1743
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Frederike Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Werner Fitz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Bianca Brix
- Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria; (B.B.); (R.N.); (M.E.R.); (T.O.B.); (N.G.)
| | - Ruslan Neshev
- Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria; (B.B.); (R.N.); (M.E.R.); (T.O.B.); (N.G.)
| | - Sarah Wedenig
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Petra Mächler
- Rehabilitation Center for Cardiovascular Disease, 8061 St. Radegund, Austria; (P.M.); (A.D.); (R.P.)
| | - Andreas Dorr
- Rehabilitation Center for Cardiovascular Disease, 8061 St. Radegund, Austria; (P.M.); (A.D.); (R.P.)
| | - Rainer Picha
- Rehabilitation Center for Cardiovascular Disease, 8061 St. Radegund, Austria; (P.M.); (A.D.); (R.P.)
| | - Maximilian E. Rudlof
- Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria; (B.B.); (R.N.); (M.E.R.); (T.O.B.); (N.G.)
| | - Till O. Bartel
- Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria; (B.B.); (R.N.); (M.E.R.); (T.O.B.); (N.G.)
| | - Josef M. Tatschl
- Health Psychology Unit, Institute of Psychology, Karl-Franzens University of Graz, 8010 Graz, Austria;
| | - Johanna M. Gostner
- Biochemical Immunotoxicology Group, Institute of Medical Biochemistry, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - Susanne A. Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Eva Z. Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (N.D.); (F.F.); (W.F.); (S.W.); (S.A.B.); (E.Z.R.)
| | - Josef Jenewein
- Department of Medical Psychology and Psychotherapy, Medical University Graz, 8036 Graz, Austria; (J.W.-S.); (J.J.)
| | - Nandu Goswami
- Department of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, 8010 Graz, Austria; (B.B.); (R.N.); (M.E.R.); (T.O.B.); (N.G.)
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10
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Eichenlaub M, Ruettner B, Seiler A, Jenewein J, Boehler A, Benden C, Wutzler U, Goetzmann L. The Actualization of the Transplantation Complex on the Axis of Psychosomatic Totality-Results of a Qualitative Study. Healthcare (Basel) 2021; 9:healthcare9040455. [PMID: 33921523 PMCID: PMC8069072 DOI: 10.3390/healthcare9040455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 11/16/2022] Open
Abstract
Although transplantation medicine is not new, there is a clinically justified gap in the existing literature with respect to the psychological processing of lung transplants. The present study aims to examine whether lung transplantation leads to an actualization of psychological, e.g., oral-sadistic fantasies. Following a qualitative approach, 38 lung transplant patients were interviewed three times within the first six months after transplantation. Data analysis focused on identifying unconscious and conscious material. The inter-rater reliability for all codes was calculated using Krippendorff’s Alpha (c-α-binary = 0.94). Direct and implicit evidence of a so-called transplantation complex was detected e.g., regarding the “incorporation” of the dead donor and his lungs. These processes occur predominantly at an imaginary level and are related to the body. Our findings emphasize that such psychological aspects should be borne in mind in the psychological treatment of lung-transplant patients in order to improve the processing of lung transplants, and that this might have a positive effect on patient adherence.
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Affiliation(s)
- Marie Eichenlaub
- Department of Psychology, Medical School Hamburg MSH, 20457 Hamburg, Germany;
- Correspondence:
| | - Barbara Ruettner
- Department of Psychology, Medical School Hamburg MSH, 20457 Hamburg, Germany;
| | - Annina Seiler
- Department of Radiation Oncology and Competence Center for Palliative Care and Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, 8091 Zurich, Switzerland;
| | - Josef Jenewein
- Department of Medical Psychology and Psychotherapy, University Hospital of Graz, 8036 Graz, Austria;
| | | | - Christian Benden
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland;
| | - Uwe Wutzler
- Clinic for Psychosomatic Medicine and Psychotherapy, Asklepios Fachklinikum Stadtroda, 07646 Stadtroda, Germany;
| | - Lutz Goetzmann
- Institute of Philosophy, Psychoanalysis and Cultural Studies (IPPK), 12047 Berlin, Germany;
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11
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Götz A, Kröner A, Jenewein J, Spirig R. Wie erleben und beurteilen Pflegende das Screening von stationären onkologischen Patient_innen mit dem Belastungsthermometer? Pflege 2021; 34:71-79. [PMID: 33535833 DOI: 10.1024/1012-5302/a000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
How do nurses experience and interpret the screening of hospitalised cancer patients by means of the distress thermometer? - A qualitative study Abstract. Background: People with cancer experience distress and may need professional support. In 2012, the University Hospital Zurich introduced its distress thermometer (DT) screening, whereby all inpatients were to be screened to gauge their support need. However, after five years, the screening rate was 40 % and the referral rate to psycho oncology was 7.9 %, surprisingly low. Aim: The aim of this qualitative study was to describe how nurses experience the screening and how they interpret the screening and referral rate. Methods: The evaluation of three focus group interviews with 14 nurses followed the principles of qualitative content analysis according to Mayring. Results: The analysis revealed four main categories. The first category "Trying to perform useful screening in a complex daily routine" comprises three subcategories: "Using the benefits of screening for comprehensive care", "The best way to recognize the individuality of the counterpart" and "Failing due to structural and personal barriers". Three further main categories addressing nurses' personal attitudes complete the screening experience: "Experiencing fewer difficulties due to competence and experience", "Being careful due to hesitations", and "Reflecting one's responsibility". Conclusions: Nurses want to use the DT. However, they need more practical and scientific support to usefully integrate screening into their everyday life.
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Affiliation(s)
- Anna Götz
- Comprehensive Cancer Center Zürich, Universitätsspital Zürich.,PhD Programm, Department für Pflegewissenschaft, Universität Witten / Herdecke
| | | | - Josef Jenewein
- Triaplus Ag - Integrierte Psychiatrie Uri, Schwyz und Zug
| | - Rebecca Spirig
- PhD Programm, Department für Pflegewissenschaft, Universität Witten / Herdecke.,Institut für Pflegewissenschaft, Universität Basel
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12
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Jenewein J, Moergeli H, Meyer-Heim T, Muijres P, Bopp-Kistler I, Chochinov HM, Peng-Keller S. Feasibility, Acceptability, and Preliminary Efficacy of Dignity Therapy in Patients With Early Stage Dementia and Their Family. A Pilot Randomized Controlled Trial. Front Psychiatry 2021; 12:795813. [PMID: 35002810 PMCID: PMC8740176 DOI: 10.3389/fpsyt.2021.795813] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose: Dementia is the major cause for disability and dependence in older people and associated with considerable psychological burden. The aim of this study was to determine the feasibility, acceptability and preliminary efficacy of Dignity Therapy, a brief psychotherapeutic intervention to enhance dignity and reduce psychological burden, in patients with early stage dementia and in their families or close friends. Materials and methods: In this randomized, waitinglist-controlled clinical trial a total of 54 patients with new diagnosis of early stage dementia and 54 study partners (spouses: n = 37; relatives: n = 14; close friends: n = 3) were randomly assigned to immediate treatment (n = 28) or delayed treatment (n = 26) after 3 months waiting. The main outcomes were feasibility: proportion of screened and invited patients who consented participation; Acceptability: number of drop-outs, and satisfaction with treatment; Efficacy: psychological burden (Hospital Anxiety and Depression Scale-HADS), quality of life (WHOQOL-Bref), and sense of dignity (Patient Dignity Inventory-PDI). Results: In total 38.6% of all eligible patients (n = 140) consented and were enrolled. Along the study six participants (11.1%) dropped out. Patients' satisfaction with the treatment was high and with no significant difference between the groups. HADS scores were significantly lower in both groups at the 3-months follow-up (immediate group: mean difference = -2.69, SE = 0.85, P = 0.003; delayed group: mean difference = -1.97, SE = 0.89, P = 0.031). There was no significant group by time interaction effect (F = 0.71; df = 2, 70.3; P = 0.50). PDI scores only decreased significantly (i.e., improvement of dignity) in the immediate group (mean difference = -6.56, SE = 1.63, P < 0.001; delayed group: mean difference = -3.01, SE = 1.69, P = 0.081), but the group by time interaction effect was not statistically significant (F = 2.29; df = 1, 46.8; P = 0.14). Quality of life improved in some respects by the treatment, but the immediate and the delayed group did not differ significantly over time. After pooling patients' data of both groups, Dignity Therapy resulted in significant improvements in almost all outcome measures. Patients' family members/close friends reported high satisfaction with the intervention. Conclusions: Our findings suggest that Dignity Therapy is feasible and highly accepted in patients with early stage dementia. Patients reported significant improvements, however, there was no significant effect of the intervention in the immediate treatment group compared to the delayed group.
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Affiliation(s)
- Josef Jenewein
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Hanspeter Moergeli
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | | | - Peter Muijres
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.,Faculty of Theology, Spiritual Care, University of Zurich, Zurich, Switzerland
| | | | - Harvey M Chochinov
- Cancer Care Manitoba Research Institute, University of Manitoba, Winnipeg, MB, Canada
| | - Simon Peng-Keller
- Faculty of Theology, Spiritual Care, University of Zurich, Zurich, Switzerland
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13
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Seiler A, Sood AK, Jenewein J, Fagundes CP. Can stress promote the pathophysiology of brain metastases? A critical review of biobehavioral mechanisms. Brain Behav Immun 2020; 87:860-880. [PMID: 31881262 DOI: 10.1016/j.bbi.2019.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 12/15/2019] [Accepted: 12/20/2019] [Indexed: 01/20/2023] Open
Abstract
Chronic stress can promote tumor growth and progression through immunosuppressive effects and bi-directional interactions between tumor cells and their microenvironment. β-Adrenergic receptor signaling plays a critical role in mediating stress-related effects on tumor progression. Stress-related mechanisms that modulate the dissemination of tumor cells to the brain have received scant attention. Brain metastases are highly resistant to chemotherapy and contribute considerably to morbidity and mortality in various cancers, occurring in up to 20% of patients in some cancer types. Understanding the mechanisms promoting brain metastasis could help to identify interventions that improve disease outcomes. In this review, we discuss biobehavioral, sympathetic, neuroendocrine, and immunological mechanisms by which chronic stress can impact tumor progression and metastatic dissemination to the brain. The critical role of the inflammatory tumor microenvironment in tumor progression and metastatic dissemination to the brain, and its association with stress pathways are delineated. We also discuss translational implications for biobehavioral and pharmacological interventions.
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Affiliation(s)
- Annina Seiler
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Josef Jenewein
- Clinic Zugersee, Center for Psychiatry and Psychotherapy, Oberwil-Zug, Switzerland
| | - Christopher P Fagundes
- Department of Psychology, Rice University, Houston, TX, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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14
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Canella C, Mikolasek M, Rostock M, Guckenberger M, Jenewein J, Linka E, Six C, Stoll S, Stupp R, Witt CM. Experiences and views of different key stakeholders on the feasibility of treating cancer-related fatigue. BMC Cancer 2020; 20:458. [PMID: 32448184 PMCID: PMC7245792 DOI: 10.1186/s12885-020-06858-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/13/2020] [Indexed: 11/18/2022] Open
Abstract
Background Although cancer-related fatigue (CRF) has gained increased attention in the past decade, therapy remains a challenge. Treatment programs are more likely to be effective if the needs and interests of the persons involved are well represented. This can be achieved by stakeholder engagement. In this paper, different key stakeholders’ experiences and views on the feasibility of treating CRF in the context of supportive care in hospital environments are analyzed. Method In a qualitative study with the aim of developing an integrative treatment program for CRF, a total of 22 stakeholders (6 medical oncologists, 5 nurses, 9 patients, 1 patient family member, 1 representative of the Swiss Cancer League) were interviewed either in a face-to-face (n = 12) or focus group setting (n = 2). For data analyses, the method of qualitative content analysis was used. Results The stakeholders referred to different contextual factors when talking about the feasibility of treating CRF in the context of supportive care in hospital environments. These included: assessment, reporting and information; treatability; attitude; infrastructure, time-management, costs and affordability; and integrative approach. Conclusions Key factors of a feasible treatment approach to CRF are a coherent, cost effective integrative treatment program facilitated by an interdisciplinary team of health care providers. Furthermore, the treatment approach should be patient orientated, adopting an individualized approach. The major challenges of making the integrative treatment program feasible for CRF are resources and interprofessional collaboration.
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Affiliation(s)
- Claudia Canella
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Sonneggstrasse 6, 8091, Zurich, Switzerland.
| | - Michael Mikolasek
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Sonneggstrasse 6, 8091, Zurich, Switzerland
| | - Matthias Rostock
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Sonneggstrasse 6, 8091, Zurich, Switzerland.,Hubertus Wald Tumorzentrum, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Guckenberger
- Department for Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Josef Jenewein
- Clinic Zugersee, Center for Psychiatry and Psychotherapy, Integrated Psychiatry, Triaplus AG, Oberwil, Zug, Switzerland
| | - Esther Linka
- Department of Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Sarah Stoll
- Cancer League Ostschweiz, St. Gallen, Switzerland
| | - Roger Stupp
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Sonneggstrasse 6, 8091, Zurich, Switzerland.,Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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15
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Berney A, Jenewein J. C-L psychiatry in Switzerland: What's-up ten years after the implementation of a C-L subspecialty? J Psychosom Res 2020; 132:109978. [PMID: 32126337 DOI: 10.1016/j.jpsychores.2020.109978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Alexandre Berney
- Consultation-Liaison Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
| | - Josef Jenewein
- Clinic Zugersee, University of Zurich, Zurich, Switzerland
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16
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Götz A, Kröner A, Jenewein J, Spirig R. Adherence to the distress screening through oncology nurses and integration of screening results into the nursing process to adapt psychosocial nursing care five years after implementation. Eur J Oncol Nurs 2020; 45:101725. [DOI: 10.1016/j.ejon.2020.101725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/16/2019] [Accepted: 01/28/2020] [Indexed: 01/30/2023]
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17
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Wu Y, Levis B, Sun Y, Krishnan A, He C, Riehm KE, Rice DB, Azar M, Yan XW, Neupane D, Bhandari PM, Imran M, Chiovitti MJ, Saadat N, Boruff JT, Cuijpers P, Gilbody S, McMillan D, Ioannidis JPA, Kloda LA, Patten SB, Shrier I, Ziegelstein RC, Henry M, Ismail Z, Loiselle CG, Mitchell ND, Tonelli M, Al-Adawi S, Beraldi A, Braeken APBM, Büel-Drabe N, Bunevicius A, Carter G, Chen CK, Cheung G, Clover K, Conroy RM, Cukor D, da Rocha E Silva CE, Dabscheck E, Daray FM, Douven E, Downing MG, Feinstein A, Ferentinos PP, Fischer FH, Flint AJ, Fujimori M, Gallagher P, Gandy M, Goebel S, Grassi L, Härter M, Jenewein J, Jetté N, Julião M, Kim JM, Kim SW, Kjærgaard M, Köhler S, Loosman WL, Löwe B, Martin-Santos R, Massardo L, Matsuoka Y, Mehnert A, Michopoulos I, Misery L, Navines R, O'Donnell ML, Öztürk A, Peceliuniene J, Pintor L, Ponsford JL, Quinn TJ, Reme SE, Reuter K, Rooney AG, Sánchez-González R, Schwarzbold ML, Senturk Cankorur V, Shaaban J, Sharpe L, Sharpe M, Simard S, Singer S, Stafford L, Stone J, Sultan S, Teixeira AL, Tiringer I, Turner A, Walker J, Walterfang M, Wang LJ, White J, Wong DK, Benedetti A, Thombs BD. Probability of major depression diagnostic classification based on the SCID, CIDI and MINI diagnostic interviews controlling for Hospital Anxiety and Depression Scale - Depression subscale scores: An individual participant data meta-analysis of 73 primary studies. J Psychosom Res 2020; 129:109892. [PMID: 31911325 DOI: 10.1016/j.jpsychores.2019.109892] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Two previous individual participant data meta-analyses (IPDMAs) found that different diagnostic interviews classify different proportions of people as having major depression overall or by symptom levels. We compared the odds of major depression classification across diagnostic interviews among studies that administered the Depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). METHODS Data accrued for an IPDMA on HADS-D diagnostic accuracy were analysed. We fit binomial generalized linear mixed models to compare odds of major depression classification for the Structured Clinical Interview for DSM (SCID), Composite International Diagnostic Interview (CIDI), and Mini International Neuropsychiatric Interview (MINI), controlling for HADS-D scores and participant characteristics with and without an interaction term between interview and HADS-D scores. RESULTS There were 15,856 participants (1942 [12%] with major depression) from 73 studies, including 15,335 (97%) non-psychiatric medical patients, 164 (1%) partners of medical patients, and 357 (2%) healthy adults. The MINI (27 studies, 7345 participants, 1066 major depression cases) classified participants as having major depression more often than the CIDI (10 studies, 3023 participants, 269 cases) (adjusted odds ratio [aOR] = 1.70 (0.84, 3.43)) and the semi-structured SCID (36 studies, 5488 participants, 607 cases) (aOR = 1.52 (1.01, 2.30)). The odds ratio for major depression classification with the CIDI was less likely to increase as HADS-D scores increased than for the SCID (interaction aOR = 0.92 (0.88, 0.96)). CONCLUSION Compared to the SCID, the MINI may diagnose more participants as having major depression, and the CIDI may be less responsive to symptom severity.
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Affiliation(s)
- Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada; Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Ying Sun
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Chen He
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Kira E Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Department of Psychology, McGill University, Montréal, QC, Canada
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Xin Wei Yan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Dipika Neupane
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Parash Mani Bhandari
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Matthew J Chiovitti
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Nazanin Saadat
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Jill T Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
| | - Pim Cuijpers
- EMGO Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Simon Gilbody
- Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK
| | - Dean McMillan
- Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK
| | - John P A Ioannidis
- Department of Clinical, Neuro and Developmental Psychology, Department of Medicine, Department of Health Research and Policy, Department of Biomedical Data Science, Department of Statistics, Stanford University, Stanford, CA, USA
| | | | - Scott B Patten
- Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, AB, Canada; Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada; Cuthbertson & Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, Canada
| | - Ian Shrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada; Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melissa Henry
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Zahinoor Ismail
- Hotchkiss Brain Institute & O'Brien Institute for Public Health, Calgary, AB, Canada; Department of Psychiatry, Clinical Neuroscience and Community Health Sciences, University of Calgary, Calgary, AB, Canada; Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Carmen G Loiselle
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Ingram School of Nursing, McGill University, Montréal, QC, Canada; Centre for Nursing Research, Jewish General Hospital, Montréal, QC, Canada; Department of Oncology, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Nicholas D Mitchell
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada; Alberta Health Services, Edmonton, AB, Canada
| | - Marcello Tonelli
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Samir Al-Adawi
- Department of Behavioural Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Oman, Oman
| | - Anna Beraldi
- Psychotherapie und Psychsomatik, kbo Lech-Mangfall-Klinik für Psychatrie, Garmisch-Partenkirchen, Bayern, Germany
| | - Anna P B M Braeken
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands; Faculty of Psychology, Open University of the Netherlands, Heerlen, the Netherlands; Department of Health Services Research, CAPHRI School for Public Health and Primary, Maastricht University, Maastricht, the Netherlands
| | - Natalie Büel-Drabe
- Department of Psychiatry and Psychotherapy, University Hospital Zürich, Zürich, Switzerland
| | - Adomas Bunevicius
- Harvard University, Boston, MA, USA; Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gregory Carter
- University of Newcastle, Australia; Calvary Mater Newcastle, Australia
| | - Chih-Ken Chen
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Keelung, Taiwan; Department of Psychiatry, Keelung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Keelung, Taiwan
| | - Gary Cheung
- University of Auckland, Auckland, New Zealand
| | - Kerrie Clover
- Centre for Brain and Mental Health Research, University of Newcastle, NSW, Australia
| | - Ronán M Conroy
- Royal College of Surgeons in Ireland Division of Population Health Sciences, Dublin, Ireland
| | | | - Carlos E da Rocha E Silva
- Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eli Dabscheck
- The Alfred Hospital, Prahran, VIC, Australia; Monash University, Melbourne, Australia
| | - Federico M Daray
- National Scientific and Technical Research Council, Buenos Aires, Argentina; Institute of Pharmacology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Elles Douven
- Alzheimer Center Limburg and School for Mental Health and Neuroscience (MHeNs), Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Marina G Downing
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Monash Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, VIC, Australia
| | - Anthony Feinstein
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Panagiotis P Ferentinos
- 2nd Department of Psychiatry, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece; Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Felix H Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alastair J Flint
- University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Maiko Fujimori
- Section of Psychological Science, Division of Health Care Research, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | | | - Milena Gandy
- The Department of Psychology, Macquarie University, Sydney, Australia
| | - Simone Goebel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Christian-Albrechts University, Kiel, Germany
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy; Psychiatric Unit, Integrated Department of Mental Health and Addictive Behavior, Health Trust, University Hospital, Ferrara, Italy
| | - Martin Härter
- Department of Medical Psychology, University of Hamburg, Hamburg, Germany
| | - Josef Jenewein
- Clinic Zugersee, Center for Psychiatry and Psychotherapie, Oberwil-Zug, Switzerland; University of Zurich, Zurich, Switzerland
| | - Nathalie Jetté
- Departments of Neurology and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Portugal
| | - Jae-Min Kim
- Chonnam National University Medical School, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Republic of Korea
| | - Marie Kjærgaard
- Endocrinology Research Group, Medical Clinic, University Hospital of North Norway, Norway; Department of Internal Medicine, Kolding Hospital, Hospital Lillebaelt, Denmark
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Wim L Loosman
- Onze Lieve vrouw Gasthuis, Amsterdam, the Netherlands
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rocio Martin-Santos
- Department of Psychiatry and Psychology, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Loreto Massardo
- Centro de Biología Celular y Biomedicina, Facultad de Medicina y Ciencia, Universidad San Sebastián. Santiago, Chile
| | - Yutaka Matsuoka
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan; Lifestyle Medicine, Cooperative Graduate Program, The Jikei University Graduate School of Medicine, Tokyo, Japan
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Germany
| | - Ioannis Michopoulos
- 2nd Department of Psychiatry, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Ricard Navines
- Department of Psychiatry and Psychology, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona, Spain; Department of Medicine, Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | | | | | - Jurate Peceliuniene
- Clinic of Internal Diseases, Family Medicine and Oncology, Vilnius University Faculty of Medicine, Vilnius, Lithuania
| | - Luis Pintor
- Consultation Liaison Psychiatry Unit, Hospital Clínico de Barcelona, Barcelona, Spain; Instituto de Investigaciones Biomédicas Augusto Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jennie L Ponsford
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Monash Epworth Rehabilitation Research Centre, Epworth HealthCare, Melbourne, VIC, Australia
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Silje E Reme
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway; Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Katrin Reuter
- Private Practice for Psychotherapy and Psycho-oncology, Freiburg, Germany
| | - Alasdair G Rooney
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Robert Fergusson Unit, Royal Edinburgh Hospital, NHS Lothian, Edinburgh, UK
| | - Roberto Sánchez-González
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Centre Emili Mira, Parc de Salut Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Marcelo L Schwarzbold
- Department of Internal Medicine, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | - Juwita Shaaban
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | | | - Sébastien Simard
- Département des sciences de la santé, Université du Québec à Chicoutimi (UQAC), QC, Canada; Centre intersectoriel en santé durable (CISD), QC, Canada; Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), QC, Canada
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre Mainz, Mainz, Germany
| | - Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Jon Stone
- University of Edinburgh, Edinburgh, UK
| | - Serge Sultan
- Université de Montréal, QC, Canada; CHU Sainte-Justine, Montréal, QC, Canada
| | - Antonio L Teixeira
- University of Texas Health Science Center at Houston, Houston, TX, USA; Santa Casa BH Ensino & Pesquisa, Belo Horizonte, Brazil
| | - Istvan Tiringer
- Institute of Behavioral Sciences, Pécs University, Medical School, Pécs, Hungary
| | - Alyna Turner
- IMPACT Strategic Research Centre and School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia; Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia; Department of Psychiatry, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | | | - Mark Walterfang
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia; Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | - Dana K Wong
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; School of Psychology & Public Health, La Trobe University, Melbourne, Australia
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, QC, Canada; Department of Medicine, McGill University, Montréal, QC, Canada.
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada; Department of Psychiatry, McGill University, Montréal, QC, Canada; Department of Psychology, McGill University, Montréal, QC, Canada; Department of Medicine, McGill University, Montréal, QC, Canada; Department of Educational and Counselling Psychology, McGill University, Montréal, QC, Canada.
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Ledermann K, Hasler G, Jenewein J, Sprott H, Schnyder U, Martin-Soelch C. 5'UTR polymorphism in the serotonergic receptor HTR3A gene is differently associated with striatal Dopamine D2/D3 receptor availability in the right putamen in Fibromyalgia patients and healthy controls-Preliminary evidence. Synapse 2020; 74:e22147. [PMID: 31868947 DOI: 10.1002/syn.22147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Extensive literature has investigated the role of serotonin (5-HT) in the control of the central dopamine (DA) systems, and their dysfunction in the pathological conditions. 5-HT stimulates the local DA release in striatal regions via activation of various receptors including serotonin receptor-3 (5-HT3). Several studies have related polymorphisms (SNPs) in the serotonin receptor-3 (HTR3) genes to be associated with the pain modulation and endogenous pain suppression. A few studies suggested a functional role of 5'UTR SNP in the serotonergic receptor HTR3A gene (rs1062613) in the development of the chronic pain and Fibromyalgia syndrome (FMS) in particular. Here, we investigated the effect of a 5'UTR SNP in the serotonergic receptor HTR3A gene (rs1062613) on striatal dopamine D2/D3 receptor (DRD2) availability and reward-associated DA release in response to unpredictable monetary rewards in 23 women with FMS and 17 age-matched healthy female controls. Furthermore, we aimed to examine if SNP rs1062613 is associated with thermal pain and pain tolerance thresholds. METHODS We used PET and [11 C]raclopride to assess the DRD2 availability. In the same participants we used the [11 C]raclopride PET bolus-plus-infusion method to measure the [11 C]raclopride receptor binding potential (ΔBP) between an unpredictable reward condition and a sensorimotor control condition. DRD2 availability and ΔBP were assessed in MRI-based striatal regions of interest. Thermal pain and pain tolerance thresholds were assessed outside the scanner. RESULTS The frequency of SNP rs1062613 genotype differed significantly between groups, indicating that CC homozygotes were more frequent in FMS patients (82.6%) than in healthy controls (41.3%). Our results showed a significant main effect of SNP rs1062613 on [11 C]raclopride binding potential in the right caudate nucleus indicating a higher DRD2 receptor availability for CC-genotype of this SNP. Furthermore, we found a significant group × SNP interaction on [11 C]raclopride binding potential in the right putamen, indicating a higher DRD2 availability in T-carriers compared to CC genotype of SNP rs1062613 in FMS patients, whereas this effect was not present in healthy controls. However, we did not find an influence of SNP rs1062613 on reward-related DA release. In addition, there was no association between SNP rs1062613 and pain threshold or pain tolerance threshold in our data. CONCLUSION These preliminary results indicate that SNP rs1062613 in the serotonergic receptor HTR3A gene possibly modulates the DRD2 receptor availability.
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Affiliation(s)
- Katharina Ledermann
- Department of Psychology, Unit of Clinical and Health Psychology, University Fribourg, Fribourg, Switzerland.,Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital, University of Zurich, Zurich, Switzerland
| | - Gregor Hasler
- Department of Psychology, Unit of Clinical and Health Psychology, University Fribourg, Fribourg, Switzerland
| | - Josef Jenewein
- Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital, University of Zurich, Zurich, Switzerland.,Clinic Zugersee, Center for Psychiatry and Psychotherapy, Oberwil-Zug, Switzerland
| | - Haiko Sprott
- University of Zurich and Arztpraxis Hottingen, Zurich, Switzerland
| | | | - Chantal Martin-Soelch
- Department of Psychology, Unit of Clinical and Health Psychology, University Fribourg, Fribourg, Switzerland
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Bleisch B, Schuurmans MM, Klaghofer R, Benden C, Seiler A, Jenewein J. Health-related quality of life and stress-related post-transplant trajectories of lung transplant recipients: a three-year follow-up of the Swiss Transplant Cohort Study. Swiss Med Wkly 2019; 149:w20019. [DOI: 10.57187/smw.2019.20019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND
Lung transplantation (LTx) provides a viable option for the survival of end-stage lung diseases. Besides survival as a clinical outcome measure, health-related quality of life (HRQoL) and psychological distress have become important outcomes in studies investigating the effectiveness of LTx in the short- and long-term.
OBJECTIVE
To assess and compare HRQoL trajectories of patients after LTx prior to and over a follow-up period of three years post-transplant, and to identify differences regarding distress, HRQoL and patient-related outcomes.
METHODS
In this longitudinal study, 27 lung transplant recipients were prospectively examined for psychological distress (Symptom Checklist short version-9; SCL-K-9), health-related quality of life (EuroQOL five dimensions questionnaire; EQ-5D), depression (HADS-Depression scale), and socio-demographic and medical outcomes at two weeks, three months, six months and three years following LTx. Additionally, potential outcome-related predictors for LTx-outcomes at three years post-transplant were assessed. Data were collected in accordance with guidelines set by the STROBE (strengthening the reporting of observational studies in epidemiology) statement.
RESULTS
Lung transplant recipients showed the most pronounced improvements in HRQoL and reduction in psychological distress between two weeks and three months post-transplant, with relative stable HRQoL and distress trajectories thereafter. The most important predictors of poor somatic health trajectories over time were the pre-transplant disease severity score and the pre-transplant HADS-Depression score. In addition, idiopathic pulmonary fibrosis (IPF) and pre-transplant extracorporeal membrane oxygenation (ECMO)-use predicted poorer survival, while cystic fibrosis was associated with better survival three years post-transplant.
COMCLUSION
Lung transplantation yields significant survival and HRQoL benefits, with its peak improvement at three months post-transplant. The majority of patients can preserve these health changes in the long-term. Patients with a worse HRQoL and higher psychological distress at six months post-transplant tended to have a poorer survival post-transplant. Other risk factors for poorer survival included IPF, pre-transplant ECMO-use, pre-transplant symptoms of depression, high pre-transplant disease severity and worse somatic disease severity trajectories. The majority of LTx-recipients were unable to work due to illness-related reasons.
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20
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Bleisch B, Schuurmans MM, Klaghofer R, Benden C, Seiler A, Jenewein J. Health-related quality of life and stress-related post-transplant trajectories of lung transplant recipients: a three-year follow-up of the Swiss Transplant Cohort Study. Swiss Med Wkly 2019; 149. [PMID: 30961347 DOI: 10.4414/smw.2019.20019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Lung transplantation (LTx) provides a viable option for the survival of end-stage lung diseases. Besides survival as a clinical outcome measure, health-related quality of life (HRQoL) and psychological distress have become important outcomes in studies investigating the effectiveness of LTx in the short- and long-term. Objective To assess and compare HRQoL trajectories of patients after LTx prior to and over a follow-up period of three years post-transplant, and to identify differences regarding distress, HRQoL and patient-related outcomes. Methods In this longitudinal study, 27 lung transplant recipients were prospectively examined for psychological distress (Symptom Checklist short version-9; SCL-K-9), health-related quality of life (EuroQOL five dimensions questionnaire; EQ-5D), depression (HADS-Depression scale), and socio-demographic and medical outcomes at two weeks, three months, six months and three years following LTx. Additionally, potential outcome-related predictors for LTx-outcomes at three years post-transplant were assessed. Data were collected in accordance with guidelines set by the STROBE (strengthening the reporting of observational studies in epidemiology) statement. Results Lung transplant recipients showed the most pronounced improvements in HRQoL and reduction in psychological distress between two weeks and three months post-transplant, with relative stable HRQoL and distress trajectories thereafter. The most important predictors of poor somatic health trajectories over time were the pre-transplant disease severity score and the pre-transplant HADS-Depression score. In addition, idiopathic pulmonary fibrosis (IPF) and pre-transplant extracorporeal membrane oxygenation (ECMO)-use predicted poorer survival, while cystic fibrosis was associated with better survival three years post-transplant. Conclusion Lung transplantation yields significant survival and HRQoL benefits, with its peak improvement at three months post-transplant. The majority of patients can preserve these health changes in the long-term. Patients with a worse HRQoL and higher psychological distress at six months post-transplant tended to have a poorer survival post-transplant. Other risk factors for poorer survival included IPF, pre-transplant ECMO-use, pre-transplant symptoms of depression, high pre-transplant disease severity and worse somatic disease severity trajectories. The majority of LTx-recipients were unable to work due to illness-related reasons.
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Abstract
Background: Being diagnosed with cancer and undergoing its treatment are associated with substantial distress that can cause long-lasting negative psychological outcomes. Resilience is an individual's ability to maintain or restore relatively stable psychological and physical functioning when confronted with stressful life events and adversities. Posttraumatic growth (PTG) can be defined as positive life changes that result from major life crises or stressful events. Objectives: The aims of this study were to 1) investigate which factors can strengthen or weaken resilience and PTG in cancer patients and survivors; 2) explore the relationship between resilience and PTG, and mental health outcomes; and 3) discuss the impact and clinical implications of resilience and PTG on the process of recovery from cancer. Methods: A literature search was conducted, restricted to PubMed from inception until May 2018, utilizing the following key words: cancer, cancer patients, cancer survivors, resilience, posttraumatic growth, coping, social support, and distress. Results: Biological, personal, and most importantly social factors contribute to cancer patients' resilience and, consequently, to favorable psychological and treatment-related outcomes. PTG is an important phenomenon in the adjustment to cancer. From the literature included in this review, a model of resilience and PTG in cancer patients and survivors was developed. Conclusions: The cancer experience is associated with positive and negative life changes. Resilience and PTG are quantifiable and can be modified through psychological and pharmacological interventions. Promoting resilience and PTG should be a critical component of cancer care.
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Affiliation(s)
- Annina Seiler
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Josef Jenewein
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.,Clinic Zugersee, Center for Psychiatry and Psychotherapy, Oberwil-Zug, Switzerland
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22
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Goetzmann L, Seiler A, Benden C, Boehler A, Büchi S, Jenewein J, Ruettner B, Mueller-Alcazar A, Weierstall R. Transplantation experience as a predictor for quality of life during the first 6 months after lung transplantation. Clin Transplant 2018; 32:e13393. [DOI: 10.1111/ctr.13393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 08/05/2018] [Accepted: 08/09/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Lutz Goetzmann
- Department of Psychosomatic Medicine and Psychotherapy; Segeberger Kliniken; Bad Segeberg Germany
| | - Annina Seiler
- Department of Psychiatry and Psychotherapy; University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - Christian Benden
- Division of Pulmonology; University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - Annette Boehler
- Division of Pulmonology; University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - Stefan Büchi
- Clinic for Psychotherapy and Psychosomatics Hohenegg; Meilen Switzerland
| | - Josef Jenewein
- Department of Psychiatry and Psychotherapy; University Hospital Zurich; University of Zurich; Zurich Switzerland
| | - Barbara Ruettner
- Department of Health Psychology; Medical School Hamburg; Hamburg Germany
| | | | - Roland Weierstall
- Department of Human Science; Medical School Hamburg; Hamburg Germany
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23
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Schubert M, Schürch R, Boettger S, Garcia Nuñez D, Schwarz U, Bettex D, Jenewein J, Bogdanovic J, Staehli ML, Spirig R, Rudiger A. A hospital-wide evaluation of delirium prevalence and outcomes in acute care patients - a cohort study. BMC Health Serv Res 2018; 18:550. [PMID: 30005646 PMCID: PMC6045819 DOI: 10.1186/s12913-018-3345-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 07/01/2018] [Indexed: 12/15/2022] Open
Abstract
Background Delirium is a well-known complication in cardiac surgery and intensive care unit (ICU) patients. However, in many other settings its prevalence and clinical consequences are understudied. The aims of this study were: (1) To assess delirium prevalence in a large, diverse cohort of acute care patients classified as either at risk or not at risk for delirium; (2) To compare these two groups according to defined indicators; and (3) To compare delirious with non-delirious patients regarding hospital mortality, ICU and hospital length of stay, nursing hours and cost per case. Methods This cohort study was performed in a Swiss university hospital following implementation of a delirium management guideline. After excluding patients aged < 18 years or with a length of stay (LOS) < 1 day, 29′278 patients hospitalized in the study hospital in 2014 were included. Delirium period prevalence was calculated based on a Delirium Observation Scale (DOS) score ≥ 3 and / or Intensive Care Delirium Screening Checklist (ICDSC) scores ≥4. Results Of 10′906 patients admitted, DOS / ICDSC scores indicated delirium in 28.4%. Delirium was most prevalent (36.2–40.5%) in cardiac surgery, neurosurgery, trauma, radiotherapy and neurology patients. It was also common in geriatrics, internal medicine, visceral surgery, reconstructive plastic surgery and cranio-maxillo-facial surgery patients (prevalence 21.6–28.6%). In the unadjusted and adjusted models, delirious patients had a significantly higher risk of inpatient mortality, stayed significantly longer in the ICU and hospital, needed significantly more nursing hours and generated significantly higher costs per case. For the seven most common ICD-10 diagnoses, each diagnostic group’s delirious patients had worse outcomes compared to those with no delirium. Conclusions The results indicate a high number of patients at risk for delirium, with high delirium prevalence across all patient groups. Delirious patients showed significantly worse clinical outcomes and generated higher costs. Subgroup analyses highlighted striking variations in delirium period-prevalence across patient groups. Due to the high prevalence of delirium in patients treated in care centers for radiotherapy, visceral surgery, reconstructive plastic surgery, cranio-maxillofacial surgery and oral surgery, it is recommended to expand the current focus of delirium management to these patient groups. Electronic supplementary material The online version of this article (10.1186/s12913-018-3345-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria Schubert
- Nursing Science, Faculty of Medicine, Department of Public Health, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland. .,Directorate of Nursing/MTT, Insel Gruppe, University Hospital Inselspital, Bern, Freiburgstr. 44a, 3010, Bern, Switzerland. .,School of Health Professions, Institute of Nursing, Zurich University of Applied Science, Technikumstr. 81, P.O. Box, 8401, Winterthur, Switzerland.
| | - Roger Schürch
- Clinical Trial Unit, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.,Virginia Tech, Department of Entomology (MC0319), 170 Drillfield Drive, Blacksburg, VA, 24061, USA
| | - Soenke Boettger
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - David Garcia Nuñez
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland.,Center for Gender Variance, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland
| | - Urs Schwarz
- Division of Neurology, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - Dominique Bettex
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Josef Jenewein
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - Jasmina Bogdanovic
- Nursing Science, Faculty of Medicine, Department of Public Health, University of Basel, Bernoullistr. 28, 4056, Basel, Switzerland
| | - Marina Lynne Staehli
- Nursing Department, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Rebecca Spirig
- Directorate of Nursing/MTT, Insel Gruppe, University Hospital Inselspital, Bern, Freiburgstr. 44a, 3010, Bern, Switzerland.,Nursing and Allied Health Care Professions Office, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland
| | - Alain Rudiger
- Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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24
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Schmick A, Jenewein J, Böttger S. [Diagnosis, differential diagnosis and therapy of substance use disorders in general hospital (general section)]. Neuropsychiatr 2018; 32:57-68. [PMID: 29327316 DOI: 10.1007/s40211-017-0257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/04/2017] [Indexed: 06/07/2023]
Abstract
Substance use disorders are becoming an increasingly significant problem in general hospitals and hence play a key role in consultation- and liaison psychiatry. Diverse psychotropic effects of various substances mimic psychiatric disorders. An alcohol intoxication can present depressive or manic symptoms, a cannabis delirium can present as a psychosis while stimulants use can suggest the diagnosis of an anxiety disorder. Obtaining dual diagnoses by identifying substance-induced and non-substance-induced psychopathologies is clinically challenging.The aim of this article is to systematically describe the psychopathology, pathophysiology and therapeutic options of substance-use disorders particularly relevant for consultation and liaison psychiatry.
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Affiliation(s)
- Anton Schmick
- UniversitätsSpital Zürich, Klinik für Psychiatrie und Psychotherapie, Abteilung für Konsiliar- und Liaisonpsychiatrie, Universität Zürich, Rämistraße 100, 8091, Zürich, Schweiz.
| | - Josef Jenewein
- UniversitätsSpital Zürich, Klinik für Psychiatrie und Psychotherapie, Abteilung für Konsiliar- und Liaisonpsychiatrie, Universität Zürich, Rämistraße 100, 8091, Zürich, Schweiz
| | - Sönke Böttger
- UniversitätsSpital Zürich, Klinik für Psychiatrie und Psychotherapie, Abteilung für Konsiliar- und Liaisonpsychiatrie, Universität Zürich, Rämistraße 100, 8091, Zürich, Schweiz
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25
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Ledermann K, Jenewein J, Sprott H, Hasler G, Schnyder U, Warnock G, Johayem A, Kollias S, Buck A, Martin-Soelch C. Altered Dopamine Responses to Monetary Rewards in Female Fibromyalgia Patients with and without Depression: A [11C]Raclopride Bolus-plus-Infusion PET Study. Psychother Psychosom 2018; 86:181-182. [PMID: 28490029 DOI: 10.1159/000455927] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 01/08/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Katharina Ledermann
- Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland
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Boettger S, Garcia Nuñez D, Meyer R, Richter A, Rudiger A, Schubert M, Jenewein J. Screening for delirium with the Intensive Care Delirium Screening Checklist (ICDSC): a re-evaluation of the threshold for delirium. Swiss Med Wkly 2018. [PMID: 29537480 DOI: 10.4414/smw.2018.14597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND With its high incidence and subsequent adverse consequences in the intensive care setting, several instruments have been developed to screen for and detect delirium. One of the more commonly used is the Intensive Care Delirium Screening Checklist (ICDSC); however, the optimal cut-off score indicating delirium has been debated. METHODS In this prospective cohort study, the ICDSC threshold for delirium set at ≥3, ≥4, or ≥5 was compared with the DSM-IV-TR-determined diagnosis of delirium (used as standard), and with the Confusion Assessment Method for the ICU (CAM-ICU), with respect to their concurrent validity. RESULTS In total, 289 patients were assessed, including 122 with delirium. The cut-off score of ≥4 had several shortcomings: although 90% of patients with delirium were correctly classified, 23% remained undetected. The agreement with the DSM-IV-TR diagnosis of delirium was only moderate (Cohen's κ 0.59) and the sensitivity was only 62%. In contrast, when the cut-off was ≥3, 83% of patients with delirium were correctly classified and only 14.5% remained undetected. The agreement with DSM-IV-TR was substantial (Cohen's κ 0.68) and the sensitivity increased to 83%. The benefit of setting the cut-off at ≥5 was not convincing: although 90% of patients with delirium were correctly classified, 30% remained undetected. The concurrent validity was only moderate (Cohen's κ 0.44), and the sensitivity reached only 44%. Changing the ICDSC cut-off score did not strengthen the moderate agreement with the CAM-ICU (Cohen's κ 0.45-0.56). CONCLUSION In clinical routine, decreasing the ICDSC threshold for delirium to ≥3 increased the accuracy in detecting delirium at the cost of over-identification and is therefore recommended as the optimal threshold. Increasing the cut-off score to ≥5 decreased the concurrent validity and sensitivity; in addition, the under-detection of delirium was substantial.
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Affiliation(s)
- Soenke Boettger
- Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Switzerland
| | - David Garcia Nuñez
- Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Switzerland; University Hospital Basel, University of Basel, Switzerland
| | - Rafael Meyer
- Pychiatric Services Aargau AG (PDAG), Department Geronto- and Neuropsychiatry, Switzerland
| | - Andre Richter
- Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Switzerland
| | - Alain Rudiger
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Maria Schubert
- Inselspital, University Hospital Bern, Directorate of Nursing/MTT, Bern, Switzerland
| | - Josef Jenewein
- Department of Consultation-Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich, Switzerland
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27
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Canella C, Mikolasek M, Rostock M, Beyer J, Guckenberger M, Jenewein J, Linka E, Six C, Stoll S, Stupp R, Witt CM. Developing an Integrative Treatment Program for Cancer-Related Fatigue Using Stakeholder Engagement - A Qualitative Study. Integr Cancer Ther 2017; 17:762-773. [PMID: 29161912 PMCID: PMC6142112 DOI: 10.1177/1534735417740629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Although cancer-related fatigue (CRF) has gained
increased attention in the past decade, it remains difficult to treat. An
integrative approach combining conventional and complementary medicine
interventions seems highly promising. Treatment programs are more likely to be
effective if the needs and interests of the people involved are well
represented. This can be achieved through stakeholder engagement.
Objectives: The aim of the study was to develop an integrative
CRF treatment program using stakeholder engagement and to compare it to an
expert version. Method: In a qualitative study, a total of 22
stakeholders (4 oncologists, 1 radiation-oncologist, 1 psycho-oncologist, 5
nurses/nurse experts, 9 patients, 1 patient family member, 1 representative of a
local Swiss Cancer League) were interviewed either face-to-face or in a focus
group setting. For data analysis, qualitative content analysis was used.
Results: With stakeholder engagement, the integrative CRF
treatment program was adapted to usual care using a prioritizing approach and
allowing more patient choice. Unlike the expert version, in which all
intervention options were on the same level, the stakeholder engagement process
resulted in a program with 3 different levels. The first level includes
mandatory nonpharmacological interventions, the second includes
nonpharmacological choice-based interventions, and the third includes
pharmacological interventions for severe CRF. The resulting stakeholder based
integrative CRF treatment program was implemented as clinical practice guideline
at our clinic (Institute for Complementary and Integrative Medicine, University
Hospital Zurich). Conclusion: Through the stakeholder engagement
approach, we integrated the needs and preferences of people who are directly
affected by CRF. This resulted in an integrative CRF treatment program with
graded recommendations for interventions and therefore potentially greater
sustainability in a usual care setting.
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Affiliation(s)
- Claudia Canella
- 1 University Hospital Zurich, Zurich, Switzerland.,2 University of Zurich, Zurich, Switzerland
| | - Michael Mikolasek
- 1 University Hospital Zurich, Zurich, Switzerland.,2 University of Zurich, Zurich, Switzerland
| | - Matthias Rostock
- 1 University Hospital Zurich, Zurich, Switzerland.,2 University of Zurich, Zurich, Switzerland.,3 University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Beyer
- 1 University Hospital Zurich, Zurich, Switzerland
| | | | | | - Esther Linka
- 1 University Hospital Zurich, Zurich, Switzerland
| | | | - Sarah Stoll
- 5 Cancer League Ostschweiz, St Gallen, Switzerland
| | - Roger Stupp
- 1 University Hospital Zurich, Zurich, Switzerland
| | - Claudia M Witt
- 1 University Hospital Zurich, Zurich, Switzerland.,2 University of Zurich, Zurich, Switzerland.,6 Charité-Universitätsmedizin Berlin, Berlin, Germany.,7 University of Maryland School of Medicine, Baltimore, MD, USA
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Boettger S, Knöpfel S, Schubert M, Garcia Nuñez D, Plichta MM, Klaghofer R, Jenewein J. Pipamperone and delirium: a preliminary evaluation of its effectiveness in the management of delirium and its subtypes. Swiss Med Wkly 2017; 147:w14471. [PMID: 28750419 DOI: 10.4414/smw.2017.14471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Delirium has been recognised as an underdiagnosed and undermanaged syndrome with substantial prevalence rates and potentially deleterious consequences in the medically ill population. Despite its frequent administration in the management of delirium, the effectiveness of pipamperone has not yet been evaluated. METHODS In this retrospective, descriptive cohort study of 192 patients, pipamperone as monotherapy and as an adjunct to haloperidol, haloperidol alone, or atypical antipsychotics were compared with respect to their effectiveness in the management of delirium and its subtypes over the course of 20 days. RESULTS In this elderly patient population, pipamperone alone and as an adjunct to haloperidol was as effective as haloperidol or atypical antipsychotics in the management of delirium. Management with low-dose pipamperone monotherapy achieved delirium resolution in 70% of patients, over a mean of 6.4 (2-20) days. With pipamperone as an adjunct to haloperidol, delirium resolved in 59% of patients, over a mean of 7.4 (2-20) days. When haloperidol or atypical antipsychotics (risperidone, olanzapine or quetiapine) were used, the delirium resolution rates were 72 and 67%, over a mean of 5.2 (2-11) and 6.4 (2-20) days, respectively. The addition of pipamperone to haloperidol decreased the requirement for lorazepam. Pipamperone proved to be equally effective in all delirium subtypes - hypoactive, hyperactive and mixed. Nonetheless, potential bias could not be excluded in this observational design. CONCLUSION From these initial results, low-dose pipamperone was as effective as haloperidol or atypical antipsychotics in the management of delirium and its subtypes, and was benzodiazepine-sparing when used as an adjunct to haloperidol.
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Affiliation(s)
- Soenke Boettger
- Department of Psychiatry and Psychotherapy, University of Zurich, University Hospital Zurich, Switzerland
| | - Silvana Knöpfel
- Department of Psychiatry and Psychotherapy, University of Zurich, University Hospital Zurich, Switzerland
| | - Maria Schubert
- Centre of Clinical Nursing Science, University of Zurich, University Hospital Zurich, Switzerland; Directorate of Nursing/MTT, Inselspital, University Hospital Bern, Switzerland
| | - David Garcia Nuñez
- Centre of Clinical Nursing Science, University of Zurich, University Hospital Zurich, Switzerland
| | - Michael Martin Plichta
- Department of Psychiatry and Psychotherapy, University of Zurich, University Hospital Zurich, Switzerland
| | - Richard Klaghofer
- Department of Psychiatry and Psychotherapy, University of Zurich, University Hospital Zurich, Switzerland
| | - Josef Jenewein
- Department of Psychiatry and Psychotherapy, University of Zurich, University Hospital Zurich, Switzerland
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29
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Ture M, Angst F, Aeschlimann A, Renner C, Schnyder U, Zerkiebel N, Perseus J, Barth J, Bredell M, Soelch CM, Walt H, Jenewein J. Short-term effectiveness of inpatient cancer rehabilitation: A longitudinal controlled cohort study. J Cancer 2017; 8:1717-1725. [PMID: 28819367 PMCID: PMC5556633 DOI: 10.7150/jca.19564] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/02/2017] [Indexed: 11/30/2022] Open
Abstract
Background: Inpatient rehabilitation for cancer patients has been demonstrated to improve patients' health related quality of life (HRQoL) effectively. The purpose of this study was to compare changes in general health and HRQoL of cancer patients who were referred to inpatient rehabilitation (IR) with those in two control groups who underwent outpatient management either with advice for inpatient rehabilitation (A+) or without (A-). Methods: In this naturalistic, longitudinal, controlled cohort study, changes in general health and HRQoL were assessed at either discharge of acute hospital or start of rehabilitation (baseline) and at the follow-up 3 weeks later or end of rehabilitation. Outcome variables included general health and HRQoL assessed by the Short Form 36 (SF-36) and the Functional Assessment of Cancer Therapy (FACT), and fatigue (FACT-F), depression and anxiety by the Hospital Anxiety and Depression Scale (HADS). Changes on the scores were compared with bivariate and multivariate analyses using standardized mean differences (SMD). Results: IR patients (n=133) were on average older, reported lower HRQoL and health, and suffered more frequently from carcinoma than patients of the A+ (n=30) and the A- (n=82) groups. In the IR patients, pain, physical functioning, mental health, vitality, and fatigue improved significantly compared to the A+ controls. Compared to the A- group, the bivariate effects were lower but still statistically significant on many scales. Conclusions: IR showed moderate, statistically significant superior effects over outpatient management of cancer patients after acute treatment. Findings indicate that inpatient cancer rehabilitation can be recommended as an effective management after acute treatment. As today, referrals to inpatient rehabilitation for cancer patients are still not based on structured standardized procedures, the implementation of such screening is needed to address patients' needs and to render the potential for rehabilitation more reliable.
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Affiliation(s)
- Maria Ture
- Department of Cranio-, Maxillo-Facial and Oral Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Felix Angst
- RehaClinic Bad Zurzach, Zurzach, Switzerland
| | | | | | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland
| | | | | | - Jürgen Barth
- Institute of Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Switzerland
| | - Marius Bredell
- Department of Cranio-, Maxillo-Facial and Oral Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Chantal Martin Soelch
- Department of Psychology, Unit of Clinical and Health Psychology, University of Fribourg, Switzerland
| | - Heinrich Walt
- Department of Cranio-, Maxillo-Facial and Oral Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Josef Jenewein
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland
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30
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Brinkhaus B, Falkenberg T, Haramati A, Willich SN, Briggs JP, Willcox M, Linde K, Theorell T, Wong LM, Dusek J, Wu D, Eisenberg D, Haramati A, Berger B, Kemper K, Stock-Schröer B, Sützl-Klein H, Ferreri R, Kaplan G, Matthes H, Rotter G, Schiff E, Arnon Z, Hahn E, Luberto CM, Martin D, Schwarz S, Tauschel D, Flower A, Gramminger H, Gupta HH, Gupta SN, Kerckhoff A, Kessler CS, Michalsen A, Kessler CS, Kim ES, Jang EH, Kim R, Jan SB, Mittwede M, Mohme W, Ben-Arye E, Bonucci M, Saad B, Breitkreuz T, Rossi E, Kebudi R, Daher M, Razaq S, Gafer N, Nimri O, Hablas M, Kienle GS, Samuels N, Silbermann M, Bandelin L, Lang AL, Wartner E, Holtermann C, Binstock M, Riebau R, Mujkanovic E, Cramer H, Lauche R, Michalsen A, Ward L, Cramer H, Irnich D, Stör W, Burnstock G, Schaible HG, Ots T, Langhorst J, Lauche R, Sundberg T, Falkenberg T, Amarell C, Amarell C, Anheyer M, Eckert M, Eckert M, Ogal M, Eckert M, Amarell C, Schönauer A, Reisenberger B, Brand B, Anheyer D, Dobos G, Kroez M, Martin D, Matthes H, Ammendola A, Mao JJ, Witt C, Yang Y, Dobos G, Oritz M, Horneber M, Voiß P, Reisenberger B, von Rosenstiel A, Eckert M, Ogal M, Amarell C, Anheyer M, Schad F, Schläppi M, Kröz M, Büssing A, Bar-Sela G, Matthes H, Schiff E, Ben-Arye E, Arnon Z, Avshalomov D, Attias S, Schönauer A, Haramati A, Witt C, Brinkhaus B, Cotton S, Jong M, Jong M, Scheffer C, Haramati A, Tauschel D, Edelhäuser F, AlBedah A, Lee MS, Khalil M, Ogawa K, Motoo Y, Arimitsu J, Ogawa M, Shimizu G, Stange R, Kraft K, Kuchta K, Watanabe K, Bonin D, Büssing A, Gruber H, Koch S, Gruber H, Pohlmann U, Caldwell C, Krantz B, Kortum R, Martin L, Wieland LS, Kligler B, Gould-Fogerite S, Zhang Y, Wieland LS, Riva JJ, Lumpkin M, Ratner E, Ping L, Jian P, Hamme GM, Mao X, Chouping H, Schröder S, Hummelsberger J, Wullinger M, Brodzky M, Zalpour C, Langley J, Weber W, Mudd LM, Wayne P, Witt C, Weidenhammer W, Fønnebø V, Boon H, Steel A, Bugarcic A, Rangitakatu M, Steel A, Adams J, Sibbritt D, Wardle J, Leach M, Schloss J, Dieze H, Boon H, Ijaz N, Willcox M, Heinrich M, Lewith G, Flower A, Graz B, Adam D, Grabenhenrich L, Ortiz M, Binting S, Reinhold T, Brinkhaus B, Andermo S, Sundberg T, Falkenberg T, Nordberg JH, Arman M, Bhasin M, Fan X, Libermann T, Fricchione G, Denninger J, Benson H, Berger B, Stange R, Michalsen A, Martin DD, Boers I, Vlieger A, Jong M, Brinkhaus B, Teut M, Ullmann A, Ortiz M, Rotter G, Binting S, Lotz F, Roll S, Canella C, Mikolasek M, Rostock M, Beyer J, Guckenberger M, Jenewein J, Linka E, Six C, Stoll S, Stupp R, Witt CM, Chuang E, Kligler B, McKee MD, Cramer H, Lauche R, Klose P, Lange S, Langhorst J, Dobos G, Chung VCH, Wong HLC, Wu XY, Wen GYG, Ho RST, Ching JYL, Wu JCY, Coakley A, Flanagan J, Annese C, Empoliti J, Gao Z, Liu X, Yu S, Yan X, Liang F, Hohmann CD, Steckhan N, Ostermann T, Paetow A, Hoff E, Michalsen A, Hu XY, Wu RH, Logue M, Blonde C, Lai LY, Stuart B, Flower A, Fei YT, Moore M, Liu JP, Lewith G, Hu XY, Wu RH, Logue M, Blonde C, Lai LY, Stuart B, Flower A, Fei YT, Moore M, Liu JP, Lewith G, Jeitler M, Zillgen H, Högl M, Steckhan N, Stöckigt B, Seifert G, Michalsen A, Kessler C, Khadivzadeh T, Bashtian MH, Aval SB, Esmaily H, Kim J, Kim KH, Klocke C, Joos S, Koshak A, Wie L, Koshak E, Wali S, Alamoudi O, Demerdash A, Qutub M, Pushparaj P, Heinrich M, Kruse S, Fischer I, Tremel N, Rosenecker J, Leung B, Takeda W, Liang N, Feng X, Liu JP, Cao HJ, Luberto CM, Shinday N, Philpotts L, Park E, Fricchione GL, Yeh G, Munk N, Zakeresfahani A, Foote TR, Ralston R, Boulanger K, Özbe D, Gräßel E, Luttenberger K, Pendergrass A, Pach D, Bellmann-Strobl J, Chang Y, Pasura L, Liu B, Jäger SF, Loerch R, Jin L, Brinkhaus B, Ortiz M, Reinhold T, Roll S, Binting S, Icke K, Shi X, Paul F, Witt CM, Rütz M, Lynen A, Schömitz M, Vahle M, Salomon N, Lang A, Lahat A, Kopylov U, Ben-Horin S, Har-Noi O, Avidan B, Elyakim R, Gamus D, NG S, Chang J, Wu J, Kaimiklotis J, Schumann D, Buttó L, Langhorst J, Dobos G, Haller D, Cramer H, Smith C, de Lacey S, Chapman M, Ratcliffe J, Johnson N, Lyttleton J, Boothroyd C, Fahey P, Tjaden B, van Vliet M, van Wietmarschen H, Jong M, Tröger W, Vuolanto P, Aarva P, Sorsa M, Helin K, Wenzel C, Zoderer I, Pammer P, Simon P, Tucek G, Wode K, Henriksson R, Sharp L, Stoltenberg A, Nordberg JH, Xiao-ying Y, Wang LQ, Li JG, Liang N, Wang Y, Liu JP, Balneaves L, Capler R, Bocci C, Guffi M, Paolini M, Meaglia I, Porcu P, Ivaldi GB, Dragan S, Bucuras P, Pah AM, Badalica-Petrescu M, Buleu F, Hogea-Stoichescu G, Christodorescu R, Kao L, Cho Y, Klafke N, Mahler C, von Hagens C, Uhlmann L, Bentner M, Schneeweiss A, Mueller A, Szecsenyi J, Joos S, Neri I, Ortiz M, Schnabel K, Teut M, Rotter G, Binting S, Cree M, Lotz F, Suhr R, Brinkhaus B, Rossi E, Baccetti S, Firenzuoli F, Monechi MV, Di Stefano M, Amunni G, Wong W, Chen B, Wu J, Amri H, Haramati A, Kotlyanskaya L, Anderson B, Evans R, Kligler B, Marantz P, Bradley R, Booth-LaForce C, Zwickey H, Kligler B, Brooks A, Kreitzer MJ, Lebensohn P, Goldblatt E, Esmel-Esmel N, Jiménez-Herrera M, Ijaz N, Boon H, Jocham A, Stock-Schröer B, Berberat PO, Schneider A, Linde K, Masetti M, Murakozy H, Van Vliet M, Jong M, Jong M, Agdal R, Atarzadeh F, Jaladat AM, Hoseini L, Amini F, Bai C, Liu T, Zheng Z, Wan Y, Xu J, Wang X, Yu H, Gu X, Daneshfard B, Nimrouzi M, Tafazoli V, Alorizi SME, Saghebi SA, Fattahi MR, Salehi A, Rezaeizadeh H, Zarshenas MM, Nimrouzi M, Fox K, Hughes J, Kostanjsek N, Espinosa S, Lewith G, Fisher P, Latif A, Lefeber D, Paske W, Öztürk AÖ, Öztürk G, Boers I, Tissing W, Naafs M, Busch M, Jong M, Daneshfard B, Sanaye MR, Dräger K, Fisher P, Kreitzer MJ, Evans R, Leininger B, Shafto K, Breen J, Sanaye MR, Daneshfard B, Simões-Wüst AP, Moltó-Puigmartí C, van Dongen M, Dagnelie P, Thijs C, White S, Wiesener S, Salamonsen A, Stub T, Fønnebø V, Abanades S, Blanco M, Masllorens L, Sala R, Al-Ahnoumy S, Han D, He L, Kim HY, In Choi D, Alræk T, Stub T, Kristoffersen A, von Sceidt C, Michalsen A, Bruset S, Musial F, Anheyer D, Cramer H, Lauche R, Saha FJ, Dobos G, Anheyer D, Haller H, Lauche R, Dobos G, Cramer H, Azizi H, Khadem N, Hassanzadeh M, Estiri N, Azizi H, Tavassoli F, Lotfalizadeh M, Zabihi R, Esmaily H, Azizi H, Shabestari MM, Paeizi R, Azari MA, Bahrami-Taghanaki H, Zabihi R, Azizi H, Esmaily H, Baars E, De Bruin A, Ponstein A, Baccetti S, Di Stefano M, Rossi E, Firenzuoli F, Segantini S, Monechi MV, Voller F, Barth J, Kern A, Lüthi S, Witt C, Barth J, Zieger A, Otto F, Witt C, Beccia A, Dunlap C, Courneene B, Bedregal P, Passi A, Rodríguez A, Chang M, Gutiérrez S, Beissner F, Beissner F, Preibisch C, Schweizer-Arau A, Popovici R, Meissner K, Beljanski S, Belland L, Rivera-Reyes L, Hwang U, Berger B, Sethe D, Hilgard D, Heusser P, Bishop F, Al-Abbadey M, Bradbury K, Carnes D, Dimitrov B, Fawkes C, Foster J, MacPherson H, Roberts L, Yardley L, Lewith G, Bishop F, Al-Abbadey M, Bradbury K, Carnes D, Dimitrov B, Fawkes C, Foster J, MacPherson H, Roberts L, Yardley L, Lewith G, Bishop F, Holmes M, Lewith G, Yardley L, Little P, Cooper C, Bogani P, Maggini V, Gallo E, Miceli E, Biffi S, Mengoni A, Fani R, Firenzuoli F, Brands-Guendling N, Guendling PW, Bronfort G, Evans R, Haas M, Leininger B, Schulz C, Bu X, Wang J, Fang T, Shen Z, He Y, Zhang X, Zhang Z, Wang D, Meng F, Büssing A, Baumann K, Frick E, Jacobs C, Büssing A, Grünther RA, Lötzke D, Büssing A, Jung S, Lötzke D, Recchia DR, Robens S, Ostermann T, Berger B, Stankewitz J, Kröz M, Jeitler M, Kessler C, Michalsen A, Cheon C, Jang BH, Ko SG, Huang CW, Sasaki Y, Ko Y, Cheshire A, Ridge D, Hughes J, Peters D, Panagioti M, Simon C, Lewith G, Cho HJ, Han D, Choi SJ, Jung YS, Im HB, Cooley K, Tummon-Simmons L, Cotton S, Luberto CM, Wasson R, Kraemer K, Sears R, Hueber C, Derk G, Lill JR, An R, Steinberg L, Rodriguez LD, la Fuente FGD, De la Vega M, Vargas-Román K, Fernández-Ruiz J, Cantarero-Villanueva I, Rodriguez LD, García-De la Fuente F, Jiménez-Guerrero F, Vargas-Román K, Fernández-Ruiz J, Galiano-Castillo N, Diaz-Saez G, Torres-Jimenez JI, Garcia-Gomez O, Hortal-Muñoz L, Diaz-Diez C, Dicen D, Diezel H, Adams J, Steel A, Wardle J, Diezel H, Steel A, Frawley J, Wardle J, Broom A, Adams J, Dong F, Yu H, Liu T, Ma X, Yan L, Wan Y, Zheng Z, Gu X, Dong F, Yu H, Wu L, Liu T, Ma X, Ma J, Yan L, Wan Y, Zheng Z, Zhen J, Gu X, Dubois J, Rodondi PY, Edelhäuser F, Schwartze S, Trapp B, Cysarz D. World Congress Integrative Medicine & Health 2017: Part one. Altern Ther Health Med 2017. [PMCID: PMC5498855 DOI: 10.1186/s12906-017-1782-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Lecheler L, Richter M, Franzen DP, Rampini SK, Cheetham M, Jenewein J, Battegay E, Nowak A. The frequent and underrecognised co-occurrence of acute exacerbated COPD and depression warrants screening: a systematic review. Eur Respir Rev 2017; 26:26/144/170026. [PMID: 28615309 DOI: 10.1183/16000617.0026-2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 04/26/2017] [Indexed: 11/05/2022] Open
Abstract
Patients with acute exacerbated chronic obstructive pulmonary disease (AECOPD) and concurrent depression suffer significant psychological stress and decreased quality of life. The aim of this study was to collate data, guidelines and recommendations from publications on the screening and management of depressive mood disorders in patients hospitalised with AECOPD.We systematically searched four databases for publications reporting screening or management of depression in patients hospitalised for AECOPD. The identification of articles was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.Out of 1494 original articles screened, 35 met all inclusion criteria. These report a prevalence of depression in AECOPD ranging between 9.5% and 85.6%. Some studies report high postadmission mortality rates for depressive AECOPD patients, and higher readmission rates in depressive versus nondepressive AECOPD patients. Importantly, none of the 35 publications included suggestions on the screening and management of depression in AECOPD.Depression and AECOPD frequently co-occur, and this worsens outcomes. Yet we did not find recommendations on management, and few interventional studies. Patients hospitalised with AECOPD should be systematically screened for depression and treatment recommendations should be developed for these patients. Randomised studies on how to screen and treat depression in hospitalised AECOPD are necessary.
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Affiliation(s)
- Leopold Lecheler
- Center of Competence Multimorbidity, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Daniel P Franzen
- Dept of Respiratory Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvana K Rampini
- Center of Competence Multimorbidity, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Dept of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Marcus Cheetham
- Center of Competence Multimorbidity, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Dept of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
| | - Josef Jenewein
- Dept of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Edouard Battegay
- Center of Competence Multimorbidity, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Dept of Internal Medicine, University Hospital Zurich, Zurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
| | - Albina Nowak
- Center of Competence Multimorbidity, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Dept of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
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Seiler A, Büel-Drabe N, Jenewein J. [Not Available]. Praxis (Bern 1994) 2017; 106:135-142. [PMID: 28169599 DOI: 10.1024/1661-8157/a002595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. Die tumorassoziierte Fatigue ist ein häufig auftretendes und ernstzunehmendes Beschwerdebild mit belastenden körperlichen, psychischen und sozialen Auswirkungen, das im Verlauf einer Brustkrebserkrankung zu jedem Zeitpunkt auftreten kann. Das Erscheinungsbild der tumorassoziierten Fatigue ist in der klinischen Symptomatik wie auch in den pathophysiologischen Mechanismen sehr heterogen und komplex. Sowohl die Abklärung von Ursachen als auch die Behandlung erfordert ein differenziertes Vorgehen. Eine frühzeitige Therapie der tumorassoziierten Fatigue ist wichtig, um einer möglichen Chronifizierung entgegenzuwirken. Die Behandlung der Fatigue-Symptomatik erfolgt mittels medikamentöser und nicht-medikamentöser Therapieansätze. Während pharmakologische Interventionen mit Psychostimulanzien in der Behandlung der Fatigue-Symptomatik inkonsistente Resultate zeigen, können die Beschwerden der Fatigue-Symptomatik durch nicht-pharmakologische Interventionen, besonders körperliches Training, kognitiv-behaviorale Therapie, Psychoedukation, komplementärmedizinische Behandlungen (Akupunktur, Yoga, phytotherapeutische Verfahren mit Ginseng) deutlich gemindert werden.
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Affiliation(s)
- Annina Seiler
- 1 Klinik für Psychiatrie und Psychotherapie, Universitätsspital Zürich
| | | | - Josef Jenewein
- 1 Klinik für Psychiatrie und Psychotherapie, Universitätsspital Zürich
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Boettger S, Bergman M, Jenewein J, Boettger S. Advanced age and decisional capacity: The effect of age on the ability to make health care decisions. Arch Gerontol Geriatr 2016; 66:211-7. [DOI: 10.1016/j.archger.2016.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 05/10/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
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Mayer KN, Ghadri JR, Jaguszewski M, Scherff F, Saguner AM, Kazemian E, Baumann CR, Jenewein J, Tsakiris M, Lüscher TF, Brugger P, Templin C. Takotsubo syndrome – A close connection to the brain: A prospective study investigating neuropsychiatric traits. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.ijcme.2016.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jenewein J. [Not Available]. Praxis (Bern 1994) 2016; 105:930. [PMID: 27524163 DOI: 10.1024/1661-8157/a002443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Josef Jenewein
- 1 Klinik für Psychiatrie und Psychotherapie, Universitätsspital Zürich
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Neudeck MR, Steinert H, Moergeli H, Weidt S, Seiler A, Strobel K, Jenewein J, Drabe N. Work ability and return to work in thyroid cancer patients and their partners: a pilot study. Psychooncology 2016; 26:556-559. [DOI: 10.1002/pon.4154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/18/2016] [Accepted: 04/11/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Marion Roberta Neudeck
- Praxis Ziegelfeld; Olten Switzerland
- Department of Psychiatry and Psychotherapy, University Hospital of Zurich; University of Zurich; Zurich Switzerland
| | - Hans Steinert
- Division of Nuclear Medicine, Department of Medical Radiology, University Hospital of Zurich; University of Zurich; Zurich Switzerland
| | - Hanspeter Moergeli
- Department of Psychiatry and Psychotherapy, University Hospital of Zurich; University of Zurich; Zurich Switzerland
| | - Steffi Weidt
- Department of Psychiatry and Psychotherapy, University Hospital of Zurich; University of Zurich; Zurich Switzerland
| | - Annina Seiler
- Department of Psychiatry and Psychotherapy, University Hospital of Zurich; University of Zurich; Zurich Switzerland
| | - Klaus Strobel
- Division of Nuclear Medicine, Department of Medical Radiology; Hospital of Luzern; Luzern Switzerland
| | - Josef Jenewein
- Department of Psychiatry and Psychotherapy, University Hospital of Zurich; University of Zurich; Zurich Switzerland
| | - Natalie Drabe
- Department of Psychiatry and Psychotherapy, University Hospital of Zurich; University of Zurich; Zurich Switzerland
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Jellestad L, Stocker L, Jenewein J, Boettger S. Serotonin Syndrome after Initiation of Pregabalin on a Stable Regimen of Antidepressant Medication. ACTA ACUST UNITED AC 2016. [DOI: 10.9734/ijmpcr/2016/28356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Seiler A, Jenewein J, Martin-Soelch C, Goetzmann L, Inci I, Weder W, Schuurmans MM, Benden C, Brucher A, Klaghofer R. Post-transplant outcome-clusters of psychological distress and health-related quality of life in lung transplant recipients. Swiss Med Wkly 2015; 145:w14236. [PMID: 26710349 DOI: 10.4414/smw.2015.14236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
QUESTIONS UNDER STUDY To (1) assess distinct clusters of psychological distress and health-related quality of life during the first 6 months following lung transplantation; (2) identify patients with poor psychosocial outcomes; and (3) determine potential predictors regarding psychological distress and health-related quality (HRQoL) of life at 6 months post-transplant. METHODS A total of 40 patients were examined for psychological distress (Symptom Checklist short version-9) and quality of life (EuroQOL five-dimension health-related quality of life questionnaire) during their first 6 months post-transplant. Hierarchical cluster analyses were performed to identify specific types of post-transplant outcomes in terms of psychological distress and HRQoL over the first six post-transplant months. Correlational analyses examined medical and psychosocial predictors of the outcome at 6 months post-transplant. RESULTS Three distinctive clusters were identified, summarizing either groups of patients with (1) optimal (35%), (2) good (42%), and (3) poor outcome-clusters (23%). The latter tended to be older, to suffer from more severe disease, to have more co-morbidities, to have had a prolonged intensive care unit and/or hospital stay, to have more hospital admissions and were more frequently treated with antidepressants post-transplant. Disease severity, length of stay, quality of life two weeks post-transplant, hospital admissions and use of antidepressants were strong predictors of psychological distress and impaired health-related quality of life at six months of follow-up. CONCLUSION Almost a quarter of the investigated patients suffered from elevated distress and substantially impaired HRQoL, with no improvements over time. Results underscore the psychosocial needs of patients with poor post-transplant outcomes.
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Affiliation(s)
- Annina Seiler
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland
| | - Josef Jenewein
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland
| | | | - Lutz Goetzmann
- Department of Psychosomatic Medicine and Psychotherapy, Segeberger Kliniken, Bad Segeberg, Germany
| | - Ilhan Inci
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Switzerland
| | - Macé M Schuurmans
- Division of Pulmonary Medicine, University Hospital Zurich, Switzerland
| | - Christian Benden
- Division of Pulmonary Medicine, University Hospital Zurich, Switzerland
| | - Angela Brucher
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland
| | - Richard Klaghofer
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland
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Ture M, Barth J, Angst F, Aeschlimann A, Schnyder U, Zerkiebel N, Perseus J, Renner C, Imesch P, Fuchs B, Huber GF, Walt H, Martin-Soelch C, Jenewein J. Use of inpatient rehabilitation for cancer patients in Switzerland: who undergoes cancer rehabilitation? Swiss Med Wkly 2015; 145:w14214. [PMID: 26636479 DOI: 10.4414/smw.2015.14214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
QUESTION UNDER STUDY Rehabilitation for cancer patients aims to reduce physical disability and mental distress resulting from the disease and its treatment. However, little is known about the use of cancer inpatient rehabilitation in Switzerland in relation to sociodemographic and medical characteristics. The main purpose of this study was to evaluate whether there are differences in sociodemographic and medical characteristics between patients who underwent inpatient rehabilitation (users) and those who did not (nonusers). METHODS A total of 238 cancer patients from the University Hospital Zurich were included. The sociodemographic and medical characteristics of inpatient rehabilitation users were assessed and compared with those of nonusers. We analysed the differences between inpatient rehabilitation users and nonusers. RESULTS Of the patients included, 101 (42.4%) used inpatient rehabilitation. They were less likely to be employed (p = 0.029), stayed longer in hospital (p <0.001), and were more likely to have semiprivate or private supplementary health insurance (p = 0.030) than nonusers. There were differences in cancer site (p = 0.001). Patients with tumours of the digestive organs or of the thoracic organs were more likely to use rehabilitation, whereas breast cancer patients were less likely to use it. Stratified analyses showed that male patients with semiprivate or private supplementary health insurance (p = 0.037), lower education (p = 0.039), and lower likelihood of employment (p = 0.051) were more likely to use rehabilitation. Women with an advanced tumour stage used inpatient rehabilitation more often (p = 0.012). CONCLUSIONS Findings show the influence of duration of hospitalisation, insurance type, cancer site, employment status, and gender on the use of inpatient cancer rehabilitation. The results indicate the need of structured standardised procedures for medical referral to be implemented based on screening.
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Affiliation(s)
- Maria Ture
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital Zurich, University of Zurich, Switzerland; Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland
| | - Jürgen Barth
- Institute of Complementary and Integrative Medicine, University Hospital Zurich, University of Zurich, Switzerland
| | | | | | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland
| | | | | | | | - Patrick Imesch
- Department of Gynaecology, University Hospital Zurich, University of Zurich, Switzerland
| | | | - Gerhard Frank Huber
- Department of Otorhinolaryngology, University Hospital Zurich, University of Zurich, Switzerland
| | - Heinrich Walt
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital Zurich, University of Zurich, Switzerland
| | | | - Josef Jenewein
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Switzerland
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Anagnostopoulos A, Ledergerber B, Jaccard R, Shaw SA, Stoeckle M, Bernasconi E, Barth J, Calmy A, Berney A, Jenewein J, Weber R. Frequency of and Risk Factors for Depression among Participants in the Swiss HIV Cohort Study (SHCS). PLoS One 2015; 10:e0140943. [PMID: 26492488 PMCID: PMC4619594 DOI: 10.1371/journal.pone.0140943] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/30/2015] [Indexed: 11/28/2022] Open
Abstract
Objectives We studied the incidence and prevalence of, and co-factors for depression in the Swiss HIV Cohort Study. Methods Depression-specific items were introduced in 2010 and prospectively collected at semiannual cohort visits. Clinical, laboratory and behavioral co-factors of incident depression among participants free of depression at the first two visits in 2010 or thereafter were analyzed with Poisson regression. Cumulative prevalence of depression at the last visit was analyzed with logistic regression. Results Among 4,422 participants without a history of psychiatric disorders or depression at baseline, 360 developed depression during 9,348 person-years (PY) of follow-up, resulting in an incidence rate of 3.9 per 100 PY (95% confidence interval (CI) 3.5–4.3). Cumulative prevalence of depression during follow-up was recorded for 1,937/6,756 (28.7%) participants. Incidence and cumulative prevalence were higher in injection drug users (IDU) and women. Older age, preserved work ability and higher physical activity were associated with less depression episodes. Mortality (0.96 per 100 PY, 95% CI 0.83–1.11) based upon 193 deaths over 20,102 PY was higher among male IDU (2.34, 1.78–3.09), female IDU (2.33, 1.59–3.39) and white heterosexual men (1.32, 0.94–1.84) compared to white heterosexual women and homosexual men (0.53, 0.29–0.95; and 0.71, 0.55–0.92). Compared to participants free of depression, mortality was slightly elevated among participants with a history of depression (1.17, 0.94–1.45 vs. 0.86, 0.71–1.03, P = 0.033). Suicides (n = 18) did not differ between HIV transmission groups (P = 0.50), but were more frequent among participants with a prior diagnosis of depression (0.18 per 100 PY, 95%CI 0.10–0.31; vs. 0.04, 0.02–0.10; P = 0.003). Conclusions Depression is a frequent co-morbidity among HIV-infected persons, and thus an important focus of care.
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Affiliation(s)
- Alexia Anagnostopoulos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
- * E-mail:
| | - René Jaccard
- Independent Researcher, HIV Practitioner, Zurich, Switzerland
| | - Susy Ann Shaw
- Division of Infectious Diseases, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Jürgen Barth
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland
| | - Alexandre Berney
- Psychiatry Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Josef Jenewein
- Department of Psychiatry and Psychotherapy, University Hospital of Zurich, Zurich, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KEJ, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med 2015; 373:929-38. [PMID: 26332547 DOI: 10.1056/nejmoa1406761] [Citation(s) in RCA: 1502] [Impact Index Per Article: 166.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood. METHODS The International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age- and sex-matched patients who had an acute coronary syndrome. RESULTS Of 1750 patients with takotsubo cardiomyopathy, 89.8% were women (mean age, 66.8 years). Emotional triggers were not as common as physical triggers (27.7% vs. 36.0%), and 28.5% of patients had no evident trigger. Among patients with takotsubo cardiomyopathy, as compared with an acute coronary syndrome, rates of neurologic or psychiatric disorders were higher (55.8% vs. 25.7%) and the mean left ventricular ejection fraction was markedly lower (40.7±11.2% vs. 51.5±12.3%) (P<0.001 for both comparisons). Rates of severe in-hospital complications including shock and death were similar in the two groups (P=0.93). Physical triggers, acute neurologic or psychiatric diseases, high troponin levels, and a low ejection fraction on admission were independent predictors for in-hospital complications. During long-term follow-up, the rate of major adverse cardiac and cerebrovascular events was 9.9% per patient-year, and the rate of death was 5.6% per patient-year. CONCLUSIONS Patients with takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome. This condition represents an acute heart failure syndrome with substantial morbidity and mortality. (Funded by the Mach-Gaensslen Foundation and others; ClinicalTrials.gov number, NCT01947621.).
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Affiliation(s)
- Christian Templin
- From University Heart Center, Department of Cardiology (C. Templin, J.R.G., J.D., D.R.B., M.J., V.L.C., V.G., C.A.N., M.S., P.E., F.R., T.F.L.), and Department of Psychiatry and Psychotherapy (K. Eisenhardt, J.J.), University Hospital Zurich, and Division of Biostatistics, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich (B.S.), Zurich, Spitalregion Rheintal Werdenberg Sarganserland, Altstätten (J.H.), Department of Cardiology, Kantonsspital Lucerne, Lucerne (F. Cuculi, P.E.), Department of Cardiology, Kantonsspital Winterthur, Winterthur (T.A.F.), and Department of Cardiology, University Hospital Basel, Basel (C.K., S.O.) - all in Switzerland; Department of Cardiology and Angiology, Hannover Medical School, Hannover (L.C.N., J.B.), Department of Cardiology, Heidelberg University Hospital, Heidelberg (J.F., H.A.K.), Deutsches Herzzentrum München, Technische Universität München (C.B., H.S., W.K.), and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (H.S., W.K.), Munich, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Lübeck (C.M., H.T.), DZHK, partner site Hamburg/Kiel/Lübeck (C.M., H.T., M.K.), Division of Cardiology, Asklepios Clinics St. Georg Hospital (A.C., K.-H.K.), and Department of General and Interventional Cardiology, University Heart Center Hamburg (M.K.), Hamburg, Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin (C. Tschöpe, H.-P.S.), Department of Internal Medicine III, Heart Center University of Cologne, Cologne (G.M., R.P.), Department of Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine, Saarland University, Homburg (C.U., M.B.), Department of Cardiology, University Hospital Essen, Essen (R.E.), Clinic for Cardiology and Pneumology, Georg August University Göttingen (C.J., G.H.), and DZHK, partner site Göttingen (C.J., G.H.), Göttingen, Department of Internal Medicine II
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Abstract
OBJECTIVE Our aim was to examine the characteristics of delirium in the severely medically ill cancer population on the basis of sociodemographic and medical variables, delirium severity, and phenomenology, as well as severity of medical illness. METHOD All subjects in the database were recruited from psychiatric referrals at Memorial Sloan Kettering Cancer Center (MSKCC). Sociodemographic and medical variables, as well as the Karnofsky Performance Status (KPS) scale and Memorial Delirium Assessment Scale (MDAS) scores were recorded at baseline. Subsequently, these variables were analyzed with respect to the severity of the medical illness. RESULTS Out of 111 patients, 67 qualified as severely medically ill. KPS scores were 19.7 and 30.7 in less severe illness. There were no significant differences with respect to age, history of dementia, and MDAS scores. Although the severity of delirium did not differ, an increased frequency and severity of consciousness disturbance, disorientation, and inability to maintain and shift attention did exist. With respect to etiologies contributing to delirium, hypoxia and infection were commonly associated with severe illness. In contrast, corticosteroid administration was more often associated with less severe illness. There were no differences with respect to opiate administration, dehydration, and CNS disease, including brain metastasis. SIGNIFICANCE OF RESULTS Delirium in the severely medically ill cancer population has been characterized by an increased disturbance of consciousness, disorientation, and an inability to maintain and shift attention. However, the severity of illness did not predict severity of delirium. Furthermore, hypoxia and infection were etiologies more commonly associated with delirium in severe illness, whereas the administration of corticosteroids was associated with less severe illness.
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Affiliation(s)
- Soenke Boettger
- Department of Psychiatry and Psychotherapy,University Hospital Zurich,Zurich,Switzerland
| | - Josef Jenewein
- Department of Psychiatry and Psychotherapy,University Hospital Zurich,Zurich,Switzerland
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences,Memorial Sloan Kettering Cancer Center,New York,New York
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Abstract
OBJECTIVE The factors associated with persistent delirium, in contrast to resolved delirium, have not been studied well. The aim of our present study was to identify the factors associated with delirium resolution as measured by the Memorial Delirium Assessment Scale (MDAS) and functional improvement as measured by the Karnofsky Performance Status (KPS) scale. METHOD All subjects were recruited from psychiatric referrals at the Memorial Sloan Kettering Cancer Center (MSKCC). The two study instruments were performed at baseline (T1), at 2-3 days (T2), and at 4-7 days (T3). Subjects with persistent delirium were compared to those with resolved delirium in respect to sociodemographic and medical variables. RESULTS Overall, 26 out of 111 patients had persistent delirium. These patients were older, predominantly male, and had more frequently preexisting comorbid dementia. Among cancer diagnoses and stage of illness, brain cancer and terminal illness contributed to persistent delirium or late response, whereas gastrointestinal cancer was associated with resolved delirium. Among etiologies, infection responded late to delirium management, usually at one week. Furthermore, delirium was more severe in patients with persistent delirium from baseline through one week. At baseline, MDAS scores were 20.1 in persistent delirium compared to 17 to 18.8 in resolved delirium (T2 and T3), and at one week of management (T3), MDAS scores were 15.2 and 4.7 to 7.4, respectively. At one week of management, persistent delirium manifested in more severe impairment in the domains of consciousness, cognition, organization, perception, psychomotor behavior, and sleep-wake cycle. In addition, persistent delirium caused more severe functional impairment. SIGNIFICANCE OF RESULTS In this delirium sample, advanced age and preexisting dementia, as well as brain cancer, terminal illness, infection, and delirium severity contributed to persistent delirium or late response, indicating a prolonged and refractory course of delirium, in addition to more severe functional impairment through one week of management.
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Affiliation(s)
- Soenke Boettger
- Department of Psychiatry and Psychotherapy,University Hospital Zurich,Zurich,Switzerland
| | - Josef Jenewein
- Department of Psychiatry and Psychotherapy,University Hospital Zurich,Zurich,Switzerland
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences,Memorial Sloan Kettering Cancer Center,New York,New York
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Seiler A, Klaghofer R, Ture M, Komossa K, Martin-Soelch C, Jenewein J. A systematic review of health-related quality of life and psychological outcomes after lung transplantation. J Heart Lung Transplant 2015; 35:195-202. [PMID: 26403492 DOI: 10.1016/j.healun.2015.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/30/2015] [Accepted: 07/17/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Lung transplantation (LTx) aims to reduce physical disability and mental distress, extend survival, and improve health-related quality of life (HRQoL). In this systematic review we aimed to: (1) augment evidence regarding measures to assess HRQoL and psychological outcomes after LTx; and (2) summarize HRQoL and psychological outcomes after LTx. METHODS Validated and standardized instruments with well-known psychometric properties used for assessing HRQoL and psychological outcomes after LTx were identified by means of comprehensive literature searches of PsychINFO and Medline/PubMed, up through March 2014, using the following search terms in various combinations: lung transplantation; physical functioning; symptom experience; mental health; anxiety; depression; distress; social functioning; life satisfaction; and health-related quality of life. RESULTS The search strategy identified 371 titles and abstracts. Of these, 279 were retrieved for further assessment and 63 articles selected for final review. Thirty-nine studies were found for HRQoL, 15 for physical functioning, 5 for mental health and 4 for social functioning. A total of 50 psychometric instruments were encountered. CONCLUSIONS Considerable heterogeneity exists in methodology, operational concepts and applied outcome measures in the existing literature on HRQoL and psychological outcomes after LTx. Nevertheless, the studies generally point to significant improvements in both mental health and HRQoL post-transplant. Further research is warranted utilizing consistent outcome measures, including LTx-specific measures and longitudinal study designs.
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Affiliation(s)
- Annina Seiler
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland.
| | - Richard Klaghofer
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
| | - Maria Ture
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
| | - Katja Komossa
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
| | | | - Josef Jenewein
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
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Drabe N, Steinert H, Moergeli H, Weidt S, Strobel K, Jenewein J. Perception of treatment burden, psychological distress, and fatigue in thyroid cancer patients and their partners - effects of gender, role, and time since diagnosis. Psychooncology 2015; 25:203-9. [DOI: 10.1002/pon.3903] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/12/2015] [Accepted: 06/12/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Natalie Drabe
- Department of Psychiatry and Psychotherapy; University Hospital Zurich, University of Zurich; Zurich Switzerland
| | - Hans Steinert
- Division of Nuclear Medicine, Department of Medical Radiology; University Hospital of Zurich, University of Zurich; Zurich Switzerland
| | - Hanspeter Moergeli
- Department of Psychiatry and Psychotherapy; University Hospital Zurich, University of Zurich; Zurich Switzerland
| | - Steffi Weidt
- Department of Psychiatry and Psychotherapy; University Hospital Zurich, University of Zurich; Zurich Switzerland
| | - Klaus Strobel
- Division of Nuclear Medicine, Department of Medical Radiology; Hospital of Luzern; Luzern Switzerland
| | - Josef Jenewein
- Department of Psychiatry and Psychotherapy; University Hospital Zurich, University of Zurich; Zurich Switzerland
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Boettger S, Bergman M, Jenewein J, Boettger S. The Assessment of Decisional Capacity: Gender Differences, Corresponding Medical and Psychiatric Illness, and Their Impact on Decisional Capacity. International Journal of Mental Health 2015. [DOI: 10.1080/00207411.2015.1035057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stocker L, Jellestad L, Jenewein J, Boettger S. Challenges in the management of delirium: a case of augmentation with donepezil following inadequate response and adverse effects with risperidone. Psychiatr Danub 2015; 27:64-66. [PMID: 25751433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Lea Stocker
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland,
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Claussen MC, Hassanpour K, Jenewein J, Boettger S. Catatonic stupor secondary to gamma-hydroxy-butyric acid (GHB)-dependence and -withdrawal syndrome. Psychiatr Danub 2014; 26:358-359. [PMID: 25377371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Malte Christian Claussen
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland,
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Ture M, Jenewein J, Angst F, Aeschlimann A, Martin-Soelch C, Schnyder U, Renner C, Walt H. Abstract 3846: On the way to specialized cancer rehabilitation in Switzerland: Preliminary results of a naturalistic controlled comparative cohort study. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-3846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Various international studies show the effectiveness of cancer rehabilitation programs. In Switzerland, however, as compared to other Western countries, only little is known about physical health and Quality of life (QoL) in patients who undergo cancer rehabilitation programs. Cancer patients are at increased risk to develop both poor physical conditions and psychological distress leading to negative QoL. Thus, research indicates social support and self-efficacy as personal resources with positive effects on QoL. The aim of this study is to compare the state and change of physical health and QoL of cancer patients with and without rehabilitation.
Methods
We perform a multicenter naturalistic, comparative cohort study on quality of life and distress using standardized questionnaires and including patients aged ≥ 18 years with a diagnosis of carcinoma, lymphoma, sarcoma or melanoma. A dementia screening by the MMSE (Mini Mental Status Examination) is performed in patients aged ≥ 50 years to ensure ability for completing the questionnaires. Allocation to rehabilitation is decided by the physician of the acute management in agreement with the patient. The intervention group undergoes rehabilitation and is compared to two control groups: Control group 1 consists of patients with medical indication for rehabilitation but will not undergo rehabilitation, whereas in control group 2 there is no indication for rehabilitation. Data are collected at the beginning (T1) and end of hospitalization (T2), at the end of rehabilitation (T3), and three months after (T4).
Results
We included 44 patients (28 female and 16 male) with the major groups consisting of breast and head and neck cancer and plan to expand up to a number of 132 patients. Preliminary analysis showed that values for QoL varied significantly with impairment between T1 and T2 (p < 0.001) and improvement between T2 and T3 (p = 0.002). T3 values stay significantly below T1 values (p < 0.001). This was similar when physical and functional well-being was analyzed. Post rehabilitation assessments are currently ongoing.
Conclusions
Evaluation of the natural trajectory of cancer treatment course and comparison of cohorts with and without rehabilitation will provide outcome and effect data that are not known up so far in Switzerland. The results may help to improve and specify cancer rehabilitation interventions and to develop appropriate guidelines for referral to post-acute management. (Supported by the Zurzach Rehabilitation Foundation SPA, Bad Zurzach, Switzerland).
Citation Format: Maria Ture, Josef Jenewein, Felix Angst, André Aeschlimann, Chantal Martin-Soelch, Ulrich Schnyder, Christoph Renner, Heinrich Walt. On the way to specialized cancer rehabilitation in Switzerland: Preliminary results of a naturalistic controlled comparative cohort study. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3846. doi:10.1158/1538-7445.AM2014-3846
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Affiliation(s)
- Maria Ture
- 1University Hospital Zurich, Zurich, Switzerland
| | | | - Felix Angst
- 2RehaClinic Bad Zurzach, Zurzach, Switzerland
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