BioPsychoSocial Medicine最新文献

[This corrects the article DOI: 10.1186/s13030-020-00186-8.].

Background: Acne vulgaris is a very common skin disorder that has negative effects on the mood, self image and social relations of the patients. We want to evaluate the effects of acne vulgaris and its severity on depression, loneliness, internet addiction levels, and the quality of life of young adult females.

Methods: Two hundred three female acne vulgaris patients and 202 healthy controls who admitted to the dermatology clinic of a university hospital formed the study sample. Global Acne Grading System (GAGS) was used to assess the severity of acne. The Young Internet Addiction Scale-Short Form (YIAS-SF), The Acne Quality of Life Scale (AQLS), The University of California Los Angeles-Loneliness Scale (UCLA-LS), and The Beck Depression Inventory (BDI) were used to collect information about the patients.

Results: The median BDI and the mean UCLA-LS and YIAS-SF scores were higher in the Acne group than those in the control group. The correlations between acne severity and the 3 scales were not significant but the correlations between AQLS and BDI, UCLA-LS, and YIAS-SF were highly significant. In multiple regression analysis, age and the BDI score predicted the YIAS-SF score significantly.

Conclusions: Our findings support the previous findings that acne vulgaris patients are prone to depression and loneliness, and expand these findings to the vulnerability against internet addiction. Loneliness and depression should be assessed and, if found, targeted by psychological means to prevent internet addiction in acne vulgaris patients.

Background: The Eating Disorder Quality of Life (ED-QOL) scale is a 25-item self-report measure that assesses health-related quality of life (HRQoL) of eating-disorder patients. Although the ED-QOL is one of the most widely used questionnaires in many countries, no prior research has addressed the psychometric properties of the Japanese translation of the ED-QOL. Therefore, the aim of the present study was to assess its reliability and validity.

Methods: A total of 99 Japanese female eating disorder patients and 469 female healthy university undergraduate students completed the Japanese translation of the ED-QOL in addition to the Eating Attitudes Test-26 (EAT-26) and Eating Disorder Inventory-2 (EDI-2). The patient group consisted of 37 patients with anorexia nervosa restricting type (AN-R), 35 patients with binge-eating/purge type (AN-BP), and 27 patients with bulimia nervosa (BN). We performed confirmatory factor analyses on the ED-QOL subscales both for Japanese eating disorder patients and for healthy university undergraduate students. Reliability was assessed using internal consistency indicated by Cronbach alpha coefficients and convergent validity was assessed using Pearson's correlation coefficients. To assess group differences between the eating disorder patients and healthy university undergraduate students, Student's t-tests were conducted.

Results: The CFA showed that the CFI was .90 and RMSEA was .084 (90% confidence interval = .079-.088). The internal consistency of the ED-QOL varied from good to excellent. The EAT-26 total score and three subscales and the EDI-2 subscales had significant correlations with the ED-QOL global QOL score and four subscales. There were no significant correlations between the EDI-2 subscale "Body Dissatisfaction" and the ED-QOL subscales "Physical/Cognitive" and "Work/School". Eating disorder patients scored significantly higher than healthy university undergraduate students on all ED-QOL subscales and the global QOL score.

Conclusions: Based on this study, the Japanese translation of the ED-QOL can be regarded as reliable, valid, and functional for female eating-disorder patients and female healthy university undergraduate students.

Background: Patients with heart failure (HF) accompanied by delirium are at risk of rehospitalization and death, thus early detection and appropriate treatment is imperative. Palliative care for patients with HF is an important issue, particularly for patients who also have delirium. This retrospective study examined the accuracy of delirium assessment by cardiologists treating patients with HF, identified factors related to the detection of delirium, and recorded the initial treatment.

Methods: This was a retrospective chart survey of 165 patients with HF referred to a consultation liaison (C-L) service during treatment in the cardiology wards of a general hospital over a 6-year period. Diagnosis of delirium by the C-L psychiatrists was based on DSM-IV-TR.Cases in which cardiologists had stated "delirium" in the medical records were classified as an accurate assessment of delirium (Agreement group). Cases in which cardiologists did not state "delirium" were classified as Disagreement.

Results: Among 81 patients with delirium (51 [62.9%] male; 74.7 ± 13.3 years old), the ratio of accurate assessment of delirium by cardiologists was 50.6% (n = 41; Agreement group). Age, sex, and HF severity did not differ significantly between the two groups. Although disquietedness was identified most frequently (n = 59, 73%), only 33 of these 59 patients (55.9%) were recognized as having delirium by cardiologists.Inappropriate initial treatments were only noted in the Disagreement group. In both groups, most cases were referred to a C-L service without new medication for psychiatric symptoms.

Conclusions: An accurate assessment of the delirium of inpatients with HF by cardiologists was found in only around half of all cases. Accurate detection is important to avoid harmful drug administration and to provide appropriate palliative care.

Background: Anorexia nervosa (AN) is a disease resulting in extreme weight loss. It is caused by multiple factors, including psychosocial, environmental, and genetic factors. A genetic abnormality affecting lipid metabolism has been recently reported in patients with AN. However, it is unknown whether lipid metabolism abnormalities in AN are caused by eating behavior, undernutrition, and/or genetic factors. The meaning of lipid metabolism in AN remains unclear. In particular, differences in the profiles of very long-chain fatty acids (VLCFAs) in patients with various types of AN have not been studied. This study aimed to determine changes to the fatty acid profile over a 3-month period, specifically that of long-chain fatty acids (LCFAs) and VLCFAs in patients with various types of AN.

Methods: We evaluated 69 female patients with AN, subclassified as AN-restricting type (AN-R) and AN-Binge-Eating/Purging type (AN-BP). On admission and after 3 months of treatment, height, weight, body mass index, plasma and serum parameters, and plasma fatty acid concentrations were measured in all patients. The control group included 25 healthy, age-matched women. Comparisons between the groups were made using one-way ANOVA, while those between the various parameters at admission and after 3 months within each group were made using the Wilcoxon signed rank test.

Results: On admission, the AN-R and the AN-BP groups had significantly higher levels of 18-24C and > 14C fatty acids (LCFAs and VLCFAs, respectively) than the control group. After 3 months of treatment, both groups showed high levels of 14-24C fatty acids. The levels of VLCFAs (C22:0 and C24:0) and LCFA (C18:3) after 3 months of treatment remained high in both AN groups relative to the control group.

Conclusions: Eating behaviors appear to be associated with levels of LCFAs. Lipid metabolism abnormalities under conditions of starvation in AN might have a genetic basis and appear to be associated with VLCFA (C22:0 and C24:0) and LCFA (C18:3) levels.

Background: The change in the benzodiazepine (BZD) use of patients with medically unexplained symptoms (MUS) following the application of relaxation therapy were examined.

Methods: Of the 221 outpatients with MUS using BZD, 42 received relaxation therapy. Change in BZD use was compared using a relaxation group (n = 42) and a control group that had 84 MUS patients whose baseline was matched by optimal matching algorithms. Logistic regression analysis was done to evaluate the effect of BZD-dependent factors on the BZD dose of the relaxation group.

Results: Compared with the control group, the number of patients who decreased the amount of BZD and the number of patients whose subjective symptoms of MUS improved were significantly higher in the relaxation group (p < 0.05). In addition, a factor that made it difficult to reduce the BZD of MUS patients who had undergone relaxation was a long history of BZD use, for more than 6 months (odds ratio, 0.06, 95% confidence interval, 0.01-0.36).

Conclusions: Relaxation therapy for patients with MUS may help reduce BZD use; however, early intervention is important to prevent BZD dependence.

Background: Noncardiac chest pain (NCCP) is one of the leading reasons for emergency department visits and significantly limits patients' daily functioning. The protective effect of physical activity has been established in a number of pain problems, but its role in the course of NCCP is unknown. This study aimed to document the level of physical activity in patients with NCCP and its association with NCCP-related disability in the 6 months following an emergency department visit.

Methods: In this prospective, longitudinal, cohort study, participants with NCCP were recruited in two emergency departments. They were contacted by telephone for the purpose of conducting a medical and sociodemographic interview, after which a set of questionnaires was sent to them. Participants were contacted again 6 months later for an interview aimed to assess their NCCP-related disability.

Results: The final sample consisted of 279 participants (57.0% females), whose mean age was 54.6 (standard deviation = 15.3) years. Overall, the proportion of participants who were physically active in their leisure time, based on the Actimètre questionnaire criteria, was 22.0%. Being physically active at the first measurement time point was associated with a 38% reduction in the risk of reporting NCCP-related disability in the following 6 months (ρ = .047). This association remained significant after controlling for confounding variables.

Conclusions: Being physically active seems to have a protective effect on the occurrence of NCCP-related disability in the 6 months following an emergency department visit with NCCP. These results point to the importance of further exploring the benefits of physical activity in this population.

Background: Many intervention studies of coronary artery disease (CAD) have found health benefits for patients in the "treatment as usual" (TAU) group like in the specific psychotherapy group. In this pilot study, we wanted to examine and discuss the role and reasons for TAU effects.

Methods: By means of a systematic review, we examined the control conditions from psychotherapeutic RCTs with CAD patients related to depressive symptoms, mortality and recurrence rate of events. The review question was limited to factors influencing the TAU effectiveness in such psychotherapeutic outcome studies.

Results: We found a decrease in depressive symptoms in TAU patients (mean ES: 0.65) and very differing mortality and recurrence rates of events. The effects were dependant on the year the study was published (1986-2016), the follow-up time of the study (0.25-7.8 years) and the treatment arms. A small dose of additional counselling, medical attention, and teaching of therapeutic techniques with clinical competence may reinforce the therapeutic alliance. These factors would be possible moderators of control group efficacy related to the reduction in depressive symptoms and a decrease in mortality and events.

Conclusion: In the reviewed studies, we found that the control condition was beneficial for CAD patients, but this benefit was highly variable. Specified psychotherapeutic interventions showed an additional independent effect of treatment on depression and effects on morbidity and mortality. There is a need to identify patients at risk of remaining depressed or under severe stress during usual care. These patients may require additional psychosocial intervention.

Background: Presenteeism has attracted much attention in the research into mental health. However, how cognitive complaints and depressive symptoms affect presenteeism remains unknown. Therefore, this study examined the correlation between subjective cognitive impairment, depressive symptoms, and work limitations.

Methods: We collected data from 477 adult workers in Japan. We evaluated subjective cognitive function using the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA), depressive symptoms with the Patient Health Questionnaire 9 (PHQ-9), and work limitations with the Work Limitations Questionnaire 8 (WLQ-8). The relations between depressive symptoms, cognitive complaints, and work limitations were examined using Spearman's rank correlations and multiple regression analysis. It was hypothesized that cognitive complaints would mediate the effects of depressive symptoms on work productivity loss, which was tested using path analysis.

Results: The results indicated that cognitive complaints were significantly correlated with work limitations and depressive symptoms. Multiple regression analysis, using the WLQ-8 productivity loss score as the dependent variable, revealed that COBRA and PHQ-9 scores were significant predictors of work productivity loss. We performed path analysis using PHQ-9, COBRA, and WLQ-8 productivity loss scores and created a path diagram, which revealed that the direct effects of both depressive symptoms and cognitive dysfunction on work productivity loss were statistically significant. Moreover, depressive symptoms indirectly affected work productivity loss through subjective cognitive impairment. There was no significant interaction effect between depressive symptoms and cognitive complaints.

Conclusions: Our results suggest that work limitations may be predicted by not only depressive symptoms but also cognitive complaints. Moreover, subjective cognitive impairment may mediate the effect of depressive symptoms on presenteeism among adult workers.

Background: Post-traumatic stress symptoms can occur in patients with medical illness. During the Middle East Respiratory Syndrome (MERS) outbreak in South Korea in 2015, some dialysis patients in three centers who were incidentally exposed to patients or medical staff with confirmed MERS-CoV infection were isolated to interrupt the spread of the infection. We aimed to investigate post-traumatic stress symptoms and risk factors among these patients.

Materials and methods: In total, 116 hemodialysis (HD) patients in contact with MERS-CoV-confirmed subjects were isolated using three strategies, namely, single room isolation, cohort isolation, and self-quarantine. We used the Impact of Event Scale-Revised-Korean (IES-R-K) to examine post-traumatic stress symptoms at 12 months after the isolation period.

Results: Of the 116 HD patients, 27 were lost to follow-up. Of the 89 patients, 67 (75.3%) completed the questionnaires. Single room isolation was used on 40 (58.8%) of the patients, cohort isolation on 20 (29.4%), and self-imposed quarantine on 8 (11.8%). In total, 17.9% of participants (n = 12) reported post-traumatic stress symptoms exceeding the IES-R-K's cutoff point (≧18). Prevalence rates of IES-R-K ≧18 did not differ significantly according to isolation method. However, isolation duration was linearly associated with the IES-R-K score (standardized β coefficient - 0.272, P = 0.026). Scores in Avoidance, Emotional numbing and Dissociation subscale were higher in patients with longer isolation period.

Conclusion: MERS was a traumatic experience for quarantined HD patients. IES-R-K scores were not significantly different by isolation methods. However, short isolation was associated with post-traumatic stress symptoms.