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Since the early 1970s experimental studies on self-care and chronic disease have demonstrated the importance of combining professional knowledge and the experiential insight of patients. As a means of promoting health the Duo Formula Group approach (DFG) method has been developed. Part of a larger DFG study focuses on the application and evaluation of a self-care programme following cardiac surgery. The duo formula method teaches patients how to assume more responsibility for the management of their physical condition. This DFG study used an experimental/control group design whereby 59 patients and 49 partners were assessed pre-intervention (M1), post-intervention (M2) and during a follow-up period of 6 months (M3). The study examined changes in illness behaviour, depression, Type A behaviour and anxiety in both patients and partners. At this intermediate stage of the study, patients show decreased depression (M2-M1: t = 2.79, p less than 0.01); and their partners decreased anxiety (M2-M1: t = 1.97, 0.05 less than p less than 0.10).
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PMID:Health promotion and self-care in the case of cardiovascular disease. 238 68

Participants in a therapeutic program for osteoporosis were studied to determine if program participation improved psychological outcomes. The 4-day program included intensive education about the disease and its prognosis, physical therapy education, nutritional counseling, and medical evaluation and treatment. All therapeutic patients enrolled in the program over a one-year period (N = 38) were interviewed individually pre- and post-participation. Knowledge of osteoporosis, level of social support, coping styles, and perceptions of the impact of pain and chronicity were assessed. Patients reported improved future outlook despite continued concern about pain and chronicity. Mention of depression was reduced, and knowledge of osteoporosis increased significantly. In addition, there were meaningful changes in patients' understanding of disease management. These included knowing when to make specific changes and avoid harmful actions. The findings suggest that an educational program can have a positive impact on patients' coping. Educational efforts may be an important component in the management of chronic disease.
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PMID:Treatment of osteoporosis. The psychological impact of a medical education program on older patients. 270 39

The Eysenck Personality Inventory and Hospital Anxiety and Depression scale were administered to 80 patients undergoing medical treatment for long standing inflammatory bowel disease: 22 patients were studied before the diagnosis was established and 40 patients with diabetes mellitus served as controls. High neuroticism and introversion scores were more prevalent in the patients with inflammatory bowel disease than controls (p less than 0.05) and these characteristics were as prominent in patients before diagnosis as in established cases. Introversion scores increased with the duration of disease (r = 0.51). Depression was uncommon, occurring only in patients with active chronic disease. Patients believed there was a close link between personality, stress and disease activity. Fifty six of the patients recognised factors that initiated the disease and in 42 this was thought to be a stressful life event or a 'nervous personality'.
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PMID:Personality profile and affective state of patients with inflammatory bowel disease. 273 54

Although evidence suggests that adolescents with chronic illness are at a greater risk for psychosocial disability, little is known about the adolescent's perception of the impact of the disease on his or her day-to-day life. Standardized measures of coping strategies, mastery, self-efficacy, social support, depression, and a semistructured interview on everyday difficulties were administered to matched groups (sex and age) of 31 adolescents with cystic fibrosis, 31 adolescents with diabetes, and 31 healthy controls. No differences were found between control and adolescents with a chronic disease responses on the standardized measures. The semistructured interview, however, revealed that the adolescent's perception of his or her physical health and the reaction of other family members to the illness were important sources of stress. These findings suggest that, in general, adolescents with a chronic illness cope effectively with their disability but that parents and clinicians must be sensitive to the adolescents' feelings and concerns regarding their health and its impact on the family.
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PMID:Chronic disease and its impact. The adolescent's perspective. 273 7

The association between depression and two-year mortality risk was assessed in 1,606 elderly community participants in the 1982-83 Epidemiologic Catchment Area-Piedmont Health Survey. Two depression measures were formed from the Diagnostic Interview Schedule (DIS) depressive symptom items. Neither measure was associated with mortality in univariate or multiple logistic regression analyses. The adjusted relative risk of mortality comparing the lowest to highest levels of a three-level depression variable was 0.9 (95% confidence interval = 0.5-1.4). Similar results were obtained with other versions of the depression variables, with each depressive symptom category, and within sex, chronic disease, widowhood status, and age groups. These results indicate that depression does not increase mortality in elderly adults, but the short follow-up, sample characteristics, and operationalization of depression may have affected this association.
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PMID:The association between depressive symptoms and mortality among older participants in the Epidemiologic Catchment Area-Piedmont Health Survey. 273 18

This presentation comprises: a) the study of psychosocial problems in children with chronic disease (1980-83); b) application and results of a "pluridimensional approach" model, designed to solve these conflicts (1982-88). Thirty-five children with end stage renal disease (ESRD) and 34 families were studied, as well as the members of the professional team. The methods of study were: conducted observations, projective tests, recording and analysis of psychotherapy (individual and familiar) and Balint sessions. The data were analized in the framework of psychoanalysis, theory of the systems and groups, etc. The results showed: depression, anguish and regression, interfering with rehabilitation, in the group of children. The problems worsening with greater length of the dialysis periods and with younger age of the patients. Poverty increases losses and guilty feelings decreasing the defensive and adaptive mechanisms. In the families, ESRD provoked migration, fragmentation, dynamic and structural dysfunctions and several inter and intrapersonal conflicts. In the professional team, tension, anxiety, compulsive and indiscriminate conducts were detected, as well as a great difficulty to communicate with the patients and their families. In an attempt to decrease these conflicts a pluridimensional approach was designed and applied in the patients, families and members of the professional team, with the aim of interrupt the pathologic interaction patterns and change them in therapeutic. This model included the practice of several independent and simultaneous psychological interventions, ergotherapy, recreative and occupational activities with the patients; group sessions for information, diagnostic interviews and psychotherapy with the families and Balint sessions with the professional team.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Psychosocial problems of children with chronic disease]. 275 79

The frail elderly, for whom chronic disease and disability are essentially universal, are at high risk for depression and are specifically vulnerable to the adverse effects of antidepressant medication. There have, however, been few investigations of either the pharmacokinetics or the clinical investigations of either the pharmacokinetics or the clinical response to antidepressants in such patients. We report on the pharmacokinetics of nortriptyline at steady state in a group of 22 patients, average age 84, living within an institutional setting. Comparison of our findings with those previously reported for younger and healthier subjects suggests that there are no clinically significant group differences in nortriptyline kinetics. Plasma levels of nortriptyline and those of both the trans- and cishydroxylated metabolites are linear with daily dose. Mean (and SD) for the parameter (plasma level/dose) was 1.21 (0.63) ng/ml/mg/day for the parent compound, 1.41 (0.86) for the trans metabolite, and 0.30 (0.16) for the cis metabolite. There was no significant correlation across individuals between the accumulation of the parent compound and the metabolites. Based upon these data, the average dose of nortriptyline required to achieve a plasma level of 100 ng/ml is 80 mg/day. Dose requirements, however, vary between individuals by a factor of 20. Plasma levels measured 24 hours after a 25-mg test dose of nortriptyline can allow early identification of slow metabolizers. Twenty-four-hour plasma levels (mean 8.8 ng/ml, SD 3.2) were significantly correlated with steady state levels at 25 mg/day (r = 0.71), steady state levels at 50 mg/day (r = 0.73), and each individual's average (plasma level/dose) (r = 0.57).
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PMID:Steady state pharmacokinetics of nortriptyline in the frail elderly. 278 62

The long-term efficacy of digoxin maintenance therapy must be determined individually for patients with normal sinus rhythm who have a history of congestive heart failure but no remaining signs or symptoms. Predictive factors for successful discontinuation of the agent in the elderly include normal mental status (including absence of depression), ability to adequately perform activities of daily living, general feelings of well-being, absence of multiple organic disease, absence of multiple drug use, and no evidence of existing congestive heart failure or atrial fibrillation. Our findings indicate that physicians and patients need to reexamine the concept that congestive heart failure is necessarily a chronic disease. Certainly, evidence exists that continuing digitalis therapy indefinitely is inappropriate and may be harmful. Further investigation may prove that congestive heart failure in the elderly, like pneumonia, is a common acute occurrence and in many cases not a chronic state for which patients are destined to receive medication indefinitely. We hope that the findings from our small sample will stimulate other investigators to question the indiscriminate long-term use of digitalis in the elderly.
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PMID:Digitalis for congestive heart disease in the elderly. A family practice view of the efficacy of long-term therapy. 310 Oct 52

Self-report questionnaires completed by young adults with Type I diabetes were examined to determine if individuals differing in recent metabolic control (Poor, Moderate or Very Good) or disease duration (Long, Short) also vary in either occurrence or type of life events during the past year or occurrence of recent emotional distress. Subjects in Poor control reported more positive and neutral life events during the past year, suggesting even those life changes individuals view benignly may be associated with metabolic control difficulties. Individuals in Poor control also reported more recent symptoms of depression, anxiety and hostility than did individuals in Moderate or Very Good control--symptomatology which may further impair their ability to adhere to a complex self-care regimen. Individuals with Long disease duration reported more positive and negative recent life experiences than did subjects with Short disease duration, but did not evidence concomitant disruptions in metabolic control. The role experience with a chronic disease may play in this finding was unclear, however. Although more research is required to clarify the exact relation of psychosocial variables and diabetic control, these findings suggest that clinically relevant subgroup parameters, subjects' perceptions of life change, and demographic variables may be important factors to assess.
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PMID:Psychosocial aspects of disease duration and control in young adults with type I diabetes. 336 73

The Chronic Illness Problem Inventory (CIPI) was used to assess level of psychosocial functioning in 89 patients with sickle cell disease. The results indicated that sickle cell patients have significant psychosocial distress in the areas of employment and finances, sleeping and eating, and performance of normal daily activities. Fear and anxiety regarding body deterioration, and lack of assertiveness in social relationships were also found. These findings suggest that depression may be a common problem among sickle cell patients. Treatment alternatives that address these areas are reviewed.
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PMID:Assessment of psychosocial functioning of patients with sickle cell disease. 337 80


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