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A psychometric study conducted among 533 women tested for statistical significance of personality traits (FPI) between selfexaminations of the breast and the attitude to examinations performed by physicians. --I. Introverts (FPI-E) performed selfexaminations with only half the frequency of extroverts (p less than 0,01). One fifth of the women with personality traits of introversion believed that screening examinations for detection of breast cancer performed by physicians are of lesser importance as did women with personality traits of extroversion (p less than 0,01). The later group believed that breast has significance in cosmetic appearance (p less than 0,05) and sexual value (p less than 0,05). Introverts are mostly of lower education (p less than 0,05) and their intelligence quotient is usually below 100 (p less than 0,1) when compared with that of extroverts. For selfexaminations of the breast this finding is of special importance to preventive medicine to provide effective instructions and guidance. --II. Emotional labile women (FPI-N) produce expected results of being especially fearsome (p less than 0,01) regarding breast change appearance produced by an conscious fear of cancer (p less than 0,05). Upon discovery of a painful lump in the breast labile women delay the visit to the physician longer as emotional stable women (p less than 0,05). Labile women stay single twice as often as emotional stable women (p less than 0,01). This produces a lower possibility to be activated by ones spouse to seek the aid of a physician for treatment of the breast. --III. In women with personality traits of depression or low selfesteem is a longer delay period apparant as in women with high selfesteem. Upon noticing a lump in the breast--if painful or not--women with high selfesteem immediately pay a visit to their physician (p less than 0,05) but the others delay. Here should be mentioned that depressed women deviate from the lot in regard to family status (p less than 0,05) and obtained education/intelligence niveau (p less than 0,01). These results are debated viewing preventive-medical and psychosocial aspects.
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PMID:[Self-examination of breast under personal and psychologic aspects. (Psychometric studies of 533 women)]. 71 84

This study compared the characteristics of patients with symptoms of irritable bowel syndrome who had either consulted or not consulted a general practitioner in the preceding two years. The subjects were identified by questionnaire in a community survey of irritable bowel syndrome symptoms and samples of 24 consulting and 24 non-consulting patients were interviewed. The groups were well matched for demographic characteristics, although those who consulted for irritable bowel syndrome also consulted more frequently for other problems. The only significant differences in the pattern, frequency and severity of a range of symptoms, which included the Manning criteria, were that more of the consulting patients experienced visible abdominal distension and had a higher mean score for severity of pain than the non-consulters. Mean negative life event scores and anxiety and depression scores were higher in the group who consulted and more of these patients were concerned about the possible serious nature of their symptoms, including fear of cancer, emphasizing the importance of eliciting patients' beliefs and anxieties about the meaning of their symptoms.
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PMID:Reasons for consultation in irritable bowel syndrome: symptoms and patient characteristics. 147 91

At best, most individuals are able to recount two to three of the seven warning signs of cancer [1]. However, this finding is primarily based on free recall of symptoms personally experienced by the respondent. In the present study, a new approach is introduced as an alternative to traditional assessment of knowledge of cancer warning signs. The Knowledge of Cancer Warning Signs Inventory (KCWSI) is a 25 item self-report questionnaire which yields three scores concerning probability judgments about symptoms: basic recognition of the seven warning signs (BRCWS), the extent to which nonwarning signs are perceived to be warning signs (NSPWS), and the extent to which one can accurately discriminate between real and false positive warning signs (accurate knowledge of cancer: AKC). The KCWSI was given to a population who live in a community facing a perceived toxic waste hazard, based on the hypothesis that such a group should be cognizant of the warning signs of cancer because of the serious health threats posed by toxic exposure and the presumed need to engage in greater health preventative activities when living with such an environmental threat. Results show that basic knowledge of the seven cancer warning signs is predicted by AKC, fear of cancer, and a family history of cancer. Misperception of common distress symptoms (of anxiety, somatization, and depression) as symptoms of cancer (nonwarning signs perceived as warning signs: NSPWS) is predicted by fear of cancer, a composite scale of perceived susceptibility to cancer and other health-related problems, Global Symptom Distress, and higher order interactions among the demographic variables of race, gender, income and education. Accurate Knowledge of Cancer (AKC) is associated with lower fear of cancer and lower psychological distress than the other two knowledge measures. The Knowledge of Cancer Warning Signs Inventory yields complex information about how symptoms are perceived and may prove superior to other methods in understanding what people believe about the warning signs of cancer and how this understanding relates to health care behaviors. This study also illustrates the need to pay attention to how health information is measured.
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PMID:Measuring knowledge of cancer. 206 7

To determine which side effects of oral contraceptives are biologic and which are psychologic in origin, 70 women were interviewed for several hours. The women were private patients of a gynecologist or attending a family planning clinic and were proven fertile, without gynecologic illness or psychiatric history, and were taking various combined or sequential pills. When the women were classified into emotionally well-adjusted and maladjusted, the maladjusted group had more severe and numerous psychological side effects. Onset of side effects was associated with fear of cancer, pregnancy despite the pill, and fear of damage to the procreative system. Most common side effects were nausea, vomiting, breast swelling, weight gain, mood changes, anxiety, irritability and nervousness. Side effects, assumed to be psychologic because they occurred in the maladjusted group, included depression (45% of total), loss of libido, breast swelling. Weight gain was not associated with maladjustment.
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PMID:Psychosomatic medicine. Side effects of oral contraceptive medication: a psychosomatic problem. 506 76

Genital human papillomavirus (HPV) infection can lead to self-inflicted blame and hypochondriac fears as well as to problems with sexuality. The aim of this study was to assess the psychological and psychodynamic aspects of patients with widespread genital HPV infection entering into a clinical trial in which they were randomly assigned to three treatment groups: CO2 laser ablation, intramuscular interferon-alpha, CO2 laser ablation plus intramuscular interferon-alpha. Fifty-one patients were studied. Patients were asked to take a series of questionnaires which included a self-rating questionnaire for gathering information on sexuality, emotional relationship with the partner and social life. A visual analog scale was used to rate intensity of pain during sexual intercourse. Each patient went also through an in-depth interview with a clinical psychologist and filled out two personality tests to measure depression (CDQ = IPAT depression test) and anxiety (ASQ = IPAT anxiety test). Results indicated a high percentage of sexual impairments after therapy (28 cases), presence of fear of cancer (14 cases) and worsenings in the emotional relationship with the partner. No difference was found among groups of treatment.
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PMID:Psychological aspects of genital human papillomavirus infection: a preliminary report. 835 27

I believe there are four essential elements in the management of patients with irritable bowel syndrome (IBS): to establish a good physician-patient relationship; to educate patients about their condition; to emphasize the excellent prognosis and benign nature of the illness; and to employ therapeutic interventions centering on dietary modifications, pharmacotherapy, and behavioral strategies tailored to the individual. Initially, I establish the diagnosis, exclude organic causes, educate patients about the disease, establish realistic expectations and consistent limits, and involve patients in disease management. I find it critical to determine why the patient is seeking assistance (eg, cancer phobia, disability, interpersonal distress, or exacerbation of symptoms). Most patients can be treated by their primary care physician. However, specialty consultations may be needed to reinforce management strategies, perform additional diagnostic tests, or institute specialized treatment. Psychological co-morbidities do not cause symptoms but do affect how patients respond to them and influence health care-seeking behavior. I find that these issues are best explored over a series of visits when the physician-patient relationship has been established. It can be helpful to have patients fill out a self-administered test to identify psychological co-morbidities. I often use these tests as a basis for extended inquiries into this area, resulting in the initiation of appropriate therapies. I encourage patients to keep a 2-week diary of food intake and gastrointestinal symptoms. In this way, patients become actively involved in management of their disease, and I may be able to obtain information from the diary that will be valuable in making treatment decisions. I do not believe that diagnostic studies for food intolerances are cost-effective or particularly helpful; however, exclusion diets may be beneficial. I introduce fiber supplements gradually and monitor them for tolerance and palatability. Synthetic fiber is often better-tolerated than natural fiber, but must be individualized. In my experience, excessive fiber supplementation often is counterproductive, as abdominal cramps and bloating may worsen. Antidiarrheal agents are very effective when used correctly, preferably in divided doses. I use them in patients in anticipation of diarrhea and especially in those who fear symptoms when engaged in activities outside the home. I encourage patients to make decisions as to when and how much to use. However, almost always, a morning dose before breakfast is used (loperamide, 2 to 6 mg) and, perhaps again later in the day when symptoms of diarrhea are prominent. I prefer antispasmodics to be used intermittently in response to periods of increased abdominal pain, cramps, and urgency. For patients with daily symptoms, especially after meals, agents such as dicyclomine before meals are useful. For patients with infrequent but severe episodes of unpredictable pain, sublingual hyoscyamine often produces rapid relief and instills confidence. In general, I recommend that oral antispasmodics be used for a limited period of time rather than indefinitely, and generally for periods of time when symptoms are prominent. For chronic visceral pain syndromes, I recommend small doses of tricyclic antidepressants. These agents are especially effective in diarrhea-predominant patients with disturbed sleep patterns but may be unacceptable to patients with constipation. I educate patients that side effects occur early and benefits may not be apparent for 3 to 4 weeks. I consider using SSRIs in low doses in patients with constipation-predominant IBS; cisapride, 10 to 20 mg three times per day, also may be beneficial. When taken with drugs that inhibit cytochrome P450, cisapride has been associated with serious cardiac arrhythmias caused by QT prolongation, including ventricular arrhythmias and torsades de pointes. These drugs include the azole fungicides; erythromycin, clarithromycin, and troleandomycin; some antidepressants; HIV protease inhibitors; and others. In patients with IBS with mild to moderate co-morbid depression, I have found that the use of SSRIs such as paroxetine, fluoxetine, or sertraline may be beneficial. It is important to tell patients that anxiety and disturbed sleep may occur during the first 10 days and benefits may not occur for 3 to 4 weeks. I prescribe a small amount of a short-acting benzodiazepine such as alprazolam, 0.5 mg two times per day, to control these symptoms. For generalized anxiety without depression, buspirone or clonazepam may be useful. I have found that patients who also have associated panic disorder may benefit from a benzodiazepine, tricyclic antidepressant, or an SSRI. However, these patients are best managed in conjunction with a psychiatrist or psychologist. I consider the use of alternative therapies in patients who fail to respond to conventional measures and who are receptive to alternative strategies. These include general relaxation techniques such as biofeedback and hypnosis therapies.
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PMID:Irritable Bowel Syndrome. 1109 67

This study was carried out to examine the factors that predicting the use of complementary and alternative medicine (CAM) among cancer patients in Tehran, Iran. Predicting factors included were patients' demographic characteristics, type of cancer, the knowledge of diagnosis, time since diagnosis, satisfaction with their care physician, fear of recurrence and measures of anxiety, depression and global quality of life. In total, 625 cancer patients were studied, and 35% (n=219) reported that they used or were using CAM. The most commonly used CAM was prayer and spiritual healing (n=178, 75.7% of responses). The results of logistic regression analysis indicated that the use of CAM among cancer patients was associated with the fear of cancer recurrence (OR=2.03, 95% CI=1.45-2.85, P<0.0001) and dissatisfaction with their care physician (OR=1.98, 95% CI=1.36-2.89, P<0.0001). The results indicate that apart from the prayer and spiritual healing, the use of the other common methods of CAM among Iranian cancer patients is unpopular. However, the findings suggest that the use of CAM is more common among cancer patients who suffer from fears, uncertainties and dissatisfaction, and these might be a marker of greater psychological distress in users as compared with non-users.
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PMID:Factors predicting the use of complementary and alternative therapies among cancer patients in Iran. 1737 23

Clinical and anecdotal findings suggest that the completion of cancer treatment may be marked by heightened distress and disrupted adjustment. The present study examined psychological adjustment during the 3 months following treatment among 89 women with stages 0-III breast cancer. Participants completed measures of depression, cancer-related anxiety, cancer concerns, and quality of life at three time points: during treatment, 3 weeks following the end of treatment, and 3 months post-treatment. Post-treatment scores were suggestive of good psychological adjustment among the majority of women. Moreover, distress did not increase following treatment; longitudinal analyses showed no significant changes in depression or recurrence worry, while intrusive thoughts decreased, and quality of life improved. Younger age predicted greater distress across measures. A history of depression or anxiety predicted greater depressive symptomatology, while more extensive treatment predicted greater cancer-related anxiety. Despite the lack of distress endorsed on general depression and anxiety indices, participants reported moderate distress associated with cancer-related concerns, including physical problems, fear of cancer recurrence, and resuming normal life. In sum, while breast cancer survivors demonstrate good adjustment on general distress indices following treatment, some women are at risk for sustained distress. Moreover, significant cancer-related concerns are prevalent and may be important intervention targets.
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PMID:Adjusting to life after treatment: distress and quality of life following treatment for breast cancer. 1800 May 3

Burning mouth syndrome (BMS) is a complex disease of unknown cause. It is characterized by a burning sensation in the oral mucosa, notwithstanding its clinical normal aspect. BMS is particularly seen in postmenopausal women. The purpose of this study was to investigate this syndrome on a clinical basis and, in addition, to analyze its possible relation to the frequency of Candida species. Thirty-one patients (28 women and 3 men; 13 Caucasians and 18 non-Caucasians; mean age = 61.3, range 30-85 years) were evaluated. Most patients (80.6%) were under long-term medication, antihypertensive, ansiolitic and antidepressant drugs being the most used. Burning mouth complaint was associated with other secondary oral complaints in 83.8% of the cases. Tongue was the most commonly affected site (70.9%), followed by the vermillion border of the lower lip (38.7%) and hard palate (32.2%). The association of the burning sensation with oral cancer (cancer phobia) was reported by 67.7% of the patients. Haematologic examination (hematocrit, haemoglobin and fasting blood glucose level) revealed 2 cases each of anemia and type 2 diabetes. Local factors, tooth extractions and dentures wearing, were associated with the onset of symptoms in 35.5% of the cases. Daily activities were changed as a consequence of BMS in 29% of the patients. Among the species of the genus Candida, C. albicans was the most frequent in BMS patients (9 - 29.03%) and controls (12 - 38.70%), followed respectively by C. parapsilosis (2 - 6.45% and 0 - 0%); C. tropicalis (1 - 3.22% and 2 - 6.45%); C. krusei and C. kefyr (1 - 3.22% and 0 - 0%). Therefore, such difference did not reach valuable results. In conclusion, these data were similar to those reported in other studies. The highlights of the present findings were the possible relation of BMS with chronic drug use, depression, menopause and cancer phobia. No association was found between BMS and the prevalence of Candida species.
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PMID:Burning mouth syndrome: clinical profile of Brazilian patients and oral carriage of Candida species. 1827 6

Primary health care use of cancer patients is increased, even years after active treatment. Insight into the reasons for this could help in developing and improving guidelines and planning of health care, which is important given the expected increase in cancer survivors. Using data from the Netherlands Information Network of Primary Care, we selected 1256 adult breast cancer, 503 prostate cancer and 487 colorectal cancer patients diagnosed between 2001 and 2006. We compared diseases and complaints for which they contacted their General Practitioner (GP) 2-5 years after diagnosis to age and sex matched non-cancer controls from the same practice. Cancer patients consulted their GP more often than controls for acute symptoms such as abdominal pain and fatigue (18% more in breast cancer, 26% more in prostate cancer) and infections, such as cystitis or respiratory infections (45% in breast cancer and 17% in colorectal cancer). Consultations for chronic diseases and psychosocial problems were slightly increased: breast cancer patients had more contacts related to diabetes (55%), sleep disturbance (60%) and depression (64%), prostate cancer patients had more contacts related to hypertension (53) and chronic obstructive pulmonary disease (COPD, 34%). Adverse drug effects were almost twice as often observed in prostate and colorectal cancer patients than in controls. Fear of cancer recurrence was noted as the reason for consulting the GP in only 20 patients. Concluding, increased primary health care use in cancer survivors is mostly related to common infections and acute symptoms, which may be due to direct effects of cancer treatment or increased health concerns.
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PMID:For which health problems do cancer survivors visit their General Practitioner? 2347 17


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