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5 - Chronic hepatitis C and psychosocial distress
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EACLLP Abstracts / Journal of Psychosomatic Research 60 (2006) 655 – 664
compliance and adherence to the therapeutic process by the patient. Moreover, the inclusion in the waiting list for OLTx activates multiple psychological reactions in the patient, mainly anxiety and depression. A need to test patients’ coping capacity is also crucial. Methods: Four hundred patients from the Liver Transplantation Surgery Unit of Modena General Hospital were assessed by professionally trained psychiatrists between January 2002 and December 2005. After a standard psychiatric assessment, the Transplant Evaluation Rating Scale (TERS) and Montgomery-Asberg Depression Rating Scale (MADRS) scales were administered to each patient. The TERS scale was specifically developed to test the attitude of the patient receiving the transplant. MADRS quantifies the depressive symptoms. Results: TERS and MADRS scores show a statistically significant inverse correlation to each other: patients showing high levels of anxious and/or depression symptoms appear to be worse candidates at the TERS evaluation. Conclusions: Psychiatric assessment of patients waiting for OLTx is relevant not only for selection of candidates but also to activate a psychological support and/or a psychopharmacological therapy and to improve patients’ coping strategies in facing both a debilitating physical illness and a difficult therapeutic pathway.
5 – Chronic hepatitis C and psychosocial distress Barbanti Silva V a, Tesini EM b, Ferrari S a, Pigozzi F a, Pingani La, Vandelli C b, Rigatelli M a a Department of Neuroscience-TCR, Section of Psychiatry, University of Modena and Reggio Emilia, Modena General Hospital, Italy b Department of Medicine, University of Modena and Reggio Emilia, Modena General Hospital, Italy Background and aims: Chronic active hepatitis C (CHC) infection has been associated with reduced quality of life (QOL), decreased cognitive functions, emotional distress, and psychiatric disorders. The present study aims to examine the impact of long-standing disease on perceived healthrelated quality of life (HRQL) and investigate the association between HRQL and emotional distress, psychiatric disorders, and cognitive deficits, by means of a case-control study. Methods: One hundred patients with CHC were consecutively recruited at the Modena General Hospital’s liver clinic. Mean age of CHC patients was 59 (SD=11) and male/female ratio was 36/64%. Accurate family and personal history and administration of SCID-I, SCID-II, MADRS, Short Form 36, AUDIT, and R-BANS were conducted by the psychiatric researcher. As many non-CHC subjects were consecutively recruited at the same clinic and constituted the control group. Results: Lower scores on SF-36 than controls were found in 51.16% of CHC patients. A statistically significant positive correlation was found between SF-36 scores and generalized anxiety disorder (Pb.01), panic disorder (Pb.05) and cognitive impairment (Pb.01). General health perception and vitality were compromised in CHC patients. Significant reductions in HRQL scores vs. controls were observed in 2 out of 8 SF-36 domains and were independent on severity of histopathology and disease duration. Conclusions: CHC patients experience a decreased QOL, cognitive deficits, reduced physical function, and role limitations. Emotional distress appears to affect CHC patient’s perception of HRQL. The approach to CHC patients should be multidisciplinary.
6 – Biological factors in medical patients depressed at the time of discharge Barcones MF, Saz P, Sarasola A, Marcos G, Lobo A Hospital Clinico Universitario, Instituto Aragone´s de Ciencias de la Salud and University of Zaragoza, Spain Aims: To consider new hypotheses about the association of depression, and severity of the somatic condition and haematological–biochemical parameters in medical inpatients.
Methods sample: Consecutive, adult patients hospitalized in medical wards in the University hospital in Zaragoza, Spain. Sample size has been calculated (type I and II errors, potency) to test the hypotheses with enough statistical power. Instruments: Standardized, Spanish versions of assessment instruments, including Hospital Anxiety and Depression Scale and the Standardized Polivalent Psychiatric Interview (SPPI) were used, and the cases of depression were diagnosed according to International Statistical Classification of Diseases, 10th Revision research criteria for medical patients (ECLW). Procedure: Hospital phase: screening by lay interviewers and assessment of bprobable casesQ and bprobable noncasesQ by standardized clinicians (SPPI). Results: Seven hundred nine patients hospitalized in medical wards were included in the sample, and 498 (70.2%) fulfilled inclusion and exclusion criteria. Depression was detected at the time of discharge in 70 patients (19.8%). Depressed patients had a higher number of abnormal haematological and biochemical parameters (such as leukocyte count, phosphorus, and calcium levels) in comparison with controls (Pb.05). Furthermore, depressed patients had a higher number of medical diagnoses and a higher severity of illness index (Pb.05). Conclusions: This study finds support for the hypothesized association of depression in medical patients and abnormal haematological and biochemical profiles.
7 – Long-term mood outcome following subthalamic deep brain stimulation for late-stage Parkinson’s disease Berney A a, Saraga M a, Wider C b, Gronchi A b, Ghika J b, Pollo C c, Villemure J-G c, Vingerhoets F b a Department of Psychiatry of Lausanne University, Switzerland b Department of Neurology of Lausanne University, Switzerland c Department of Neurosurgery of Lausanne University, Switzerland Background: Changes in mood on occasions of clinical severity were reported in late-stage Parkinson’s Disease (PD) patients who underwent subthalamic deep brain stimulation (STN-DBS) (Berney et al. 2002, Anderson et al. 2003; for review). The aim of this study was to further characterize long-term mood outcome in PD patients prospectively studied for at least 2 years after STN-DBS implantation. Method: PD patients were systematically examined preoperatively (T0), at 10.2F2.9 (T1) and 35.7F10.6 months (T2) following STN-DBS, using the Montgomery Asberg Depression Rating Scale (MADRS), and a brief structured psychiatric interview (MINI), in addition to the cognitive and motor assessments. Results: Fifty PD patients (30 male and 20 female; mean PD duration, 15.1F4.8 years; mean age at implantation, 64.7F7.9 years) were studied. Repeated measures analysis of variance on MADRS scores showed a significant main effect of time; post hoc analysis revealed that patients significantly worsened their mood scores from baseline to T1 (P=.03), whereas mood scores did not significantly change from T1 to T2. Using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for major depression and a conservative cutoff score of 20 on the MADRS, (1/50) 2% were depressed at baseline, (8/50) 16% at T1 and (5/43) 12% at T2. Female patients appeared to be at higher risk for developing major depression in our sample. Conclusions: This long-term follow-up study reveals a high rate of Major Depressive Episodes occurring during the first year following DBS neurosurgery for PD. STN-DBS may precipitate the development of comorbid depression in at-risk individuals.
8 – Mental vulnerability and disability pension Birket-Smith M a, Eplov T b, Jørgensen T b a Liaison Psychiatry Unit, Bispebjerg University Hospital, Copenhagen b Centre for Preventive Medicine, Glostrup University Hospital, Glostup, Denmark
EACLLP Abstracts / Journal of Psychosomatic Research 60 (2006) 655 – 664
compliance and adherence to the therapeutic process by the patient. Moreover, the inclusion in the waiting list for OLTx activates multiple psychological reactions in the patient, mainly anxiety and depression. A need to test patients’ coping capacity is also crucial. Methods: Four hundred patients from the Liver Transplantation Surgery Unit of Modena General Hospital were assessed by professionally trained psychiatrists between January 2002 and December 2005. After a standard psychiatric assessment, the Transplant Evaluation Rating Scale (TERS) and Montgomery-Asberg Depression Rating Scale (MADRS) scales were administered to each patient. The TERS scale was specifically developed to test the attitude of the patient receiving the transplant. MADRS quantifies the depressive symptoms. Results: TERS and MADRS scores show a statistically significant inverse correlation to each other: patients showing high levels of anxious and/or depression symptoms appear to be worse candidates at the TERS evaluation. Conclusions: Psychiatric assessment of patients waiting for OLTx is relevant not only for selection of candidates but also to activate a psychological support and/or a psychopharmacological therapy and to improve patients’ coping strategies in facing both a debilitating physical illness and a difficult therapeutic pathway.
5 – Chronic hepatitis C and psychosocial distress Barbanti Silva V a, Tesini EM b, Ferrari S a, Pigozzi F a, Pingani La, Vandelli C b, Rigatelli M a a Department of Neuroscience-TCR, Section of Psychiatry, University of Modena and Reggio Emilia, Modena General Hospital, Italy b Department of Medicine, University of Modena and Reggio Emilia, Modena General Hospital, Italy Background and aims: Chronic active hepatitis C (CHC) infection has been associated with reduced quality of life (QOL), decreased cognitive functions, emotional distress, and psychiatric disorders. The present study aims to examine the impact of long-standing disease on perceived healthrelated quality of life (HRQL) and investigate the association between HRQL and emotional distress, psychiatric disorders, and cognitive deficits, by means of a case-control study. Methods: One hundred patients with CHC were consecutively recruited at the Modena General Hospital’s liver clinic. Mean age of CHC patients was 59 (SD=11) and male/female ratio was 36/64%. Accurate family and personal history and administration of SCID-I, SCID-II, MADRS, Short Form 36, AUDIT, and R-BANS were conducted by the psychiatric researcher. As many non-CHC subjects were consecutively recruited at the same clinic and constituted the control group. Results: Lower scores on SF-36 than controls were found in 51.16% of CHC patients. A statistically significant positive correlation was found between SF-36 scores and generalized anxiety disorder (Pb.01), panic disorder (Pb.05) and cognitive impairment (Pb.01). General health perception and vitality were compromised in CHC patients. Significant reductions in HRQL scores vs. controls were observed in 2 out of 8 SF-36 domains and were independent on severity of histopathology and disease duration. Conclusions: CHC patients experience a decreased QOL, cognitive deficits, reduced physical function, and role limitations. Emotional distress appears to affect CHC patient’s perception of HRQL. The approach to CHC patients should be multidisciplinary.
6 – Biological factors in medical patients depressed at the time of discharge Barcones MF, Saz P, Sarasola A, Marcos G, Lobo A Hospital Clinico Universitario, Instituto Aragone´s de Ciencias de la Salud and University of Zaragoza, Spain Aims: To consider new hypotheses about the association of depression, and severity of the somatic condition and haematological–biochemical parameters in medical inpatients.
Methods sample: Consecutive, adult patients hospitalized in medical wards in the University hospital in Zaragoza, Spain. Sample size has been calculated (type I and II errors, potency) to test the hypotheses with enough statistical power. Instruments: Standardized, Spanish versions of assessment instruments, including Hospital Anxiety and Depression Scale and the Standardized Polivalent Psychiatric Interview (SPPI) were used, and the cases of depression were diagnosed according to International Statistical Classification of Diseases, 10th Revision research criteria for medical patients (ECLW). Procedure: Hospital phase: screening by lay interviewers and assessment of bprobable casesQ and bprobable noncasesQ by standardized clinicians (SPPI). Results: Seven hundred nine patients hospitalized in medical wards were included in the sample, and 498 (70.2%) fulfilled inclusion and exclusion criteria. Depression was detected at the time of discharge in 70 patients (19.8%). Depressed patients had a higher number of abnormal haematological and biochemical parameters (such as leukocyte count, phosphorus, and calcium levels) in comparison with controls (Pb.05). Furthermore, depressed patients had a higher number of medical diagnoses and a higher severity of illness index (Pb.05). Conclusions: This study finds support for the hypothesized association of depression in medical patients and abnormal haematological and biochemical profiles.
7 – Long-term mood outcome following subthalamic deep brain stimulation for late-stage Parkinson’s disease Berney A a, Saraga M a, Wider C b, Gronchi A b, Ghika J b, Pollo C c, Villemure J-G c, Vingerhoets F b a Department of Psychiatry of Lausanne University, Switzerland b Department of Neurology of Lausanne University, Switzerland c Department of Neurosurgery of Lausanne University, Switzerland Background: Changes in mood on occasions of clinical severity were reported in late-stage Parkinson’s Disease (PD) patients who underwent subthalamic deep brain stimulation (STN-DBS) (Berney et al. 2002, Anderson et al. 2003; for review). The aim of this study was to further characterize long-term mood outcome in PD patients prospectively studied for at least 2 years after STN-DBS implantation. Method: PD patients were systematically examined preoperatively (T0), at 10.2F2.9 (T1) and 35.7F10.6 months (T2) following STN-DBS, using the Montgomery Asberg Depression Rating Scale (MADRS), and a brief structured psychiatric interview (MINI), in addition to the cognitive and motor assessments. Results: Fifty PD patients (30 male and 20 female; mean PD duration, 15.1F4.8 years; mean age at implantation, 64.7F7.9 years) were studied. Repeated measures analysis of variance on MADRS scores showed a significant main effect of time; post hoc analysis revealed that patients significantly worsened their mood scores from baseline to T1 (P=.03), whereas mood scores did not significantly change from T1 to T2. Using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for major depression and a conservative cutoff score of 20 on the MADRS, (1/50) 2% were depressed at baseline, (8/50) 16% at T1 and (5/43) 12% at T2. Female patients appeared to be at higher risk for developing major depression in our sample. Conclusions: This long-term follow-up study reveals a high rate of Major Depressive Episodes occurring during the first year following DBS neurosurgery for PD. STN-DBS may precipitate the development of comorbid depression in at-risk individuals.
8 – Mental vulnerability and disability pension Birket-Smith M a, Eplov T b, Jørgensen T b a Liaison Psychiatry Unit, Bispebjerg University Hospital, Copenhagen b Centre for Preventive Medicine, Glostrup University Hospital, Glostup, Denmark