- Email: [email protected]
Group-based Acceptance and Commitment Therapy for severe functional somatic syndromes in adolescents – uncontrolled pilot study
Abstracts
Results: The initial search identified 679 articles for possible inclusion. After screening by independent reviewers, 17 articles met inclusion criteria. Three cases reported on adverse outcomes while 9 cases reported no adverse outcomes. At least 25 additional cases were reported to be taking antidepressants though details were not provided. Conclusions: There is insufficient evidence to recommend completely avoiding the use of antidepressants in patients with carcinoid/NET as previous authors have recommended. We hope that our findings will also help guide future research in this understudied area. Future studies should further examine their safety. doi:10.1016/j.jpsychores.2017.03.252
43 It’s Easy to Spot When You Know What to Look for: 18 Cases of Nonalcoholic Wernicke Encephalopathy E. Isenberg-Grzedaa, Y. Alicib, V. Hatzogloub, C. Nelsonb, W. Breitbartb a
University of Toronto, Toronto, Canada Memorial Sloan Kettering Cancer Center, New York, United States
b
Aims: Cancer patients are at risk for thiamine deficiency (TD) and Wernicke-Korsakoff Syndrome (WKS). This study aims to describe the phenomenology, associated factors, treatment outcomes, and causes of diagnostic delay in 18 cancer patients diagnosed with WE. Methods: A retrospective chart review was performed at Memorial Sloan Kettering Cancer Center. Adult inpatients were identified during routine care provided by inpatient CL psychiatrists. Patients were included if diagnosed with WKS by operational criteria (Caine et al., 1997) and had an additional supporting feature (low thiamine concentration, radiologic findings, or improvement following thiamine). If presentation was better explained by other diagnoses, patients were excluded. IRB exemption was obtained. Results: 18 patients with WKS were included. Hematologic malignancies were the most common (n= 7, 39%). Thiamine concentration was measured in 16 patients and all cases were abnormally low. All patients presented with cognitive symptoms (n =18, 100%), whereas 39% (n =7) presented with cerebellar signs and only 17% (n= 3) with ocular signs. The classic “Wernicke’s triad” was present in 2 cases (11%). Treatment delay and residual deficits were common findings. Conclusions: This is the largest descriptive study on the presentation and outcome of nonalcoholic WKS in cancer. Many patients were indistinguishable from delirium due to other causes. Therefore, WKS must be considered in all cancer patients with delirium. Wernicke’s classic triad results in missed diagnoses, and the operationalized criteria should be used instead. Problems of diagnostic and treatment delay are common, which may explain high rates of residual deficits in our sample.
doi:10.1016/j.jpsychores.2017.03.253
44 The importance of epidemiological studies towards functional syndromes: An introduction R. Judith, J. Monica, J. Karin University Medical Center Groningen, Groningen, Netherlands
155
Aims: Many studies investigating the etiology of functional somatic syndromes are case-control studies. They provide valuable information on biomarkers and other factors associated with these syndromes. However, they are also associated with limitations, of which two important examples are the selection of the controls and the causal directions of the found associations. Methods: The added value of epidemiological cohorts will be demonstrated using data from LifeLines. LifeLines is a populationbased cohort consisting of 167.729 participants, in which chronic fatigue syndrome (CFS), fibromyalgia (FM) and irritable bowel syndrome (IBS) have been assessed. Psychiatric morbidity and quality of life were analysed in relaton to these three syndromes. Results were compared to those obtained in controls and in patients with similar symptoms due to a recognized disease (multiple sclerosis (MS), rheumatoid arthritis (RA), inflammatory bowel disease (IBD)). Results: The comorbidity between functional somatic syndromes is much higher than expected by chance, with an up to 37.7 times higher number of persons reporting all three syndromes than could be expected based on the separate prevalence rates. Functional somatic syndromes are associated with functional limitations, to a comparable degree as the recognized diseases. Psychiatric morbidity is increased in CFS, FM and IBS as compared to controls; this is also the case for MS, RA and IBD although to a lesser degree. The presence of an anxiety disorder or depression increases the risk for new onset functional somatic syndromes. Conclusions: The results underline the importance of broad epidemiological studies, since they can provide appropriate disease controls and shed more light on premorbid risk factors. However, only very few of the large ongoing cohort studies include data on functional somatic syndromes. This is unfortunate given the high prevalence of and disability associated with functional somatic syndromes.
doi:10.1016/j.jpsychores.2017.03.254
46 Group-based Acceptance and Commitment Therapy for severe functional somatic syndromes in adolescents – uncontrolled pilot study K.H. Kallesøea, A. Schrödera, J.S. Jensena, T. Preussa, R.K. Wicksellb, P. Finka, C.U. Raska a
Aarhus University Hospital, Aarhus, Denmark Karolinska University Hospital, Stockholm, Sweden
b
Background: Approximately 5-10% of adolescents report recurrent functional somatic symptoms. Some experience persistent symptoms and may receive functional somatic syndromes (FSS) diagnoses, characterised by severe disability and reduced quality of life. Despite a high need for care, there is lack of empirically supported treatments for this age group. The aim of this pilot study was to examine the feasibility and overall impression of change in physical health of group based Acceptance and Commitment Therapy (ACT) for adolescents with severe FSS. Method: Twenty-one patients attended a manualized groupbased ACT-programme, specifically developed for adolescents (aged 15-19 years) with severe FSS. The programme consisted of 9 modules and one follow up meeting (30 hours). Close relatives participated in a workshop to increase their support to the patient throughout the treatment. Change in the adolescents health status was evaluated by self-reported physical health (SF36 aggregate score of the subscales physical functioning, bodily pain and vitality; primary outcome) and symptom interference, illness worry, and
156
Abstracts
global improvement (secondary outcomes). Process measures were illness behaviour and psychological flexibility. Feasibility was evaluated by means of questionnaires evaluating the patient’s and relatives opinions of the treatment after end of treatment. Results: Nineteen patients (90.5 %) completed the treatment. Patients’ physical health improved considerably from group start to 3 months after treatment, with a mean difference of 5.5 points (95 % CI 2.8 - 8.2; SRM 0.9, 95% CI (0.4; 1.5)). All patients would recommend the treatment to a friend with similar problems. Close relatives rated it valuable to meet other relatives to adolescents with FSS. Secondary outcome variables and process measures will be presented. Conclusion: The ACT-based programme was associated with clinically relevant improvement in physical health. An ongoing RCT will evaluate treatment effects by self-reported outcome measures and objective markers for physiological stress response and physical activity (clinicaltrials.gov, NCT02346071). If the treatment is effective this may result in significant improvement in the well-being and overall quality of life of these young patients.
doi:10.1016/j.jpsychores.2017.03.255
47 What qualifies depression to be an aetiological risk factor for coronary artery disease? L. Karl-Heinz Universitätsklinium Rechts der Isar der TUM, München, Germany Background: Depressed mood and exhaustion (DEEX) have gained attention as a risk predictors for cardiovascular disease (CVD). Studies to estimate its ranking in prediction models are sparse. Methods: The study included 3,500 men aged 45 to 74 years who participated in one of three MONICA/KORA Augsburg populationbased surveys conducted between 1984 and 1995. Within a follow-up time of 10 years (33,400 person-years), 577 cases of all-cause mortality and 276 fatal CVD events were observed. Adjusted Cox proportional hazards models were used to assess mortality risks for DEEX and five classical cardiovascular risk factors. The predictive ability was evaluated by the area under the receiver-operating characteristic curve, the integrated discrimination improvement statistics and the net classification index. Results: The absolute DEEX mortality risk was 23.7 cases per 1,000 person years for all-cause and 11.2 for CVD mortality. The crude population-attributable risk (PAR) for DEEX accounted for 12.7% of all-cause and 12.2% of CVD mortality, which gives DEEX a middle ranking amongst the classical risk factors. The adjusted hazard ratios of 1.51 for all-cause and 1.45 for CVD mortality (p b 0.01) were higher than those for hypercholesterolemia and obesity but lower than for hypertension, smoking and diabetes. The improvements in risk prediction from DEEX were comparable to those of hypercholesterolemia and obesity but substantially lower than those of hypertension, smoking and diabetes. Conclusions: The value of DEEX in mortality risk prediction in relation to cardiovascular risk factors is confirmed.
doi:10.1016/j.jpsychores.2017.03.256
48 Improving intra-professional collaboration in complex cases in hospital patient care K. Nauta Department of Psychiatry VUmc, Amsterdam, The Netherlands Aims: Complex patients are increasingly common in clinical practice. For the provision of safe and optimal care to these patients, a high level of intra-professional collaboration is vital. However, collaboration between doctors in the hospital is often ineffective. The most important barriers are conflicting views and interests between different medical disciplines involved in patient care. We developed a training method that teaches medical professionals skills and knowledge to communicate more effectively in complex cases. Methods: The training method was developed on the basis of: 1) a developed framework for complex collaborative cases in hospital patient care that focuses on conflicting views between different disciplines, 2) the identification of representative complex cases from practice, 3) a complex case discussion based on the model, and 4) use of a personality questionnaire for behaviour styles. Post-hoc evalutions of the training were done through questionnaires. Results: In 2015 and 2016 22 trainings were conducted for 104 medical specialists, 63 residents and 20 other disciplines. Questionnaires gave the following results; “I gained more insights in barriers for communication in complex cases”: average score 4,6 on a 5-point scale. “I gained more insights in my personal interaction style”: average score 4,3 on a 5-point scale. “I will use what I learned in practice”: average score 4,9 on a 5-point scale. Overall average rating was 8,1 on a 10-point scale. Interviews with individual participants one month after training suggested benefits for teambuilding, interpersonal communication and efficient care for complex patients. Conclusion: Intra-professional collaboration in complex cases can be improved by a training that focusses on conflicting views between different medical disciplines involved in patient care. 1. Hewett DG, Watson BM, Gallois C, Ward M, Leggett BA. Intergroup communication between hospital doctors: implications for quality of patient care. Social Science and medicine 2009; 69: 1732-1740. 2. Lingard LL, McDougall A, Levstik M, Chandok N, Spafford MM, Schryer C. Representing complexity well: a story about teamwork, with implications for how we teach collaboration . Medical Education 2012; 46: 869-877.
doi:10.1016/j.jpsychores.2017.03.257
49 Coping strategies and sexual satisfaction in bladder cancer males W. Krajewski, K. Koscielska-Kasprzak, D. Szczesniak, R. Zdrojowy, J. Rymaszewska Wroclaw Medical University, Wroclaw, Poland Aims: Bladder cancer (BC) is one of the most frequent human cancers. Manipulation on genitourinary tract (GUT) generates intensified psychological problems (stress, depression, anxiety about deterioration of sexual function and potency, lowered self-esteem, fear of harming sexual partner, lack of acceptance of one’s body). The purpose was to identify how patients with non-muscle invasive bladder cancer (NMIBC) cope with stress and what is the influence of pain perception, depression, anxiety and sexual satisfaction on stress coping.
Results: The initial search identified 679 articles for possible inclusion. After screening by independent reviewers, 17 articles met inclusion criteria. Three cases reported on adverse outcomes while 9 cases reported no adverse outcomes. At least 25 additional cases were reported to be taking antidepressants though details were not provided. Conclusions: There is insufficient evidence to recommend completely avoiding the use of antidepressants in patients with carcinoid/NET as previous authors have recommended. We hope that our findings will also help guide future research in this understudied area. Future studies should further examine their safety. doi:10.1016/j.jpsychores.2017.03.252
43 It’s Easy to Spot When You Know What to Look for: 18 Cases of Nonalcoholic Wernicke Encephalopathy E. Isenberg-Grzedaa, Y. Alicib, V. Hatzogloub, C. Nelsonb, W. Breitbartb a
University of Toronto, Toronto, Canada Memorial Sloan Kettering Cancer Center, New York, United States
b
Aims: Cancer patients are at risk for thiamine deficiency (TD) and Wernicke-Korsakoff Syndrome (WKS). This study aims to describe the phenomenology, associated factors, treatment outcomes, and causes of diagnostic delay in 18 cancer patients diagnosed with WE. Methods: A retrospective chart review was performed at Memorial Sloan Kettering Cancer Center. Adult inpatients were identified during routine care provided by inpatient CL psychiatrists. Patients were included if diagnosed with WKS by operational criteria (Caine et al., 1997) and had an additional supporting feature (low thiamine concentration, radiologic findings, or improvement following thiamine). If presentation was better explained by other diagnoses, patients were excluded. IRB exemption was obtained. Results: 18 patients with WKS were included. Hematologic malignancies were the most common (n= 7, 39%). Thiamine concentration was measured in 16 patients and all cases were abnormally low. All patients presented with cognitive symptoms (n =18, 100%), whereas 39% (n =7) presented with cerebellar signs and only 17% (n= 3) with ocular signs. The classic “Wernicke’s triad” was present in 2 cases (11%). Treatment delay and residual deficits were common findings. Conclusions: This is the largest descriptive study on the presentation and outcome of nonalcoholic WKS in cancer. Many patients were indistinguishable from delirium due to other causes. Therefore, WKS must be considered in all cancer patients with delirium. Wernicke’s classic triad results in missed diagnoses, and the operationalized criteria should be used instead. Problems of diagnostic and treatment delay are common, which may explain high rates of residual deficits in our sample.
doi:10.1016/j.jpsychores.2017.03.253
44 The importance of epidemiological studies towards functional syndromes: An introduction R. Judith, J. Monica, J. Karin University Medical Center Groningen, Groningen, Netherlands
155
Aims: Many studies investigating the etiology of functional somatic syndromes are case-control studies. They provide valuable information on biomarkers and other factors associated with these syndromes. However, they are also associated with limitations, of which two important examples are the selection of the controls and the causal directions of the found associations. Methods: The added value of epidemiological cohorts will be demonstrated using data from LifeLines. LifeLines is a populationbased cohort consisting of 167.729 participants, in which chronic fatigue syndrome (CFS), fibromyalgia (FM) and irritable bowel syndrome (IBS) have been assessed. Psychiatric morbidity and quality of life were analysed in relaton to these three syndromes. Results were compared to those obtained in controls and in patients with similar symptoms due to a recognized disease (multiple sclerosis (MS), rheumatoid arthritis (RA), inflammatory bowel disease (IBD)). Results: The comorbidity between functional somatic syndromes is much higher than expected by chance, with an up to 37.7 times higher number of persons reporting all three syndromes than could be expected based on the separate prevalence rates. Functional somatic syndromes are associated with functional limitations, to a comparable degree as the recognized diseases. Psychiatric morbidity is increased in CFS, FM and IBS as compared to controls; this is also the case for MS, RA and IBD although to a lesser degree. The presence of an anxiety disorder or depression increases the risk for new onset functional somatic syndromes. Conclusions: The results underline the importance of broad epidemiological studies, since they can provide appropriate disease controls and shed more light on premorbid risk factors. However, only very few of the large ongoing cohort studies include data on functional somatic syndromes. This is unfortunate given the high prevalence of and disability associated with functional somatic syndromes.
doi:10.1016/j.jpsychores.2017.03.254
46 Group-based Acceptance and Commitment Therapy for severe functional somatic syndromes in adolescents – uncontrolled pilot study K.H. Kallesøea, A. Schrödera, J.S. Jensena, T. Preussa, R.K. Wicksellb, P. Finka, C.U. Raska a
Aarhus University Hospital, Aarhus, Denmark Karolinska University Hospital, Stockholm, Sweden
b
Background: Approximately 5-10% of adolescents report recurrent functional somatic symptoms. Some experience persistent symptoms and may receive functional somatic syndromes (FSS) diagnoses, characterised by severe disability and reduced quality of life. Despite a high need for care, there is lack of empirically supported treatments for this age group. The aim of this pilot study was to examine the feasibility and overall impression of change in physical health of group based Acceptance and Commitment Therapy (ACT) for adolescents with severe FSS. Method: Twenty-one patients attended a manualized groupbased ACT-programme, specifically developed for adolescents (aged 15-19 years) with severe FSS. The programme consisted of 9 modules and one follow up meeting (30 hours). Close relatives participated in a workshop to increase their support to the patient throughout the treatment. Change in the adolescents health status was evaluated by self-reported physical health (SF36 aggregate score of the subscales physical functioning, bodily pain and vitality; primary outcome) and symptom interference, illness worry, and
156
Abstracts
global improvement (secondary outcomes). Process measures were illness behaviour and psychological flexibility. Feasibility was evaluated by means of questionnaires evaluating the patient’s and relatives opinions of the treatment after end of treatment. Results: Nineteen patients (90.5 %) completed the treatment. Patients’ physical health improved considerably from group start to 3 months after treatment, with a mean difference of 5.5 points (95 % CI 2.8 - 8.2; SRM 0.9, 95% CI (0.4; 1.5)). All patients would recommend the treatment to a friend with similar problems. Close relatives rated it valuable to meet other relatives to adolescents with FSS. Secondary outcome variables and process measures will be presented. Conclusion: The ACT-based programme was associated with clinically relevant improvement in physical health. An ongoing RCT will evaluate treatment effects by self-reported outcome measures and objective markers for physiological stress response and physical activity (clinicaltrials.gov, NCT02346071). If the treatment is effective this may result in significant improvement in the well-being and overall quality of life of these young patients.
doi:10.1016/j.jpsychores.2017.03.255
47 What qualifies depression to be an aetiological risk factor for coronary artery disease? L. Karl-Heinz Universitätsklinium Rechts der Isar der TUM, München, Germany Background: Depressed mood and exhaustion (DEEX) have gained attention as a risk predictors for cardiovascular disease (CVD). Studies to estimate its ranking in prediction models are sparse. Methods: The study included 3,500 men aged 45 to 74 years who participated in one of three MONICA/KORA Augsburg populationbased surveys conducted between 1984 and 1995. Within a follow-up time of 10 years (33,400 person-years), 577 cases of all-cause mortality and 276 fatal CVD events were observed. Adjusted Cox proportional hazards models were used to assess mortality risks for DEEX and five classical cardiovascular risk factors. The predictive ability was evaluated by the area under the receiver-operating characteristic curve, the integrated discrimination improvement statistics and the net classification index. Results: The absolute DEEX mortality risk was 23.7 cases per 1,000 person years for all-cause and 11.2 for CVD mortality. The crude population-attributable risk (PAR) for DEEX accounted for 12.7% of all-cause and 12.2% of CVD mortality, which gives DEEX a middle ranking amongst the classical risk factors. The adjusted hazard ratios of 1.51 for all-cause and 1.45 for CVD mortality (p b 0.01) were higher than those for hypercholesterolemia and obesity but lower than for hypertension, smoking and diabetes. The improvements in risk prediction from DEEX were comparable to those of hypercholesterolemia and obesity but substantially lower than those of hypertension, smoking and diabetes. Conclusions: The value of DEEX in mortality risk prediction in relation to cardiovascular risk factors is confirmed.
doi:10.1016/j.jpsychores.2017.03.256
48 Improving intra-professional collaboration in complex cases in hospital patient care K. Nauta Department of Psychiatry VUmc, Amsterdam, The Netherlands Aims: Complex patients are increasingly common in clinical practice. For the provision of safe and optimal care to these patients, a high level of intra-professional collaboration is vital. However, collaboration between doctors in the hospital is often ineffective. The most important barriers are conflicting views and interests between different medical disciplines involved in patient care. We developed a training method that teaches medical professionals skills and knowledge to communicate more effectively in complex cases. Methods: The training method was developed on the basis of: 1) a developed framework for complex collaborative cases in hospital patient care that focuses on conflicting views between different disciplines, 2) the identification of representative complex cases from practice, 3) a complex case discussion based on the model, and 4) use of a personality questionnaire for behaviour styles. Post-hoc evalutions of the training were done through questionnaires. Results: In 2015 and 2016 22 trainings were conducted for 104 medical specialists, 63 residents and 20 other disciplines. Questionnaires gave the following results; “I gained more insights in barriers for communication in complex cases”: average score 4,6 on a 5-point scale. “I gained more insights in my personal interaction style”: average score 4,3 on a 5-point scale. “I will use what I learned in practice”: average score 4,9 on a 5-point scale. Overall average rating was 8,1 on a 10-point scale. Interviews with individual participants one month after training suggested benefits for teambuilding, interpersonal communication and efficient care for complex patients. Conclusion: Intra-professional collaboration in complex cases can be improved by a training that focusses on conflicting views between different medical disciplines involved in patient care. 1. Hewett DG, Watson BM, Gallois C, Ward M, Leggett BA. Intergroup communication between hospital doctors: implications for quality of patient care. Social Science and medicine 2009; 69: 1732-1740. 2. Lingard LL, McDougall A, Levstik M, Chandok N, Spafford MM, Schryer C. Representing complexity well: a story about teamwork, with implications for how we teach collaboration . Medical Education 2012; 46: 869-877.
doi:10.1016/j.jpsychores.2017.03.257
49 Coping strategies and sexual satisfaction in bladder cancer males W. Krajewski, K. Koscielska-Kasprzak, D. Szczesniak, R. Zdrojowy, J. Rymaszewska Wroclaw Medical University, Wroclaw, Poland Aims: Bladder cancer (BC) is one of the most frequent human cancers. Manipulation on genitourinary tract (GUT) generates intensified psychological problems (stress, depression, anxiety about deterioration of sexual function and potency, lowered self-esteem, fear of harming sexual partner, lack of acceptance of one’s body). The purpose was to identify how patients with non-muscle invasive bladder cancer (NMIBC) cope with stress and what is the influence of pain perception, depression, anxiety and sexual satisfaction on stress coping.