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Psychosocial variables in the development of chronic headache disability
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P.5.f. Dementia and neurological disorders − Other (clinical)
involve multiple organs and general dysfunction of the immune system, which could affect the brain and induce psychiatric symptoms [5]. References [1] Bonavita, S., Tedeschi, G., Gallo, A. 2013. Morphostructural MRI abnormalities related to neuropsychiatric disorders associated to multiple sclerosis. Mult Scler Int., 102454. [2] Pozuelo Moyano, B., Benito Le´on, J. 2015. Trastornos afectivos y psic´oticos en la esclerosis m´ultiple. Rev Neurol. 61, 503–508. [3] Marrie, R.A., Reingold, S., Cohen, J., Stuve, O., Trojano, M., Sorensen, P.S., Cutter, G., Reider, N. 2015. The incidence and prevalence of psychiatric disorders in multiple sclerosis: a sistematic review. Mult Scler. 21 (3), 305−17. [4] Guernion, N., Le Cadet, E., Tirel, A., Le Galudec, M., Edan, G., Walter, M. 2013. Neuropsychiatric manifestations in multiple sclerosis (MS): Might psychotic symptoms signal the onset of the disease? Presse Med. 42 (9 Pt 1): 1186−95. [5] Benros, M.E., Eaton, W.W., Mortensen, P.B. 2014. The epidemiologic evidence linking autoimmune diseases and psychosis. Biol Psychiatry Feb. 15;75 (4), 300−6.
P.5.f.005 Psychosocial variables in the development of chronic headache disability M. Henry1 ° , A.A. Henry-Gonzalez2 , A.A. Perez-Morell3 , L. Huerga-Garcia3 1 School of Medicine, Department of Internal Medicine- Dermatology and Psychiatry, Santa Cruz de Tenerife, Spain; 2 Gerencia de Atenci´on Primaria, Health Care Department, Santa Cruz de Tenerife, Spain; 3 University of La Laguna Medical School, Health Sciences Department, La Laguna, Spain Introduction: Headache is considered a common chronic disease that occurs with varying frequency and it can result in different levels of disability. Some recent studies have shown that psychosocial and behavioural factors are important predictors of treatment outcome. A biopsychosocial approach is recommended to be used for the assessment and management in this medical condition, in particular, in patients with major psychosocial involvement which determines a clear combination of biological, psychological, behavioural and social factors [1−3]. But there has been a relative lack of prospective research in evaluating potential psychosocial risk that is associated with patients suffering from headache concerning work productivity and social performance. Such research has been quite limited possibly because of the time and dedication involved in conducting long prospective studies. Thus, an assessment related to work and social implications in these patients can be clearly welcomed. The substantial impact of cephalalgia on individual headache sufferers and on society needs more attention. While the individual impact of migraine is determined by pain and role dysfunction, the societal impact is primarily determined by work loss and disability in the work place and at home. Aim: The present study aims at evaluating the predictive power of a comprehensive assessment of psychosocial variables in identifying acute cephalalgia patients who subsequently develop chronic headache disability, pertaining job as ell as social performance. Methods: All study patients (24; 18 female, 6 male) were symptomatic with headache syndrome initially for no more than 8 weeks. These acute patients were tracked every 2 months, culminating in a final clinical interview being conducted at month 8 follow-up condition after the initial evaluation to assess “returnto-work” and “return-to-social-living” status. Results: Statistical analyses was conducted in order to differentiate between patients who were back at work and social life
commitment at a 4, 6 or 8 month period or hadn’t returned to the previous functional status, thus, revealing the importance of three medical and psychosocial items: namely, the presence or not of self-reported headache, psychopathology, and social gains or benefits. Results revealed that psychopathology, mainly depression and drug abuse (higher intake of the prescribed dose), and genuine substance abuse, as social benefits and rental gains did not precede or cause the onset and progression of chronic headache disability. Discussion and Conclusions: The results seem to show a relevant “psychosocial disability factor” that is associated with those “headachers” who are likely to develop chronic headache disability. Based on these data, those acute patients who will require early intervention to prevent the development of chronic disability can be identified in the initial sessions. The previous psychopathology does not appear to predispose patients to the disability status, although high rates of psychopathology have been shown in chronic ones. Future research should be directed at emotional vulnerability and psychosocial beneficial events after “complaining”, that may lead to chronicity. References [1] Turk, D.C., Okifuji, A., 2002. Psychological factors in chronic pain: evolution and revolution. J Consult Clin Psychol. 70: 678–690. [2] Von Korff, M., Ormel, F., Keefe, F.J., Dworkin, S.F., 1992. Grading the severity of chronic pain. Pain. 50: 133–149. [3] Yap, A.U., Chua, E.K., Tan, K.B., Chan, Y.H., 2004. Relationships between depression/somatization and self-reports of pain and disability. J Orofac Pain. 18: 220–225.
P.5.f.008 Delirium severity and length of hospital stay in elderly patients S. Martins1 ° , J.A. Paiva2,3 , M.R. Sim˜oes4 , L. Fernandes1,5,6 Center for Health Technology and Services Research, Porto, Portugal; 2 CHSJ, Intensive Medicine and Emergency Autonomous Management Unit, Porto, Portugal; 3 Faculty of Medicine - University of Porto, Medicine Department, Porto, Portugal; 4 Faculty of Psychology and Educational Sciences University of Coimbra, Psychological Assessment Laboratory. CINEICC, Coimbra, Portugal; 5 Faculty of Medicine - University of Porto, Clinical Neurosciences and Mental Health Department, Porto, Portugal; 6 CHSJ, Clinic of Psychiatry and Mental Health, Porto, Portugal 1 CINTESIS,
Introduction: Delirium is a frequent and complex syndrome among elderly people, affecting as much as 50% of the elderly in hospital. It has been consistently identified as a strong independent predictor of adverse outcomes, including prolonged hospital stay, cognitive and functional decline, institutionalization, mortality and high health care costs [1]. Previous studies have shown that these outcomes are influenced by delirium severity, since these negative results are worse in elderly patients with severe delirium compared with patients with mild delirium [2]. Aim: To analyze the relationship between severity of delirium and the length of hospital stay in elderly patients. Methods: This study was carried out with an elderly hospitalized sample, recruited from an intermediate care unit (IMCU) in the Intensive Care Medicine Service in S˜ao Jo˜ao Hospital Centre (CHSJ), in Porto, Portugal. The inclusion criteria were: aged 65 years and admission for at least 48 hours in the IMCU. Patients who were blind or deaf, unable to communicate or had a total score 11 on the Glasgow Coma Scale were excluded.
P.5.f. Dementia and neurological disorders − Other (clinical)
involve multiple organs and general dysfunction of the immune system, which could affect the brain and induce psychiatric symptoms [5]. References [1] Bonavita, S., Tedeschi, G., Gallo, A. 2013. Morphostructural MRI abnormalities related to neuropsychiatric disorders associated to multiple sclerosis. Mult Scler Int., 102454. [2] Pozuelo Moyano, B., Benito Le´on, J. 2015. Trastornos afectivos y psic´oticos en la esclerosis m´ultiple. Rev Neurol. 61, 503–508. [3] Marrie, R.A., Reingold, S., Cohen, J., Stuve, O., Trojano, M., Sorensen, P.S., Cutter, G., Reider, N. 2015. The incidence and prevalence of psychiatric disorders in multiple sclerosis: a sistematic review. Mult Scler. 21 (3), 305−17. [4] Guernion, N., Le Cadet, E., Tirel, A., Le Galudec, M., Edan, G., Walter, M. 2013. Neuropsychiatric manifestations in multiple sclerosis (MS): Might psychotic symptoms signal the onset of the disease? Presse Med. 42 (9 Pt 1): 1186−95. [5] Benros, M.E., Eaton, W.W., Mortensen, P.B. 2014. The epidemiologic evidence linking autoimmune diseases and psychosis. Biol Psychiatry Feb. 15;75 (4), 300−6.
P.5.f.005 Psychosocial variables in the development of chronic headache disability M. Henry1 ° , A.A. Henry-Gonzalez2 , A.A. Perez-Morell3 , L. Huerga-Garcia3 1 School of Medicine, Department of Internal Medicine- Dermatology and Psychiatry, Santa Cruz de Tenerife, Spain; 2 Gerencia de Atenci´on Primaria, Health Care Department, Santa Cruz de Tenerife, Spain; 3 University of La Laguna Medical School, Health Sciences Department, La Laguna, Spain Introduction: Headache is considered a common chronic disease that occurs with varying frequency and it can result in different levels of disability. Some recent studies have shown that psychosocial and behavioural factors are important predictors of treatment outcome. A biopsychosocial approach is recommended to be used for the assessment and management in this medical condition, in particular, in patients with major psychosocial involvement which determines a clear combination of biological, psychological, behavioural and social factors [1−3]. But there has been a relative lack of prospective research in evaluating potential psychosocial risk that is associated with patients suffering from headache concerning work productivity and social performance. Such research has been quite limited possibly because of the time and dedication involved in conducting long prospective studies. Thus, an assessment related to work and social implications in these patients can be clearly welcomed. The substantial impact of cephalalgia on individual headache sufferers and on society needs more attention. While the individual impact of migraine is determined by pain and role dysfunction, the societal impact is primarily determined by work loss and disability in the work place and at home. Aim: The present study aims at evaluating the predictive power of a comprehensive assessment of psychosocial variables in identifying acute cephalalgia patients who subsequently develop chronic headache disability, pertaining job as ell as social performance. Methods: All study patients (24; 18 female, 6 male) were symptomatic with headache syndrome initially for no more than 8 weeks. These acute patients were tracked every 2 months, culminating in a final clinical interview being conducted at month 8 follow-up condition after the initial evaluation to assess “returnto-work” and “return-to-social-living” status. Results: Statistical analyses was conducted in order to differentiate between patients who were back at work and social life
commitment at a 4, 6 or 8 month period or hadn’t returned to the previous functional status, thus, revealing the importance of three medical and psychosocial items: namely, the presence or not of self-reported headache, psychopathology, and social gains or benefits. Results revealed that psychopathology, mainly depression and drug abuse (higher intake of the prescribed dose), and genuine substance abuse, as social benefits and rental gains did not precede or cause the onset and progression of chronic headache disability. Discussion and Conclusions: The results seem to show a relevant “psychosocial disability factor” that is associated with those “headachers” who are likely to develop chronic headache disability. Based on these data, those acute patients who will require early intervention to prevent the development of chronic disability can be identified in the initial sessions. The previous psychopathology does not appear to predispose patients to the disability status, although high rates of psychopathology have been shown in chronic ones. Future research should be directed at emotional vulnerability and psychosocial beneficial events after “complaining”, that may lead to chronicity. References [1] Turk, D.C., Okifuji, A., 2002. Psychological factors in chronic pain: evolution and revolution. J Consult Clin Psychol. 70: 678–690. [2] Von Korff, M., Ormel, F., Keefe, F.J., Dworkin, S.F., 1992. Grading the severity of chronic pain. Pain. 50: 133–149. [3] Yap, A.U., Chua, E.K., Tan, K.B., Chan, Y.H., 2004. Relationships between depression/somatization and self-reports of pain and disability. J Orofac Pain. 18: 220–225.
P.5.f.008 Delirium severity and length of hospital stay in elderly patients S. Martins1 ° , J.A. Paiva2,3 , M.R. Sim˜oes4 , L. Fernandes1,5,6 Center for Health Technology and Services Research, Porto, Portugal; 2 CHSJ, Intensive Medicine and Emergency Autonomous Management Unit, Porto, Portugal; 3 Faculty of Medicine - University of Porto, Medicine Department, Porto, Portugal; 4 Faculty of Psychology and Educational Sciences University of Coimbra, Psychological Assessment Laboratory. CINEICC, Coimbra, Portugal; 5 Faculty of Medicine - University of Porto, Clinical Neurosciences and Mental Health Department, Porto, Portugal; 6 CHSJ, Clinic of Psychiatry and Mental Health, Porto, Portugal 1 CINTESIS,
Introduction: Delirium is a frequent and complex syndrome among elderly people, affecting as much as 50% of the elderly in hospital. It has been consistently identified as a strong independent predictor of adverse outcomes, including prolonged hospital stay, cognitive and functional decline, institutionalization, mortality and high health care costs [1]. Previous studies have shown that these outcomes are influenced by delirium severity, since these negative results are worse in elderly patients with severe delirium compared with patients with mild delirium [2]. Aim: To analyze the relationship between severity of delirium and the length of hospital stay in elderly patients. Methods: This study was carried out with an elderly hospitalized sample, recruited from an intermediate care unit (IMCU) in the Intensive Care Medicine Service in S˜ao Jo˜ao Hospital Centre (CHSJ), in Porto, Portugal. The inclusion criteria were: aged 65 years and admission for at least 48 hours in the IMCU. Patients who were blind or deaf, unable to communicate or had a total score 11 on the Glasgow Coma Scale were excluded.