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Urticaria and angioedema with psychogenic triggers
506
Abstracts / Journal of Psychosomatic Research 76 (2014) 495–520
present emotional states or reawakening feelings or even complex emotions;-somatic level: the usual somatic correlates of emotions, induced by listening to music and being evaluated either subjectively (bodily sensations) or by the mean of laboratory (biomedical markers) 4. Verbalization capacity of subjects thoughts and feelings (one of the major purposes of the music therapy): the ease/difficulty of putting into words the contents of the musical message (cognitive, emotional)
doi:10.1016/j.jpsychores.2014.03.052
38 - Urticaria and angioedema with psychogenic triggers I.B. Iamandescu Carol Davila Medical Pharmacy University, Bucharest, Romania Purpose: It is not always easy to distinguish between the psychological trigger and other etiologies (food, drugs etc.) of urticaria (U) and/or angioedema (AE). U/AE of pure psychogenic etiology has been contested in the literature. Some clinical observations of U/AE during many years have evidentiated the appearance of new episodes provoked by other triggers than distress. Method: The author reviews published data and personal researches made between 1979 and 2010, focused on U/AE psychologically triggered and on personality traits of urticaria patients. Results: Studies infirm the existence of U/AE exclusively induced by psychological factors, but confirm that psychological etiology has a constant involvement in cholinergic U and an optional role in triggering some forms of spontaneous acute U/AE or physical U/AE, as well as in maintaining and aggravating chronic U. The psychological trigger could frequently act as a conditioned reflex agent also in allergic U/AE (own observations). About 32% of U/AE can be triggered by psychological factors, alternately or associated with common etiologic agents. U/AE with psychogenic trigger occur in patients with increased vulnerability to emotional distress (more frequently in females) and in cases of prolonged evolution of the disease. Conclusions: In such U/AE patients, especially with chronic U, it is advisable to search for psychological triggers and for certain psychiatric disorders, especially anxiety and depression. The approach by a team of specialists (including psychologists and psychiatrists) might have a positive effect on the evolution of the disease, as well as adding to antihistamines the antidepressants and anxiolytics. doi:10.1016/j.jpsychores.2014.03.053
39 - The internet informed patient and his communication with physician I.B. Iamandescu, M. Scarlatescu Toma, M. Mincu Medical Pharmacy University Carol Davila, Bucharest, Romania Purpose: Authors want to demonstrate the ambivalent role of the immixture of internet information in medical communication. In this respect it is necessary to take into account its involvements in each three levels (intellectual, affective and ethical) of physician patient relationship, affecting especially medical communication. Method: 80 patients (using internet for medical information) and 64 physicians have filled in special questionnaires (dedicated to each group) referring to the informed patients behavior regarding medical indications, and to the affective impact of this situation on physician and his thinking and attitude.
Results and Discussions: Analysis of responses of both patients and physicians permitted to underline some aspects regarding the distortions of the therapeutic relation, manifested in all 3 levels of this relation: – at intelectual level, it generates patients approval or disapproval of physician medical opinions regarding the diagnosis of exposed symptoms and of recommended medicines. The resistance to medical indications is often caused by internet immixture. – at affective level, the discordance between patients' and physicians' diagnosis could create mistrust – for patient, and frustration and irritability – for physician. – at ethical level, as result of the negative impacts of internet immixture, behavioral reactions will occur: patients could follow – partially or at all – therapeutical indications, according to his own opinions, and physicians could develop a strong aversion and hostility towards the patient. Finally, both will contribute to the break of their interrelationship and patients will begin their way of doctor shopping. Conclusions: Internet related health care information realize a real empowerment of every patient, giving them the chance to contribute to maintain a better state of health in comparison with uninformed patients. The most negative use of internet medical information which is present in patients who avoid contact with physician (sometimes from financial and lack of time reasons) are the self-diagnosis and selftreatment, both having as major result, the lack of psychological support (informational and affective) offered by the physician. doi:10.1016/j.jpsychores.2014.03.054
40 - The impact of a cognitive-behavioral intervention on the relapse rate of type 2 diabetes depressive patients M. Iordachea, I. Ciocab,c, O. Popa-Veleab,c a Individual Office of Psychotherapy “Melina Iordache”, Constanta, Romania, bUniversity of Medicine and Pharmacy Carol Davila, Bucharest, Romania, cFaculty of Medicine, Department of Medical Psychology, Romania Purpose: To test the impact of a Romanian version of an existing cognitive behavioral therapy (CBT) life skills classes (Living Life to The Full LLTTF) delivered to a population of patients with diabetes and to analyze the efficiency of this program in reducing the depressive and anxious state and improving the self management of diabetes. Method: Study design is a simple before/after design, with no control group. 10 patients attended a course during 4 weeks with a follow up in the tenth week. The classes used a cognitive-behavioral therapy (CBT) approach. Scores of the following psychometric instruments were recorded, before and after the intervention: Patient Health Questionnaire — PHQ9 (Spitzer et al.); Generalized Anxiety Disorder — GAD7 (Spitzer et al.); Self-Efficacy Questionnaire (Stanford Patient Education Research Center), Work and Social Adjustment Scale — WSAS (Mundt et al.); Health-related Quality of Life questionnaire — EQ5D (Brooks R.) Results: We found a considerable improvement in symptoms of depression and anxiety. All patients obtained a lower score on depression (7 patients from moderate to low and 3 from low to minimum) and anxiety scale (6 patients from moderate to low and 4 from low to minimum). Social adaptation and quality of life did not improve significantly after the program but the self management of diabetes was better. Conclusions: The LLTTF classes proved to be efficient in helping people to learn key life skills that improve symptoms of depression and anxiety. As a whole, they contributed to a better self-management of diabetes. doi:10.1016/j.jpsychores.2014.03.055
Abstracts / Journal of Psychosomatic Research 76 (2014) 495–520
present emotional states or reawakening feelings or even complex emotions;-somatic level: the usual somatic correlates of emotions, induced by listening to music and being evaluated either subjectively (bodily sensations) or by the mean of laboratory (biomedical markers) 4. Verbalization capacity of subjects thoughts and feelings (one of the major purposes of the music therapy): the ease/difficulty of putting into words the contents of the musical message (cognitive, emotional)
doi:10.1016/j.jpsychores.2014.03.052
38 - Urticaria and angioedema with psychogenic triggers I.B. Iamandescu Carol Davila Medical Pharmacy University, Bucharest, Romania Purpose: It is not always easy to distinguish between the psychological trigger and other etiologies (food, drugs etc.) of urticaria (U) and/or angioedema (AE). U/AE of pure psychogenic etiology has been contested in the literature. Some clinical observations of U/AE during many years have evidentiated the appearance of new episodes provoked by other triggers than distress. Method: The author reviews published data and personal researches made between 1979 and 2010, focused on U/AE psychologically triggered and on personality traits of urticaria patients. Results: Studies infirm the existence of U/AE exclusively induced by psychological factors, but confirm that psychological etiology has a constant involvement in cholinergic U and an optional role in triggering some forms of spontaneous acute U/AE or physical U/AE, as well as in maintaining and aggravating chronic U. The psychological trigger could frequently act as a conditioned reflex agent also in allergic U/AE (own observations). About 32% of U/AE can be triggered by psychological factors, alternately or associated with common etiologic agents. U/AE with psychogenic trigger occur in patients with increased vulnerability to emotional distress (more frequently in females) and in cases of prolonged evolution of the disease. Conclusions: In such U/AE patients, especially with chronic U, it is advisable to search for psychological triggers and for certain psychiatric disorders, especially anxiety and depression. The approach by a team of specialists (including psychologists and psychiatrists) might have a positive effect on the evolution of the disease, as well as adding to antihistamines the antidepressants and anxiolytics. doi:10.1016/j.jpsychores.2014.03.053
39 - The internet informed patient and his communication with physician I.B. Iamandescu, M. Scarlatescu Toma, M. Mincu Medical Pharmacy University Carol Davila, Bucharest, Romania Purpose: Authors want to demonstrate the ambivalent role of the immixture of internet information in medical communication. In this respect it is necessary to take into account its involvements in each three levels (intellectual, affective and ethical) of physician patient relationship, affecting especially medical communication. Method: 80 patients (using internet for medical information) and 64 physicians have filled in special questionnaires (dedicated to each group) referring to the informed patients behavior regarding medical indications, and to the affective impact of this situation on physician and his thinking and attitude.
Results and Discussions: Analysis of responses of both patients and physicians permitted to underline some aspects regarding the distortions of the therapeutic relation, manifested in all 3 levels of this relation: – at intelectual level, it generates patients approval or disapproval of physician medical opinions regarding the diagnosis of exposed symptoms and of recommended medicines. The resistance to medical indications is often caused by internet immixture. – at affective level, the discordance between patients' and physicians' diagnosis could create mistrust – for patient, and frustration and irritability – for physician. – at ethical level, as result of the negative impacts of internet immixture, behavioral reactions will occur: patients could follow – partially or at all – therapeutical indications, according to his own opinions, and physicians could develop a strong aversion and hostility towards the patient. Finally, both will contribute to the break of their interrelationship and patients will begin their way of doctor shopping. Conclusions: Internet related health care information realize a real empowerment of every patient, giving them the chance to contribute to maintain a better state of health in comparison with uninformed patients. The most negative use of internet medical information which is present in patients who avoid contact with physician (sometimes from financial and lack of time reasons) are the self-diagnosis and selftreatment, both having as major result, the lack of psychological support (informational and affective) offered by the physician. doi:10.1016/j.jpsychores.2014.03.054
40 - The impact of a cognitive-behavioral intervention on the relapse rate of type 2 diabetes depressive patients M. Iordachea, I. Ciocab,c, O. Popa-Veleab,c a Individual Office of Psychotherapy “Melina Iordache”, Constanta, Romania, bUniversity of Medicine and Pharmacy Carol Davila, Bucharest, Romania, cFaculty of Medicine, Department of Medical Psychology, Romania Purpose: To test the impact of a Romanian version of an existing cognitive behavioral therapy (CBT) life skills classes (Living Life to The Full LLTTF) delivered to a population of patients with diabetes and to analyze the efficiency of this program in reducing the depressive and anxious state and improving the self management of diabetes. Method: Study design is a simple before/after design, with no control group. 10 patients attended a course during 4 weeks with a follow up in the tenth week. The classes used a cognitive-behavioral therapy (CBT) approach. Scores of the following psychometric instruments were recorded, before and after the intervention: Patient Health Questionnaire — PHQ9 (Spitzer et al.); Generalized Anxiety Disorder — GAD7 (Spitzer et al.); Self-Efficacy Questionnaire (Stanford Patient Education Research Center), Work and Social Adjustment Scale — WSAS (Mundt et al.); Health-related Quality of Life questionnaire — EQ5D (Brooks R.) Results: We found a considerable improvement in symptoms of depression and anxiety. All patients obtained a lower score on depression (7 patients from moderate to low and 3 from low to minimum) and anxiety scale (6 patients from moderate to low and 4 from low to minimum). Social adaptation and quality of life did not improve significantly after the program but the self management of diabetes was better. Conclusions: The LLTTF classes proved to be efficient in helping people to learn key life skills that improve symptoms of depression and anxiety. As a whole, they contributed to a better self-management of diabetes. doi:10.1016/j.jpsychores.2014.03.055