Psychological comorbidity in elderly patients with cancer

Human life expectancy has increased, nationally and internationally, during recent years and will continue to increase in the future. Old age is commonly associated with health-related impairments, chronic diseases, increasing multimorbidity, as well as with psychosocial burdens, such as social deprivation, reduced social participation, and impairment in activities of daily living. Against this background, studies on mental health addressing psychological?distress and mental disorders of older people have gained increasing attention. The aim of the present overview is to provide insight into psychological comorbidity in elderly with chronic illnesses. The following questions are addressed: (1) what are the prevalence rates of mental disorders in the elderly in general and, specifically, in patients with cancer? (2) How are mental disorders and cancer, respectively, diagnosed in elderly?patients? (3) What are common risk factors associated with the development of mental disorders? (4) Which treatment options are available, and which aspects of health care for elderly patients with chronic diseases need to be considered?     

Psychological comorbidity in patients with musculoskeletal diseases

The present review summarizes the evidence on epidemiology, etiology, and treatment of comorbid mental disorders in patients with musculoskeletal diseases. Epidemiological studies highlight a significantly increased risk of comorbid mental disorders in patients with musculoskeletal diseases compared to patients without musculoskeletal diseases and physically healthy persons. With regard to the question of the causal link between these comorbidities, specific musculoskeletal disease?Cmental disorder combinations show specific pathogenetic pathways. Using the example of arthritis?Cdepression comorbidity, a causality model is presented. This model describes depression as following arthritis and, in turn, aggravating the course of arthritis. Treatment studies emphasize the effectiveness of both psychotherapeutic and psychopharmacological interventions for the treatment of patients with musculoskeletal diseases and comorbid mental disorders. In particular, collaborative care interventions are promising approaches to improve the routine care of comorbid patients.     

Psychological interventions in patients with chronic physical diseases and psychological comorbidity

The term chronic physical disease summarizes various diseases characterized by a multifactorial genesis, long-term and often progressive course, as well as frequent restricting physical and psychosocial sequelae. Over the last 2?decades, research in medical psychology has demonstrated high prevalence rates of psychological comorbidity among patients with chronic medical conditions, indicating an urgent need for psychosocial treatment. The goal of psychosocial interventions is to reduce adverse disease consequences and improve quality of life. The intervention programs can be differentiated according to target populations, healthcare models, indications, treatment models, and treatment settings. They range from rather general approaches based on broad psychosocial support, health promotion, and patient education programs to problem-specific interventions. Concerning theoretical approaches, cognitive?Cbehavioral interventions currently dominate; however, psychodynamic oriented and mixed approaches are being increasingly implemented. Reviews and meta-analyses of evaluation studies demonstrate the efficacy of these programs. However, there is still a discrepancy between psychotherapeutic options for patients with chronic physical diseases and their practical implementation.     

Psychological comorbidity in children and adolescents with chronic somatic diseases

This article analyzes emotional and behavioral problems in children and adolescents with chronic somatic disorders. Within the German Health Interview and Examination Survey for Children and Adolescents (Kinder- und Jugendgesundheitssurvey, KIGGS), chronic somatic conditions and obesity were assessed in 11,529 children and adolescents aged 7?C17?years old. Special health care needs (CSHCN), emotional and behavioral problems (SDQ), as well as personal, familial, and social resources were surveyed. About 10.8% of the respondents displayed special health care needs and declared a chronic somatic disorder. Of these cases, 20.6% were classified as abnormal in the SDQ (non-somatic conditions: 6.4%). In a logistic regression analysis, male gender (OR=2.0), low socioeconomic status (Winkler index; OR=2.6), family structure (OR>1), and deficits in familial (OR=2.4) and personal (OR=2.1) resources were found to be significantly associated with psychological comorbidity in chronic somatic conditions. The results confirmed previous findings. Especially socioeconomic, structural, and functional aspects of a family have to be considered in the development and prevention of psychological comorbidity in chronic somatic conditions in childhood and adolescence.     

Psychological comorbidity. A challenge in acute care

Comorbid mental disorders are common in patients with chronic conditions. It can be assumed that around 30% of all inpatients have some kind of mental disorder. Most frequent are depressive disorders, anxiety disorders, somatoform disorders, and addictive disorders. Mental disorders are not only a subjective burden for the patient, but may also lead to an unfavourable course of the disease, longer hospital stay, and increased treatment costs. However, despite its importance comorbid mental disorders are often not recognized or appropriately treated. Wherever possible, patients with psychological issues should be presented to a psychosomatic or psychiatric consultation-liaison service for further diagnosis and treatment. To treat patients with comorbid mental disorders, physicians must be well experienced in psychotherapeutic treatment and a collaborative interdisciplinary working environment must have been established.     

宫颈癌患者心理困扰现状及其影响因素

目的 探讨宫颈癌患者心理困扰程度及其影响因素,为宫颈癌患者进行个体化的心理护理提供理论依据. 方法 采用非实验研究设计的描述性研究,选取2013年1月1日-2015年1月31日本院妇科收治的宫颈癌患者,应用心理困扰影响因素问卷和心理困扰管理量表(DM)对宫颈癌患者进行调查研究. 结果 共发放问卷200份,有效回收问卷200份,有效率100％.宫颈癌患者均有不同程度的心理困扰,心理困扰程度平均得分为(4.7±2.2)分,中重度心理困扰占81.0％.宫颈癌患者的年龄、文化程度、职业、子女情况、既往史、治疗方式和化疗次数对宫颈癌患者的心理困扰程度有影响. 结论 宫颈癌患者心理困扰发生率较高,应根据患者心理困扰的影响因素及原因进行个体化的心理干预,降低患者心理困扰程度.     

Poverty, comorbidity, and survival of colorectal cancer patients diagnosed in Connecticut

Studies have reported reduced survival rates for colorectal cancer patients in lower socioeconomic status categories, but this finding could be due (at least in part) to higher comorbidity. This study involved 1,219 patients diagnosed with invasive colorectal cancer in 1992 who were reported to the population-based Connecticut Tumor Registry and followed to their death or through the end of 1997. Risk of death was elevated for patients living in census tracts in the highest quintile for poverty rate, independent of comorbidity (as recorded in a hospital discharge database), age, and stage at diagnosis. Patients living in census tracts with a poverty rate of 20 percent or higher had the highest risk of death. The explanation for these findings requires further study, in order to reduce socioeconomic status disparities in survival rates.     

Psychological impact of thyroid surgery on patients with well-differentiated papillary thyroid cancer

Purpose  

Most patients with well-differentiated thyroid cancer (WDTC) have favorable prognosis and survive for many years. We investigated the effect of thyroid cancer surgery on subsequent psychological aspects.     

Possibilities and limitations of psychopharmacological treatments in patients with psychological comorbidity

Comorbid depressive and anxiety disorders are associated with chronic physical illnesses. Treatment with antidepressants and mood stabilizers require knowledge about toxicity, potential side effects, and drug interactions. According to controlled studies in comorbid cardiovascular diseases, diabetes mellitus, and cerebrovascular disorders (post-stroke depression), serotonin-selective reuptake inhibitors (SSRIs), e.g., sertraline and citalopram, are preferred. Pramipexole, reboxetine, mirtazapine, or nortriptyline showed efficacy in treatment of Parkinson depression. Chronic pain syndromes can be improved with low-dose tricyclic antidepressants. Both establishment of compliance and follow-up examinations are essential. Combined treatment with psychotherapeutic interventions, including coping strategies, should be used whenever possible.     

应对方式在肿瘤护理上的指导

了解国内外应对方式的研究情况,包括不同学者对应对的定义,应对的分类,评估应对方式的常用工具,肿瘤患者应对方式及与身心症状的相关研究,讨论护理层面对患者应对方式的心理指导.     

乳腺癌患者的心理状况及心理康复

为了探究乳腺癌患者的心理状况及心理干预的临床效果,提供更多乳腺癌心理干预的临床依据,该文从乳腺癌患者的心理问题、影响乳腺癌患者心理状况的相关因素以及乳腺癌患者的心理干预方式等方面,结合国内外相关文献作一综述.     

The correlation of age and comorbidity with therapy and survival in cancer patients in North-Brabant and North-Limburg, 1995-2001

The proportion of elderly cancer patients has increased considerably. This means that more patients are being diagnosed with one or more serious concomitant condition which may complicate the treatment of cancer. Little is known about treatment outcomes, as elderly patients with comorbidity are often excluded from clinical trials. The Eindhoven Cancer Registry has been registering serious co-morbidity in North-Brabant and North-Limburg in the Netherlands since 1993. Using data from patients diagnosed with cancer in 1995-2001, the correlation between age and comorbidity and choice of therapy and survival rates was described. Very elderly patients or patients with co-morbidity often were not treated in accordance with the guidelines. Elderly patients with localized lung cancer or prostate cancer underwent less surgery as often and elderly patients with colorectal cancer, breast cancer or ovarian cancer received less adjuvant chemotherapy or radiotherapy than younger patients. The prognosis was often worse for elderly patients than for younger patients, and the presence of co-morbidity decreased survival in most types of tumour. The question remains whether the prognosis for elderly patients with cancer would improve if more of them were treated in accordance with the guidelines, or if this will only lead to more complications.     

心理护理干预对宫颈癌患者术后生活质量的影响

目的:研究并探讨心理护理干预对宫颈癌患者术后生活质量的影响.方法:随机选取80例宫颈癌患者,分为对照组和实验组,每组各40例,对照组患者入院接受治疗后实施常规护理措施,实验组患者在常规护理基础上,开展心理护理干预.比较两组宫颈癌患者术后的生活质量.结果:实验组患者术后经心理护理干预,生活质量评分明显高于对照组,且差异具有统计学意义(P<0.05).结论:心理护理干预能够明显提高并改善宫颈癌患者术后的生活质量.     

尘肺病合并肺部感染病原菌及耐药性分析

目的 研究尘肺病合并肺部感染患者病原菌分布及耐药性,为临床医师早期经验性抗感染治疗提供依据.方法 对医院2010-2011年尘肺病合并肺部感染患者痰标本检出的269株病原菌进行回顾性分析,药敏判断采用CLSI标准.结果 269株病原菌中革兰阴性杆菌177株占65.8％、革兰阳性球菌70株占26.0％、真菌22株占8.2％;革兰阴性杆菌主要为铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌等,革兰阳性球菌主要为金黄色葡萄球菌、肺炎链球菌等;耐甲氧西林金黄色葡萄球菌(MRSA)检出率达63.0％;主要革兰阴性杆菌对碳青霉烯类耐药率为4.3％～18.2％,阿米卡星、哌拉西林/他唑巴坦、左氧氟沙星、头孢吡肟耐药率为25.8％～51.6％,其他耐药率均较高为50.0％～100.0％;其中肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌和鲍氏不动杆菌对亚胺培南耐药率分别为9.7％、8.7％、17.1％和18.2％,对美罗培南耐药率分别为6.5％、4.3％、14.3％和18.2％;肺炎克雷伯菌、大肠埃希菌产ESBLS菌株检出率分别为54.8％和65.2％;革兰阳性球菌未发现万古霉素、替考拉宁耐药菌株,其他抗菌药物除氯霉素、左氧氟沙星外耐药率均较高为57.7％～96.3％.结论 尘肺病合并肺部感染病原菌以革兰阴性杆菌为主,常用抗菌药物耐药现象严重,应加强患者个人防护并合理使用抗菌药物,提高患者生存质量.