Psychological factors in fatal childhood asthma

A review of three recent cases of death due to childhood asthma revealed consistent themes of depression, emotional precipitation of attacks, unsupportive families, and a tendency to deny asthma symptoms. Possible psychosomatic mechanisms are identified as potentially important for the interaction of emotions and asthma.     

Psychological and self-management factors in near-fatal asthma

Background

Several studies that have analyzed differences in psychological and self-management variables between patients with a near-fatal asthma (NFA) attack and asthmatics without a NFA attack (non-NFA) have shown conflicting results, probably due to the heterogeneity of the events studied and the selection of comparison groups.

Objective

To determine whether NFA patients, in stable situation, have greater psychological morbidity and worse self-management behavior than non-NFA patients with similar sociodemographic and clinical characteristics.

Methods

A sample of 44 NFA patients (mean=5.65 years after the NFA episode) and 44 non-NFA patients matched for age, sex, and asthma severity was assessed. All patients were in clinical stable situation. Information about sociodemographic, clinical, functional, and morbidity variables was collected for each patient, and the Cognitive Depression Inventory, the Trait-Anxiety Scale, the Toronto Alexithymia Scale, the Practical Knowledge of Self-management questionnaire, and the Medication Adherence scale were administered.

Results

In comparison with non-NFA patients, NFA patients showed higher levels of trait-anxiety (23.84 vs. 16.86; P=.001) and more difficulties describing and communicating feelings (11.36 vs. 8.90; P=.002). NFA and non-NFA patients did not differ in self-management variables. After adjustment in multivariate logistic regression analysis for age, sex, and asthma severity, significant differences were observed between NFA and control group patients in marital status [odds ratio (OR)=0.26; P=.017; 95% confidence interval (CI)=0.09-0.78], prescribed dose of inhaled corticoids (OR=4.48; P=.006;95% CI=1.53-13.09), and trait-anxiety (OR=1.071;P=.025;95%CI=1.01-1.14).

Conclusions

NFA patients show higher psychological morbidity than non-NFA, even years after the NFA episode.     

Psychological adjustment of children with mild and moderately severe asthma

The relationship between the severity and duration of asthma and psychological adjustment was investigated in 29 children with mild and 31 children with moderately severe asthma, who were compared with 60 healthy control children. The severity of asthma was evaluated using the Pearlman-Bierman classification. Psychological adjustment was measured using the Achenbach Child Behavior Checklist (CBCL) and a semi-structured interview. The results of the interviews indicated that regressive symptoms such as clinging, childish behaviour, dependence, and a demanding nature were widespread. Using the illness in the service of achieving other aims was also common in the asthmatic children. CBCL total problem behaviour scores, social competency, and broad band scores were significantly higher in the asthmatic group than the control sample. Problem scores for asthmatic children were significantly correlated with parental friction at home, unsatisfactory relationships with siblings and other health problems in children. However, neither the CBCL total problem scores nor the social competency scores were correlated with the severity and the duration of illness.

---

Zusammenfassung Die Beziehung zwischen Schweregrad und Dauer des Asthmas und der psychologischen Anpassung wurde bei 29 Kindern mit leichtem und 31 Kindern mit mittelgradigem Asthma untersucht, die mit 60 gesunden Kontrollkindern verglichen wurden. Der Schweregrad des Asthmas wurde mit der Pearlman-Bierman-Klassifikation evaluiert. Die psychologische Anpassung wurde mit der Achenbach-Child-Behavior-Checklist und einem semistrukturierten Interview gemessen. Die Ergebnisse der Interviews deuten darauf hin, daß regressive Symptome, wie z.B. anhängliches, kleinkindliches, abhängiges und forderndes Verhalten weitverbreitet waren. Die Instrumentalisierung der Erkrankung zur Erreichung anderer Ziele war bei den Kindern mit Asthma ebenfalls häufig zu beobachten. Der Gesamt-Problemscore in der CBCL, die soziale Kompetenz und Breitbandwerte waren signifikant höher in der Gruppe mit Asthma als in der Kontrollgruppe. Die Problemscores bei asthmatischen Kindern korrelierten signifikant mit elterlichen Auseinandersetzungen zu Hause, unbefriedigenden Beziehungen zu Geschwistern und anderen gesundheitlichen Störungen bei Kindern. Jedoch korrelierten weder der CBCL-Gesamt-Problemscore noch die sozialen Kompetenz-Scores mit dem Schweregrad und der Dauer der Erkrankung.

---

Résumé La relation entre la sévérité et la durée de l'asthme et l'aménagement psychologique fut recherché chez 29 enfants avec un asthme modéré et 30 enfants avec un asthme modérément sévère qui ont été comparés avec un groupe contrôle de 60 enfants sains. La sévérité de l'asthme fut évaluée en utilisant la classification der Pearlman-Bierman. L'aménagement psychologique fut mesuré en utilisant l'Achenbach Child Behavior Checklist (CBCL) et un entretien semi-structuré. Les résultats de l'entretien indiquaient que les symptômes régressifs tels que l'agrippement, le comportement infantile, la dépendance et une nature exigeante étaient répandus. L'utilisation de la maladie au service de l'obtention d'autres buts était aussi habituelle chez les enfants asthmatiques. Le score totale CBCL de problèmes comportementaux, et la compétence sociale étaient significativement plus élevés dans le groupes d'asthmatiques que dans le groupe contrôle. Les scores des problèmes pour les enfants asthmatiques étaient corrélés significativement avec les conflits parentaux à la maison, les relations insatisfaisantes avec les pairs et les autres problèmes de santé chez les enfants. Cependant, ni le score total de problèmes CBCL, ni les scores de compétence sociale n'étaient corrélés avec la sévérité et la durée de la maladie.

     

Psychological factors contributing to disproportionate disability in chronic bronchitis

Disability in fifty chronic bronchitis patients was measured by the twelve-minute walking test. The degree of disability was examined in relation to lung function and a measure of disproportion of disability was derived. This measure was significantly related to a number of attitude measures, in particular the patients' beliefs about treatment and treatment outcome, but was not strongly related to psychiatric disturbance on the GHQ. However, high levels of psychiatric disturbance were found within the overall sample.     

Psychological factors associated with severe abuse of the hemodialysis diet

Thirty-one maintenance hemodialysis patients were observed for a six-month period. Seven of these patients (22.6%) were severe and persistent abusers of the hemodialysis diet. Because there are serious, even lethal, consequences of the sequelae of hemodialysis diet abuse such as fluid overload and/or hyperkalemia, this finding demands explanation. All seven severe abusers were men and, as a group, their current life situation was devoid of typical adult male gratifications. Their developmental histories indicated major difficulties with resolution of dependency/independency conflicts. Statistical analysis of demographic data and extensive psychiatric interviews support this. The author postulates that severe abuse of the hemodialysis diet results in part from the combination of unresolved dependency conflict, unfavorable current environmental circumstances, and a dependency-provoking treatment regimen. Severe abuse of the hemodialysis diet may serve an adaptive function by allowing at least some gratification in one area of the lives of these patients who suffer severe deprivation.     

Psychological factors predict symptoms of severe recurrent genital herpes infection

In a group of patients with severe recurrent genital herpes infection, we measured symptoms (pain and itching), psychological factors (depression, anxiety, somatisation, interpersonal sensitivity, and life change) and objective indices of disease (number of recurrences in the previous year, total number of recurrences, duration of recurrences, number of lesions per recurrence). Psychological factors were more predictive of pain and itching than were somatic indices, even after correcting for sex.     

Parental criticism and treatment outcome in adolescents hospitalized for severe, chronic asthma

This pilot study investigated the relationship between parental criticism and medical treatment outcome across an inpatient hospitalization in 19 adolescents with severe, chronic asthma. Parental criticism toward their asthmatic adolescent was assessed using the Five Minute Speech Sample technique (FMSS) at the beginning of the adolescent's inpatient stay at a national asthma referral center. Those adolescents whose parents were rated as high in criticism on the FMSS were found to have greater improvement in their overall asthma severity, greater reduction in their steroid medication dose, and shorter lengths of stay in the hospital than those whose parents were rated as low in criticism. The adolescents whose parents were rated as high in criticism also showed lower compliance with their prescribed theophylline and oral steroid medication at admission than the low criticism group. These findings do not appear to be due to misdiagnosis secondary to the presence of vocal cord dysfunction or to the allergy status of the children. Clinical implications and possible causal mechanisms underlying these findings are discussed.     

Psychological factors associated with acute and chronic central serous chorioretinopathy

Background: Central serous chorioretinopathy (CSC) has been associated with several psychological factors. But previous psychological data are limited and mainly restricted to male patients and small sample size. In this study we investigated psychosomatic complaints, personality factors, life events, and stress coping in acute and chronic recurrent CSC patients. Methods: Ninety-five patients (71 men, 24 women) with either acute or chronic CSC were evaluated regarding critical life events before diagnosis, psychosomatic complaints, personality traits and coping style. The characteristics of CSC patients were compared with a control group comprising 75 patients (46 men, 29 women) suffering from acute or chronic ophthalmic disorders other than CSC. Results: Compared with patients of the control group, CSC patients reported more psychosomatic problems, unfavourable stress coping strategies and critical life events as well as elevated tension, aggression, strain, emotional instability and achievement orientation. Except for aggression the observed characteristics were more pronounced in acute than in chronic CSC patients. Conclusions: The appearance of CSC may be associated with an accumulation of stressful life events with an unfavourable coping style and distinctive personality factors. Acute CSC is related to more unfavourable stress coping and more physical complaints compared to its chronic course. Elevated aggression may imply one potential risk factor for CSC manifestation and also may have an adverse effect with its chronification.     

Psychological findings in chronic anal pain

The psychological characteristics of 21 patients suffering from chronic anal pain were studied. They underwent a clinical interview and completed the Eysenck personality questionnaire, the Zung self-rating depression scale and an analogue scale for the assessment of perceived pain. Data derived from the self-rating scales were compared with those obtained from a matched control group afflicted with fissure-in-ano. The pain patients reported higher scores for neuroticism, psychoticism, depression and perceived pain than the controls. Fifty percent of the experimental group had suffered prior to the onset of pain from depressive disturbances, and 11 subjects reported at the clinical interview somatic symptoms which usually accompany depression. These results support the hypothesis that the pain symptom in some patients with chronic anal pain could represent the manifestation of an underlying depressive disturbance.     

Similar psychological characteristics in mild and severe asthma

OBJECTIVE: Psychological factors have been implicated as potentially contributing to asthma severity. In the present study, we investigated whether patients with mild and severe asthma differ with regard to several psychological characteristics. METHODS: Ninety outpatients with severe asthma (74% female, mean [S.D.] age: 46.5 [13.7] years) and 37 outpatients with mild asthma (73% female, age: 39.4 [13.9] years) were compared with respect to general psychological health, anxiety sensitivity, hyperventilation symptoms, personality, and locus-of-control orientation, all measured by well-validated self-report questionnaires. Analysis of (co)variance (ANCOVA) was used to assess between-groups differences. RESULTS: No significant differences in psychological characteristics were found between patients with mild and severe asthma. Only on the subscale for external locus-of-control orientation, severe asthmatic patients differed from those with mild disease (P=.005) in showing less trust in physicians and medication with regard to influencing their asthma. CONCLUSION: The results suggest that mild and severe asthmatic patients cannot be differentiated on the basis of psychopathology or personality. Whether or not the observed lack of confidence in the influence of physicians or medication on asthma course is cause or consequence of disease severity, remains to be established.     

Personality factors and disorders in chronic pain.

It has long been recognized that there is a relationship between certain personality types and personality disorders (PD) and chronic nonmalignant pain (CP). The relationship, however, is far from understood and the physiological and psychological mechanisms that underlie it are unclear. Those who treat chronic pain face many challenges when dealing with individuals who have personality disorders and they often become frustrated when interacting with these patients. Patients with certain traits and personality disorders may continue to worry and ruminate about their symptoms long after the tissue pathology has resolved. Other individuals may overly rely on the clinician and assume a passive role in their treatment, thereby decreasing the likelihood for a positive outcome. Moreover, patients with personality disorders may be demanding (eg, borderline), self-absorbed (eg, narcissistic), or substance seeking (eg, antisocial, borderline). In an attempt to improve management of such patients, pain specialists have attempted to better understand the complex relationship between personality and chronic pain. In this article, we will review the predominant historical and current theories of pain and personality, discuss aspects of the gate-control theory of pain that may relate to personality, and discuss the diathesis-stress model of personality disorders in pain. Last, we will review studies of personality and personality disorders in chronic pain and their treatment implications. We conclude that, based on the underlying neurochemistry, there may be a direct or indirect link between PD and CP, but further prospective research, both on the biological and psychological relationship, should be conducted.