Positive affect and negative affect correlate differently with distress and health-related quality of life in patients with cardiac conditions: Validation of the Danish Global Mood Scale

Objective

The Global Mood Scale (GMS), assessing negative affect (NA) and positive affect (PA), is sensitive to tapping treatment-related changes in patients with cardiac conditions. We examined the psychometric properties of the Danish GMS and the influence of NA and PA on distress and health-related quality of life (HRQL).

Method

A mixed group of patients with cardiac conditions (n=502) completed the GMS, the Hospital Anxiety and Depression Scale, the Type D Scale, and the 36-item Short-Form Health Survey.

Results

The two-factor model of the Danish GMS was confirmed, and the scale was shown to be valid, internally consistent (Cronbach's α NA/PA=.93/.85), and stable over 3 weeks (Pearson's r NA/PA=.82/.80). Unadjusted multiple linear regression analyses showed NA (β=0.67, P<.001), PA (β=−0.17, P=.001), and the interaction effect NA×PA (β=−0.17, P=.015) to be associated with anxiety and depressive symptoms (NA:β=0.99, P<.001; PA:β=−0.12, P=.004; NA×PA:β=−0.43, P<.001), as well as with physical HRQL (NA:β=−0.37, P<.001; PA:β=0.17, P=.001; NA×PA: β=−0.27, P<.001) and mental HRQL (NA:β=−0.72, P<.001; PA:β=0.27, P=.004; NA×PA:β=0.23, P<.001). When adjusting for demographic and clinical characteristics, only NA (β=0.26, P=.003) was associated with anxiety, whereas NA (β=0.75, P<.001) and NA×PA (β=−0.34, P=.002) were associated with depressive symptoms. For physical HRQL, PA (β=0.21, P=.03) and NA×PA (β=−0.36, P=.005) remained significant, whereas NA (β=−0.38, P<.001) and PA (β=0.21, P=.002) remained significant for mental HRQL.

Conclusion

The Danish GMS is a psychometrically sound measure of affect in patients with cardiac conditions. Future studies should examine changes in both PA and NA and their impact on health outcomes.     

The positive and negative affect schedule: psychometric properties of the korean version

Objective

The Positive and Negative Affect Schedule (PANAS) was developed as a measure of positive affect (PA) and negative affect (NA). The aim here is to examine the factor structure and concurrent validity of the Korean version of the Positive and Negative Affect Schedule (K-PANAS) in a clinical sample in Korea.

Methods

K-PANAS was administered to a clinical sample in Korea. Internal consistency, test-retest reliability, and confirmatory factor analysis (CFA) were undertaken to examine the factorial structure and reliability of the K-PANAS.

Results

The reliability of K-PANAS is satisfactory. CFA showed that several of the models commonly used in Western populations provided an insufficient fit. The modified model provided a more adequate fit to the data.

Conclusion

The authors demonstrate that the K-PANAS has adequate psychometric properties, and that findings obtained in the West using PANAS were partially replicated.     

类风湿关节炎伴有抑郁症状的中药治疗

目的使用中药治疗类风湿关节炎伴有的抑郁症状,观察抑郁症状的改善对类风湿关节炎患者的生命质量及疼痛、晨僵、肿胀等影响。方法将60例伴有抑郁症状的RA患者,随机分为治疗组和对照组。使用抑郁自评量表(SDS),健康评估(HAQ)及疼痛、晨僵、肿胀等临床指标进行前后疗效的评定。结果治疗3个月后,治疗组在SDS评分,HAQ等方面的改善优于对照组。结论抑郁症状的改善能更好的改善RA患者的生活质量及临床症状。提示应注意RA患者的心理因素对病情的影响并给予适当的治疗。     

血管内皮生长因子在类风湿关节炎周围神经病变患者中的应用价值

目的探讨血管内皮生长因子在类风湿性关节炎(类风湿关节炎)合并周围神经病变患者诊断与治疗中的应用价值。方法选取2013—2015年类风湿关节炎合并周围神经病变患者40例及仅类风湿关节炎患者40例,同时选择40例健康体检者,对受检者血清VEGF水平进行检验。结果类风湿关节炎组患者血清VEGF明显高于健康人群(P0.05),类风湿关节炎合并周围神经病变患者VEGF水平明显高于类风湿关节炎患者(P0.05),类风湿关节炎患者中重度与轻中度神经损伤患者血清VEGF水平无显著差异(P0.05),类风湿关节炎患者神经损伤范围与血清VEGF无明显关系(P0.05)。结论类风湿关节炎合并周围神经病变患者血清相比健康人群与单纯类风湿关节炎患者明显升高,VEGF水平能够提示类风湿关节炎患者是否存在周围神经病变,但无法有效标识神经受损区域及程度。     

Positive affect, psychological well-being, and good sleep

OBJECTIVE: To discover whether positive affect and purpose in life (eudaimonic well-being) are associated with good sleep independently of health problems and socioeconomic status, and to evaluate their role in mediating the influence of psychosocial risk factors on poor sleep. METHODS: A cross-sectional study was carried out with 736 men and women aged 58-72 years, with positive affect assessed by aggregating ecological momentary samples. Sleep problems were assessed with the Jenkins Sleep Problems Scale, and psychosocial risk factors were measured by standardized questionnaires. RESULTS: Both positive affect and eudaimonic well-being were inversely associated with sleep problems after adjustment for age, gender, household income, and self-rated health (P<.001). Negative psychosocial factors including financial strain, social isolation, low emotional support, negative social interactions, and psychological distress were also related to reported sleep problems. The strength of these associations was reduced by 20-73% when positive affect and eudaimonic well-being were taken into account, suggesting that effects were partly mediated by positive psychological states. CONCLUSIONS: These results suggest that both positive affect and eudaimonic well-being are directly associated with good sleep and may buffer the impact of psychosocial risk factors. The relationships are likely to be bidirectional, with disturbed sleep engendering lower positive affect and reduced psychological well-being, and positive psychological states promoting better sleep.     

Distinct psychological distress trajectories in rheumatoid arthritis: findings from an inception cohort

Objective

As with other chronic physical illness, rates of depressive disorder are high in rheumatoid arthritis (RA). The aim of the current study was to identify distinct trajectories of psychological distress over 10 years in a cohort of RA patients recruited very early in the course of the disease.

Methods

Psychological distress as measured by the Hospital Anxiety and Depression Scale total score was assessed annually in a subgroup of 784 patients enrolled in a multi-centre RA inception cohort (Early RA Study). A latent growth mixture modelling (GMM) approach was used to identify distinct psychological distress patterns.

Results

Four distinct psychological distress trajectories were observed: low-stable (68%), high-stable (12%), high-decreasing (9%) and low-increasing (11%). Symptoms of pain, stiffness and functional impairment were significantly associated with levels of psychological distress at the time of diagnosis and after 3 years; serological markers of disease activity (ESR and CRP) were not.

Conclusions

Although the majority of individuals developing RA experience little or no impact of the effects of the disease on their psychological well-being, a significant proportion experience high levels of distress at some point which may be related to their subjective appraisal of their condition. Assessment and treatment of psychological distress should occur synchronously with somatic symptoms.     

Understanding the relationship between co-occurring PTSD and MDD: symptom severity and affect

How to best understand theoretically the nature of the relationship between co-occurring PTSD and MDD (PTSD + MDD) is unclear. In a sample of 173 individuals with chronic PTSD, we examined whether the data were more consistent with current co-occurring MDD as a separate construct or as a marker of posttraumatic stress severity, and whether the relationship between PTSD and MDD is a function of shared symptom clusters and affect components. Results showed that the more severe depressive symptoms found in PTSD + MDD as compared to PTSD remained after controlling for PTSD symptom severity. Additionally, depressive symptom severity significantly predicted co-occurring MDD even when controlling for PTSD severity. In comparison to PTSD, PTSD + MDD had elevated dysphoria and re-experiencing – but not avoidance and hyperarousal – PTSD symptom cluster scores, higher levels of negative affect, and lower levels of positive affect. These findings provide support for PTSD and MDD as two distinct constructs with overlapping distress components.     

Unfavorably altered fibrin clot properties in patients with active rheumatoid arthritis

Objective

Altered fibrin clot properties have been reported in cardiovascular diseases (CVD) and inflammatory states. Given increased prevalence of CVD in patients with rheumatoid arthritis (RA), we investigated whether fibrin characteristics are also altered in RA patients.

Patients and methods

We studied 46 consecutive RA patients versus 50 controls matched for age and gender. Ex vivo plasma clot permeability, turbidity, tissue-type plasminogen activator (tPA)-induced fibrinolysis, and scanning electron microscopy (SEM) images of clots were evaluated.

Results

Patients with RA had lower clot permeability, faster clot formation, higher maximum clot absorbancy indicating thicker fibrin fibers, maximum clot mass and prolonged fibrinolysis time than controls. Maximum rates of clot lysis were similar in both groups. SEM images showed formation of dense clots with many projections on fibrin fibers. Clot permeability inversely correlated with fibrinogen, tPA, plasminogen activator inhibitor-1 (PAI-1), CRP, platelet count, disease activity score (DAS28) and a marker of oxidative stress, 8-iso-prostaglandin F_2α (r from -0.44 to -0.79; all, p < 0.0001). Similar positive associations were found for clot lysis time (r 0.44 to 0.69; all, p < 0.01). Multiple regression analysis showed that fibrinogen was the only independent predictor of clot permeability (R² = 0.87, p < 0.0001) and lysis time (R² = 0.80, p < 0.003) in RA. Maximum D-dimer levels released from clots, maximum clot turbidity and the time of clot formation were predicted by PAI-1 (all, p < 0.05).

Conclusion

We showed unfavorably altered plasma fibrin clot structure and function in RA, which might contribute to an increased risk of thrombotic events in this disease.     

Psychometric Properties of the Positive and Negative Affect Scale for Children (PANAS-C) in Children with Anxiety Disorders

This study investigated the psychometric properties of the Positive and Negative Affect Scale for Children (PANAS-C) (Laurent et al. Psychol Asses 1: 326–338, 1999) in a sample of 139 children (ages 7–14 years) diagnosed with a principal anxiety disorder. Results from this study provided support for the convergent validity of the PANAS-C with established measures of childhood anxiety and depression. As predicted, negative affect was significantly associated with measures of anxiety and depression whereas positive affect was associated with depression. However, weaknesses in discriminant validity were found, most notably with regard to social anxiety. Consistent with previous research, social anxiety was significantly associated with low levels of positive affect (PA). Furthermore, results from regression analyses indicated that PA made a significant unique contribution to the prediction of social anxiety as well as depression scores. Findings are discussed with regard to the usefulness of the PANAS-C to differentiate anxiety and depression in children with anxiety disorders.     

Positive affect,anhedonia, and compliance with self-care in patients with chronic heart failure

Objective

Optimal self-care is crucial in patients with chronic heart failure (HF). While the focus of research has been on negative mood states, adequate psychological resources may be required to successfully engage in HF self-care. Therefore, the longitudinal associations of multiple positive affect measures in explaining HF self-care including consulting behavior were examined while adjusting for depressive symptoms and potential covariates (e.g., disease severity).

Methods

In this prospective cohort study, 238 patients (mean age: 66.9 ± 8.6 years, 78% men), with chronic HF completed questionnaires at baseline and 1-year follow-up. Positive affect was assessed with the Positive and Negative Affect Schedule (PANAS) and the Global Mood Scale (GMS). Anhedonia, i.e. diminished interest or pleasure, was assessed with a subscale of the Hospital Anxiety and Depression Scale (HADS). The 9-item European Heart Failure Self-care Behaviour scale was completed to assess HF self-care including consultation behavior.

Results

Linear mixed modeling results showed that anhedonia was most strongly associated with both poor self-care (estimate = − .72, P < .001) and consulting behavior (estimate = − .44, P < .001) over time, after adjustment for covariates and depressive symptoms. GMS positive affect was related to better HF self-care adjusting for standard depressive symptoms but not when adjusting for anhedonia. PANAS positive affect was not independently related to self-care.

Conclusion

Anhedonia was associated with worse compliance with self-care among chronic HF patients over time, irrespective of disease severity and depression. Associations between positive affect and self-care were dependent on the measures used in multivariable analyses.     

Depression in rheumatoid arthritis patients: demographic, clinical, and psychological predictors

OBJECTIVE: To confirm the prevalence of depression in a sample of rheumatoid arthritis (RA) patients; to identify the most significant predictors of depression in RA and to explore patients attitudes to medication in relation to depression. METHODS: A cross-sectional survey was used to collect data from 134 RA patients (77% female, 23% male). Participants were divided into depressed and nondepressed groups based on their scores on the Center for Epidemiological Studies-Depression (CES-D) scale. Discriminant analysis was conducted to identify the predictors that would best categorise patients into those two groups. RESULTS: Twelve predictors correctly classified 80% of patients into depressed or nondepressed groups. The strongest predictors of depression were high tension and low self-esteem followed by the perceived impact of RA, fatigue, passive coping, pain, and physical disability. Other predictors included medication effectiveness and importance as well as perceived lack of control over pain. CONCLUSION: Both physical and psychological factors have an impact on depression in RA. The key predictors identified in this study need to be considered within the regular RA management as possible cues to depression development.     

Preliminary study of the association of serum irisin levels with poor sleep quality in rheumatoid arthritis patients

Study objectivesSleep disorders are significant problems in patients with rheumatoid arthritis (RA) and are associated with poor quality of life. Irisin is myokine which may have anti-inflammatory and energy regulatory roles. This study assessed the association of serum irisin levels with the quality of sleep and disease activity in RA patients.MethodsIn sum, 58 RA patients and 30 matched healthy controls were included. Disease activity score in 28 joints (DAS28-ESR) and the patients’ global score were calculated. RA patients were grouped according to the Pittsburgh Sleep Quality Index score (PSQI) into good-sleepers (group 1) defined as a PQSI score≤5 and poor sleepers (group 2) with a PSQI > 5. Serum irisin levels were measured for both patients and controls by commercially available enzyme-linked immunosorbent assay kits.ResultsPoor sleep quality was found in 26 (45%) of the RA patients. Irisin levels were significantly lower in RA patients with poor sleep compared to those with good sleep and healthy controls (p < 0.001). Serum irisin levels correlated inversely with disease duration, morning stiffness duration, DAS28-ESR, global score, and total PSQI score (r = −0.722 to −0.263 & p values≤0.001–0.04) indicating a possible anti-inflammatory role of irisin in RA patients. The analysis employed Student's t-test, ANOVA, and Pearson correlation.ConclusionsIrisin levels were decreased in RA patients with poor sleep quality compared to RA patients with good sleep quality and healthy controls, indicating a possible association of decreased serum irisin with sleep impairment in RA patients.     

Maternal positive affect over the course of pregnancy is associated with the length of gestation and reduced risk of preterm delivery

Objective

The association between maternal psychological state during pregnancy and birth outcomes is well established. The focus of previous studies has been on the potentially detrimental consequences of maternal stress on pregnancy and birth outcomes, particularly shortened gestation and increased risk of preterm birth. Despite a growing literature linking positive affect with favorable health outcomes this construct has received little attention in the context of pregnancy. Therefore, in the current study, we tested the hypothesis that maternal positive affect during pregnancy is associated with beneficial consequences in terms of increased length of gestation and reduced risk of preterm birth above that of the absence of stress.

Methods

In 169 pregnant women maternal positive affect and perceived stress were serially assessed at 15.2±0.9 weeks (T1; mean ± SD), 19.7 ± 0.9 weeks (T2) and 30.7 ± 0.7 weeks (T3) gestation. Pregnancy and birth outcomes were abstracted from the medical record.

Results

Higher maternal positive affect and a steeper increase in maternal positive affect over pregnancy were positively associated with length of gestation (p < .05) and reduced risk of preterm delivery (p < .01), whereas maternal perceived stress was not significantly associated with shorter length of gestation (p > .10).

Conclusions

These findings suggest that maternal positive affect may be beneficial for outcomes related to the length gestation, and that this effect cannot be accounted for by the lower stress levels associated with higher positive affect. Interventions to increase maternal positive affect may be beneficial for fetal development.     

Dural involvement in rheumatoid arthritis

Summary Involvement of the cranial dura in rheumatoid arthritis is rate; a new case of this complication is added to the four recorded instances. Dural involvement in rheumatoid arthritis may occur in the absence of other rheumatoid lesions of the CNS; it appears to take a clinically uneventful course and does not seem to represent a factor predisposing to the development of chronic subdural hematoma.     

外用甲氨蝶呤柔性纳米脂质体治疗类风湿关节炎

摘要 背景：研究表明,甲氨蝶呤直接外用治疗能使关节局部药物质量浓度提高,具有疗效好而全身毒副作用少的优点。目前的外用剂型有乳剂、涂膜剂、药膜等,但透皮吸收效果均不理想。研制具有优良透皮特性的载药纳米柔性脂质体,将会极大地拓宽适用于经皮给药的药物范围。 目的：观察甲氨蝶呤柔性纳米脂质体局部外用治疗类风湿性关节炎的疗效,并对其不良反应进行评估。 方法：40例类风湿性关节炎患者随机分为两组,在常规抗风湿治疗基础上分别局部外用甲氨蝶呤柔性纳米脂质体(治疗组)或口服甲氨蝶呤(对照组),共治疗12周;观察关节压痛指数、关节肿胀指数、关节功能障碍指数、晨僵时间和平均握力等各项临床指标,并对外用甲氨蝶呤柔性纳米脂质体的安全性进行评估。 结果与结论：两组患者经治疗12周时,治疗组较对照组能明显缓解关节的疼痛和压痛症状(P < 0.01);经治疗12周,治疗组和对照组的总有效率分别为90%和75%,两组比较差异无显著性意义(P > 0. 05);治疗组不良反应发生率低于对照组(P < 0. 01)。结果提示局部外用甲氨蝶呤柔性纳米脂质体和口服甲氨蝶呤均能明显改善类风湿性关节炎的多种临床症状和体征,但对改善关节疼痛、压痛和关节肿胀,前者明显优于后者,且不良反应低。 关键词：甲氨蝶呤;脂质体;类风湿关节炎;疗效;安全性 doi:10.3969/j.issn.1673-8225.2010.47.038     

Co-existence of Lambert-Eaton myasthenic syndrome and subacute cerebellar degeneration in a patient with rheumatoid arthritis

A 38 year old woman with rheumatoid arthritis had a rare co-existence of Lambert-Eaton myasthenic syndrome and subacute cerebellar degeneration. She had mild but transient improvement in muscle power following plasmapheresis, which correlated with the degree of increment on high rate repetitive nerve stimulation (RNS). Her cerebellar signs did not improve, however. This differential therapeutic response may be due to different mechanisms of injury and tissue susceptibility.     

Perceived importance of activities of daily living and arthritis helplessness in rheumatoid arthritis; a prospective investigation

OBJECTIVE: To examine the contribution of perceived importance of activities of daily living (ADL) to arthritis-specific helplessness in a sample of rheumatoid arthritis (RA) patients over a 1-year period. METHOD: Forty-two individuals from an outpatient rheumatology clinic completed measures of ADL importance, helplessness, depression, pain, and disability; the physician's assistant provided objective ratings of disability. RESULTS: Time 1 importance of ADL predicted a significant amount of variance in Time 2 arthritis helplessness after statistically controlling disease and psychological covariates. Moreover, increased perceived ADL importance predicted decreased arthritis helplessness over the 1-year period. CONCLUSIONS: Results indicate that RA patients' experience of arthritis-specific helplessness may be minimized over time when performing ADL is perceived as important. Furthermore, these findings provide preliminary evidence for one possible antecedent to increased perceptions of arthritis helplessness in individuals with RA.     

Psychosocial factors, disease status, and quality of life in patients with rheumatoid arthritis

Objective

To explore the interrelationships between the psychosocial and illness factors that determine the disease status of patients with rheumatoid arthritis (RA) and to identify how each factor is associated with quality of life (QOL).

Methods

The study group comprised 120 RA outpatients who completed a series of health examinations and questionnaires. Disease severity, functional disability, counts of swollen and/or tender joints, duration of RA, frequency of arthritis surgery, and C-reactive protein level were assessed by rheumatologists. Self-report inventories completed by the patients were used to assess perceived degree of pain, fatigue (visual analogue scales), depression (Beck Depression Inventory-II), anxiety (Hospital Anxiety and Depression Scale), and social support (Social Support Questionnaire). Mental and physical components of health-related QOL were evaluated using the Short-Form 36 Health Survey.

Results

After z-transformation of the data, a principal axis factor analysis was conducted. A four-factor structure was identified in which the components reflected psychosocial factors, disease activity, current symptoms, and physical functional status, respectively. There was no significant association between psychosocial factors and disease activity, while the other components were moderately correlated with each other. Multiple regression analysis revealed that physical QOL was determined by current symptoms and physical functions. Mental QOL was determined by psychosocial factors, current symptoms, and physical functions.

Conclusion

Disease activity was independent from psychosocial factors and failed to reflect the perceived physical and mental QOL of RA patients. Clinicians should therefore evaluate psychosocial factors, as well as subjective disease status, to improve the QOL of patients with RA.     

Verbal expression of affect in rheumatoid arthritis patients. A blind, controlled test for alexithymia

The claim that alexithymia is associated with specific disease categories is subjected to empirical testing. We report results from a controlled, single blind study in which Thematic Aperception Test (TAT) protocols from 64 arthritis patients attending an outpatient clinic were examined for operationally defined characteristics of alexithymia. We studied two groups of rheumatoid arthritis patients, one with the combination of rheumatoid factor and erosive joint changes and the other without and a third group with other forms of arthritis. Controlling for all variables that may confound alexithymia, we were unable to find any relationship between alexithymia and diagnostic subgroup, duration of illness or functional impairment.