Creative novation behaviour therapy as a prophylactic treatment for cancer and coronary heart disease: Part II--Effects of treatment

In this article we consider the effectiveness of creative novation behaviour therapy in preventing cancer and coronary heart disease in disease-prone probands, and also its effectiveness in extending life for patients suffering from terminal cancer. In all cases, suitably matched controls are provided as part of the general methodology, and results are reported to testify to the effectiveness of the therapy, whether administered a long-term individual therapy, group therapy, or bibliotherapy plus short-term individual treatment. We also consider the negative effects of psychoanalysis on outcome.     

Self-Efficacy and Psychological Well-Being in Cardiac Patients: Moderated Mediation by Affect and Meaning-Making

Abstract

Prior research suggests a potential moderated mediation effect between self-efficacy and psychological well-being. Based on the Meaning Making Model and the Broaden-and-Build Theory, this study examines the relationship between self-efficacy and psychological well-being in the moderated mediation perspective of affect and meaning-making in coronary heart disease patients. The questionnaires measuring self-efficacy, psychological well-being, affect, and meaning-making were used to collect data from one hundred and fifty six patients (73 women and 83 men) who were suffering from coronary heart disease. The patients had a history of coronary heart disease in the previous .1?7.9?years and were aged 47?82. Findings demonstrated that meaning-making mediated the indirect relationship between self-efficacy and psychological well-being. In addition, the moderated mediation effect of positive affect, but not of negative affect was significant. Positive affect moderated the indirect effect between self-efficacy and psychological well-being through meaning-making; the indirect effect was stronger when positive affect was high as opposed to low. The results suggest the interplay of affective and meaning-making processes in the relationship between self-efficacy and well-being.     

稳定性冠心病何时需要PCI

目前稳定性冠心病通行的治疗策略是药物治疗的同时常规作冠脉造影,如果病变严重,则尽可能地作介入治疗。但最近COURAGE试验结果的公布,证实介入治疗仅可以缓解症状,但不能改善预后。因此,我们要对PCI在稳定性冠心病中的作用和定位重新进行思考。     

合理应用运动平板试验与冠脉CT诊断冠心病临床策略分析

本文针对临床诊断冠心病的两种常用手段即运动平板试验和冠脉CT进行分析,鉴于目前临床普遍存在重视采用冠脉CT,甚至达到滥用的地步,而逐渐忽视平板运动试验的现象,紧密结合临床,客观分析两者的特点,阐述各自优缺点。希冀通过本文以帮助临床医师正确选择应用,避免偏颇,最终达到将两者有机的结合,真正适合临床需要,提高冠心病患者的检出率,有利于更好地对冠心病进行二级预防。     

Depression Screening,Assessment, and Treatment for Patients with Coronary Heart Disease: A Review for Psychologists

Depression prevalence is between 15% and 20% in coronary heart disease patients, such as those with angina, or after a myocardial infarction or coronary artery bypass graft surgery. The presence of depression places a coronary heart disease patient at twofold higher risk for further major cardiac events and death, as well as poor quality of life and early exit from the labour force. As a consequence, several learned societies, including the National Heart Foundation of Australia, have published guidelines that recommend questionnaire screening to improve identification and management strategies for depression in coronary heart disease patients. Psychologists in hospitals, community settings, and private practice can have a key role in the realisation of the National Heart Foundation of Australia's aims. We review the recent guidelines and outline implications for psychologists to identify and manage depression in coronary heart disease patients. The evidence reviewed suggests that cognitive‐behavioural therapy and problem‐solving therapy are frontline non‐pharmacological interventions for depression in CHD patients.     

Satisfaction profile (SAT-P) in 732 patients: Focus on subjectivity in hrqol assessment

Abstract

A 32-item questionnaire aimed at assessing patient's satisfaction about every day life is presented. In the Satisfaction Profile (SAT-P) patients are asked to evaluate their own satisfaction level on 32 daily life aspects concerning the last month. 732 participants were enrolled into the study: 490 in-patients suffering from different types of chronic diseases (e.g., chronic heart failure, severe respiratory failure, coronary heart disease) and 242 healthy persons of working age. SAT-P validity was confirmed by comparing its scores with the NHP, EPQ and STAI-X2 scores. The factor analysis extracted 5 factors which corresponded to the hypothesised areas (54% of variance explained). Test-retest reliability and internal consistency were confirmed: Pearson's coefficients were ranging from 0.45 to 0.93 and Cronbach's alpha coefficient was 0.92. SAT-P responsiveness, evaluated by comparing baseline and 6 months follow up scores from 45 chronic heart failure patients, resulted to be satisfatory, although further studies are needed. These results, together with the “user-friendly” structure, the brief administration and scoring time, the simple graphic representation, suggest to consider the SAT-P a useful complementary tool in HRQoL assessment. The Italian, English and French versions are available.     

Diagnosing depression in patients with physical diseases using the beck depression inventory (BDI)

Abstract

Four-hundred-and-forty-three patients with a physical illness (355 with coronary heart disease and 88 with chronic pain), 150 unemployed persons and 623 subjects from the normal population in Jämtland, Sweden were tested using the BDI (Beck Depression Inventory). The aim of the study was to investigate whether scores on both the physical and non-physical components of the BDI differed between the patients and the other groups, or whether only the physical component was significantly higher in the patient group, and in such a case whether this could be interpreted as symptomatic of physical disease and not of depression. A cutoff score of ≥ 10 to determine mild depression and two different alternative physical and non-physical components were used. Forty-three percent of the patients with coronary heart disease and 50% of patients with chronic pain were categorized as being at least mildly depressed. Factor analyses indicated that a physical component comprising five items was the most meaningful and could best discriminate the physical symptoms. The patients' scores were significantly higher than those of the other two groups on the physical component but only higher than the normal population sample on the nun-physical component. This supports the idea that the items for physical symptoms in the BDI might be confounding when determining depression in patients with physical diseases. The non-physical component seems to be the best indicator of depression and is recommended as a complement to the total BDI scale when determining the degree of depression in patients suffering from a physical disease.     

Cognitive orientation and physical disease or health

This paper deals with a new approach to physical disease and health based on the theory of cognitive orientation (CO) (Kreitler and Kreitler, 1976, 1982). It presents an outline of the theory which is a comprehensive cognitive-motivational model of behaviour describing how cognitive contents and processes bring about the elicitation of behaviour. The theory generated a methodology for the prediction of behaviour that has been applied in different domains ofhealth psychology. Studies are described dealing with behaviours affecting health (quitting smoking, smoking, overeating, undergoing examinations for the early detection of breast cancer), behaviours of the individual in the role of sick person (hospitalization for safeguarding pregnancy, getting information on a cancer ward), aetiologies of physiopathologies (coronary heart disease, diabetes, vaginal infections) and disorders (menstrual and sexual disorders, and infertility in women), recovery and rehabilitation (from chronic pain, and following MI), and general health orientation. Finally, the outlines of an emergent CO model of physiopathology are presented, specifying how cognitions affect health, and in which sense the processes involved in physiopathology resemble and differ from those involved in the elicitation of overt behaviours.     

Psychosoziale Interventionen bei Patientinnen mit Brustkrebs

Breast cancer patients are subject not only to physical strain but also to substantial psychological and social stress as well as major threats and challenges.The paper presented gives an overview of the research status on psychosocial interventions to support patients in their coping endeavours.Psychosocial basic care of women with breast cancer is performed by the physicians treating oncologically and includes information fitting patients' information needs,and responding to their emotional stress.Evaluated training and educational programs are available for physicians to enhance their psychosocial competence.Psychosocial basic care is completed by psychoeducational interventions.In 20–30% of women with breast cancer, there is a need for a special psychotherapeutic treatment.Especially, supportive and cognitive-behavioral therapies in an individual or a group setting contribute to a reduction of anxiety and depression. Even anticipated side-effects of somatic treatments can be diminished by psychotherapy. Research in the field supports that there is a need for broad integration of psychosocial interventions into disease management programs for women suffering from breast cancer.     

Effects of a post-hospitalization group health education programme for patients with coronary heart disease

Abstract

Effects of a post-hospitolization group health education programme for patients with coronary heart disease. A health education programme was offered to groups of coronary heart patients and their partners after discharge from hospital. A randomized pre-test post-test control group design was used to evaluate the effects of this experimental intervention. The health education programme was offered to 109 coronary heart patients in groups of between five and eight patients together with their partners in addition to standard medical care and physical training. A control group of 108 patients received only standard medical care and physical training.

The intervention consisted of eight weekly two-hour group health education sessions and one follow-up session. All sessions focused on the promotion of healthy habits and the reduction of adverse psychosocial consequences of the incident.

In the short term (about four months after the incident) the health education programme showed statistically significant intervention effects on knowledge about coronary heart diseases, smoking cessation, healthy eating habits and the number of consultations with the family physician, but no effects on emotional distress. In the long term (one year after the incident) there was only a significant intervention effect on smoking cessation.

These results suggest that the effects of the programme are modest, especially in terms of maintenance of behavioural change. As a consequence, it is suggested that the programme should not be offered to all coronary patients during cardiac rehabilitation, but only to those who can be expected to profit most from it.     

Behaviour Therapy as an Aid in the Prevention of Cancer and Coronary Heart Disease

Abstract

Three experiments are reported in which details about personality, stress, smoking and other variables are elicited at the beginning of the study, and death and cause of deàth ascertained ten years later. It is found that personality and stress can successfully predict cancer and coronary heart disease, and do so very significantly better than does cigarette consumption. Behaviour therapy is shown to be able prophylactically to reduce very significantly the risk of cancer or coronary heart disease.     

Humor and the coronary-prone behavior pattern

The belief is widely held that humor is related to recovery from, and perhaps an increased resistance to, coronary and other stress-related diseases. Such generalizations do not typically distinguish between benign and hostile humor. In the present research, the relationship between a measure of proneness to coronary heart disease (CHD) and appreciation of hostile and nonhostile humor is examined. In two studies, one with college students and one with patients suffering from CHD, the relationship between humor preferences and the coronary-prone (Type A) behavior pattern was examined. Each subject was given the Jenkins Activity Survey as a measure of the coronary-prone personality type, and aggressive and nonaggressive jokes to rate for funniness. Hostile humor was preferred to nonhostile humor by all groups, but among those suffering from CHD, those who could be classified as “Type B’s” preferred nonhostile humor. The results indicate that those less prone to CHD appreciate both hostile and nonhostile humor, while Type A’s seem to enjoy hostile humor only.     

Psychological perspectives on the development of coronary heart disease

Psychological science has new opportunities to have major input into the understanding of the development of coronary heart disease. This article provides an overview of advances in understanding the etiology of heart disease, recently applied technologies for measuring early stages of heart disease, and an accumulating base of evidence on the psychosocial predictors of clinical and subclinical coronary disease. It suggests that it is now time to develop conceptual models that integrate our understanding of separate psychosocial predictors. It offers and provides preliminary evidence for a model that integrates socioeconomic status, environmental stress, and person-level factors from a life span perspective.     

国外癌症患者疾病获益感的研究现状及启示

虽然癌症及其治疗会给患者带来一些消极的心理后遗症,但是许多患者也从他们的患病经历中发现了对他们有益的变化。积极心理学家将此益处相关的认知命名为疾病获益感,即特定疾病经历中感知到益处。研究发现这种认知有助于患者的疾病适应,使患者积极乐观地面对生活。目前,癌症患者的疾病获益感已受到广泛关注,并应用于相关研究。本文通过综述国外研究中疾病获益感的内涵,测量工具及干预模式,以探讨其对国内癌症患者心理护理的启示。     

青年颈心综合征避免误诊为冠心病的临床诊疗策略

通过对临床收集的187例青年(≤45岁)颈心综合征患者的临床资料进行分析。探讨青年颈心综合征临床误诊为冠心病的原因及避免误诊的诊疗策略。目的在于帮助临床医师对青年颈心综合征进行识别,注意如何与冠心病心绞痛相鉴别,对防止病情延误,尽早明确诊断积极治疗,排除冠心病,减少诊疗费用及避免冠脉造影的风险意义很大。     

Stress and Disease: An examination of psychophysiological effects and alternative treatment approaches

This article examine the psychophysiological relationship between psychosocial stressors and physiological changes. Stress has been shown to cause changes in the human immune system, increasing susceptibility to disease. A selective review of the literature explores this relationship. Alternative treatment modes are being implemented to supplement traditional therapies for the preventative and post hoc care of diseases, particularly those associated with the immunologic system deficiencies which could be related to stress. Implications are explored for implementing biofeedback, guided imagery, and stress management techniques for supplemental treatment in cancer, coronary heart disease, and immunologic diseases such as the acquired immune deficiency syndrome.     

依那普利叶酸片与依那普利片改善动脉硬化效果比较

探讨马来酸依那普利叶酸片对冠心病患者血清同型半胱氨酸（Hcy）及脉搏波传导速度（PWV）的影响。选取108例冠心痛患者随机分为依叶组（口服马来酸依那普利叶酸片1片,每日1次）和依苏组（口服依那普利片1片,每日1次）,疗程6个月,另选取冠状动脉造影为非冠心病患者40例作对照。检测各组患者治疗前后血清Hcy水平及PWV,并进行比较。冠心病患者血清Hcy水平及PWV较非冠t心病患者明显升高（P〈o．01）,治疗6个月后,两组冠心病患者血清Hcy水平及PWV均较治疗前降低（P〈o．05,P〈o．01）,而依叶组血清Hcy水平及PWV较依苏组降低更为显著（P〈0．05,P〈0．01）。冠心病常规治疗的基础上联用叶酸可进一步降低患者血清Hcy水平及PWV,从而改善患者内皮功能及动脉硬化。     

Type D personality as a prognostic factor in heart disease: assessment and mediating mechanisms

Type D personality, a synergy between negative affectivity and social inhibition, has established itself as a serious risk factor for morbidity and mortality in patients suffering from cardiovascular disease. In this review, we summarize studies on the validity of the assessment methods of Type D, emphasizing its role as an independent vulnerability factor in the progression of cardiovascular disease. We further present evidence on the physiological characteristics that accompany the 2 psychological traits negative affectivity and social inhibition and may mediate the relation between personality and prognosis in heart disease. Further research needs to determine the mechanisms by which Type D affects the course and outcome of cardiovascular disease as well as how Type D patients may benefit from psychosocial intervention.     

Type D Personality as a Prognostic Factor in Heart Disease: Assessment and Mediating Mechanisms

Type D personality, a synergy between negative affectivity and social inhibition, has established itself as a serious risk factor for morbidity and mortality in patients suffering from cardiovascular disease. In this review, we summarize studies on the validity of the assessment methods of Type D, emphasizing its role as an independent vulnerability factor in the progression of cardiovascular disease. We further present evidence on the physiological characteristics that accompany the 2 psychological traits negative affectivity and social inhibition and may mediate the relation between personality and prognosis in heart disease. Further research needs to determine the mechanisms by which Type D affects the course and outcome of cardiovascular disease as well as how Type D patients may benefit from psychosocial intervention.