Is there an association between severity of illness and psychiatric symptoms in patients with chronic renal failure?

Chronic renal failure (CRF) is a frequent condition in elderly subjects, and it is associated with psychiatric comorbidity, especially depressive symptoms. Purpose of the present research was to compare patients with different severity of chronic kidney disease (CKD) in terms of psychiatric symptoms. One hundred CKD subjects were randomly selected among those attending the Department of Nephrology, University of Milan. The patients were evaluated through the following rating scales: Mini-Mental State Examination (MMSE), Beck Depression Inventory (BDI), Symptom Checklist (SCL-90), Kidney Disease Quality of Life- Short Form (KDQOL-SF) and Cumulative Illness Rating Scale (CIRS). A multivariable linear regression analysis was performed considering eGFR as continuous-dependent variable and rating scale scores as independent variables. A worse eGFR significantly correlated with the score about the effects of kidney disease on daily life (r = 0.25, p = 0.01) and the burden of kidney disease (r = 0.18, p = 0.05). Statistical significance of kidney disease on daily life persisted also in the final multivariate model (t = 2.04, p = 0.04). Severity of renal dysfunction seems to influence few psychiatric outcomes, particularly those related to quality of life and daily functioning. This result might depend on the over-worrying derived from the necessity to start a renal replacement therapy in the near future.     

Resisting temptation: alcohol specific self-efficacy mediates the impacts of compensatory health beliefs and behaviours on alcohol consumption

Awareness of health risks linked with excessive alcohol consumption appears to have little influence on how much some people drink. Compensatory health beliefs (CHBs), in which the consequences of unhealthy behaviour are considered to be neutralised by additional healthy behaviours, are one way of justifying poor health choices. Currently, the role of CHBs within the context of drinking behaviour is not well understood. This research examined associations between alcohol specific compensatory health beliefs (ACH-Beliefs) and behaviours (ACH-Behaviours), alcohol consumption and alcohol specific self-efficacy (ASE), via an online survey completed by 249 participants, aged 18 + years (63.1% female; M age = 41.62 years; SD = 14.80). Higher ACH-Beliefs were associated with increases in ACH-Behaviours. While both predicted alcohol consumption, a greater proportion of variance was explained by ACH-Behaviours. ASE was a significant mediator of those relationships, suggesting that those with higher ASE may be better equipped to regulate drinking behaviour. Recommendations for future research include measuring both CHBs and behaviours within an experimental design, and further investigation of related cognitions such as compensatory behaviour intentions. Alcohol misuse interventions may wish to consider the potential roles of CHBs and behaviours in facilitating maladaptive coping strategies, and how addressing these may reduce harms.     

A preliminary examination of the role of psychotherapist fidelity on outcomes of cognitive processing therapy during an RCT for military sexual trauma-related PTSD

While cognitive processing therapy (CPT) is an effective evidence-based treatment for many veterans with military-related post-traumatic stress disorder (PTSD), not all veterans experience therapeutic benefit. To account for the discrepancy in outcomes, researchers have investigated patient- and research design-related factors; however, therapist factors (e.g. fidelity) have received less attention. The present study is a preliminary examination of the effect of psychotherapists’ fidelity during CPT on clinical outcomes during a randomized clinical trial (RCT) for military sexual trauma-related PTSD. PTSD symptoms, trauma-related negative cognitions (NCs), and depression symptoms were assessed for 72 participants at baseline, and 1-week, 2-month, 4-month, and 6-month posttreatment. Of the four CPT therapists, two were found to have significantly poorer (i.e. “below average”) treatment fidelity scores compared to the other two therapists who had “good” treatment fidelity scores. To examine possible therapist effects on outcomes, hierarchical linear modeling was utilized with therapist fidelity entered as a Level 2 predictor. Participants treated by a therapist with “good” treatment fidelity experienced significantly greater reductions in PTSD symptoms, NCs, and depression symptoms than patients treated by a therapist with “below average” treatment fidelity. Our preliminary findings highlight the importance of monitoring, maintaining, and reporting fidelity in psychotherapy treatment RCTs.     

Anger and effortful control moderate aggressogenic thought–behaviour associations

The effects of anger and effortful control on aggressogenic thought–behaviour associations were investigated among a total of 311 Finnish fifth and sixth graders (mean age = 11.9 years). Self-reported aggressive cognitions (i.e., normative- and self-efficacy beliefs about aggression) were expected to be associated with higher peer-reported aggressive behaviour. Teacher reported anger and effortful control were hypothesised, and found, to moderate the effects of aggressive cognitions on aggression, such that the effects were strongest for children who were high in anger and low in effortful control, as compared to other conditions. Furthermore, under the conditions of high anger and high effortful control, self-efficacy was negatively related to aggression. Thus, aggression is a result of a complex, hierarchically organised motivational system, being jointly influenced by aggressive cognitions, anger and effortful control. The findings support the importance of examining cognitive and emotional structures jointly when predicting children’s aggressive behaviour.     

Psychological predictors for health-related quality of life and disability in persons with chronic obstructive pulmonary disease (COPD)

Objective: Individuals with chronic obstructive pulmonary disease (COPD) exhibit low physical and mental health-related quality of life (HRQL) and high susceptibility to disability. We investigated the influence of psychological factors on HRQL and disability in COPD individuals recruited from the general population. In line with Leventhal’s common sense model, we expected psychological factors to be associated with HRQL and disability even after controlling for medical status.

Methods: Individuals with COPD (n = 502; 59.7 years old; GOLD grades were I: 3%, II: 17%, III: 34%, IV: 46%) were assessed through an online survey administered via COPD patient organisations in Germany. Individuals filled in the Short Form Health Survey (SF-12), COPD Assessment Test, Patient Health Questionnaire (modules: GAD-2, PHQ-15, PHQ-9), Brief Illness Perception Questionnaire, a questionnaire that assesses causal illness attributions, and the internal illness-related locus of control scale of the ‘KKG questionnaire for the assessment of control beliefs about illness and health’. Multiple linear regressions were calculated.

Results: The investigated factors explained high variances (disability = 56%, physical HRQL = 28%, mental HRQL = 63%, p ≤ .001). Better mental health, more optimistic illness perceptions, attribution to psychological causes, and stronger internal locus of control were associated with lower disability and better HRQL. Comorbid somatic symptoms contributed to high disability and low quality of life.

Conclusion: Psychological factors, such as illness perception, attribution and internal locus of control, were associated with disability and HRQL. These factors should be considered when designing treatments for individuals with COPD, and adequate interventions should be provided to enhance illness understanding and self-management skills.     

3-D bone models to improve treatment initiation among patients with osteoporosis: A randomised controlled pilot trial

Objective: To investigate the efficacy of 3-D printed bone models as a tool to facilitate initiation of bisphosphonate treatment among individuals who were newly diagnosed with osteoporosis.

Design: Fifty eight participants with estimated fracture risk above that at which guidelines recommend pharmacological intervention were randomised to receive either a standard physician interview or an interview augmented by the presentation of 3-D bone models.

Main outcome measures: Participants’ beliefs about osteoporosis and bisphosphonate treatment, initiation of bisphosphonate therapy assessed at two months using self-report and pharmacy dispensing data.

Results: Individuals in the 3-D bone model intervention condition were more emotionally affected by osteoporosis immediately after the interview (p = .04) and reported a greater understanding of osteoporosis at follow-up (p = .04), than the control group. While a greater proportion of the intervention group initiated an oral bisphosphonate regimen (alendronate) (52%) in comparison with the control group (21%), the overall initiation of medication for osteoporosis, including infusion (zoledronate), did not differ significantly (intervention group 62%, control group 45%, p = .19).

Conclusion: The presentation of 3-D bone models during a medical consultation can modify cognitive and emotional representations relevant to treatment initiation among people with osteoporosis and might facilitate commencement of bisphosphonate treatment.     

Adaptation to an autoimmune disorder: Does mental flexibility impact illness-related self-regulation?

Objective: To examine whether mental flexibility moderates the relationship between illness representations of control and coping behaviour in individuals suffering from rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).

Design: Recently, diagnosed RA (N = 80) and SLE (N = 75) patients completed questionnaires about illness representations of personal and treatment control and four coping behaviours: instrumental coping, adherence to medical advice, palliative coping and wishful thinking. Mental flexibility was assessed with the Trail Making Test Part B (TMT-B), while visuomotor processing speed, as a confounder, was assessed with the Trail Making Test Part A (TMT-A). Moderated mediation models were tested within a bootstrapped multiple regression framework.

Results: TMT-A scores had no statistically significant moderation effects on the relation between representations and coping behaviour. Conversely, in those participants with SLE, TMT-B scores moderated the relation of personal control to wishful thinking and palliative coping, as well as the relation of treatment control to both wishful thinking and palliative coping. All significant effects were restricted to the SLE group.

Conclusion: Interactions between neurocognitive factors and the process of illness adaptation may emerge early during the course of SLE. The present findings highlight the role of cognitive functioning as an integral part of the illness-related self-regulation mechanism.     

Brain drawings following traumatic brain injury (TBI) and links to illness perceptions and health outcomes – Findings from a population-based study

Objective: Individuals’ illness perceptions predict health behaviours and influence functional outcomes. This study examined associations between a novel assessment of illness perceptions, in the form of adult’s brain drawings after traumatic brain injury (TBI) and questionnaire measures of illness perceptions, quality of life and post-concussive symptoms.

Design: Population-based, prospective longitudinal study examining 245 adults with predominantly mild TBI with high risk of complications.

Main outcome measures: Participants were asked to draw pictures of what they thought their brain looked like before injury and at baseline and one month post-injury. Drawing characteristics (height, width and percentage damage at one month) were examined in relation to each outcome of interest at six months.

Results: Greater damage at one month was associated with more negative illness perceptions (rs = .23), poorer mental health (rs = ?.21), and more total post-concussive symptoms (rs = .27 to r = .35) at six months. The extent of damage depicted reduced over time (p < .001). No associations were found between the amount of damage drawn and injury severity, nor the height or width of drawings and injury severity or illness perceptions.

Conclusion: Drawings post-TBI offer a simple, cost- and time-effective way to begin discussions and improve understanding of peoples’ illness perceptions.     

Home-based smoking prevention program Smoke-free Kids on smoking-related cognitions: Secondary outcomes from a cluster randomized controlled trial

Objectives: The home-based smoking prevention programme ‘Smoke-free Kids’ did not have an effect on primary outcome smoking initiation. A possible explanation may be that the programme has a delayed effect. The aim of this study was to evaluate the effects on the development of important precursors of smoking: smoking-related cognitions.

Methods: We used a cluster randomised controlled trial in 9- to 11-year-old children and their mothers. The intervention condition received five activity modules, including a communication sheet for mothers, by mail at four-week intervals. The control condition received a fact-based programme. Secondary outcomes were attitudes, self-efficacy and social norms. Latent growth curves analyses were used to calculate the development of cognitions over time. Subsequently, path modelling was used to estimate the programme effects on the initial level and growth of each cognition.

Results: Analyses were performed on 1398 never-smoking children at baseline. Results showed that for children in the intervention condition, perceived maternal norms increased less strongly as compared to the control condition (β = ?.10, p = .03). No effects were found for the other cognitions.

Conclusion: Based on the limited effects, we do not assume that the programme will have a delayed effect on smoking behaviour later during adolescence.     

Conscious contents as reflexive processes: Evidence from the habituation of high-level cognitions

Reflexes are often insuppressible, predictable, and susceptible to external control. In contrast, conscious thoughts have been regarded as whimsical, ‘offline,’ and shielded from external control. Recent advances suggest that conscious thoughts are more reflex-like and susceptible to external control than previously thought. In one paradigm, high-level conscious thoughts (subvocalizations) are triggered by external control, as a function of external stimuli and experimenter-induced action sets. It has been hypothesized that these conscious contents are activated involuntarily and in a reflex-like manner. If such is the case, then these activations should possess a well-known property of the reflex: habituation. Accordingly, we found that involuntary high-level cognitions (subvocalizations) habituated (i.e., were less likely to arise) after repeated stimulation. As in the case of the habituation of a reflex, this novel effect was stimulus-specific. We discuss the implications of this finding for theories about consciousness and about psychopathological phenomena involving undesired, involuntary cognitions.