The Brief Strategic Treatment of Cardiophobia: A Clinical Case Study

AbstractMany individuals presenting to medical settings with heart-related symptoms for which no medical explanation is found might suffer from cardiophobia, but this condition is still poorly identified and addressed. This article presents a case of cardiophobia treated in an outpatient cardiac rehabilitation unit and, for the first time, describes the application of brief strategic therapy for the treatment of this condition. In the case reported, the first therapeutic encounter and the key elements of the strategic approach are described in detail with the aim to explain how brief strategic therapy works and how it can be used to identify and address cardiophobia-related behaviors. A 64-year-old male presented to cardiac rehabilitation reporting intense anxiety-provoking heart palpitations, and believing he was at risk of dying from a heart attack. After 3 sessions, an overall improvement in heart-related bodily sensations followed a decrease in the patient's continuous checking of his heartbeat and seeking reassurance—factors that were largely responsible for the persistence of the problem. Moreover, quantitative evaluation showed increased scores of mood state at the end of treatment. This improvement persisted at the 18-month follow-up. This case is an interesting example of how brief strategic therapy can contribute to the development of a new conceptual model for the diagnosis and treatment of cardiophobia. Still, more systematic research in the field is needed to prove the efficacy and effectiveness of this therapeutic approach on symptoms of heart-focused anxiety

Just ignore or counterattack? On the effects of different strategies for dealing with political attacks

During political races, candidates have to decide how to deal with the negative remarks from opposing candidates: just ignore or counterattack? In two studies, we investigated some of the consequences of this choice. In Study 1, participants were presented with a political candidate who systematically attacked his opponent and with the reactions of the attacked candidate: across conditions, the attacked candidate only focused on his political program or counterattacked. Results showed an overt condemnation of the choice to counterattack but a higher spontaneous conformity toward the candidate who counterattacked. Study 2 replicated and extended these results indicating that the gender of the attacked candidate did not affect the results. Moreover, Study 2 showed that conformity toward the attacked candidate was positively related to the predicted chances of winning the election. Results are discussed in relation to their theoretical and applied implications

Nocturnal polyuria in men performing uroflowmetry for lower urinary tract symptoms

Purpose: To assess the prevalence of nocturnal polyuria (NP) in males performing uroflowmetry (UF) for lower urinary tract symptoms (LUTS), the impact of NP on UF outcomes, and bladder emptying, the association between NP and LUTS. Materials and methods: Men scheduled for UF were recruited in two Centres. Data collected were medical history, IPSS, UF, post-void residual urine volume (PVR), 3-day frequency-volume charts (FVC). The NP index was used to assess NP with a threshold of ≥ 33%. The relationship between NP and patient's aging was assessed. Results: 162 patients were included in the analysis. Mean age was 70.95 ± 8.04 years. The prevalence of NP was 54.9% (89/162). 110 (68%) patients reported nocturia, and among these, NP was documented in 76 (69%). Nocturia was found in 85% (76/89) of the population with NP. Total IPSS score, IPSS items #1, #2 and #7 showed a significant difference in men with NP compared with those without. Maximum flow rate and PVR did not significantly change comparing men with or without NP. Mean voiding volume (VV) of the night-time micturitions was significantly higher in men with NP compared to those without NP (532.1 ± 275.6 ml vs 175 ± 168.7 ml respectively, p < 0001), while mean VV day-time micturitions and mean VV at UF did not change between groups. Conclusions: NP had a high prevalence in men with LUTS performing UF. Aged males were more commonly affected by NP. Data demonstrated a strong relationship between NP and nocturia and increased urinary frequency while voiding symptoms were poorly related to NP

43rd Annual Congress of the Italian Urodynamic Society, Rome, Italy, 13th-15th June 2019: Influence of emotional condition on uroflowmetry

Introduction and aim of the study: The emotional condition of patients before uroflowmetry (UF) may affect the micturition and consequently the results of the examination. Limited literature data are available on the correlation between anxiety levels and uroflowmetry1. Aim of this study was to assess the correlation between emotional condition of the patients at UF and whether anxiety/embarrassment may affect patient\u2019s micturition. Materials and methods: This is a prospective multicenter ongoing study started on July 2018. Patients were enrolled during an office uroflowmetry. Data recorded were: demographics (sex, age, educational level), urological history (therapy, surgical urological treatment), International Prostate Symptoms Score (IPSS) questionnaire in males, and ICIQ\u2010FLUTS questionnaire in females. General anxiety level of the patient was evaluated by the General Anxiety Disorder \u2010 7 (GAD \u2010 7) questionnaire2 considering the levels of severity as following: score <5 no anxiety, 5 to 9 mild anxiety, 10 to 14 moderate anxiety, 15 to 21 severe anxiety. Moreover, to better understand the anxiety level related to UF we applied questions #4 to 6 of the Amsterdam Preoperative Anxiety and Information Scale (APAIS).3 Levels of severity were considered as follow: 3 to 6 no anxiety, 7 to 10 moderate anxiety, 11 to 15 severe anxiety. Specific linker\u2010type scales assessed the subjective micturition satisfaction/reproducibility and the discomfort. A dedicated nurse measured post\u2010void residual (PVR) urine by bladder\u2010scan immediately after the examination. Statistical analysis was performed using one\u2010way ANOVA test, and Mann\u2010Whitney test. Results: Patients enrolled in the study were 125 (mean age 65+13 years): 85 men (68%) and 40 women (32%). Voided volumes, Qmax, PVR, and discomforts did not correlate with higher level of anxiety. However, greater anxiety negatively influenced the subjectivesatisfaction and the UF reproducibility. Patients with higher anxiety levels showed greater symptomatology questionnaires (Table 1\u20102). A general high level of anxiety was assessed by GAD in 41,6% (52/125) of the cohort, while a high level of UF\u2010related anxiety was recorded by APAIS in 42,4% (53/125). Women reported GAD score >5 in the 87.5% (35/40), and APAIS score >6 in the 70% (28/40). GAD score >5 and APAIS modified score >6 were documented in males in 44,7% (38/85) and 29% (25/85) respectively. The relation between GAD \u2010 APAIS levels and satisfaction/reproducibility and discomforts of the patient are reported in Tables 3 to 4. A low satisfaction/reproducibility of the examination was reported by 31.2% of the patients (39/ 125): 38.5% males and 45% females. High discomforts were recorded in 51.2% (74/125) of the population: 56.5% men and 65% women. Interpretation of results: Most factors may influence UF outcomes, but the level of anxiety has been poorly investigated. In our study a high levels of general, and UF\u2010related anxiety was found in 4/10 patients. Surprisingly, we found a severe discrepancy of anxiety levels between genders. Women were mostly affected by high general and UF\u2010related high anxiety. Quite the reverse, in men an impaired emotional condition was documented in less than a half of the cases. Moreover, the higher levels of anxiety mainly influenced the subjective satisfaction/reproducibility of the UF. However, no significant differences were found among the objective outcomes (VV/Qmax/PVR). Patients with higher anxiety levels showed worst results at the symptomatology questionnaires. The emotional condition poorly influenced the UF discomforts.Conclusions: A relevant rate of patients showed high anxiety levels. This study demonstrated that UF, although is a simple and not invasive test, has an important impact on the emotional condition of the patients, mostly in women. This issue should be considered in the counseling of the patients. Anxiety influenced the subjectivity of the patients leading to the sensation of not having reproduced the normal urinary pattern. Therefore, a proper counseling may lower anxiety levels obtaining more physiological results at UF