Positive psychology interventions in patients with medical illness: What predicts improvement in psychological state?

Positive psychology interventions (PPIs) have been shown to promote wellbeing in individuals with medical illness, although it is still unknown whether certain patient characteristics make participants more likely to benefit from such interventions. The present study tested whether, using individual patient data across five published PPI studies (three single-arm proof-of-concept trials, one non-randomized controlled trial, and one randomized controlled trial) in medically-ill persons, sociodemographic or psychological factors predicted subsequent change in wellbeing. In 208 participants, lower baseline psychological wellbeing and optimism, and higher symptoms of depression and anxiety were associated with greater improvement in psychological symptoms during the PPI. Other factors were unrelated to symptom changes. In a sub-analysis of controlled studies, there were no group differences in the relationship between baseline factors and changes in wellbeing from pre- to post-intervention. Findings suggest that patients with more severe psychiatric and/or medical comorbidity are no less likely to benefit from a PPI compared to those with higher levels of health, even though these programs do not directly target psychological distress. PPIs may be widely applicable to medical patients, with lower psychological wellbeing a potential predictor of increased benefit

Feasibility and utility of positive psychology exercises for suicidal inpatients

ObjectiveThe objective was to assess the feasibility and acceptability of nine positive psychology exercises delivered to patients hospitalized for suicidal thoughts or behaviors, and to secondarily explore the relative impact of the exercises.MethodParticipants admitted to a psychiatric unit for suicidal ideation or behavior completed daily positive psychology exercises while hospitalized. Likert-scale ratings of efficacy (optimism, hopelessness, perceived utility) and ease of completion were consolidated and compared across exercises using mixed models accounting for age, missing data and exercise order. Overall effects of exercise on efficacy and ease were also examined using mixed models.ResultsFifty-two (85.3%) of 61 participants completed at least one exercise, and 189/213 (88.7%) assigned exercises were completed. There were overall effects of exercise on efficacy (χ(2)=19.39; P=.013) but not ease of completion (χ(2)=11.64; P=.17), accounting for age, order and skipped exercises. Effect (Cohen's d) of exercise on both optimism and hopelessness was moderate for the majority of exercises. Exercises related to gratitude and personal strengths ranked highest. Both gratitude exercises had efficacy scores that were significantly (P=.001) greater than the lowest-ranked exercise (forgiveness).ConclusionIn this exploratory project, positive psychology exercises delivered to suicidal inpatients were feasible and associated with short-term gains in clinically relevant outcomes

Relatório de estágio em farmácia comunitária

Relatório de estágio realizado no âmbito do Mestrado Integrado em Ciências Farmacêuticas, apresentado à Faculdade de Farmácia da Universidade de Coimbr

The relationship between depression, anxiety, and cardiovascular outcomes in patients with acute coronary syndromes

Jeff C Huffman1, Christopher M Celano1, James L Januzzi21Department of Psychiatry, 2Department of Cardiology, Massachusetts General Hospital, Boston, MA USAAbstract: Depression and anxiety occur at high rates among patients suffering an acute coronary syndrome (ACS). Both depressive symptoms and anxiety appear to adversely affect in-hospital and long term cardiac outcomes of post-ACS patients, independent of traditional risk factors. Despite their high prevalence and serious impact, mood and anxiety symptoms go unrecognized and untreated in most ACS patients and such symptoms (rather than being transient reactions to ACS) persist for months and beyond. The mechanisms by which depression and anxiety are linked to these negative medical outcomes are likely a combination of the effects of these conditions on inflammation, catecholamines, heart rate variability, and endothelial function, along with effects on health-promoting behavior. Fortunately, standard treatments for these disorders appear to be safe, well-tolerated and efficacious in this population; indeed, selective serotonin reuptake inhibitors may actually improve cardiac outcomes. Future research goals include gaining a better understanding of the combined effects of depression and anxiety, as well as definitive prospective studies of the impact of treatment on cardiac outcomes. Clinically, protocols that allow for efficient and systematic screening, evaluation, and treatment for depression and anxiety in cardiac patients are critical to help patients avoid the devastating effects of these illnesses on quality of life and cardiac health.Keywords: acute coronary syndrome, anxiety, anxiety disorders, depression, myocardial infarction, unstable angin

Positive Psychological Interventions for Patients with Type 2 Diabetes: Rationale, Theoretical Model, and Intervention Development

Most patients with type 2 diabetes (T2D) have suboptimal adherence to recommended diet, physical activity, and/or medication. Current approaches to improve health behaviors in T2D have been variably effective, and successful interventions are often complex and intensive. It is therefore vital to develop interventions that are simple, well-accepted, and applicable to a wide range of patients who suffer from T2D. One approach may be to boost positive psychological states, such as positive affect or optimism, as these constructs have been prospectively and independently linked to improvements in health behaviors. Positive psychology (PP) interventions, which utilize systematic exercises to increase optimism, well-being, and positive affect, consistently increase positive states and are easily delivered to patients with chronic illnesses. However, to our knowledge, PP interventions have not been formally tested in T2D. In this paper, we review a theoretical model for the use of PP interventions to target health behaviors in T2D, describe the structure and content of a PP intervention for T2D patients, and describe baseline data from a single-arm proof-of-concept (N=15) intervention study in T2D patients with or without depression. We also discuss how PP interventions could be combined with motivational interviewing (MI) interventions to provide a blended psychological-behavioral approach