Tailoring a cognitive behavioural model for unexplained physical symptoms to patient's perspective: a bottem-up approach.

The prevalence of unexplained physical symptoms (UPS) in primary care is at least 33%. Cognitive behavioural therapy has shown to be effective. Within cognitive behavioural therapy, three models can be distinguished: reattribution model, coping model and consequences model. The consequences model, labelling psychosocial stress in terms of consequences rather than as causes of UPS, has high acceptance among patients and is effective in academic medical care. This acceptance is lost when applied in primary care. To increase acceptance of the consequences model among patients in primary care, we tailor this model to patient's perspective by approaching the model from bottom-up instead of top-down. Subsequently, we use this tailored model in an easily accessible group training. We illu

Behandeling van de depressieve stoornis en comorbide persoonlijkheidspathologie: gecombineerde therapie versus farmacotherapie

BACKGROUND: Comorbidity of depressive and personality disorder occurs frequently, in literature percentages of around 50 to nearly 80 percent are found. Also in the Mentrum depression study on which this article is grounded, high percentages of around 66% were found. There is no equivocal treatment method of choice in literature, and opinions differ as to whether personality pathology has an adverse influence on the efficacy of the treatment for depression. AIM: To compare the results of pharmacotherapy and combined therapy in the treatment of depressive disorders in patients with and without comorbid personality disorder. METHOD: A 6 month randomised clinical trial of antidepressants and combined therapy in ambulatory patients with major depressive disorder and a baseline score of at least 14 points on the 17-item Hamilton Rating Scale for Depression. Pharmacotherapy follows three subsequent steps in case of intolerance/inefficacy: fluoxetine, amitriptyline and moclobemide. In addition combination therapy includes 16 short-term sessions of psychodynamic supportive psychotherapy. Possible personality pathology is assessed by means of the 'Vragenlijst Kenmerken Persoonlijkheid' (a self report version of the International Personality Disorder Examination). Analyses of (co) variance and chi-squared tests were applied to assess the differences in both treatment conditions in the group with and without personality pathology. RESULTS: Combined therapy was significantly more effective than pharmacotherapy for depressed patients with personality disorders. For depressed patients without personality disorders, combined therapy was not more effective than pharmacotherapy alone. CONCLUSION: The combination of psychotherapy and pharmacotherapy seems to be the treatment of choice for depressed patients with comorbid personality pathology

Risk of regional recurrence in triple-negative breast cancer patients: a Dutch cohort study

Triple-negative breast cancer is associated with early recurrence and low survival rates. Several trials investigate the safety of a more conservative approach of axillary treatment in clinically T1-2N0 breast cancer. Triple-negative breast cancer comprises only 15 % of newly diagnosed breast cancers, which might result in insufficient power for representative results for this subgroup. We aimed to provide a nationwide overview on the occurrence of (regional) recurrences in triple-negative breast cancer patients with a clinically T1-2N0 status. For this cohort study, 2548 women diagnosed between 2005 and 2008 with clinically T1-2N0 triple-negative breast cancer were selected from the Netherlands Cancer Registry. Follow-up data until 2014 were analyzed using Kaplan–Meier. Sentinel lymph node biopsy was performed in 2486 patients, and (completion) axillary lymph node dissection in 562 patients. Final pathologic nodal status was pN0 in 78.5 %, pN1mi in 4.5 %, pN1 in 12.3 %, pN2–3 in 3.6 %, and pNx in 1.1 %. During a follow-up of 5 years, regional recurrence occurred in 2.9 %, local recurrence in 4.2 % and distant recurrence in 12.2 %. Five-year disease-free survival was 78.7 %, distant disease-free survival 80.5 %, and 5-year overall survival 82.3 %. Triple-negative clinically T1-2N0 breast cancer patients rarely develop a regional recurrence. Their disease-free survival is more threatened by distant recurrence, affecting their overall survival. Consequently, it seems justified to include triple-negative breast cancer patients in randomized controlled trials investigating the safety of minimizing axillary staging and treatment

Anxiety sensitivity profile: dimensional structure and relationship with temperament and character

FSW - Self-regulation models for health behavior and Psychopathology - Ou

Major depressive disorder, personality disorders and coping strategies are independent risk factors for lower quality of life in non-metastatic breast cancer patients.

International audienceObjective: To identify risk factors for lower quality of life (QOL) in non-metastatic breast cancer patients.Methods: Our study included 120 patients from the University Hospital Centers of Tours and Poitiers. This cross-sectional study was conducted 7 months after patients’ breast cancer diagnosis and assessed QOL (Quality of Life Questionnaire-Core 30 = QLQ-C30), socio-demographic characteristics, coping strategies (Brief-Cope), physiological and biological variables (e.g., initial tumor severity, types of treatment received), the existence of major depressive disorder (Mini International Neuropsychiatric Interview) and pain severity (QDSA). We assessed personality disorders 3 months after diagnosis (VKP questionnaire). We used multiple linear regression models to determine which factors were associated with physical, emotional and global QOL. Results: Lower physical QOL was associated with major depressive disorder, younger age, a more severe initial tumor stage and the use of the behavioral disengagement coping. Lower emotional QOL was associated with major depressive disorder, the existence of a personality disorder, a more severe pain level, higher use of self-blame and lower use of acceptance coping strategies. Lower global QOL was associated with major depressive disorder, the existence of a personality disorder, a more severe pain level, higher use of self-blame and lower use of positive reframing coping strategies and an absence of hormone therapy.Conclusions: Lower QOL scores were more strongly associated to variables related to the individual’s premorbid psychological characteristics and the manner in which this individual copes with the cancer (e.g., depression, personality and coping) than to cancer-related variables (e.g., treatment types, cancer severity)

Type D Personality, Temperament, and Mental Health in Military Personnel Awaiting Deployment

Type D personality, temperament, and mental health in military personnel awaitin

No improvement in long-term wear and revision rates with the second-generation Biomet cup (RingLoc) in young patients: 141 hips followed for median 12 years

Optimising joint reconstruction management in arthritis and bone tumour patient