Impact of comorbid conditions on asthmatic adults and children

Comorbid conditions (comorbidities) can complicate the diagnosis and management of asthma. In different age groups, comorbid conditions can present varying challenges, including diagnostic confusion due to mimicking asthma symptoms, exacerbation of asthma symptoms, therapy for comorbid conditions affecting asthma or therapy for asthma affecting these conditions. This review aims to summarise some common comorbid conditions with asthma, such as rhinitis, vocal cord dysfunction, gastro-oesophageal reflux, psychiatric disorders, obesity and obstructive sleep apnoea, and discuss their prevalence, symptoms, diagnosis and treatment, highlighting any differences in how they impact children and adults. Overall, there is a lack of data on the impact of treating comorbid conditions on asthma outcomes and further studies are needed to guide age-appropriate asthma management in the presence of these conditions.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.A.K. reports personal fees from AstraZeneca, Behring, Boehringer Ingelheim, GlaxoSmithKline, Griffols, Teva, Novartis, Novo Nordisk, Paladdin, Pfizer, Purdue, Sanofi and Trudel, outside the submitted work. D.M.G.H. reports personal fees from AstraZeneca, Chiesi and Pfizer and grants and personal fees from Boehringer Ingelheim, GlaxoSmithKline and Novartis, outside the submitted work. S.J.S. reports fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, Propeller Health, Regeneron and Sanofi, outside the submitted work all paid to the University of Colorado School of Medicinepublished version, accepted version, submitted versio

Face-to-face and internet-based cognitive therapy for social anxiety disorder: Mechanisms of change and treatment dissemination

While effective psychological interventions for common mental health difficulties exist, our understanding of how they work, and our ability to disseminate them at scale, is limited. This thesis aimed to 1) examine the mechanisms underlying clinical improvement in one such intervention, Cognitive Therapy for Social Anxiety Disorder (CT-SAD), and 2) disseminate and evaluate an internet-based version (iCT-SAD) in a new culture (Hong Kong). Following an introduction and literature review (Chapters 1 and 2), eight studies are presented. Studies 1, 2a, and 2b (Chapters 3 and 4) investigated three candidate mediators (negative social cognitions, self-focused attention, and depressed mood) of the relationship between time in therapy and social anxiety symptoms. Results indicated that cognitions consistently mediated subsequent clinical improvement, with weaker and less consistent effects for self-focused attention and depressed mood. Studies 3a, 3b, and 3c (Chapter 5) examined ‘sudden gains’: large and stable symptom reductions between consecutive therapy sessions, in CT-SAD and iCT- SAD. Sudden gains were common in both treatments, occurring with similar frequency and magnitude. They were associated with better overall therapy outcome. There was some evidence of reductions in negative cognitions and self- focused attention prior to, and concurrently with, gains. Clients in CT made more statements indicating ‘generalised’ learning in ‘pre-gain’, relative to control, sessions. Study 4 (Chapter 6) implemented a new iCT-SAD therapist training programme with three therapists from Hong Kong, who delivered the treatment in a pilot case series. Study 5 (Chapter 7) then evaluated the efficacy of iCT-SAD in Hong Kong compared to waitlist controls in a randomized controlled trial. Results indicated the training was effective at developing iCT skills and competence, and that iCT-SAD was superior to waitlist, showing large effect sizes comparable to UK studies. Implications for theory, research, and practice are discussed (Chapter 8). Overall, the findings indicate that negative social cognitions play an important role in determining clinical improvement in CT-SAD and iCT-SAD, that the therapy mechanisms of change investigated appear to be similar between these treatment formats, and that iCT-SAD was successfully disseminated to another culture without losing efficacy.</p

Anxiety and depression on an acute respiratory ward

Psychological difficulties are a common complication among patients with respiratory disease, and are associated with poorer health outcomes and increased use of healthcare. As prevalence studies typically sample patients from community settings, this study aimed to explore the extent and nature of psychological difficulties during acute hospital admission.A case example of an acute respiratory ward is presented. In total, 41 acute respiratory inpatients completed standardised measures of depression, anxiety, and health anxiety.Rates of clinically significant depression, anxiety, and health anxiety were 71%, 40%, and 21%, respectively, with 76% of participants showing clinically significant scores on at least one measure. Comparison to existing literature suggests depression rates may be elevated in the acute inpatient context. The difficulties experienced encompassed both contextual factors related to being in hospital and broader health concerns.We suggest that psychological distress may be particularly prevalent in inpatient settings and that larger-scale studies are warranted

suddengains: an R package to identify sudden gains in longitudinal data

Sudden gains are large and stable changes on an outcome variable between consecutive measurements, for example during a psychological intervention with multiple sessions. Researching these occurrences could help understand individual change processes in longitudinal data. Tang and DeRubeis (1999) suggested three criteria to define sudden gains in psychological interventions. However, identifying sudden gains based on these criteria can be time consuming and prone to errors if not fully automated. Further, methodological decisions such as how missing data, or multiple gains, are handled vary across studies and are reported with different levels of detail. These problems limit the comparability of individual studies and make it hard to understand or replicate the exact methods used. The R package suddengains provides a set of tools to facilitate sudden gains studies by automating their identification, adjusting for missing data, and providing descriptive statistics as well as exportable data files for further analysis

Postcard from G. Grace, Cologne, Germany, to Anna Robertson, Dresden, Germany, March 21, 1910

Physical health outcomes for patients with long-term conditions can be significantly affected by their psychological wellbeing; those experiencing psychological difficulties are less able to manage symptoms, have a poorer quality of life, and more frequent hospital admissions. National guidance recommends the assessment and treatment of psychological difficulties secondary to respiratory disease, but implementation of this across services is inconsistent. Here, we describe the process and findings of a nine-month study integrating psychological assessment and intervention into an acute respiratory department. The aim of this provision was to provide appropriate interventions for both inpatients and outpatients with identified psychological needs, and to evaluate the impact of these across a range of outcome domains. Psychological assessment and intervention was flexibly implemented as clinically appropriate within the context of the wider multidisciplinary team. Hospital admissions data were collated, and feedback obtained from both patients and staff. Results highlighted that psychological provision was well received by both patients and staff, and was associated with improved patient experiences and a greater focus on holistic care. Of the 73 patients receiving psychology input with at least one month follow-up data, 75% showed a reduction in their admission frequency following intervention. The estimated savings to the wider NHS exceeded the costs of providing psychology input. In light of existing literature, national guidance, and the present findings, we highlight the need for those commissioning and managing respiratory services to consider the various potential benefits of integrating psychological provision for a patient group with high levels of psychological need