Psychological symptom patterns and vital exhaustion in outpatients with chronic obstructive pulmonary disease

<p>Abstract</p> <p>Background</p> <p>Several studies have reported high prevalence of anxiety and depression in chronic obstructive pulmonary disease (COPD) outpatients. Moreover, these patients share psychological or psychopathological characteristics that inhibit their ability to cope with the disease. In the present study we aimed to record the prevalence of psychological symptom patterns in a sample of Greek COPD outpatients and to assess which psychological factors (and to which degree) contribute to vital exhaustion (VE).</p> <p>Methods</p> <p>The study included 139 COPD outpatients. We used the Symptom Checklist 90 - Revised (SCL-90-R) and the Maastricht Questionnaire (MQ) in order to evaluate psychological symptom patterns and VE, respectively.</p> <p>Results</p> <p>The mean MQ score was 19.6, which is significantly higher than the corresponding score in the general population. Regarding the SCL-90-R dimensions, depression was the highest followed by somatization, obsessive-compulsive and anxiety dimensions. Additionally, a positive correlation was observed between the MQ and the SCL-90-R dimensions. MQ failed to demonstrate correlation with age, gender, education level or the severity of the disease. Depression seems to be responsible for 57.9% of the variation of VE, while obsessive-compulsiveness is responsible for an additional 2.4%. All the remaining dimensions of SCL-90-R had no statistically significant contributions.</p> <p>Conclusions</p> <p>Our findings suggest the high prevalence of VE, together with high rates in most of the SCL-90-R dimensions with greater depression, somatization, obsessive-compulsiveness and anxiety in a Greek COPD group at various Global Initiative for Chronic Obstructive Lung Disease (GOLD) diagnostic criteria stages. The coexistence of such symptoms should be further assessed as an eventual unfavorable prognostic factor.</p

Prevalence of alexithymia and its association with anxiety and depression in a sample of Greek chronic obstructive pulmonary disease (COPD) outpatients

<p>Abstract</p> <p>Background</p> <p>Chronic obstructive pulmonary disease (COPD) is a major health problem, especially in adults over 40 years of age, and has a great social and economic impact. The psychological morbidity of COPD patients with regard to anxiety and depressive symptoms has been extensively studied in the past. However, few studies have investigated the prevalence of alexithymia in these patients, as well as its association with this comorbidity. Based on this fact, we studied the prevalence of alexithymia and its association with anxiety and depressive symptoms in COPD outpatients.</p> <p>Methods</p> <p>The present study included 167, randomly selected, outpatients diagnosed with COPD. Alexithymia, anxiety and depression were assessed using the Toronto Alexithymia Scale (TAS-20), Spielberger Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI), respectively.</p> <p>Results</p> <p>The mean BDI score was 12.88 (SD: 7.7), mean STAI score 41.8 (SD: 11.0) and mean TAS-20 score 48.2 (SD: 11.5). No differences were observed between genders regarding age and alexithymia (t test <it>P </it>> 0.05), while female patients presented higher depression and trait anxiety scores than males (t test <it>P </it>< 0.05). Clinically significant levels of anxiety were present in 37.1% of men, and in 45.7% of women. The mean depression score was also higher than the corresponding mean score in the general population (one-sample t test <it>P </it>< 0.01), while 27.7% and 30.5% of the sample presented mild and moderate to severe depression, respectively. Finally, a strong correlation was observed between alexithymia, depression and anxiety.</p> <p>Conclusions</p> <p>This study confirms the high prevalence of anxiety and depression symptoms in Greek outpatients with COPD. The prevalence of alexithymia in COPD patients, contrary to what has been observed in patients with other chronic respiratory diseases, seem to be lower. However, we observed a strong association between alexithymia, depression and anxiety levels. This observation suggests that alexithymia should be taken into consideration when drafting specific psychotherapeutic interventions for these patients.</p

Α 75 year-old male with a solitary pulmonary mass, pleuritic pain and persistent fever

SUMMARY.The lung is an extremely rare primary site for the developmentof malignant melanoma, in contrast with other tissues where thistumour presents, such as skin, head and neck mucosa, eyes and thegastrointestinal tract. Primary malignant melanoma of the lungs(PMML) is a diagnostic challenge, as clinically and radiologicallyit cannot be distinguished from the usual primary bronchogeniclung cancer, and its histopathological and immunohistochemicalcharacteristics are little different from those of a lung metastasisfrom another primary site of malignant melanoma, which is morecommon. Its diagnosis is based on a number of clinical, radiologicaland histopathological criteria. In addition, because of its rarity,the knowledge and experience about the prognosis and treatmentmodalities concerning PMML are inadequate, due to lack of largeseries. From the little that we know, it appears to be a tumour withpoor prognosis, which should be treated by radical surgery, if thisis possible, followed by adjuvant chemotherapy and radiotherapy,practically the same as those used for skin melanomas. Metastasesto the spleen are an unusual manifestation of malignant melanoma,and may be the cause of continuous high fever. Pneumon 2011,24(1):411-416

The health related quality of life of Greek patients with chronic obstructive pulmonary disease

SUMMARY.Background: Chronic Obstructive Pulmonary Disease (COPD) is an advancing disease, characterized by progressive deterioration of lung function. The impact of the disease on human health is massive and it affects the health related quality of life (HRQoL) of patients in every aspect. This study assessed HRQoL of Greek patients with COPD and its association with demographic and clinical factors, and compared the findings with with those of COPD studies in other countries. In addition, the cost of pharmaceutical treatment of these patients was assessed. Material and methods: The study group consisted of 136 Greek patients with COPD (103 men, mean age 64.7±9.2 years, mean FEV1 59±25.6% predicted).I Information was recorded about their demographic and clinical parameters. Their HRQoL was assessed using the Greek versions of the Medical Outcomes Study Short Form 12 (SF-12) and St George’s Respiratory Questionnaire (SGRQ). Results: The HRQoL of Greek patients with COPD was found to be significantly lower than both that in the general population and that of patients COPD reported in other countries. Almost all the HRQoL scores were shown to be associated with gender, educational and financial status, duration of symptoms, age at onset of symptoms, pack-years of cigarettes smoked, disease stage, degree of dyspnoea, pO2 and pCO2 levels, numbers of medical visits and hospital admissions, participation in rehabilitation programmes, and co-morbidities, such as cardiovascular disease and diabetes mellitus (DM). The average cost of pharmaceutical treatment was assessed at 110 ± 63 € / month and was associated with the stage of the disease, the smoking habit, the degree of dyspnoea, annual numbers of medical visits and admissions and nebulizer usage. Conclusions: The HRQoL of Greek patients with COPD is influenced by multiple parameters, which should all be taken into consideration when their treatment is being planned. Cost-effective studies should be made on populations of Greek patients with COPD and more emphasis should be placed on rehabilitation programmes in Greece. Pneumon 2013, 26(2):139-151

Exercise testing and exercise-limiting factors in patients with bilateral bronchiectasis

SUMMARY. Introduction: Exercise capacity is reduced in many patients with bronchiectasis, but there is little information available regarding exercise responses in these patients. Objectives: The aim of this study was to investigate exercise capacity and exercise responses in patients with bilateral bronchiectasis in order to identify possible exercise-limiting factors. Population and Methods: Fifteen patients with bronchiectasis aged 50±16 years underwent lung function testing, including assessment of tidal expiratory flow limitation (EFL), and performed a maximum incremental (20 watts/min) symptom-limited bicycle exercise test. Results: Exercise performance was reduced in 7 of the 15 patients, particularly in those with a greater degree of impairment of lung function, and specifically lower FEV1 (p<0.001) and FVC (p<0.001). EFL was detected in 5 of the 7 patients with exercise limitation and absent in all with normal exercise capacity. Patients with reduced exercise capacity exhibited significantly lower maximal ventilation (V.Emax %pred; p<0.001), maximal tidal volume (VTmax; p= 0.03), breathing reserve (higher V.Emax/MVV; p<0.001), peak-exercise oxygen saturation measured by pulse oximetry (SpO2, p<0.001), O2-pulse (p<0.001) and anaerobic threshold (AT, p<0.001) and perceived a higher degree of dyspnoea (Borg score; p=0.007). The best correlate of maximal work rate (WRmax, %pred) was the AT (r= 0.90, r2 = 0.81, p<0.001), while for peak oxygen uptake (V.O2max, %pred) the most significant correlation was the peak-exercise SpO2 (r=0.83, r2 = 0.69, p<0.001). Conclusions: Patients with bronchiectasis who have tidal EFL and a low FEV1 exhibit a reduction in exercise capacity. Ventilatory limitation, desaturation and impaired O2-transport/utilization to the periphery appear to be the principal factors limiting exercise. V.O2max can be predicted accurately from parameters obtained by simple means, such as peak-exercise SpO2 obtained by pulse oximetry. Pneumon 2009, 22(4):296-314