Which symptoms are the psychopathological core affecting the manifestation of pseudo-cardiac symptoms and poor sleep quality in young adults? Symptoms of personality disorders versus clinical disorders

BackgroundDiagnosing and identifying the psychological origin of pseudo-cardiac symptoms and comorbid conditions such as poor sleep quality is very difficult due to its extensive and complex nature. The present study was conducted to determine the contribution of symptoms of personality disorders (PDs) and clinical disorders (CDs; i.e., psychological symptoms measured using the Symptom Checklist-90) to the manifestation of pseudo-cardiac symptoms and poor sleep quality.MethodsSubjects in this cross-sectional study were 953 (64.3% female; 28.8 ± 6.2 years) community samples in the west of Iran who were selected by convenience sampling. After applying the inclusion criteria, data were collected using the Symptom Checklist-90 (SCL-90-R), the Personality Diagnostic Questionnaire (PDQ-4), and the Scale for Pseudo-Cardiac Symptoms and Poor Sleep Quality (SPSQ). Pearson correlations, factor analytical techniques, and hierarchical regression models were used to examine associations between symptoms of PDs/CDs and outcome factors.ResultsFactor analytical techniques confirmed both the integrated structure of symptoms of PDs and CDs. Both pseudo-cardiac symptoms and poor sleep quality were more strongly associated with symptoms of CDs than PDs. The results of the hierarchical analysis show that the CDs factor alone could explain the total variance of both pseudo-cardiac symptoms (change in R2 = 0.215 vs. 0.009; p < 0.001) and poor sleep quality (change in R2 = 0.221 vs. 0.001; p < 0.001).ConclusionThe different capabilities of two unique factors for the symptoms of PDs and CDs were confirmed by factor analytical methods and regression analysis techniques. Although each of the symptoms of PDs and CDs independently contributes to the manifestation of pseudo-cardiac symptoms and poor sleep quality, the CDs factor is the psychopathological core

Cardiac patients’ perception about psychological risk factors on chest pain intensity and discomfort

Dear Editor, Perceived heart risk factors including psychological and non-psychological factors (components of behavioral, biological, environmental, and physiological) are as part of the mental representation of illnesses that arise from patients' health knowledge and independently can predict their health behavior (1-2). Causal beliefs and perceived risk factors are associated not only with patient's health and adjustment but also the impact on their adherence to treatment recommendations (3). Patients' cognition has a significant impact on disease course and progression during all stages of illness experience including understanding signs, looking for a reason to link the disease to it, and considering a change in an individual’s behavior (3), so it is suggested that patients with perceived psychological risk factors and who experienced more anxiety and depression be compared to other patients in the stage of secondary prevention (2, 3). Angina and suffering caused by it are other clinical representations of heart disease that almost a third of these patients complain of it even after successful revascularization and express inability to control it (4). It seems that pain intensity and discomfort, as important aspects of angina, were not affected only by cardiac event or procedure and nonphysical factors also play a role in its experience. Thus, since identifying factors associated with angina in the secondary prevention can be effective in improving the quality of life and returning patients to normal life, it seems that there is a need to conduct further studies with regard to the relationship between perceived risk factors and clinical representation of angina in heart patients. Based on these considerations, a study was conducted to compare the chest pain severity and discomfort in heart patients with and without perceived psychological risk factors. From May to July 2015, 219 cardiac patients (23- 79 years with the mean [SD] = 58.5±9.4) after cardiac surgery were invited to participate in the study in Imam Ali Hospital of Kermanshah City (Western part of Iran). After obtaining a written informed consent to participate in the study, demographic data and medical histories of the patients were evaluated and recorded by an expert cardiologist. Then, a brief pain inventory (5), pain discomfort scale of Jensen et al. (6), and open single-item related to perceived heart risk factors (2, 4), as appropriately validated scales were provided for the patients by a clinical psychologist. Descriptive statistics and independent t-test were used to compare the differences between the two groups in terms of pain intensity and discomfort. All statistical analysis was performed using SPSS 20 software. According to descriptive data, 63% of patients were males, 89.4% married, 34.7% housekeepers, 32.2% self-employed, 8.2% employees, and 21.9% retires. In terms of level of education, 70.3% were below high school level 18.3% high school graduate and 11.4% with a college degree. In addition, the results show that 118 and 110 people respectively are with the perceived non-psychological and psychological risk factors. The means (SD) of pain intensity respectively were 3.751.94 and 4.321.86 for the patients with perceived non-psychological and psychological risk factors. Also, the means (SD) of pain discomfort respectively were 9.486.52 and 12.307.58 for patients with the perceived non-psychological and psychological risk factors. In relation to the main analysis, the independent t-test results show that there is a significant difference between the two groups in term of pain intensity (P=0.030) and discomfort (P=0.004) and the patients with perceived psychological risk factors indicate more pain severity and discomfort compared with the patients with perceived non-psychological risk factors. Our results showed that the severity of pain and pain discomfort are more in patients with perceived psychological risk factors compared with those patients with perceived non-psychological risk factors. In this regard, the results of the two studies showed that the patients with perceived psychological risk factors experience more anxiety and depression compared to others (2, 3). Since the patient's perception of illness directly linked to actual risk factors of disease (1), and considering the relationship between chest pain and psychological symptoms, it seems that the identification of patients perceived risk factors can play an important role in screening patients suffering from angina. Therefore, there is the possibility that we can quickly recognize and control the psychological symptoms (3) and discomfort or pain through changing the patients’ perception of disease risk factors in the stage of secondary prevention

A new delivery model to increase adherence to methadone maintenance treatment

Dear Editor, Today, a large number of Iranian addicts are treated in methadone maintenance treatment (MMT) centers (1). According to the current procedure, each patient has treatment record in only one clinic. So, each patient is able to get prescribed medications and other medical services of the center. Receiving drugs and center-based services has always faced serious challenges such as access (2). For example, some patients with mobility jobs, people with movement restrictions and physical conditions, and patients living in rural and remote areas are unable to refer to get the medication according to a regular timetable (3). The mentioned issues are a serious challenge for persistence and adherence to MMT. Under such circumstances, a significant proportion of patients abandoned treatment plan and they lost the ancillary services, including medical visits, psychological interventions, and physical and emotional support from a social worker. Ultimately, this situation led to an increased the risk of relapse and resume high risk behaviors related to substance abuse (4). Social damage and financial losses of the country's health system are only some of the negative consequences of this situation. Based on these considerations, presentation of the strategies and constructive recommendations in support of the related organizations is a necessity. Despite the several offers raised, it seems that the abolition of the system receiving drugs from the origin center and the use of digital identification systems can be useful and practical (5). In the form of drug delivery system, patients can receive their daily dosages in any of the center across the country. This project is done in such a manner that each patient first enrolls in an MMT center and fills out a medical record form. Then, the doctor will determine the types of medication and drug dose based on the patients’ medication history. In the first three months of treatment (i.e. until the stabilization of the dose), visits or appointments will be face to face. After the period and stabilized drug dose, the patient who receives medication is no longer confined to the origin center. This means that each patient is issued an entity identifier such as a smart card for medication. By issuing the smart card, the patient can receive quota set medication use in any part of the country. Definitely to prevent abuse of patients, it is recommended that the patient's identity be verified through the finger, eye, or facial recognition digital sensors (5). Meanwhile, bringing up an instruction can be useful based on a mandatory visit to the center of origin for medical examination and psychological services at least once a month. So far, few studies have been conducted to review and confirm the delivery format of pharmaceutical services (6, 7). However, previous studies show that the facial assessment via computer evaluation and photo anthropometric variations in facial features are standard references for personal identification in the field of health and forensic (8, 9). Thus, our offer could possibly be effective in increasing adherence to treatment and reducing problems caused by the access to origin MMT center. As a result, we recommend using this pilot model for at least a one-year period. Then, if the benefit of this model is in practice, this proposal could be implemented permanently

Presentation of new classification of perceived risk factors and etiologies of cardiovascular diseases

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What is role of sex and age differences in marital conflict and stress of patients under Cardiac Rehabilitation Program?

BACKGROUND: To investigate the role of sex and age differences in marital conflict and stress of patients who were under cardiac rehabilitation (CR) program. METHODS: The data of this cross-sectional study were collected from the database of the CR Department of Imam Ali Hospital, Kermanshah, Iran. The demographics and medical data of 683 persons were collected from January 2003 and January 2010 using medical records, the Beck Anxiety Inventory, the Beck Depression Inventory, the Hudson&rsquo;s Index of Marital Stress, and the Structured Clinical Interview for axis I disorders. Data were analyzed through Analysis of Covariance and Bonferroni test. RESULTS: About 74.8% of the subjects were male. After adjustment for age, educational level, anxiety, and depression-the findings showed that women in CR program had a higher level of marital stress compared to men (54.75 &plusmn; 2.52 vs. 49.30 &plusmn; 0.89; P = 0.042). Furthermore, it was revealed that women who aged 56-65 years and more experienced higher level of marital stress compared to younger patients (P &lt; 0.050); however, no significant difference was observed between different age groups in male patients (P &gt; 0.050). CONCLUSION: Marital conflict and stress threaten healthiness of women who aged 56-65 years more prominently than does in males or younger patients. Regarding the effect of marital stress on recurrence of the disease and cardiac-related morbidity and mortality in women, providing effective education and interventions to this group of patients, especially older women and even their spouses could be one of the useful objectives of CR programs.&nbsp;</div

Open Single Item of Perceived Risk Factors (OSIPRF) toward Cardiovascular Diseases Is an Appropriate Instrument for Evaluating Psychological Symptoms

Psychological symptoms are considered as one of the aspects and consequences of cardiovascular diseases (CVDs), management of which can precipitate and facilitate the process of recovery. Evaluation of the psychological symptoms can increase awareness of treatment team regarding patients’ mental health, which can be beneficial for designing treatment programs (1). However, time-consuming process of interviews and assessment by questionnaires lead to fatigue and lack of patient cooperation, which may be problematic for healthcare evaluators. Therefore, the use of brief and suitable alternatives is always recommended.The use of practical and easy to implement instruments is constantly emphasized. A practical method for assessing patients' psychological status is examining causal beliefs and attitudes about the disease. The causal beliefs and perceived risk factors by patients, which are significantly related to the actual risk factors for CVDs (2), are not only related to psychological adjustment and mental health but also have an impact on patients’ compliance with treatment recommendations (3).It seems that several risk factors are at play regarding the perceived risk factors for CVDs such as gender (4), age (5), and most importantly, patients’ psychological status (3). Accordingly, evaluation of causal beliefs and perceived risk factors by patients could probably be a shortcut method for evaluation of patients’ psychological health. In recent years, Saeidi and Komasi (5) proposed a question and investigated the perceived risk factors with an open single item: “What do you think is the main cause of your illness?”. According to the authors, the perceived risk factors are recorded in five categories including biological (age, gender, and family history), environmental (dust, smoke, passive smoking, toxic substances, and effects of war), physiological (diabetes, hypertension, hyperlipidemia, and obesity), behavioral (lack of exercise, nutrition, physical work stress, cigarette smoking, and sub­stance abuse), and psychological factors (stress, anxiety, mourning and de­pression, anger and rage, and spouse abuse) (5, 6). This instrument was designed in 2014 and has been employed in numerous studies (4).The conducted studies using the open single item of perceived risk factors (OSIPRF) demonstrated that patients’ causal beliefs regarding CVDs could be a suitable instrument for screening for psychological symptoms, particularly anxiety and depression. In this regard, the results of a study showed that patients with a perceived risk factor experience higher levels of depression and anxiety compared with patients without a perceived risk factor (7). Furthermore, two studies revealed that patients with a physiological and/or psychological perceived risk factor experience higher levels of depression and anxiety compared with those with other classes of risk factors (6, 8). Therefore, management of their psychological status seems to be imperative.Overall, it seems that application of the OSIPRF rather than time-consuming screening instruments is more affordable in terms of time, patient cooperation, diagnosis, and provision of timely services to those with adverse psychological status. Thus, given the knowledge of patients' regarding their psychological status and its management at disease onset may be beneficial in the process of physical recovery and returning to work, use of this diagnostic method by health professionals in the field of CVDs is recommended