Near fatal asthma and psychopathological characteristics: a group-control study.

ABSTRACT Psychological factors may play a role in asthma. In particular, emotional upsets have been correlated with fatal asthma attacks, and an abnormal personality attitude is considered to be a risk factor in fatal asthma. Moreover, some authors have recently reported favourable asthma outcome in patients with severe asthma and psychiatric abnormalities, when psychoactive treatment was initiated. On the understanding that people with fatal and "near fatal asthma" (NFA) are components of the same subset of the asthmatic population, we undertook a study aimed at assessing the importance of personality and psychiatric factors in asthma mortality. Between June 1991 and December 1993, a sample of 17 patients with asthma who had experienced one or more near fatal asthma attacks (respiratory arrest, or need for respiratory assistance, or altered conscious state, or arterial carbon dioxide tension (Pa,CO2) > 6.7 kPa (50 mmHg)), and 17 control patients with asthma who had never experienced such an attack (control group) were enrolled. All patients underwent: 1) an interview concerning their personal and family psychiatric history; 2) a psychodiagnostic investigation by a battery of four of the most widely used psychiatric tools: Hamilton scales for anxiety and depression; Zung scales for anxiety and depression; and Minnesota Multiphasic Personality Inventory. No statistical difference was found in psychodiagnostic tests between study and control groups. The psychiatric history was similar in the two groups. Our results suggest that personality characteristics and psychiatric history are not related to asthma outcome, and that the psychiatric approach is not expected to be useful in preventing mortality in asthma.

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    ABSTRACT: Asthma can be affected by stress, anxiety, sadness, and suggestion, as well as by environmental irritants or allergens, exercise, and infection. It also is associated with an elevated prevalence of anxiety and depressive disorders. Asthma and these psychological states and traits may mutually potentiate each other through direct psychophysiological mediation, nonadherence to medical regimen, exposure to asthma triggers, and inaccuracy of asthma symptom perception. Defensiveness is associated with inaccurate perception of airway resistance and stress-related bronchoconstriction. Asthma education programs that teach about the nature of the disease, medications, and trigger avoidance tend to reduce asthma morbidity. Other promising psychological interventions as adjuncts to medical treatment include training in symptom perception, stress management, hypnosis, yoga, and several biofeedback procedures.
    Journal of Consulting and Clinical Psychology 07/2002; 70(3):691-711. · 4.85 Impact Factor
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    ABSTRACT: Psychiatric morbidity appears common in fatal and near-fatal asthma and may be a factor in difficult to control asthmatic subjects. We examined the prevalence of psychiatric morbidity (using psychiatric interview) in a cohort of sequentially referred poorly controlled asthmatics and related this to (a) asthma outcome (b) assessing chest physician opinion and (c) Hospital Anxiety Depression Scale (HADS). Patients were evaluated using a systematic evaluation protocol to identify and manage all co-morbidity. Psychiatric assessment was performed by experienced liaison psychiatrists and ICD10 diagnosis and treatment programme assigned. Subjects completed HADS at presentation and follow-up. Asthma was managed according to BTS/SIGN Guidelines. Of 65 subjects who attended for psychiatric interview, 32 (49%) had an ICD10 diagnosis, (6 (9%) previously identified) with depression most common (59%). Physician assessment had poor discrimination for psychiatric illness. Anxiety scores (13.4+/-0.8 vs. 8.5+/-0.7) and depression scores (10.2+/-0.7 vs. 4.8+/-0.5) scores were significantly higher in subjects with ICD10 diagnosis (P<0.001), who were also more likely to be current smokers (P<0.01). HADS had a poor positive predictive value for psychiatric illness but a good negative predictive value for depression. There was no relationship between ICD10 diagnosis and asthma outcome. Subjects identified as therapy-resistant asthma after systematic evaluation, had significantly lower depression scores after treatment (P<0.05). In difficult asthmatics, there is a high prevalence of undiagnosed psychiatric morbidity, with depression being particularly prevalent. A simple screening questionnaire such as HADS, has a high false positive rate when compared to psychiatric interview, but may be useful in excluding depressive illness. There appears to be little association between identification and management of co-existent psychiatry morbidity and asthma outcome.
    Respiratory Medicine 09/2005; 99(9):1152-9. · 2.59 Impact Factor
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    ABSTRACT: OBJECTIVE:Selective attention to GI sensations has been suggested as an important mechanism that affects symptom perception in patients with irritable bowel syndrome (IBS), but this hypothesis has not yet been tested empirically. Differential recall of words describing negative affect has been used to demonstrate that depressed patients selectively attend to negative affect words. This technique may be useful for examining selective attention to somatic sensations. The aim of this study was to determine whether patients with IBS demonstrate selective recall of GI sensations compared with neutral words and words describing respiratory sensations.METHODS:A total of 16 IBS patients, nine asthmatic patients (medical controls), and eight healthy controls were shown 10 GI sensation words or phrases, 10 respiratory sensation words or phrases, and 10 neutral words in random order for 3 s each. After a distraction task, subjects wrote down all of the words or phrases they could remember.RESULTS:As predicted, IBS patients were more likely to recall GI words than other categories. Asthmatic patients were more likely to recall respiratory words in comparison with healthy controls.CONCLUSIONS:IBS patients selectively recall words describing GI sensations; this suggests that they may selectively attend to GI sensations, thus supporting the cognitive-behavioral theory of IBS.
    The American Journal of Gastroenterology 05/2001; · 9.21 Impact Factor