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      Determinants of anxiety in patients with advanced somatic disease: differences and similarities between patients undergoing renal replacement therapies and patients suffering from cancer

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          Abstract

          Objective

          Anxiety is the most frequent emotional reaction to the chronic somatic disease. However, little is known about anxiety and coping strategies in patients with end-stage renal disease (ESRD) undergoing renal replacement therapies (RRTs). The purpose of the study was to assess the intensity and determinants of anxiety in patients treated with different RRTs in comparison with end-stage breast cancer patients and healthy controls.

          Methods

          The study involved (1) ESRD patients undergoing different RRTs: 32 renal transplant recipients, 31 maintenance haemodialysis and 21 chronic peritoneal dialysis patients, (2) women with end-stage breast cancer ( n = 25) and (3) healthy persons ( n = 55). We used State–Trait Anxiety Inventory, Scale of Personal Religiousness, Mental Adjustment to Cancer Scale, Rotterdam Symptom Checklist with reference to medical history. The data thus obtained were analysed using the analysis of variance, the Tukey’s HSD post hoc test and Spearman’s rank correlation coefficient.

          Results

          Both ESRD and breast cancer patients revealed higher level of anxiety state and trait than healthy controls; however, there was no statistically significant difference found between both findings. There was a tendency towards higher levels of anxiety state in breast cancer patients when compared to ESRD patients undergoing the RRT treatment and for both groups non-constructive coping strategies correlated with the levels of anxiety state. With ESRD patients undergoing RRTs, the intensity of anxiety state did not depend on the mode of treatment but on the correlation between the levels of anxiety and the general quality of their life, psychological condition and social activity.

          Conclusion

          In patients with advanced somatic disease (ESRD and end-stage breast cancer), non-constructive strategies of coping with the disease require further evaluation and possibly psychological support.

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          Most cited references 23

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          ESRD patient quality of life: symptoms, spiritual beliefs, psychosocial factors, and ethnicity.

          Recent research suggests that patients' perceptions may be more important than objective clinical assessments in determining quality of life (QOL) for patients with end-stage renal disease (ESRD). We interviewed 165 hemodialysis patients from 3 sites using a QOL questionnaire that included the Satisfaction With Life Scale (SWLS) and the McGill QOL (MQOL) scale, which includes a single-item global measure of QOL (Single-Item QOL Scale [SIS]). The MQOL scale asks patients to report their most troublesome symptoms. We also initiated the use of a Support Network Scale and a Spiritual Beliefs Scale. Mean patient age was 60.9 years, 52% were men, 63% were white, and 33% were African American. Patients had a mean treatment time for ESRD of 44 months, mean hemoglobin level of 11.8 g/dL (118 g/L), mean albumin level of 3.7 g/dL (37 g/L), and mean Kt/V of 1.6. Forty-five percent of patients reported symptoms. Pain was the most common symptom (21% of patients). There was an inverse relationship between reported number of symptoms and SWLS (P < 0.01), MQOL scale score (P < 0.001), and SIS (P < 0.001). The Spiritual Beliefs Scale correlated with the MQOL scale score, SWLS (both P < 0.01), and SIS (P < 0.05). The Support Network Scale score correlated with the MQOL Existential (P = 0.01) and MQOL Support (P < 0.01) subscales. No clinical parameter correlated with any measure of QOL, spiritual beliefs, or social support. Symptoms, especially pain, along with psychosocial and spiritual factors, are important determinants of QOL of patients with ESRD. Additional studies, particularly a longitudinal trial, are needed to determine the reproducibility and utility of these QOL measures in assessing patient long-term outcome and their association with other QOL indices in larger and more diverse patient populations.
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            Anxiety disorders in adults treated by hemodialysis: a single-center study.

            Anxiety is a complicating comorbid diagnosis in many patients with medical illnesses. In patients with end-stage renal disease (ESRD), anxiety disorders often are perceived to represent symptoms of depression rather than independent conditions and therefore have been relatively understudied in this medical population. To evaluate the psychosocial impact of anxiety disorders on patients with ESRD, we sought to identify the rates of these disorders in a sample of patients receiving hemodialysis at a single center by using a structured clinical interview. We also compared a commonly used screening measure, the Hospital Anxiety and Depression Scale (HADS), with these clinical diagnoses to determine the measure's criterion validity or ability to predict a psychiatric diagnosis in ESRD populations. Finally, we examined the relationship between anxiety diagnosis and perceptions of quality of life (QOL) and health status. A sample of 70 randomly selected hemodialysis patients from an urban metropolitan center. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Diagnosis (SCID-I). HADS and Kidney Disease Quality of Life Short Form. Using the SCID, 71% of the sample received a DSM-IV Axis I diagnosis, with 45.7% of subjects meeting criteria for an anxiety disorder and 40% meeting criteria for a mood disorder. The concordance between DSM-IV anxiety disorders and anxiety scores acquired by using the HADS was not significant. Thus, although the HADS may provide an acceptable measure of overall "psychic distress" compared against the SCID-I, it has poor predictive power for anxiety diagnoses in patients with ESRD. Additionally, the presence of an anxiety disorder was associated with an overall perceived lower QOL (t = 2.4; P < 0.05). Single-center study and a population not representative of US demographics. A substantial proportion of participating patients met criteria for an anxiety disorder. The utility of the HADS as a screening tool for anxiety in patients with ESRD should be questioned. The finding that anxiety disorders negatively impact on QOL and are not merely manifestations of depression in patients with ESRD emphasizes the importance of accurate diagnosis and effective treatment. Strategic options are necessary to improve the diagnosis of anxiety disorders, potentially enhancing QOL and medical outcome in patients with ESRD.
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              Influences of gender role and anxiety on sex differences in temporal summation of pain.

              Previous research has consistently shown moderate to large differences between pain reports of men and women undergoing experimental pain testing. These differences have been shown for a variety of types of stimulation. However, only recently have sex differences been demonstrated for temporal summation of second pain. This study examined sex differences in response to temporal summation of second pain elicited by thermal stimulation of the skin. The relative influences of state anxiety and gender role expectations on temporal summation were investigated. Asymptomatic undergraduates (37 women and 30 men) underwent thermal testing of the thenar surface of the hand in a temporal summation protocol. Our results replicated those of Fillingim et al indicating that women showed increased temporal summation compared to men. We extended those findings to demonstrate that temporal summation is influenced by anxiety and gender role stereotypes about pain responding. When anxiety and gender role stereotypes are taken into account, sex is no longer a significant predictor of temporal summation. These findings highlight the contribution of social learning factors in the differences between sexes' pain perception. Results of this study demonstrate that psychosocial variables influence pain mechanisms. Temporal summation was related to gender role expectations of pain and anxiety. These variables explain a significant portion of the differences between men and women's pain processing, and may be related to differences in clinical presentation.
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                Author and article information

                Contributors
                +48-3491573 , +48-3491573 , jjaniszewska@gumed.edu.pl
                Journal
                Int Urol Nephrol
                Int Urol Nephrol
                International Urology and Nephrology
                Springer Netherlands (Dordrecht )
                0301-1623
                1573-2584
                17 November 2012
                17 November 2012
                2013
                : 45
                : 1379-1387
                Affiliations
                [ ]Department of Palliative Medicine, Medical University of Gdansk, Dębinki 2, 80-211 Gdańsk, Poland
                [ ]Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdańsk, Poland
                [ ]Department of Research on Quality of Life, Medical University of Gdansk, Gdańsk, Poland
                Article
                326
                10.1007/s11255-012-0326-6
                3824345
                23161377
                © The Author(s) 2012
                Categories
                Nephrology - Original Paper
                Custom metadata
                © Springer Science+Business Media Dordrecht 2013

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